Canada's Health Infostructure


The development of Canada's health infostructure has been dynamic and relatively rapid. It was just two years between the earliest recommendations and the federal government's 1997 Budget commitment to develop a national health information highway.

In April 1994, the Government mandated the Information Highway Advisory Council (IHAC) (1994-1997) to investigate the development and use of the information highway for the economic, cultural and social advantage of all Canadians. The Council presented its final report in September 1995. One of its 300 recommendations called for the creation of an advisory council to identify new information technology applications for the health sector.

In October 1994, the Prime Minister of Canada launched the National Forum on Health (NFOH) (1994-1997) to advise the federal government on innovative ways to improve the health care system. In its 1997 report, the Forum concluded that a prime objective should be the rapid development of an evidence-based health system in which decisions would be made by health care providers, administrators, policy makers, patients and the public on the basis of appropriate, balanced and high-quality evidence. The NFOH also recommended the creation of a nationwide population health information system.

In August 1997, the Minister of Health established the Advisory Council on Health Infostructure (1997-1999). Given an 18-month mandate, the Council presented its final report in February 1999. It affirmed that setting up a nationwide health information highway could significantly improve the quality, accessibility and efficiency of health services across the entire spectrum of care in Canada. The Council's four objectives included: developing a Canadian vision of a health information system on the information highway and identifying the essential needs it should meet; generating a federal action agenda to implement the most vital components of the system; suggesting collaborative mechanisms to achieve a Canadian consensus on an integrated health information system; and identifying issues, challenges and barriers to the effective use of information and communications technologies, and recommending possible solutions.

Earlier that same year, Health Canada also established the Office of Health and the Information Highway (OHIH) as Health Canada's focal point for all matters concerning the use of information and communications technologies (ICTs) in the health sector. The strategic orientations for OHIH were knowledge development, partnerships and collaboration, and federal policy development.

In September 1997, the Canadian Network for the Advancement of Research, Industry and Education (CANARIE), (now CANARIE Inc. - Canada's Advanced Internet Development Organization) issued a vision paper describing a Canadian health "Iway" - "a virtual "information centre" that is created and used by communities and individuals across Canada. It will be open and accessible, yet assure sufficient confidentiality and privacy to assist decision-making by health professionals and patients, support research and training, facilitate management of the health system, and respond to the health information needs of the public".

In February 1998, Health Canada hosted a two-day meeting of senior government officials to discuss impediments to the application of information management and information technology within Canada's health system. The Federal/Provincial/Territorial Chief Information Officers Forum (1998-1999) recognized the benefits of intergovernmental collaboration and in June 1999 the Forum evolved into the Advisory Committee on Health Infostructure at the Federal/Provincial/Territorial Deputy Ministers of Health Conference.

The Advisory Committee on Health Infostructure (ACHI) (1999 - 2002) which had federal, provincial, and territorial representatives, included working groups addressing five priorities: strategic planning, telehealth, protection of personal health information, health surveillance, and electronic health records. Health Canada participated on all five priorities. From this committee came the Advisory Committee on Information and Emerging Technologies (ACIET) (2002-2005). It was comprised of representatives from the federal, provincial, and territorial governments as well as six external experts. Its mandate was to address five priorities: Emerging Technologies Assessment, Genomics, Pharmaceuticals Strategic Advances, Strategic Directions for a pan-Canadian Health Infostructure (includes Information Technology), and Privacy.

On September 11, 2000, in support of a First Ministers' agreement, the Canadian federal government announced that it would "invest $500 million immediately in an independent corporation mandated to accelerate the development and adoption of modern systems of information technology, such as electronic patient records, so as to provide better health care".

As a result, the $500 million federal investment was granted in March 2001 to Canada Health Infoway Inc., a not-for-profit organization established earlier that year. Infoway's initial priority is to foster and accelerate the development and implementation of effective, interoperable Electronic Health solutions.

On February 18, 2003, in support of the 2003 First Ministers' Accord on Health Care Renewal, the 2003 budget announced the provision of an "additional $600 million to Canada Health Infoway to accelerate the development of EHRs, common information technology standards across the country, and the further development of telehealth applications, which are critical to care in rural and remote areas."

An additional $100 million was granted to Infoway in March 2004 to support the development of a pan-Canadian health surveillance system.

The Office of Health and the Information Highway (OHIH) evolved in response to developments in eHealth implementation in Canada. In 2004, OHIH's Privacy Policy Division (now the Access to Information and Privacy Division) became part of Health Canada's Health Policy Branch. The remainder of OHIH joined Health Canada's Corporate Services Branch and is known as the Health and the Information Highway (HIH) section. It remains the primary source of policy continuity as well as expertise regarding the implementation of eHealth in Canada. Its work also includes research, and its web resources including databases and a free electronic newsletter eHealth InfoSource cybersanté aid in disseminating information and knowledge about eHealth to stakeholders across Canada, as well as abroad.

HIH supports Health Canada's membership in Infoway which works with the provinces and territories and other stakeholders in their efforts to implement electronic health records (EHRs), telehealth and public health surveillance information systems across Canada.

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