box10.gif (1299 bytes)







Government & policy

Experts calling for a national, e-health watchdog

OTTAWA – In response to a recent World Health Organization (WHO) report that ranks Canada’s progress in e-health as 21st among global nations, healthcare leaders are calling for a new body to assess, track and monitor healthcare I.T. efforts across the country. They also say that new policies are needed to spur faster development of electronic solutions in the healthcare sector.

Canada’s progress in the development of a national electronic health record system has been “very slow” and “pretty incomplete”, agreed Dr. Brian Postl (pictured).

In an article in the Canadian Medical Association Journal (CMAJ), Dr. Postl, dean of medicine at the University of Manitoba in Winnipeg and chair of the Canadian Institute for Health Information, asserted that a new organization is needed to monitor Canada’s e-health activities. “From an accountability perspective, the public should have some awareness that we’re not as far along as we would like to be or as they think we are.”

Louis Barré, CIHI vice-president of strategy, planning and outreach said that Canada must adopt new and better measures to track and assess national e-health efforts. This would help ensure that national investments in e-health properly address “the real paucity of clinical systems” that currently exist. He said greater efforts must be made to ensure that electronic systems are applied to medical research, as well as to the clinical sector.

Postl and Barré would like to see an independent body created that would assess and report on government efforts – perhaps with arms’ length assistance and funding from a federal agency or department such as CIHI, the Canadian Institutes of Health Research (CIHR) or the Health Council of Canada.

There’s a need for better tracking and monitoring of e-health by analysts independent of government, concurs Dominic Covvey, president of the National Institutes of Health Informatics (NIHI), a Canada-wide network of 151 e-health researchers who collaborate within a “virtual institute of institutes.”

Canada needs an e-health “watchdog,” says Covvey, who notes that Canada Health Infoway, the federal e-health agency, faces growing criticism for strategies that have left the nation trailing other nations in e-health development, despite years of planning and some $4 billion in federal and provincial spending.

“Infoway has no evaluation mandate,” Covvey adds, charging that any evaluation of e-health performance that occurs within Canada Health Infoway amounts to little more than “government evaluating itself.”

Robyn Tamblyn, health informatics researcher at McGill University in Montreal, Quebec and leader of a CIHR-funded team that investigates the use of e-health technologies to support integrated care for chronic disease, says the recent WHO snapshot suggests that a much closer look at Canada’s e-health policies and progress is now warranted.

By providing impartial information, a current state assessment will allow policymakers to substantiate official claims, Tamblyn argues. A thorough assessment will also help steer e-health development toward patient-centered solutions and foster such innovation, she argues. “Policies are needed to support research and translation of local successful initiatives [within] a ‘bottom-up’ approach.”

“To avoid unnecessary political wrangling,” Tamblyn recommends the effort be conducted under the rubric of the CIHR in order to achieve “objective, systematic collection of empirical information.”

The calls for an independent assessment of Canada’s e-health efforts follow in the wake of a WHO report that ranked Canada 21st in terms of information technology progress among 159 nations – just ahead of Estonia, but well behind much of Scandinavia, Europe, and the Republic of Korea (

The report, Atlas: e-health Country Profiles, concludes that Canada’s e-health deficiencies include a lack of supportive federal laws and regulations, national procurement and technology policies, educational policies and scholarships, and evaluations to monitor progress on important areas such as the capacity to deliver health information to patients via mobile telephones.

The WHO profile indicates the time has come for a much more detailed review of Canada’s e-health status, he adds. Canadians are often “stunned” to discover that basic health information technologies are unavailable, Postl argues. “The public thinks that much more exists than actually does exist.”

“Do we know what is happening? The answer is no,” says Barré. “A current state assessment would be very helpful.”

Tamblyn argues that Canada also needs to develop an ambitious new basket of national policies to galvanize e-health progress. The policies should facilitate timely clinical information-sharing between providers in all settings, make personal health records and self-management tools accessible, enable reimbursement for e-visits, enable interdisciplinary teamwork and provider consultation, establish incentives for using electronic reminders for preventive care and personalized healthcare, and implement patient outcome-based financial incentives, she says.

David Thomas, spokesman for Health Canada, said “the timing of the WHO survey in 2009 coincided with advance planning for H1N1, a public health priority in Canada, so unfortunately not all of the provinces and territories were able to provide input to the Survey. In addition, as with any survey, there are limitations, which include the interpretation and applicability of the questions.”

Thomas also noted that “e-health applications were difficult to assess, and the responses provided may not apply equally across the country.”

Posted January 27, 2011