title: A qualitative study of Canada's experience with the implementation of electronic health information technology.
abstract: BACKGROUND
  In 2001, Canada Health Infoway unveiled a plan to implement a national system of interoperable electronic health records. This government-funded corporation introduced a novel model for interprovincial/territorial collaboration to establish core aspects of a national framework. Despite this $1.6 billion initiative, Canada continues to lag behind other Western countries in adopting electronic health records. We conducted a study to identify the success of different aspects of the Canadian plan and ways to improve the adoption of electronic health records.
  
  
  METHODS
  We used a case study approach to assess the 10-year history of Canada's e-health plan. National reports and documents were reviewed, and structured interviews were conducted with 29 key stakeholders representing national and provincial organizations responsible for establishing policy and strategic direction for health information technology. Using grounded theory, we analyzed transcripts of the interviews to identify themes and their relationships.
  
  
  RESULTS
  Key stakeholders identified funding, national standards, patient registries and digital imaging as important achievements of the e-health plan. Lack of an e-health policy, inadequate involvement of clinicians, failure to establish a business case for using electronic health records, a focus on national rather than regional interoperability, and inflexibility in approach were seen as barriers to adoption of the plan.
  
  
  CONCLUSIONS
  To accelerate adoption of electronic health records and timely return on investment, an e-health policy needs to be tightly aligned with the major strategic directions of health care reform. Adoption needs to be actively fostered through a bottom-up, clinical-needs-first approach, a national policy for investment in electronic health records, and financial incentives based on patient outcomes that can be achieved with electronic health records.
authors.affiliation: Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass, USA.
authors.forename: Ronen
authors.initials: R
authors.lastname: Rozenblum
authors.forename: Yeona
authors.initials: Y
authors.lastname: Jang
authors.forename: Eyal
authors.initials: E
authors.lastname: Zimlichman
authors.forename: Claudia
authors.initials: C
authors.lastname: Salzberg
authors.forename: Melissa
authors.initials: M
authors.lastname: Tamblyn
authors.forename: David
authors.initials: D
authors.lastname: Buckeridge
authors.forename: Alan
authors.initials: A
authors.lastname: Forster
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
authors.forename: Robyn
authors.initials: R
authors.lastname: Tamblyn
mesh_terms: D002170:Canada; D003695:Delivery of Health Care; D057286:Electronic Health Records / Q000458:organization & administration*; D005069:Evaluation Studies as Topic; D005260:Female; D018166:Health Care Reform; D006284:Health Plan Implementation / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008490:Medical Informatics / Q000458:organization & administration*; D011050:Policy Making; D015397:Program Evaluation