5 Reasons Why Canada Could Be a Hotbed for EHR innovation

Posted on June 4, 2016 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin is a true believer in #HealthIT, social media and empowered patients. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He currently leads the marketing efforts for @PatientPrompt, a Stericycle product. Colin’s Twitter handle is: @Colin_Hung

From June 5th to 8th thousands of Canadian HealthIT professionals, government representatives, hospital leaders and policy consultants will gather for the annual eHealth Conference (#eHealth2016) in Vancouver. This event is like HIMSS, but smaller and focused on Canada.

Full disclosure: I am Canadian, but I spend about 80% of my time focused on US Healthcare. I manage to stay informed about the happenings in my home country through the tweets and posts of people like Glenn Lanteigne @GlennLanteigne, Mark Casselman @markcasselman, Michael Martineau @eHealthMusings, Colleen Young @colleen_young and Pat Rich @pat_health

Ahead of the #eHealth2016 conference Pat Rich sent out this tweet:

This tweet got me thinking about the state of EHRs in my home country. After hours of catching up on the latest Canadian EHR news – a light bulb went off – Canada could be the ideal test bed for new EHR innovations.

Here’s 5 reasons why

Reason 1 – No Meaningful Use, MACRA or MIPS

Like the US, Canada did allocate government dollars to help encourage the adoption of EHRs by physician practices and healthcare institutions. However, the dollars given out to Canadians paled in comparison to the US $34B CMS program. In fact, in some provinces (like Quebec) the incentive payments were so insignificant that many choose not to fill out the paperwork to receive their funding.

As well, none of the incentive programs have attestation requirements similar to the US Meaningful Use criteria. Nor do Canadian programs have penalties for not adopting an EHR.

This combination of relatively low incentive dollars, lack of MU-style adherence programs and zero penalties means that EHR vendors in Canada are relatively free to pursue their own product roadmaps. There is less government and end-user pressure to build functionality simply to meet funding criteria. Instead, EHR vendors can focus more on what end-users really want (better user interfaces anyone?)

Reason 2 – PIPEDA vs HIPAA

Canada does have privacy legislation. It’s called PIPEDA and it places the onus on healthcare organizations to protect the personal identifiable health information of patients. At a high level the protections for health information under PIPEDA is similar to that of the US HIPAA laws.

The biggest difference, however, is in the attitude of healthcare providers towards PIPEDA vs HIPAA. In Canada PIPEDA is not thought of as a barrier to information sharing. Privacy is definitely a concern, but PIPEDA isn’t used as often as an excuse to prevent access to information.

Reason 3 – Single Payer

Each provincial government in Canada is the single payer for healthcare for its citizens. If you live in Ontario and you go to the hospital, the hospital bills the Ontario government for the care you received. There are no other payers involved, no co-pays, nothing.

For EHR vendors this makes payment processing and collection a lot simpler – giving them more time to focus on other areas of EHR functionality.

Reason 4 – Patient Identifiers

A beneficial consequence of the single-payer system is that every person in Canada has a unique patient identifier. Consolidating health information from multiple healthcare organizations is therefore much easier since every lab result, prescription, requisition and image has this unique identifier. It’s Canada’s built-in unique key.

Reason 5 – Sorry, eh.

Canadians by nature are very apologetic. We say “sorry” when people bump into us. We apologize when we feel we are inconveniencing someone else. It’s something in the water.

I’ve personally found Canadian end-users to be very tolerant and understanding of new technologies. It’s not in our nature to complain so things have to go REALLY wrong before we make it an issue. Admittedly I have a small sample size, but when I speak to HealthIT vendors doing business in Canada, I hear similar stories.


In combination, the 5 reasons above create an innovation-friendly environment for EHR vendors. Instead of having product functionality dictated by government legislation and financial incentives, vendors are free to incorporate real end-user feedback into their EHR platforms. They can push the usability envelop in a tolerant environment where privacy isn’t used as a blocker to progress.

Maybe I’m delusional, but I’m really hoping to see signs of EHR innovation at the upcoming #eHealth2016 conference. If you are an EHR vendor that’s doing business in Canada and you are doing something innovative with user experience or functionality I want to hear from you!