Canada’s health systems began shifting from paper charts to electronic health records decades ago. These records hold patients’ critical health information, including medications, diagnoses, clinical notes, test results, specialist consults and plans for care.
Our research, published today in the Canadian Medical Association Journal, raises major concerns about the state of these electronic health records nationwide.
In most provinces and territories, information is currently siloed in separate software programs in different offices, designed by multiple vendors with differing standards. This fragments patients’ health records across services and leaves clinicians without the information they need to provide safe care.
This is harming patients, costing taxpayers $9.4 billion annually and hindering health-system improvement.
Canada’s missed opportunity
Ideally, patients’ health information should follow them over time and across locations. Some might assume that’s how it works now. After all, hotel chains remember whether we prefer foam or feather pillows, no matter what country we are in. Uber ratings follow us everywhere.
Unfortunately, in health care, things aren’t so seamless. In the rush to abandon paper charts and transition to electronic records, Canada missed a major opportunity for standardization.
Without an overarching plan, clinics, hospitals and jurisdictions chose from dozens of incompatible platforms sold by vendors competing for market share, without considering the need for personal health information to follow the patient.
THE CANADIAN PRESS/Adrian Wyld
A provincial and territorial legislative focus on the privacy of patient records has also fostered an environment that splinters patient information between health services.
The Connected Care Scorecard
Collecting, tracking and exchanging patients’ health information is key to safe, co-ordinated care. In some jurisdictions, like Taiwan, electronic health records from different vendors dock securely together. If a family doctor changes a medication, then pharmacy, hospital and specialist records are automatically updated. A treatment plan from a specialist lands directly in a family doctor’s electronic record, without need for faxing, scanning or uploading.
In Canada, hospitals, specialists and primary-care services still rely heavily on fax machines and mail, rather than automated, instant, accurate data exchange.
As part of our research, we created a Connected Care Scorecard that reveals where each province and territory stands in connecting its health records.
(Connected Care Scorecard)
In British Columbia, for example, dozens of incompatible electronic health record systems are used in community clinics alone. Hospitals, even within the same health authority, run on different platforms. A patient who visits an emergency room in downtown Vancouver will have to tell their story again if they later seek care in Burnaby. Clinicians may end up retesting for illnesses already ruled out.
Prince Edward Island does much better — with one electronic health record uniting all hospitals and a single platform for primary-care clinics. The hospital record feeds information into primary care so details are available for follow-up.
Interoperability matters
Connected, integrated electronic health records allow all clinicians to work together on a common plan. Sharing patient information is critical for team-based care. It improves outcomes like medication safety and enables patients’ access to records, making them part of the care team.
Most jurisdictions do have patient portals where some people can see portions of their health information, like lab results or prescriptions. However, a 2025 study found that only 13.2 per cent of adult Canadians have electronic access to such records.
Despite tremendous hype and opportunity to improve care through artificial intelligence, most health systems can’t use it at scale. That’s largely because the opportunities it offers — assisting with diagnoses and prompting clinicians to order the tests and treatments patients need — are wholly dependent on ready access to comprehensive, accurate patient health data.
Interoperable electronic health records would also help health systems access population-based information to inform planning. Data could help predict disease outbreaks and spot bottlenecks in hospital flow. It could improve cancer care and ensure patients with the greatest needs are prioritized.
Our research shows that although most jurisdictions use some hospital data for planning, information in electronic health records, especially from primary care, rarely gets used to improve health systems. This has long-term implications: you can’t manage what you don’t measure.
All of this adds up to massive costs for taxpayers, patients and clinicians.
Common health data standards
The federal government recently reintroduced the proposed Connected Care for Canadians Act, which would require vendors to adopt common standards for exchanging information across systems. It’s a solid first step, but more is needed.
Most importantly, governments must establish clear accountability — nationally, provincially and territorially — for health data oversight. This must balance minimizing privacy breaches with limiting all other forms of harm arising from disconnected records, including damage to patients, clinicians and health systems.
Jurisdictions must also establish common health data standards, tools and incentives to improve data coordination.
Our challenge is not adopting electronic health records, but connecting them. Without that, our investment simply won’t pay off. Care will continue to suffer.
Dr. Ewan Affleck, physician, senior medical advisor in health informatics at the College of Physicians and Surgeons of Alberta and chair of Networked Health, co-authored this article.
