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I agree fully with Dr. Persaud that health data should be stored and administered at a national level, or failing that at a provincial level. This would eliminate costly retesting, reduce medical error, improve the efficiency of health care provision, and allow for improved research and quality monitoring in the health care system. It is truly unfortunate that the greatest promise of electronic health records were never realized due the diverse set of incompatible systems implemented by siloed IT departments and care providers with no national or provincial direction.
The solution proposed by Dr. Persaud, however, is fundamentally flawed and lacks insight into the realities and complexities which have precluded such an approach in the past. For instance, requiring a single national EHR system would hold hostage all Canadians, health care providers, and institutions to a single corporate entity. Consider how all the varying requirements of every stakeholder would be collected and negotiated into a manageable service contract? Who would pay for voiding all existing EHR service contracts with providers who were not selected for the single national service?
We need to work towards alternative but feasible solutions to achieve the stated goals.
In my opinion, the best solution is centrally managed data with interoperability standards and requirements for querying and storing health data. EHR systems implemented across the country would be required and certified to query and store a comprehensive set of health data attributes using the national database. This approach permits local customization of EHR systems, and safe migration from siloed local databases to the national database without forcing all stakeholders out of their existing service contracts.
Database technology has advanced tremendously in the last decade, with flexible horizontally scaling NoSQL systems becoming commonplace in the tech world. These systems permit centralization of data without compromising query performance on enormous datasets or database architecture flexibility.
Significant capital investment and technical leadership will still be required to achieve this. I fear that in the current environment of increasing austerity, gaining traction on this initiative will remain a challenge even if cost-effective in the mid-long term.