HESA Committee Report

ANALYSIS OF IMPLEMENTATION

PRIMARY HEALTH CARE AND

ELECTRONIC HEALTH RECORDS

Primary Health Care

50% have 24/7 Access           

 Though all provinces and territories (P/Ts) have introduced variations of multidisciplinary teams, most Canadians still do not have 24/7 access to high-quality primary health care.  PHC is still chiefly delivered by family physicians, most of whom provide services only during office hours. 

Most P/Ts have telephone information lines providing 24/7 access to health advice.

Through the $800 million Primary Health Care Transition Fund (PHCTF) from 2000 to 2006, there was a significant amount of PHC renewal activity.  Since then, many provincial/territorial governments have sustained renewal activity in the sector.

Most jurisdictions continue to implement some form of PHC renewal post-PHCTF.  In some cases, provinces are encouraging the uptake of a particular model (e.g., Primary Care Networks in Alberta or Family Health Teams in Ontario), while others are encouraging certain activities, such as improved chronic disease management, within existing frameworks.  To this end, many P/Ts have devoted substantial funding to PHC activities, and Alberta was a leader in this regard, using $100 million of its Health Reform Transfer allocation to its Primary Care Network initiative.

Best Practices Network

Health Canada funded and led three events under the Best Practices Network commitment. The Canadian Health Services Research Foundation has developed a Primary Healthcare Network designed to promote partnerships and knowledge exchange between decision makers, policy makers and researchers throughout Canada. 

Future Work on Primary Health Care Renewal

Notwithstanding concerns that activity in primary health care renewal might lag or slow down following the wrap-up of the PHCTF, in fact many jurisdictions have sustained momentum and devoted significant resources to PHC activities.  As noted, most P/Ts continue to support key targeted areas of PHC reform in their jurisdictions (for example, continued implementation of information and communication technology in Alberta, enhanced chronic disease management throughout British Columbia, and emphasis on evaluation, and therefore ability to report on system change, in Saskatchewan).

Future efforts should continue to support the shift to team-based care.  PHC has a significant role to play in the prevention and management of age-related illness, as well as ensuring continuity of care (across sectors and over time).  Better management of chronic conditions within the primary health care sector through a team-based approach will contribute to reducing the incidence of complications and secondary illnesses.

Health Council comments

The Health Council has placed a very high premium on the role of primary health care renewal in health care system reform.  Recent reports have acknowledged that progress is occurring, but are qualified in their assessment. 

The Health Council released a report on primary health care and home care renewal in January 2008 which noted that the vast majority of Canadians (96 percent) report having either a regular medical doctor or regular place they go to for primary health care.  However, the Health Council also reported that one-quarter of people who needed care for minor health problems had difficulty getting timely appointments.  More than one-third of people who used an emergency department believed their conditions could have been treated by their family doctor if he/she had been available.  The Health Council recommended several measures to accelerate change: 24/7 access to health information and care providers, electronic patient records and interprofessional primary care teams.

Report:  Fixing the Foundation: An Update on Primary Health Care and Home Care Renewal in Canada, January 2008.

Electronic Health Records (EHRs)

All jurisdictions are working with Canada Health Infoway (Infoway) to implement EHRs and telehealth, and it would be fair to conclude that there has been an acceleration of efforts by P/Ts on both telehealth and the electronic health record.   

All P/T’s have accelerated the development and implementation of the EHR commitment in their jurisdictions, in part by working on projects with Canada Health Infoway. 

Infoway has also invested in P/T projects to expand and sustain telehealth initiatives in Canada including Aboriginal, rural and remote communities.  Infoway also continues to work on linkages between telehealth and electronic health records systems, and the integration of telemedicine activities into mainstream healthcare service delivery.  Telehealth strategic plans are now in place in most jurisdictions, with the goal of implementation of telehealth solutions by all jurisdictions by December 31, 2009.

Since 2001, the Government of Canada has provided $1.6B, including $400M in Budget 2007, to Infoway to support the development and adoption of health information systems, including electronic health records, public health surveillance systems, telehealth and tools to support wait times reductions.

Future Work on EHRs and Telehealth

Canada’s goal for Electronic Health Records by all F/P/T jurisdictions with Infoway was initially set out in 2002-03.  Canada’s goal for EHR development (agreed to by all jurisdictions) is for 50% of Canadians to have an electronic health record by 2009 (the target date was subsequently changed to “by the end of 2010").

Adoption of health information technologies by clinicians and other health professionals is key to successful EHR implementation.  This requires change management strategies, including training; Infoway and most jurisdictions are working on this issue.

Health Council comments

The Health Council believes that electronic information management systems offer tremendous potential to reduce error and improve patient safety, through the timely transmittal of accurate information.  According to the Health Council, about one half of Canada’s 13 P/T jurisdictions are doing very well on EHR development, comparing favourably to the “ambitious plan/associated investment’ aspect mentioned in the Accord.  While the Health Council has acknowledged the progress that Infoway and P/Ts have made, the Council believes progress on the EHR is too slow and the goals too low, and in its 2006 Annual Report released in February 2007, for the second year in a row, called for 100 percent coverage of EHRs for all citizens by 2010, well ahead of Infoway’s goal of a fully interoperable EHR for 50 percent of Canadians by 2010.

In its January 2008 report on primary health care renewal, the Health Council noted that the majority of physicians in Canada still rely on hand-written records.  The Health Council noted that while more than $1 billion has been spent on implementing EHRs, only 5 percent of Canadians have an electronic health record.  The Health Council urges all jurisdictions to make this a priority.

Report:  Fixing the Foundation: An Update on Primary Health Care and Home Care Renewal in Canada, January 2008.