A.  Canada Health Infoway


Established in 2001, Canada Health Infoway Inc. (Infoway) is a non-profit corporation tasked with leading the nation-wide EHR initiative.  In the eight years since its establishment, Infoway has supported almost 300 EHR projects nation-wide.[41]

Infoway recognizes that although each province and territory will have an EHR system that meets their specific jurisdictional needs, provincial and territorial systems should be based on a core set of principles and characteristics and promote interoperability.[42]  But according to a 2009 Auditor General of Canada report on Electronic Health Records, although Infoway takes steps to ensure that EHR projects align with certain privacy and security requirements, it has no responsibility for ensuring that systems comply with privacy laws.[43] Further, Infoway has not followed up with provincial and territorial partners on conformance test results, nor has a plan been fully developed to deal with EHR project variances.[44] Importantly, Canada Health Infoway strategies and published reports do not adequately address its vision for governance as it relates to the ownership of electronic health records.



·         What are the potential short-term and long-term implications of Infoway failing to ensure that EHR projects nation-wide comply with privacy and security standards? 

·         Given the Auditor General of Canada’s unfavourable review of Infoway, what can be done if any, to improve its functioning, specifically as these relate to its constitution, governance and objectives?

·         Is there another alternative to Infoway?


B.  eHealth Ontario

Several Canadian provinces have restructured healthcare delivery in ways that are intended to enhance the role and responsibility of electronic health information technology.[45] Established in September of 2008, eHealth Ontario is charged with harnessing information technology and innovation to support the provincial health strategy.[46] The agency’s key priority is to have an electronic health record in place for Ontarians by 2015.[47] The Ministry consolidated provincial eHealth efforts with eHealth Ontario: the Ministry replaced Smart Systems for Health Agency (SSHA),that had been tasked to develop the technical infrastructure, and the Ministry of Health, tasked to formulate the overall EHR strategy.[48]

A recent Auditor General of Ontario report confirms that Ontario trails behind its provincial eHealth counterparts.[49]  SSHA’s $800 million dollar investment utilized has reaped little value: although a network is in place, it is underutilized as there is insufficient health-information contained within the system.[50]  The documented poor coordination between SSHA and the Ministry’s eHealth Program Branch, and delay in the development of an eHealth Ontario strategic plan have contributed to the poor return on investment to date, and slow EHR project progress.  

eHealth Ontario has released a three-year strategic plan.[51]  The strategy focuses upon three clinical priorities meant to provide significant clinical value to both patients and physicians, and includes diabetes management, medical management and wait-times management.[52] Although the three-year plan provides concrete targets and deliverables on each of the key EHR components, it appears to de-emphasize the eHealth Ontario goal of delivering an EHR by 2015.[53]  Last, eHealth Ontario appears to postpone addressing strategies adhering to PHIPA and does not at all seem to consider ownership issues.[54]


Ontario has chosen to utilize the clinical priority of diabetes management as a springboard to the creation of a province-wide EHR.  What are the implications of choosing this arguably narrow starting point rather than establishing a basic EHR infrastructure for all patients? 

During the current 3 year strategic plan period, eHealth Ontario plans to develop a comprehensive strategy for managing consent in compliance with PHIPA.  What are the implications of not having a consent strategy at the outset of eHealth’s strategic plan?



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