Observations on the Canadian EMR Market

At the end of August I published a blog post entitled “Meaningful Engagement” in which I explored lessons that might be learned from the US process for defining “meaningful use”. In that blog post I reference an article entitled “Certification of Primary Care Electronic Health Records: Lessons Learned from Canada” written by Dr. Mark Dermer and Dr. Matthew Morgan. Although the article offers insights on the engagement process that led to the definition of meaningful use, its primary purpose is to explore the Canadian EMR certification process. In their assessment of Canadian EMR programs, Drs. Dermer and Morgan assert that “the significant variation in which products are chosen in competitions that use very similar specifications (derived from Infoway’s POSR) calls into question the process by which products are evaluated“. To further illustrate the points made in the article, I analyzed data that I have collected on the Canadian EMR market and offer the following observations for consideration:

  • According to Dr. Alan Brookstone from CanadianEMR, there are approximately 35 vendors offering some form of EMR solution to Canadian physicians.
  • Nearly all of the 35 EMR vendors are Canadian companies.
  • Sixteen or slightly less than half of these vendors have products that have been certified by one or more of the six provincial EMR programs (BC, AB, SK, MB, ON, and NS).
  • None of the sixteen certified vendors has products which are certified by all six provincial EMR programs.
  • Only one vendor has product which has been certified by four of the six provincial programs.
  • The majority (62%) of the 16 vendors whose products have been certified by a provincial program have only been certified by a single program.


5 responses to “Observations on the Canadian EMR Market

  1. Mike, while you state the facts, you don’t offer potential reasons. I contend that its because in many cases, the return on investment in these jurisdictions simply doesn’t exist. For example, a vendor based in ON has significant investments to make to deliver a solution in BC…even to mealy certify with the provincial program,leet alone do business there if they certify successfully. This has the effect ( which Canada is experiencing) of creating a fragmented, cottage industry based on local solutions. The multiple and varying certification Programs are a huge impediment Canada seeing an evolving, sustainable, and financial robust EMR market. One thing the US has right is certify once, and sell to ALL States.

    • Schlomo,
      I purposely did not offer reasons as I wanted to stimulate discussion. Thanks for rising to the occasion. I share your concerns regarding the resulting fragmented market. I too think that they are a huge impediment to progress.


  2. I agree with both of you, but the question I keep asking myself is that given the political nature of healthcare services delivery in Canada, how do you convince the Provinces/Feds to stay out of it?

  3. Upon reflection there is a role for the feds. I think there is a role for Infoway, especially if they can figure out a way to cross-certify provincial vendors in some kind of manner. There is also a pretty compelling case to made for them in terms of national standards, but that is an entire blog post on its own.

    I think we need to stop wishing that the government is not involved with the EMR market, and figure out some kind of realistic way forward. What is that path? Good question.


  4. One of the biggest problems with EMR systems is the cost. Any government involvement or standardization requirement would drastically increase those costs. Their only solution is to offer incentives (money) to offset the increased cost. OntarioMD gives doctors about $27,000 over 3 years for implementation of an approved EMR. Other provinces may require configurations (Eg. ASP) that the providers do not want.

    Government involvement is a total waste of time and money.

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