Health records just a click away

Alberta, Canada’s electronic health record system could provide lessons for U.S.

Orion Web site

U.S. health officials only have to look as far as Canada to discover how to build a successful electronic health record system that saves money and gives doctors the most up-to-date information on their patients.

The Canadian province of Alberta launched NetCARE — the first regionwide, integrated electronic health record system — in April 2004. NetCARE links 2,000 doctors, hospitals and home care providers for 1.6 million patients, about half the province’s population. And the cost of building it was a mere $8 million in U.S. dollars.

The Bush administration has proposed a similar health e-records system in the United States, and the Department of Veterans Affairs and the Defense Department already use health e-records systems at various locations.

The seed for creating the system’s Web-based portal was sown eight years ago when Canadian officials regionalized the country’s health care system and began creating e-records for patients. But according to experts in Canada and the United States, much of NetCARE’s success can be attributed to the fact that Canada has a single-payer system run by the government, which simplifies referrals and billing. The system offers a single place for health care providers to send bills.

The NetCARE database stores patients’ medical histories along with the results of X-rays and lab tests. Doctors now have access to faster and more complete data for their patients without shuffling through paper records or waiting days or weeks for paper files to be transferred from one office to another. And patients have the benefit of seeing doctors who are up-to-speed on their medical histories, know what medications they are taking and can make sure not to prescribe drugs that could interact badly or even kill them.

Nevertheless, Donna Strating, chief information officer for Capital Health in Edmonton, said officials still have some decisions to make about what information goes into the electronic database and how to protect the privacy of patients whose most intimate medical details are stored in the system.

“The challenge is to effectively share patient information with caregivers across our facilities and in the community, providing secure access when and where required,” Strating said.

Medical personnel viewing a patient’s documents must have the authority to do so, she said, and patients can “mask” certain data. For example, records related to communicable diseases such as AIDS and tuberculosis are blocked from general view, and a health provider must have authorization to access such information about a patient.

“Masking doesn’t mean a physician can’t look at it,” she said. “What pops up is a box that asks, ‘Who are you? What’s your relationship to the patient?’ A physician has to answer these questions before seeing the information.”

The plan was developed with the help of a consortium of five companies: Hewlett-Packard, Oracle, Sierra Systems, Quovadx and Orion Systems International.

Orion is a New Zealand company that has been a pioneer in the development of software for electronic health records. Company officials had experience developing such systems in New Zealand, Australia and the United Kingdom using its Concerto Medical Applications Portal software.

Sarah Renshaw, Orion’s marketing director, said a number of American institutions are trying the company’s Web-based platform, including the Johns Hopkins Hospital in Baltimore and hospitals in Washington state and Ohio.

She said the system has the ability to store patients’ entire health records, including the results of MRIs, mammograms and heart-monitoring procedures.

The records are usually stored on hospitals’ servers with intricate firewalls and security systems to prevent unauthorized users from accessing the encrypted information, Renshaw said.

Medical model?

The electronic health record system in Alberta, Canada, could be a model for the United States, but some significant differences exist between the two countries, not the least of which is size. Canada has a government-sponsored health system, while the United States has a wide range of plans.

“In the United States, the lack of a single payer and the government’s reluctance to call the shots mean that progress will be slow and spotty for several years,” said

Barry Hieb, a research director at Gartner who is also a physician. “Collaboration and standards will eventually pull us through this knothole, but it will be a slow and frustrating journey.”

Donna Strating, chief information officer at Capital Health in Edmonton, Alberta, agreed. “I think the biggest challenge when you build something like this is that people want more information, but it has to be appropriate information so it doesn’t become a big garbage can,” she said.

Strating said that when officials in Alberta created their e-record system, they decided to include the results of patients’ X-rays and other lab work beginning with the previous year and then record everything moving forward. Although that decision meant that earlier information will not be incorporated into patients’ e-records, the payoff is still enormous.

“We now have a list in one spot,” she said, adding that “you actually can accumulate data and populate it in real time.”

— Judi Hasson


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