Shared Medical Records Can Transform Care, But Big Barriers Remain

Abhi Kalra pictures a near future where people in Canada can get access to their digital health record through a bar code.

It would be a simple way to let everyone see their own health information, perhaps connect it to data kept on their phone or other device, and have it available to share if they need to, said Kalra, the executive vice-president of connected care for Canada Health Infoway, a federal-government funded agency.

A health-care provider with custody of a patient’s electronic medical record, or EMR, could create and provide the bar code which could then be scanned to see the person’s medications, immunizations, diagnostic test results, allergies and other basic health information.

Kalra gave the example of patients who rely on walk-in clinics, as many do in a country where millions lack connection to a primary care provider. “The walk-in clinic doctor has no history about that patient,” he said. “Would it not be nice for the doctor to actually have the information at their disposal at the time of the visit, because the information is all there in the system?”

The change could be implemented within a matter of months and would be an improvement people could see immediately and that would help providers deliver better care, Kalra said. “It just helps the health system overall. Every small saving in the health system contributes to goodwill.”

It would also feel like a big step from the current situation.

Despite hundreds of millions of dollars having been spent over decades, and roughly 93 per cent of doctor’s offices adopting EMRs, there is still no national or provincial system in Canada. Instead there is a sprawling patchwork of dozens of providers and numerous products with no agreed upon data-sharing standard that would allow them to work more effectively together.

EMRs have so far failed to live up to their promise as a way to make health care better, safer and more efficient for patients, providers and the system as a whole.

As Kalra puts it, “We are transitioning from a pen and paper health system to more of a digitized health system, but then the digitized health system also comes with its own set of problems.” While past efforts weren’t wasted, he said, clearly the job is unfinished.

Medical offices generate enormous amounts of data, but it’s not always good quality and it’s difficult to share. “We’ve got these massive pipes that we’ve built across various health settings,” he said. “Now how do we make sure the data coming from these pipes are connected and they contribute to a singular or longitudinal health record?”

Kalra spoke with The Tyee on the phone from Mississauga, Ontario, on a mid-April day when other Canada Health Infoway executives were in B.C. meeting with provincial government officials.

In the past the federal government flowed billions of dollars through Canada Health Infoway to the provinces. Now money for EMRs is going directly to the provinces and territories, and the agency is shifting to a role providing co-ordination or support.

In recent years the federal, provincial and territorial governments developed a draft Pan-Canadian Health Data Strategy that the federal government says is reflected in the commitments related to health data included in the bilateral health-care agreements signed last year with the provinces and territories.

“Now Infoway is purely into a value-based role,” said Kalra. “Not only just defining the national standards and approaches, but also working hand-in-hand with the jurisdictions and the vendors to make sure it’s implemented and it’s maintained.”

There are three key elements to the way forward, Kalra said.

The first is to give vendors a clear indication of the format data needs to be exchanged in. “We are doing active work on that and we will be actually publishing those standards to the market,” he said. “We’re going to hold the private sector accountable with whatever capacity we have to make sure they are enabled with that.”

The second is to build the technology infrastructure so that it can support the collection and exchange of information, said Kalra, adding that most jurisdictions in Canada have a plan to get there.

The final element is policy, he said, with leaders providing signals through incentives and well co-ordinated federal and provincial legislation. There needs to be a desire to constantly improve and an understanding that progress will be incremental.

While incentives can help, laws are essential, he said, giving the example of the 21st Century Cures Act in the United States that includes penalties for vendors or physicians who try to block the flow of data. “That really unlocked a huge amount of value for them.”

There are at least 15 EMR systems in common use in Canada in physicians’ offices. As of 2021 even the most popular, Accuro EMR, owned by QHR Technologies, was used by no more than about 17 per cent of physicians according to survey results. QHR has been owned since 2016 by grocery store corporation Loblaw Companies Ltd.

The other big providers are telecommunications company Telus Health, which owns and operates at least five different systems, and WELL Health which has at least four. The sector is similarly fragmented in the country’s hospitals.

Canadian survey results released Monday found only half of respondents said that their health-care providers had access to their health history ahead of their visit. Two out of five people surveyed expressed frustration with having to repeat information to different health-care providers.

Kalra cautioned that making sure systems talk with each other will need ongoing attention. “I would say from my experience, interoperability is always going to be a journey. It’s not a destination.”

There’s a clear need to align on a national approach and standards, Kalra said. “If each of the health systems, each of the jurisdictions, starts to build their infrastructure and work with the same common vendors in 13 different ways, there is no way we can actually deliver faster solutions.”

There’s much that can be improved and positive change is coming, he said. “I’m very positive and hopeful.”