JAMIA: Canada has advice for U.S. on national health IT policy
When it comes to implementing national health IT policy, the U.S. could learn from Canada, according to research published online in the Journal of the American Medical Informatics Association.
During the past decade, Canada has faced the same strategic issues related to funding health IT and encouraging its adoption that the U.S. now faces, wrote Eyal Zimlichman, MD, of the division of general medicine at Brigham and Women's Hospital in Boston, and colleagues.
Canadian health IT stakeholders believe that much of the current U.S. direction is positive, especially regarding incentives and meaningful use, Zimlichman and colleagues wrote in the report, titled “Lessons from the Canadian National Health Information Technology Plan for the United States: Opinions of Key Canadian Experts.”
“In addition, there are key opportunities for the U.S. to emphasize direct engagement with providers, define a clear business case for them, sponsor large scale evaluations to assess health IT impact in a broad array of settings and determine standards, but also enable access to resources needed for midcourse corrections of standards when issues are identified and, finally, leverage implementation of digital imaging systems,” the authors wrote.
Zimlichman et al conducted qualitative analysis of interviews with 29 key Canadian health IT stakeholders followed by an electronic survey to summarize the Canadian health IT policy experience and impart lessons learned.
Since its inception in 2001, Canada Health Infoway (CHI) has functioned as an independent, federally funded, nonprofit organization and has worked as a strategic investor with Canadian provinces to accelerate the development of electronic health records (EHR) across Canada. With the goal of attaining a 50 percent EHR adoption rate among Canadians by 2010, CHI had invested $1.58 billion in 283 individual projects as of March 2009.
CHI sought to promote health IT by developing a national EHR system and encouraging EMR adoption and focused first on addressing issues around standards and interoperability, in particular large scale provincial data exchanges.
However, stakeholders felt that it would have been more helpful to focus more on provider engagement, the authors observed. “They felt that the government should have worked closely with regulatory and professional bodies, and that insufficient focus had been placed on this. Specifically, respondents believed that a structured program was needed that not only took into account policy addressing financing through incentives, disincentives and setting standards, but also regarding leadership, engagement of physicians during planning and the support of change management.”
On the other hand, stakeholders cited the rapid acceptance of PACS, which some found to be a direct result of CHI’s engagement, with widespread provider acceptance across provinces. “This implementation success was also attributable to the fact that providers appreciated the added value to quality of care of having direct access to imaging archives,” wrote Zimlichman et al.
The authors acknowledged that their research had some limitations: not all stakeholder groups were included, such as providers or patients. In addition, a selection bias could be present due to the relatively small sample size.
Canadian and U.S. healthcare systems are different, and their health IT policy approaches have also differed. However, many similarities exist, such as the setting of national standards and infrastructure to enable country-wide data sharing. “Taking these differences and similarities into account, the advantage of being able to look back and explore the outcomes of the Canadian approach may carry important implications that can be applied to the current U.S. plan,” the authors concluded.
During the past decade, Canada has faced the same strategic issues related to funding health IT and encouraging its adoption that the U.S. now faces, wrote Eyal Zimlichman, MD, of the division of general medicine at Brigham and Women's Hospital in Boston, and colleagues.
Canadian health IT stakeholders believe that much of the current U.S. direction is positive, especially regarding incentives and meaningful use, Zimlichman and colleagues wrote in the report, titled “Lessons from the Canadian National Health Information Technology Plan for the United States: Opinions of Key Canadian Experts.”
“In addition, there are key opportunities for the U.S. to emphasize direct engagement with providers, define a clear business case for them, sponsor large scale evaluations to assess health IT impact in a broad array of settings and determine standards, but also enable access to resources needed for midcourse corrections of standards when issues are identified and, finally, leverage implementation of digital imaging systems,” the authors wrote.
Zimlichman et al conducted qualitative analysis of interviews with 29 key Canadian health IT stakeholders followed by an electronic survey to summarize the Canadian health IT policy experience and impart lessons learned.
Since its inception in 2001, Canada Health Infoway (CHI) has functioned as an independent, federally funded, nonprofit organization and has worked as a strategic investor with Canadian provinces to accelerate the development of electronic health records (EHR) across Canada. With the goal of attaining a 50 percent EHR adoption rate among Canadians by 2010, CHI had invested $1.58 billion in 283 individual projects as of March 2009.
CHI sought to promote health IT by developing a national EHR system and encouraging EMR adoption and focused first on addressing issues around standards and interoperability, in particular large scale provincial data exchanges.
However, stakeholders felt that it would have been more helpful to focus more on provider engagement, the authors observed. “They felt that the government should have worked closely with regulatory and professional bodies, and that insufficient focus had been placed on this. Specifically, respondents believed that a structured program was needed that not only took into account policy addressing financing through incentives, disincentives and setting standards, but also regarding leadership, engagement of physicians during planning and the support of change management.”
On the other hand, stakeholders cited the rapid acceptance of PACS, which some found to be a direct result of CHI’s engagement, with widespread provider acceptance across provinces. “This implementation success was also attributable to the fact that providers appreciated the added value to quality of care of having direct access to imaging archives,” wrote Zimlichman et al.
The authors acknowledged that their research had some limitations: not all stakeholder groups were included, such as providers or patients. In addition, a selection bias could be present due to the relatively small sample size.
Canadian and U.S. healthcare systems are different, and their health IT policy approaches have also differed. However, many similarities exist, such as the setting of national standards and infrastructure to enable country-wide data sharing. “Taking these differences and similarities into account, the advantage of being able to look back and explore the outcomes of the Canadian approach may carry important implications that can be applied to the current U.S. plan,” the authors concluded.