Virtually everyone who has had any dealings with the Canadian health-care system has the same story to tell: You get referred by your GP to a specialist and when you arrive you have to sit down and go through your entire medical history anew; or your X-rays didn't show up on time and you basically have to go back and start the process all over again.

This is medicine in the 21st century and the internal contrasts couldn't be more stark.

On the one hand you have ultra-high tech machines such as CT-scans that can produce exacting images of the tiniest tumours from any vantage imaginable. On the other, personal medical records are taken down by hand in a scrawl that perhaps no one else can read and stashed in a metal filing cabinet.

Canada's health-care system is, arguably, the country's biggest industry and yet it seems to be stuck in a time warp of its own making. Look around, and you can see that over the past 20 years or so the computer chip has transformed virtually every form of human endeavour.

Yet the doctor's office today and many hospitals as well remain a bastion of 19th century paperwork. What's more sad is that, in international terms, Canada is one of the worst offenders.

The electronic age

Six years ago, the federal and provincial governments came together to do something about this. They created an independent agency called Canada Health Infoway to lead the charge into the information technology age and endowed it with an initial $1.1-billion budget.

Six years later, that budget is almost fully spent, and what is there to show for it?

Well, there has been some progress. Infoway has helped launch a number of pilot projects across the country, usually involving information-sharing technology, within a batch of mid-sized local hospitals and the offices of local specialists. Some involve the sharing of diagnostic imagery, others the monitoring of prescription drugs.

More importantly, Infoway has been relentless in promoting the electronic health message at every available medical function. But old habits die hard, as the saying goes, and getting doctors and provincial health authorities to move more quickly into information technology is not proving to be as easy as it might have looked.

Indeed, a recent Infoway study of the IT use by general practitioners in 11 industrialized countries, including Canada, found Canadian doctors lagged well behind their international counterparts.

In Britain, Australia and most of Europe, more than 95 per cent of GPs have office computers that are used for clinical purposes, which usually means managing drug prescriptions and dealing with lab results, though some (and some here, too) are now starting to receive digitalized CT-scans and X-rays online.

In Canada, by contrast, the number of GPs who use electronic medical records or IT for clinical care is only about 20 per cent, says the University of Victoria study released by Infoway and the Canadian Medical Association in July.

In fact, if you read the small print, the study says that only 20.9 per cent of family physicians have an electronic record system and only 16.9 per cent of them actually use it.

See Canadian Medical Association research reports http://www.cma.ca/index.cfm/ci_id/49044/la_id/1.htm

What is E-health?

Electronic health records, or e-health to the initiated, represent an idea that's been around since at least the early 1980s. Alberta was one of the early promoters.

At first, the notion of keeping an individual's entire medical history in one or more electronic medical banks, to be accessed by authorized personnel and patients themselves, ran into all sorts of privacy concerns.

But in recent years, with vastly improved encryption codes and even personal banking carried out online, most of these concerns seem to have gone by the wayside.

An electronic health record means storing a patient's entire medical history — lab and diagnostic tests, past treatments, prescription drug profiles, immunization records, allergies — in a place that could be accessed by a hospital code or a card swipe, probably along with a personal identification number or PIN.

The data would be updated every time you went to a doctor's office or filled a prescription, and so trips to the specialist would have all the pertinent information available electronically.

Many health researchers say that an electronic database such as this, with patient identifiers blocked out, would be just the ticket for reducing wait times and developing a more responsive health-care system.

But there are many immediate benefits as well. The Infoway study of other jurisdictions found that in Denmark, for example, doctors saved on average 50 minutes each day that had previously been spent phoning hospitals or other providers to seek clarification or track results.

Electronic prescriptions in Denmark have been credited with cutting medication problems by more than half and reducing labelling errors in the lab to almost nothing.

The U.S. Department of Veterans Affairs has invested significantly in an electronic health record system in recent years. And one U.S. study estimates that if a similar system were implemented nationwide it would reduce medication errors by two million annually and prevent more than 190,000 unnecessary hospitalizations.

The price tag

So what is holding things back? Canadian doctors appear disposed to becoming more computer efficient, CMA surveys suggest. However, the physicians are worried about adequate technical support and, more importantly, who would pay for all this technology in their office.

Infoway and its many pilot projects appear to have narrowed the field as to which systems work best. But there is still a steep professional learning curve in this country.

Some provinces don't even have electronic billing between doctors and their respective health plans. And only five provinces — B.C., Alberta, Ontario, Quebec and Nova Scotia — have programs in place to help doctors buy computers and the necessary software.

Infoway has estimated that the full cost of implementing an e-health system in Canada would be close to $10 billion, but that the initiative should return something like $80 billion in direct cost savings and efficiencies over a 20-year period.

In its first report in the spring of 2006, the Ontario Health Quality Council said electronic health records linked to an information management system "is the single most important step Ontario can take to support continuous quality improvement."

The report lauded the huge number of e-health pilot projects underway in Ontario at the moment — at least 108 involving 45 separate entities (mostly hospitals) and 14 different funding authorities.

But it also noted there did not seem to be any coherent plan to move everyone under the same roof and, while noting many Ontario hospitals now have some sort of internal electronic record keeping, observed: "Critically, most hospitals have no ability to share data with other organizations electronically."

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