The electronic health record in Canada: the first steps.

• Author: Morris, Anthony A.

William Pascal, Director General, Office of Health and the Information Highway, Health Canada, described the "ideal" health care system in Canada as follows:

 Borderless. Seamless. Accessible in all reaches of the country. Delivering fast, accurate diagnosis and treatment. A system where health care providers are equipped to focus on prevention and evidence based treatment, where all points of care (homes, schools, family practitioners, community clinics and hospitals) are linked. Free from red tape and wasteful duplication. Offering individuals the tools to take control over their own health. Where the privacy, security and confidentiality of personal health information are assured. That is indeed the vision for Canada's health care system. It's based on e-health to improve the quality, accessibility and effectiveness of health care. It features a pan-Canadian electronic health record, a range of integrated provider solutions and trusted health information for all Canadians. (1) 

This paper will briefly canvas the impetus behind an "electronic health record" ("EHR") in Canada and some of the organizations created to support its development.

What is an Electronic Health Record?

There are many definitions of an EHR. The Health and the Information Highway Division ("HIHD"), Health Canada has defined an EHR to be "a health record of an individual that is accessible online from many separate, interoperable automated systems within an electronic network". (2) The Federal/Provincial/Territorial Advisory Committee on Health Infostructure ("F/P/T Committee") has used the following definition of an EHR: (3)

A longitudinal collection of personal health information of a single individual, entered or accepted by health care providers, and stored electronically. The record may be made available at any time to providers, who have been authorized by the individual, as a tool in the provision of health care services. The individual has access to the record and can request changes to its content. The transmission and storage of the record is under strict security.

Therefore, the essential elements of an EHR are that it is:

* electronic ... it consists of bits and bytes--voice, video, images and data;

* contains personal health information .... identifiable information about a person's health status and the events that have had an impact;

* longitudinal ... all relevant personal health information collected over a period of time that can be shared among health professionals;

* accepted by a health professional ... a record that can be accepted for use by a health professional in the provision of quality care;

* organized to support care ... structured to support clinicians and their support staff in the delivery of health care services;

* under the custody of a known party ... under the management of a trusted entity that can ensure only approved access;

* virtual ... it does not reside all in one place and can be assembled as required;

* available to the individual ... a tool for the health consumer. (4)

In an excellent and wide ranging paper reviewing the United States' quest for an EHR and its implications on privacy, Lawrence Gostin poses the following question:

 What exactly are the goals of a health information infrastructure and how can these goals be attained? Overall, the goals are: (1) to guarantee the integrity of health data so that information is accurate, complete, current, and trustworthy, since the integrity of information is critical to quality patient care, assessment of services, research, and public health; (2) to ensure the availability of health data so that persons who need the information for legitimate health purposes have ready access to the data, since without readily available clinical information, providers cannot make informed decisions regarding diagnosis and treatment; and (3) to allow the administrative simplification of financial and other transactions, since burdensome and duplicative processing of transactions can significantly drive up the costs of providing health care. (5) 

The History of Canada's...