Embracing the Digital Age: EHRs, Meaningful Use, and Canadian Healthcare

by Andrew Ringer

As the CEO of a Canadian healthcare information technology and electronic health record software company, I like to keep appraised of goings-on in the healthcare industry, locally and internationally.

Between the Affordable Care Act and Meaningful Use, there’s a lot going on down south of the border, and I feel that we as Canadians can learn some valuable lessons from the successes and stumbles that are occuring in the new Wild West of EHRs and health IT.

Such successes and stumbles have lead to EHRs and healthIT becoming hot topics in the US. With increasing numbers of clinics, practitioners and hospitals adopting EHRs through Meaningful Use, the discussion has exploded across the internet, and even leading to a National HealthIT Week, a weeklong convention discussing new ideas and present issues in the US healthIT industry.


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New health-tech blogs seem to spring up every week, and tech news heavy-hitters like Gigaom and Venturebeat are featuring stories on the impacts of EHRs with increasing frequency. The variety of subjects in the discussion has increased dramatically too.

Now, the focus is not so much “What the heck is an EHR?” and “Why the heck should I bother with an EHR?” but has expanded to encompass security, functionality, and efficiency metrics, and so much more. The amount of discussion on these topics has provided some incredible insight that we should be taking note of.

Meaningful use has lead to the mass adoption, competition and Darwinian struggle for supremacy in the EHR, EMR, and digital health environment. Specialized clinical apps to sprawling, hospital-wide infrastructures currently saturate the US market. The ecosystem is ripe for it; Meaningful Use provides financial incentives for private practices to adopt EHR and health IT solutions that fall into MU guidelines, essentially paying them to use a service that will save them money.

With such a highly competitive environment already existing within their privatized healthcare system, such incentives to potentially streamline their business models are hard to pass up. However, having such incentives to promote rapid competition and growth presents its own risks—with so many EHR tools coming out of the woodwork, there’s bound to be half-baked, phony bologna pretenders that squeak through MU screening, who simply give clinics an excuse to buy iPads for their office. Those EHR platforms end up costing the practitioner time, money and manpower, through poorly implemented design and stunted functionality, simply because the sooner they could get it MU-certified and to market, the faster they could take advantage of the incentives. It’s these stumbles in EHR adoption that we should be wary of when we look at adoption in the Canadian healthcare industry.

However, to say Canada is doing nothing to support EHR implementation is a gross misrepresentation; organizations like Canada Health Infoways are instrumental in our transition to a national digital healthcare system, providing support, investment and interoperability projects in partner with both provincial and federal governments. By 2011 they reported having succeeded in having put in place the “core elements” of an electronic health record for 50% of Canadians.


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In overall adoption however, compared to the United States, Canada is still lagging behind. Over 80% of US hospitals have transitioned to an EHR system, as well as 50% of doctor’s offices, and having a nation-wide adoption rate of 70% among primary care physicians in 2013. Our overall adoption rate is just touching 57%—well below the US, and the US is even lower than Norway, the Netherlands, the United Kingdom, New Zealand, Australia and Germany, respectively. Granted, those European countries are in a much different situation than Canada—their landmass is a fraction of ours, their population density is magnitudes above our own, and their relationship with healthcare is typically much less controversial.

But how can we apply what’s going on down south of the border to our own country, Canada? Healthcare is traditionally a very reactive industry: we adapt and react when a problem arises, but especially within the realm of healthcare information technology and communication we seem to be stuck in a “if it ain’t broke” mentality. This lack of foresight and eagerness to innovate and embrace change has the possibility of leaving us scrambling for new ideas in the coming years.

We also lack, for better or worse, the hyper-competitive climate brought about by both privatized healthcare and Meaningful Use; and while the legacy of Tommy Douglas is an iconic badge of honour that Canada proudly wears for the rest of the world to see, the bureaucracy involved—in addition to factors unique to Canada, like being of one of the lowest population densities of any G20 country—does lead to some stagnation in adopting new ideas and technologies within healthcare. Such stubborn behaviours are most likely one of the key reasons why Canada isn’t even in the top 25 of the World Health Organization’s global index of healthcare systems

According to the 2013 National Physician Survey, only 45% of licensed physicians contacted reported having “satisfactory” access to EHRs, only 11% having “excellent” access and 42% having unsatisfactory access, not including territories. By province, the only provinces with more satisfied than unsatisfied were (in order) Alberta, Ontario, British Columbia, Saskatchewan and Manitoba. Quebec reported a whopping 68% unsatisfied. That only 11% actually have good-to-great EHR solutions—where they’re not creating more work through workarounds and poorly designed functionality—is indeed troubling. Canadian healthcare ought to be amazing, not summed up by a non-committal shrug.


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With healthcare tax and expenditure being a hot topic seemingly every election both provincial and federal, EHR could be the panacea our healthcare system needs: a way to lower costs, thereby lowering taxpayer burden, and a way to improve quality and quantity of care in preparation for the future. With a rapidly aging generation ready to retire, we need to drastically improve our capabilities of caring for each other.

In an industry where the technological gap remains high—with many primary care providers and private organizations still using pen, paper and fax as their primary means of record-keeping and communication—there needs to be the same kind of pressure to adapt as in the US that has been brought on by consumer demand.

That consumer demand does in fact exist in Canada. In a recent study presented by Canada Health Infoway, “89% [of Canadians] feel it is important that they personally have full advantage of digital health tools and capabilities.” The unfortunate aspect to that statistic is that such high demand won’t necessarily be felt by the healthcare industry; clinics and hospitals aren’t as outwardly competitive, and our health insurance doesn’t dock us for going to a doctor without EHR.

While that pressure is likely to come about naturally when our healthcare system is overloaded with new retirees and looking for ways to streamline their patient load, I strongly believe that Canadian healthcare needs to be looking to the future now. MU has provided the incentive for rapid and often reckless progress for advances in health IT, but I fear such incentives will neither be seen nor felt in Canada, though we share the same aging demographic.

Without current pressure to adapt competitively, I fear many homecare organizations will attempt to address the new waves of patients by simply hiring more people, as opposed to adopting new technology. Getting more people to row your leaky boat isn’t smart in the long run; you’re more likely to sink before you see the shore. We stand at the forefront of a brave new world in healthcare technology. Should we choose to embrace it, we have the ability to drastically improve the quality we can afford to our fellow Canadians, as well as the ability to swiftly adapt to the growing number of Canadians that will require more attentive care, both at-home and in hospital.

If we want to be fully prepared for the future, and put Canada’s healthcare system back on the map, I fully believe that strong, smart EHR adoption is the answer.

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Andrew Ringer

Andrew Ringer

Andrew Ringer is the CEO and entrepreneur behind Canadian EHR & healthcare IT company Professional Performance. A University of Laurier graduate and former member of CWS, he passionately follows news in the world of health technology, and is constantly seeking ways to improve and rethink Canada's healthcare landscape. more

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