Health Care IT Lessons from North of the 49th Parallel

We Yanks might learn a thing or two about making decisive, countrywide health care decisions from our Canadian neighbors

We in the United States are facing a crisis with the inequality and high cost of our health care services. We have a fragmented health care delivery system that functions with discrete silos of data.

Creating a cohesive health care system is exactly what we need to meet the common objective of delivering high-quality, cost-effective, and timely patient care. Luckily, we have a model to follow directly to our north: Canada.

There, the 14 federal, provincial, and territorial deputy ministers of health — as well as regional health care authorities and other health care organizations and information technology vendors and suppliers — are working together to provide 50 percent of Canadians with access to a secure electronic health record (EHR) by 2010.

How does a country with more than 33 million people come to an agreement and move forward with a countrywide health care IT system?

Easy: In Canada, the health care IT infrastructure functions like a business unit. To move forward with EHR adoption, this representative group did research, made a decision, secured funding, and began implementation.

Churning costs money

Here in the United States we don’t make decisions nearly this quickly. We’ve been churning over patient identification, for example, for more than a decade. Churning costs money; churning costs development time and effectiveness; ultimately, churning costs lives. Let’s take a lesson from our northern neighbors and get the job done.

Canada Health Infoway, an independent not-for-profit organization that invests with public partners across Canada to implement and reuse compatible health information systems architecture, is spearheading the initiative.

One of the first steps in implementing this nationwide project, and one of the most pivotal aspects of its success, was to create a common blueprint — an electronic health record infostructure.

This blueprint includes:

  • Client registry systems, similar to enterprise master-person indexes and record locator services that commonly support regional health information organizations (RHIOs) in the United States. A master person index is a software application that identifies persons in an integrated delivery network across different registration, scheduling, financial, and clinical systems.
  • A longitudinal record service, to coordinate data across multiple domains and registries
  • Standardized common services and communication services to sustain privacy, security, and overall interoperability
  • Standardized information and message structures to support ease of implementation and interoperability and data sharing within and across provinces.

In this model, each infostructure, which may include client or provider registries, data warehouses, and diagnostic and clinical applications, operate with other infostructures in a peer-to-peer manner through the Health Information Access Layer (HIAL), which is where end users begin their journey for data sharing.

Watch and learn

Let’s learn from Canada’s success and follow a business-model approach.

First, of course, let’s have a blueprint. Second, let’s invest wisely and strategically — and measure results to monitor that investment. The Canadian government invested $1.6 billion in the initiative. Government entities knew they needed value from their investment, so they funded a few targeted areas rather than spreading their investment across a range of initiatives.

Second, we must demand results. In Canada, Infoway must report status and success metrics each year. Again, this mirrors the way a business unit would operate.

Third, there can be no churning. Period. We need to make decisions and start to move.

Ron G. Parker, director of architecture in the solution architecture group at Infoway, adds this advice: “It is important to invest in a structured collaboration model that ensures all key stakeholder communities are represented in the process of standardization.”

He explains that standardization of business processes in any industry requires a three-level simultaneous “sell.” The first sell is to the executive decision makers/sponsors, the second to the people with industry expertise who “live” the problem today, and the third to the people that implement the business processes directly.

“Only if everybody in this stack knows the other groups are good to go can you have success,” Parker said.

O Canada!

I love Canada. It is just not convenient for me to move there. In fact, my personal goal is to retire in Montana. My hope is that we will have a nationwide health care IT system in place by that time. Needless to say, the clock is ticking. Can’t we follow someone else’s lead?

Lorraine Fernandes is a vice president of Initiate Systems and is a recognized leader in the health care IT industry. She frequently speaks at domestic and international industry conferences on topics such as RHIOs, health data exchange, patient identification, and best practices for master person index (MPI) cleanup. She serves on committees and workgroups for HIMSS, AHIMA, and Health Initiatives. She can be reached at

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