I have been fortunate to travel and interact regularly with my physician and HIT colleagues in Canada, and am always surprised by the difference between political rhetoric and real life.
For instance, frequently cited waiting lists just don’t apply to emergency and urgent care. It is true that delays exist for elective procedures, but statistics showing increases in cataract surgery, coronary bypass, and joint replacement seem to negate claims of healthcare rationing.
The cultural difference between American and Canadians seems to have a profound effect on the perception of problems. When I order a non-urgent MRI for my US patients, they are confronted by a choice of several imaging centers, and delay of a few days scheduling is due frequently to a desire for more convenient location, hours, or open magnet.
When I ask my friends in Canada about week-long (sometime month-long) waits, I almost always receive a response like “well, yes it’s annoying, but I suppose it’s a reasonable price to pay knowing that children in our society all have equal access to healthcare.”
There appears to be a community ethos in Canada that profoundly influences reactions to their universal care system. The concept of sharing seems to have a lot to do with this, and I wonder if Information Exchange has a different societal context.
How will this emphasis on “community” effect Canadians’ adoption of HIE? With their impressive recent ramp-up of HIT, it seems that meaningful sharing of key medical information via technology is at the core of several important initiatives. These include community care plans and registries for chronic disease management, insuring safety and continuity during transitions of care, quality measure compliance, and basic access to a complete patient data set at all venues of care.
A recent article in the Ontario Globe and Mail discusses concerns about an aging population and its potential negative effects on healthcare delivery efficiencies. Given the Canadian emphasis on “we” rather than “me” the benefits of HIE will markedly influence this debate.
I am privileged to be working with the Manitoba eHealth Initiative. Part of their mission statement sums all this up nicely: "We are all on the same team, we win and lose together… win/lose is not an option."
