CMAJ 2011 election survey: electronic health records.

“health” and “medical” interchangeably, often without consequence, on the presumption that everyone knows what everyone is talking about. The distinction, though, can create major difficulties, particularly in terms of people’s comprehension, as evidenced by debate surrounding Canada’s multibillion investment in the development of electronic record systems for health, or medicine, as the case may be. Canada Health Infoway, the agency responsible for the development of a national information infrastructure (or infostructure, as many refer to it), views the concept of Electronic Health Records (EHRs) as being completely distinct from Electronic Medical Records (EMRs). The former, EHRs, refers to the national electronic architecture, says the agency, which argues that the development of an “interoperable” national infostructure is its primary responsibility. When completed, that national architecture would primarily be used to aggregate health information in such a way that it would be valuable for policy-makers and researchers. The agency sees the latter concept of EMRs, by contrast, as record-keeping systems at the doctor–patient level that would be used primarily as an aid in the clinical diagnosis and treatment of disease. That the two concepts are, in a manner of speaking, worlds apart, is demonstrated by an ongoing CMAJ series which has indicated that there is a fundamental disconnect by Canada Health Infoway’s plan for a national EHR system and an EMR model that be useful at the physician–patient level. Even an Infoway-commissioned performance evaluation reached that conclusion (www.cmaj.ca/cgi/doi/10.1503 /cmaj.109-3860). The two concepts are also often at the root of rationalizations or squabbles over responsibilities within the system. Canada Health Infoway is quick to essentially argue that EMRs are the responsibility of provinces. The provinces and territories, along with various academic and medical professional voices, are as quick to chide Canada Health Infoway for policies and programs that are aimed at nebulous objectives that have little to do with medical treatment. It’s raised a raft of questions about Canada’s strategy in developing a health information system, including: • The advisability of using industrial policy, rather than health system needs, to drive development of the system (www.cmaj.ca/cgi/doi/10 .1503/cmaj.109-3717). • The wisdom of Canadian planners in News CMAJ