Experts call for health infoway “watchdog”

Paul Christopher Webster

doi:10.1503/cmaj.109-3783

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Small can be idiosyncratic
Raymond Simkus

Posted on: 28 February 2011
Experts call for health infoway "watchdog"
Brian Postl

Posted on: 16 February 2011
Point of clarification: Experts call for health infoway "watchdog"
Misha Kay

Posted on: 26 January 2011

Posted on: (28 February 2011)
Page navigation anchor for Small can be idiosyncratic
Small can be idiosyncratic
Raymond Simkus
In the article referring to Infoway needing a watchdog and related articles criticizing the big approach and favouring the small approach there are a few things that should be considered. Thirty years ago I was involved with a grass roots approach and tried to build an EMR. It did not take too long before it was clear that to develop a high performance product was going to take a multimillion dollar effort. Since then I h...
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In the article referring to Infoway needing a watchdog and related articles criticizing the big approach and favouring the small approach there are a few things that should be considered. Thirty years ago I was involved with a grass roots approach and tried to build an EMR. It did not take too long before it was clear that to develop a high performance product was going to take a multimillion dollar effort. Since then I have seen one attempt after another trying to do the same thing and typically the products are incomplete, use impoverished information models and have idiosyncratic functionality. The problem is that physicians keep buying these products.
An example was given of being able to receive lab results electronically. My office accumulated about 800,000 lab results over a 10 year period. When we changed to a different EMR vendor the identifier for each test was wiped out because the provincial requirement did not include that identifier. The problem was related to the needs of the end user not being met by the labs using legacy systems and those that set the provincial requirements not recognizing this as an issue.
The requirements for a high performance EMR are not immediately apparent to the typical clinical user. They seem to be not that apparent to some EMR vendors who listen to those typical users. There seems to be a widespread unawareness of the tremendous amount of work that has already been done regarding EMR requirements. If this work was paid attention to we could have an impressive leap forward in EMR functionality. There are so few people that are interested in this type of work that there is not the critical mass to do this on a small scale but requires a national effort. While things could be improved at Infoway I think a larger part of the problem are the owners and funders of outdated legacy systems that are not willing to move forward with systems that would be more conducive to delivering what is needed today.
Conflict of Interest:
None declared
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Competing Interests: None declared.
Posted on: (16 February 2011)
Page navigation anchor for Experts call for health infoway "watchdog"
Experts call for health infoway "watchdog"
Brian Postl
With respect to the article entitled, Experts Call for Health Infoway “Watchdog” which appeared in the CMAJ on January 17th, I believe the journalist, Paul Webster, misconstrued the essence of what was discussed. Contrary to the way the article reads, I do not believe Infoway requires further oversight.
I was a member of Infoway’s Board of Directors for five years and can attest to the organization’s ongoing co...
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With respect to the article entitled, Experts Call for Health Infoway “Watchdog” which appeared in the CMAJ on January 17th, I believe the journalist, Paul Webster, misconstrued the essence of what was discussed. Contrary to the way the article reads, I do not believe Infoway requires further oversight.
I was a member of Infoway’s Board of Directors for five years and can attest to the organization’s ongoing commitment informing the public about progress and to ensuring Canadians are receiving good value for the investments being made in electronic health records systems across Canada. Canadians need only to refer to Infoway’s Annual Report if they want to see how electronic health records systems are progressing throughout the country. The organization is also accountable to the federal government through its funding agreements, as reflected by the Fall 2009 audit conducted by the Office of the Auditor General of Canada. In her report, Ms. Fraser indicated that Infoway has accomplished much since its inception. She also acknowledged that the organization has been working with “due regard” for taxpayer’s money, and that it had sound systems in place for managing projects efficiently.
We all share responsibility for the development of and commitment to the EHR across our country. Governments need to maintain and accelerate their commitment; health agencies need to monitor progress; physicians need to increase their “buy-in” and the public needs to assert its interests in the EHR to ensure improvements in patient safety.
It is not Infoway that requires additional oversight; rather all of the involved parties must be seen as accountable.
Yours truly,
Brian Postl, MD Dean
Conflict of Interest:
Dr. Postl is a former member of the Infoway Board of Directors.
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Competing Interests: None declared.
Posted on: (26 January 2011)
Page navigation anchor for Point of clarification: Experts call for health infoway "watchdog"
Point of clarification: Experts call for health infoway "watchdog"
Misha Kay
I am writing in an attempt to clarify what appears to be some confusion over Canada's "eHealth status" as reported in the Canadian Medical Association's Journal article, "Experts call for health infoway watchdog" published on January 17, 2011. The source for the data was a recent publication by the WHO Global Observatory for eHealth "Atlas of eHealth Country Profiles" December 2010, http://www.who.int/goe/en As the hea...
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I am writing in an attempt to clarify what appears to be some confusion over Canada's "eHealth status" as reported in the Canadian Medical Association's Journal article, "Experts call for health infoway watchdog" published on January 17, 2011. The source for the data was a recent publication by the WHO Global Observatory for eHealth "Atlas of eHealth Country Profiles" December 2010, http://www.who.int/goe/en As the head of the Observatory I am responsible for its research work and publications in the eHealth domain worldwide.
I understand that it was the ranking of Canada as 21 according to the ICT Development Index (IDI) that has been the source of some confusion. This is not an Observatory index but one developed by the International Telecommunication Union (ITU). This is an indicator which has been developed over many years by the ITU and has had no input from WHO in its formulation. It is not a health-related indicator but one which can be applied to any sector which uses ICT. It reflects the level of ICT sophistication or development in countries and cannot be used to measure a country's eHealth maturity or development. More information about this indicator can be found at:
http://www.itu.int/ITU- D/ict/publications/idi/2010/Material/MIS_2010_Summary_E.pdf To put Canada's IDI ranking at 21 in perspective, it is worth noting that the United States comes in at 19. The index itself is a composite value made up of 11 indicators relating to ICT access, use and skills. If you wish to enquire further as to the breakdown values of each individual indicator for Canada I suggest you contact the ITU in Geneva as I do not have access to these figures. None of the questions we asked in our global survey on eHealth have any influence on Canada's ranking in the IDI as it is purely ICT-related.
Finally the Global Observatory for eHealth does not have a policy of ranking countries based on survey responses as we do not feel that it is productive or often indicative of where a country is really at and can be misinterpreted or even abused. However, if one studies the country profile page of Canada it is evident that your country is in a very strong position regarding eHealth development. Further, during the last two global surveys, Canada submitted exceptionally detailed and comprehensive responses, far beyond our expectations, and has now raised the bar for other countries in terms of quality information reporting.
I would be happy to answer any further questions you may have.
Dr Misha Kay Manager - Global Observatory for eHealth World Health Organization, Geneva
Conflict of Interest:
None declared
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Competing Interests: None declared.