Electronic Personal Health Records in Canada: An Exploratory Review of the Literature
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Abstract
Background: Electronic personal health record (ePHR) is a technology that could facilitate information sharing, health professional-patient relationship as well as improving patient care. In Canada, stakeholders have shown interest in the implementation and use of ePHRs, but there is insufficient evidence about their benefits and potential effects on the health care system.
Objective: The aim of this review was to document the situation of ePHRs in Canada and to identify main federal and provincial laws and policies influencing their implementation.
Methods: We conducted an exploratory review, including published and grey literature as well as key federal and provincial laws, through criteria: 1) in Canada, 2) addressing benefits and challenges, 3) assessing responses to challenges, 4) published in English or French. Inclusion was limited to a decade period (January 1st, 2003 to November 31st, 2013). The following keywords and their variations in combination with each other were used: personal health record, patient portal, Canada. We used Pubmed database and search engines (Google, Google Scholar). Relevant information was extracted by two members and revised by three members.
Results: We identified a total of 36 publications.
The benefits of ePHRs identified for patients were control (condition prevention, self-management) and access to education and care (access to reliable information, better understanding and adherence, better communication). For the health system, benefits were seen in the access to patient data, streamlining of administrative processes (scheduling, reduction of errors), research (interaction with patients) as well as public health and ease on the health system (time gains, lower costs, improvement on quality and efficacy of care).
One particularity of the health care system in Canada is the slow uptake of e-Health in many provinces. Consequently, authors often mentioned “potential†benefits. Other challenges to the implementation of ePHRs in Canada mainly concerned user adoption (trust issues with data, difficulties in seeing advantages, increased workload, reluctance in giving access to records) as well as security, privacy and confidentiality concerns.
While some systems were functional nationally, most of them were local initiatives affiliated to an institution. A few provincial projects have been initiated, but no official documentation was available at the time of the search.
Additionally, the Canadian legislative and regulatory system does not seem well suited for handling some of the challenges arising from ePHRs. Current laws and norms are not designed to apply to ePHRs and rarely address appropriately challenges particular to ePHRs, notably on privacy and confidentiality, data usage, third parties and online communities. Federal and provincial legislation, as well as judicial decisions, deal generally with issues such as privacy and confidentiality, but their field of application does not explicitly include ePHRs, thus requiring adaptation to be truly relevant to the ePHR context. A more thorough analysis of the legal framework is underway. Finally, certifications available in Canada are still lacking for ePHR systems.
Conclusions: This review highlights the paucity of literature on the topic of ePHR and related policies in Canada. Most publications identified potential benefits for ePHR since there are few ePHR systems available for Canadians.
Objective: The aim of this review was to document the situation of ePHRs in Canada and to identify main federal and provincial laws and policies influencing their implementation.
Methods: We conducted an exploratory review, including published and grey literature as well as key federal and provincial laws, through criteria: 1) in Canada, 2) addressing benefits and challenges, 3) assessing responses to challenges, 4) published in English or French. Inclusion was limited to a decade period (January 1st, 2003 to November 31st, 2013). The following keywords and their variations in combination with each other were used: personal health record, patient portal, Canada. We used Pubmed database and search engines (Google, Google Scholar). Relevant information was extracted by two members and revised by three members.
Results: We identified a total of 36 publications.
The benefits of ePHRs identified for patients were control (condition prevention, self-management) and access to education and care (access to reliable information, better understanding and adherence, better communication). For the health system, benefits were seen in the access to patient data, streamlining of administrative processes (scheduling, reduction of errors), research (interaction with patients) as well as public health and ease on the health system (time gains, lower costs, improvement on quality and efficacy of care).
One particularity of the health care system in Canada is the slow uptake of e-Health in many provinces. Consequently, authors often mentioned “potential†benefits. Other challenges to the implementation of ePHRs in Canada mainly concerned user adoption (trust issues with data, difficulties in seeing advantages, increased workload, reluctance in giving access to records) as well as security, privacy and confidentiality concerns.
While some systems were functional nationally, most of them were local initiatives affiliated to an institution. A few provincial projects have been initiated, but no official documentation was available at the time of the search.
Additionally, the Canadian legislative and regulatory system does not seem well suited for handling some of the challenges arising from ePHRs. Current laws and norms are not designed to apply to ePHRs and rarely address appropriately challenges particular to ePHRs, notably on privacy and confidentiality, data usage, third parties and online communities. Federal and provincial legislation, as well as judicial decisions, deal generally with issues such as privacy and confidentiality, but their field of application does not explicitly include ePHRs, thus requiring adaptation to be truly relevant to the ePHR context. A more thorough analysis of the legal framework is underway. Finally, certifications available in Canada are still lacking for ePHR systems.
Conclusions: This review highlights the paucity of literature on the topic of ePHR and related policies in Canada. Most publications identified potential benefits for ePHR since there are few ePHR systems available for Canadians.
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