The Evolution of the Electronic Health Record

Almost 15 years ago, Canada was introduced to the electronic health record (EHR), which was initially hailed as the end-all solution to bestow efficiency and improved patient care in our healthcare system. With many Canadians now having access to EHR data — and with healthcare costs the highest they’ve ever been —providers are starting to question when we’ll see the big payoff for implementing EHRs.

Over the last decade, most of the provinces and territories initiated work on an EHR that would allow for the more expedient handling of patient data and would provide many advantages for patient care in the province. Much of this work was prompted by Canada Health Infoway’s strategic investments and was considered a major step forward in several jurisdictions.

Fast forward to today. Now is a fitting time to evaluate these assets and determine if the EHR can continue to provide increased value into the future – a future where several provinces are moving forward with digital health initiatives to address the ongoing needs in our healthcare delivery system.

The goal of the EHR was to enable the Longitudinal Patient Record (LPR) allowing the collection of all data related to the patient – and making that data available to clinicians as needed to assist with decisions on the patient’s care. It was a lofty goal, but easier in conception, yet difficult to accomplish in the actual environment. Nevertheless, with the dedication of many professionals, great strides have been made. Today we can say the jurisdictions and their strategic partners have in fact accomplished many tasks associated with the goal of the Longitudinal Patient Record. It is also a fair conclusion that we have much left to be accomplished.

Requirements are changing rapidly putting more demands on the delivery system to keep up from an IT perspective. We have many discussions today that bring new facets into play such as consumer health, patient connectivity, telemedicine, analytics, community care, and cloud computing among others. These topics tend to lead us toward discussions of procurements for innovative technologies and services.

“Innovation” is a word that is being used in the healthcare conversation today and tends to reflect the need for new technologies to meet healthcare delivery demands. Discussions around innovation and procurement are inexorably linked – “how can we procure innovative solutions,” is a conversation that, by necessity is beginning to include the IT vendor community.

As we contemplate the evolving IT requirements for Canadian healthcare, we must also be aware that the technology itself is not the ultimate solution. We must continue to emphasize integration
and adoption of technology by the end users. Procurement teams need to ensure that these factors are not discarded during their process or the results may in fact be very disappointing.

As technology evolves for healthcare, we are looking for more innovative solutions that expand capabilities well beyond the patient chart. The evolution of the EHR and continued expansion of the Longitudinal Patient Record will serve the market very well.

Acknowledging the pressures and concerns facing procurement and ensuring that technology adoption is a key consideration is a vital component of successful implementations. The EHR, the EMR in
clinicians’ offices and the Pharmacy Management Systems (PMS) in community pharmacies have each provided building blocks that we should look to capitalize on as we look to continue to evolve
healthcare delivery. Continuing open dialogue on the needs for delivery, the expanded use of current technologies, our changing environments, and IT as an enabler will serve Canadians well for their healthcare needs. This includes providing citizens direct access to online digital clinical data – a both their historical information from the EHR, and their current, real time episodes of care.

While EHRs were a vital first step in creating a more efficient healthcare system, there is a need for an evolution of the healthcare strategy in Canada, one that builds upon the foundation created by EHRs, promotes the continuity of patient care and takes advantage of information to extend thelongitudinal record.