An article published in yesterday’s Canadian Medical Association Journal notes that “confusion and disarray appear to be the only form of national standards in operation within health information record-keeping circles“. Why does this situation exist? Dr. Alexander Jadad, Canada Research Chair in ehealth innovation at the University of Toronto, is quoted as saying, “We don’t really have any federal governance” and “governments have to figure out how to make people comply with these standards“.
While I have been making a similar plea for national standards in various forums, I think that people need to keep in mind the political realities. To start, and perhaps most importantly, healthcare, along with many other matters, is a provincial responsibility. This division of responsibilities drives many aspects of federal / provincial relations and makes it very difficult for the federal government to take an active role in anything related to healthcare. Indeed, Infoway is a creative response to this dilemma that attempts to direct federal money in a manner that respects provincial responsibilities. Any attempt to drive national standards must consider the federated nature of Canadian laws and politics.
So …. where should the leadership about which everyone is yelling about come from? Infoway? Health Canada? A new organization? Or, do we start at the provincial level? Maybe the new eHealth Ontario CEO, Greg Reed, should cease work on provincial eHealth standards and immediately work with Infoway to adapt Pan-Canadian standards instead. As the largest province such a move not only sends a strong signal to other provinces but also creates a market of sufficient size for vendors to come on side.