The United States isn't alone in suffering from a lack of interoperability between electronic health records. Our neighbors to the north are experiencing similar difficulties with their EHR systems.

A new report from a Toronto-based policy research group, the C.D. Howe Institute, reveals that only 12 percent of physicians are notified electronically of patients’ interactions with hospitals or send and receive electronic referrals for specialist appointments, and fewer than three in 10 primary care physicians have electronic access to clinical data about a patient who has been seen by a different health organization.

This limited exchange of e-health records in Canada has negatively impacted the ability of primary care physicians to carry out higher order functions such as e-prescribing, receiving discharge summaries, receiving reports from specialists, receiving lab results electronically, preventative care follow-up, generating a medications list, providing clinical summaries and sending reminder notices, according to institute officials.

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Report author Denis Protti highlights five key objectives for the Canadian EHR architecture, which are very similar to the ideal goals set out by American informatics experts. Those highlights include:

*Shared electronic records should be regarded as essential to care;

*Features of electronic records systems that get in the way of effective clinical practice should be regarded as safety issues that need to be resolved as a priority;

*Clinicians should have a single point of access to electronic records about patients they are treating, regardless of where the record was created;

*Patients and their caregivers should not find relevant data inaccessible, expensive to access or at risk of loss because of commercial or financial decisions made by EHR system vendors; and

*Patients should ultimately be able to access their EHRs online.

The report also includes analysis of EHR status among primary care physicians and specialists worldwide, examples of leading U.S. EHR deployments, and a comparison of the number of hospitals in the U.S. and the province of Ontario in reaching stages 1-7 of the HIMSS EHR adoption classification.

Overall, Protti, professor emeritus of health information science at the University of Victoria, in British Columbia, told Health Data Management the U.S. has been moving somewhat more quickly than Canada in establishing its health information networks.

"Both countries have invested in infrastructure though the U.S. did more so," he said in an email. "Both countries have centralized organizations and wouldn’t be as far along as they are without them. The Meaningful Use initiative and incentives in the U.S. is helping move the quality of care agenda; there is very little similar in Canada at the moment. The U.S. is also steaming ahead on ePrescribing while we continue to make very slow progress in Canada. Both countries are struggling with data sharing and interoperability. What each country can learn from the other is how critical a role leadership plays in the use of IT in healthcare."

The report is available here.

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