In his speech to congress on Wednesday, President Obama made no specific mention of EHRs, or even health information technology for that matter. He did, however, mention Canada, which received immediate applause from the audience. Though Obama was referring to the Maple Leaf's single-payer system, there are also notable differences between the two countries' EHR adoption strategies. With a population 10 times as large, and the most complex healthcare system in the world, the United States presents a unique technology challenge. But perhaps we can still benefit from some "lessons learned" by our neighbors to the North.

While scouring the web for reactions to Obama's speech, I came across a blog by an obviously satisfied Canadian health customer. In it, Sara Robinson details her near-perfect visit to a Vancouver ER where the wait time is measured in seconds, medical records are immediately available, and strong painkillers are liberally supplied. Contrast this to US headlines of a man, recently rescued after 8 days lost at sea, who left a Texas ER because the wait was too long.
 
But is Canada's system really that much better?
 
In a recent report (PDF) by Canada Health Infoway, the government body created in September, 2000 with the mission of "accelerating the use of Electronic Health Records across the country", it is noted that after spending some $1.5 billion only 17% of hospitals are using EHRs. Yet Infoway remains upbeat that its original goal of 50% can still be reached by 2010 – way to look at the glass half full Canada!
 
Nevertheless, Canada's attempts at coordinating EHR adoption are noteworthy, and should be fully vetted by the United States (I'm looking at you, CCHIT). In a white paper (PDF) by Sierra Systems, the authors point to 3 main areas where the United States can benefit:

• National funding incentives by Canada Health Infoway, as opposed to state-by-state initiatives in the United States. The US has moved in this direction by offering incentive funds under ARRA, but the requirements remain as mysterious as ever.
   
• Early establishment of technology standards. In the US, EHR frameworks originated out of public standard bodies like HL7 and HIPPA. CCHIT is supposed to define these types of standards in the US, but we're still months away from the final criteria.
   
• Excellence in program and project management. In Canada, EHR adoptions have been viewed largely as business transformation programs. In the US, there has been a lack of physician adoption due to poor project and workflow management.

 
Meanwhile, ultra-skeptics have declared Canada and the United States in a "tight race for slowest adopter of electronic medical records". A recent blog post on Healthcare IT News compares the United States to the likes of Denmark, a country at near 100% EHR adoption.
 
While the situation in Canada probably isn't as great as Ms. Robinson describes, nor as dire as some have claimed, it has provided some important lessons in the adoption of EHR technology in general.
 
The United States provides excellent quality of care, so I'm not quite ready to move just yet. But if EHRs take much longer, I'll be keeping one eye to the North.