The COVID-19 pandemic that amplified staffing shortages and rising clinician burnout in our health-care system has created an urgent need to reimagine and improve it.
Clinicians know that digital health tools can be part of the solution, but without the ecosystem to support innovation and data sharing, technology can also amplify the problem. We must modernize to allow health-care technology to communicate seamlessly, share data effectively and serve as a tool for clinicians rather than a hindrance.
The 2024 National Survey of Canadian Physicians, conducted by Canada Health Infoway (Infoway) and the Canadian Medical Association, revealed important trends in physicians’ use of digital health tools, shedding light on areas of progress as well as those that have seen less advancement.
Today, 95 per cent of physicians use electronic records for clinical documentation, up from 87 per cent in 2021 and a dramatic rise from 39 per cent in 2010 (pan-Canadian Trendlines Dashboard). That represents a substantive transformation, especially in family medicine, with 97 per cent adoption of electronic records. This progress has been accompanied by gradual uptake of complementary functions like decision support and sourcing patient information such as test results.
In contrast, digital tools that facilitate connected care, enabling clinicians to share patient information within the circle of care, have been slow to gain widespread adoption. According to the 2024 results, only a minority of physicians report sending referrals or clinical summaries electronically, while 73 per cent cite system fragmentation and lack of integration as significant barriers. These disconnected systems that often require multiple logins and cumbersome workarounds limit the potential benefits of digital health.
Why has progress in some areas accelerated but not in others, and what lessons can be drawn from experience advancing electronic medical records (EMRs)? In a 2014 analysis on the progress of EMRs, my co-author and I concluded:
The decision to fund Electronic Medical Records was consistent with a long-term framework for digital health established in consultation with stakeholders across the country, spurred by analysis demonstrating the economic impact of such investments and data on Canada’s low rate of EMR use in primary care compared with other countries. The decision reflected widespread public and stakeholder consensus regarding the importance of such investments.
We described an environment where a strong value proposition and consensus among stakeholders created momentum for change. Clear expectations and product improvements were essential, alongside certification for quality assurance. Governments saw the long-term value of EMRs, understanding that their impact reaches far beyond individual practices, improving care coordination and patient outcomes across the health-care system.
We believe these conditions must be replicated, and that many of the pieces already are coming into place.
First and foremost, the reasons are evident. Survey data reveals that valuable physician time – up to two hours a day – is spent searching for patient information that could otherwise be readily available. This inefficiency adds unnecessary strain to an overburdened system. By reducing these administrative barriers, we can free up more time for direct patient care and improve overall health outcomes. The Interoperability Saves Lives report highlights additional positive effects interoperability has on patient care, while the pan-Canadian Health Data Strategy outlines a bold vision for unlocking health data to benefit patients and clinicians.
Next, key regulatory frameworks are taking shape. In March 2023, the Shared pan-Canadian Interoperability Roadmap was endorsed at the Conference of Deputy Ministers, acknowledging the urgent need for seamless data sharing across Canada’s health-care ecosystem. This endorsement represents a collective commitment from federal, provincial and territorial leaders to tackle long-standing interoperability challenges. Initial technical specifications and guidance documents to operationalize the roadmap are being developed in collaboration with stakeholders from across the health-care continuum.
Furthermore, the introduction of Bill C-72 in June 2024 marked another critical step forward, proposing clear rules to enforce standards adoption and promote the integration of health systems. This legislation, if passed, will provide a necessary regulatory framework to ensure that patient data can flow across care settings.
Finally, funding has been mobilized to jumpstart this ambitious journey. Investments have been made in organizations like Infoway and the Canadian Institute for Health Information (CIHI), which are spearheading interoperability initiatives as outlined in the roadmap. Additionally, bilateral agreements between the federal government and individual provinces and territories have earmarked funds specifically for roadmap priorities. These investments and partnerships already are generating tangible progress, such as New Brunswick’s patient summary initiative. While some stakeholders must bear a higher burden of implementation or adoption, the long-term benefits of high-quality, shareable data will be felt by all.
To ensure sustained progress, it will be essential to maintain a balanced approach, offering the right mix of financial incentives, technical support and policy guidance to encourage widespread adoption across all regions and sectors of the health-care system. This is not just about the initial investment but about ensuring a long-term commitment to creating a health-care system that truly works for both clinicians and patients.
The steps we take today will shape the future of health care in Canada. The progress we’ve made is just the beginning.
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