Policy Evaluation Reform as Relates to Electronic Health Records


Electronic Health Record (EHR) also referred to as Electronic Patient Record (EPR) has become a fundamental tool in the management of health care systems. Electronic Health Records ensure smooth workflow in the various healthcare institutions. Consequently, different departments can share information about a particular patient at the same time. This leads to quality management of patients and proper reporting on the treatment outcomes of such a patient. Electronic storage allows long-term preservation of the records and easy retrieval when needed (Romanow, 2002, p. 75-84). The essay scrutinizes the policy evaluation reforms as they are related to Electronic Health records. Further, the essay examines the Romanow commission’s suggestion on the execution of the Electronic Patient Record (EPR) structure in Canada.

Literature review

The health care system is increasingly getting complex due to a fast-growing society that demands quality and efficient health care. It involves collection of health information of an individual patient through electronic means. The information collected from the patients can be shared by different health departments through a local network at the health care center. The records contain demographic information of the patients, medical history, medications given, any allergic reaction observed from the patient, immunization status, radiology images, laboratory tests outcomes and payment information. Electronic health record is developed and maintained by the institution such as hospital for efficient coordination and management. Collection and storage of health information electronically help in avoiding clinical errors. Clinicians are able to access vital information about the patient and this helps in making informed diagnoses and giving the right medication. Romanow made great contributions to the development of electronic health records in Canada. On embracing the recommendations of Romanow report positive changes were realized in the ministry of health Canada.


Before the establishment of Electronic Medical records by health care institutions, proper considerations should be put in place to avoid future failures. The institution should survey to determine the interest of the entire institution on Electronic Medical Records. Patients’ information collected by the health care providers should be treated with a lot of confidentiality. Principles on how to handle electronic information about the patient should be laid down. Four principles were established by the University Health Network (UHN) of Toronto. The first principle stated that the data collected by the health care providers belong to the patients. This information should not be accessed by non-clinicians; rather it should be securely shared among the health care providers. Secondly accessibility of the information ought to be monitored and regulated. Depending on the rank in the health care institution, different members of staff should posses’ different degrees of accessing patients’ information. Thirdly, patients should be given a chance to decide on who should access their medical information. The hospital/ health care center should be the custodian of the information collected or the health care provider who collects the patient’s data to uphold the principle of consent. Finally management of the information should be done by experts to ensure that the information is safe and can be easily retrieved when required. Well-organized information leads to better health results, health care providers should adopt electronic health records in order to realize good health outcomes (Mc Cathy, 2007, p. 67).

Advantages of electronic medical records

Electronic Health Records are considered to be safer, affordable, more efficient and responsive. They result in increased confidentiality of individual health data and generally the privacy of all Canadians if safeguards that do not exist in the modern systems are installed. Strategic plans to improve the health information in Canada was established in response to the needs which were expressed by Canada’s First ministers. In September 2000 the ministers agreed to work together to strengthen a Canada – broad health infrastructure. The aim was to improve the quality, accessibility and timeliness of health services for Canadians. They were ready to work with all the stakeholders and including the non-governmental organizations in order to realize the goal of electronic health records in the entire country. The commission’s role was to recommend policies and actions to enhance the lasting sustainability of a uniform accessible and high-quality health care system to the public. The report had individual electronic health information systems as one of its highlights. Mr. Romanow emphasized the importance of using modern information technologies in the health care sector and chooses to recommend informatics at the start of his report. Informatics figured so prominently at the start of the Future of Canada’s Health care structure report (Westhues, 2006, p.13).

Romanow recommendations

The Romanow report had the following specific recommendations, establishment of an individual electronic health record of every Canadian that support all health issues in provinces and across the territories. Canada’s health information system should continue taking the lead in establishing a pan- Canadian electronic health information framework based on provincial systems. This includes the promotion of interoperability of modern electronic health records systems addressing health concerns such as security levels and harmonization of privacy policies. All Canadians should be the custodian of their individual health information, ready accessibility to their individual health data, protection of their health records and access to complete and credible information on health and health care systems. The report also advocated for the amendment of the Criminal Code of Canada to protect the privacy of Canadians and abuse of individual health information (Willison, 2008, p.23). Finally the Canadian information system was required to promote the literacy of the public by establishing and maintaining a health system that links the public to health information which properly explored, credible, and trustworthy. All these recommendations were geared towards the promotion of a good health system to all Canadians. The health requirements of Canadians in remote rural settings present special setbacks. Romanow advocates for a nationwide approach to be achieved by the use of special access money to draw and retain health professionals. This is also promoted by increasing the time spent by health care providers in remote rural areas as part of training and expanding telehealth projects. He says that the diagnostic services money should be used in order to reduce the waiting durations by acquiring equipment and hiring and training persons to run the machines. Romanow wanted to see superior diagnostic machines such as MRIs and CT scans, these machines were considered medically important under Canada Health Act. The use of advanced equipment would bring to an end the use of private tests thus avoiding the long queues for public treatment (Romanow, 2002, p. 119).

Impacts of Romanow report

The Romanow report acted as a major booster to the establishment of electronic health records in Canada. This aided in improving and remodeling the Canadian health care structure. This also provided the public with the relevant information which they required in order to promote better health for the country. The report stated that the Electronic Health Record was one of the fundamental requirements in modernizing Canada’s health structure and in improving the accessibility of health care services. Canada health information continued to take lead on electronic information systems and eventually developed a pan- Canadian electronic health record structure. The Romanow commission appreciated that the Electronic Health Record would greatly improve the quality of health care and the safety of the patients. This would also enhance the sustainability of the health care system. Contemporary information systems are considered to be the key to better health for Canadians (Elaine, 2003, p. 4). When the doctors, nurses and other health care providers have the correct information at the right time, they are able to make informed decisions and to deliver good health services to the Canadians. Realization of electronic information in the health sector in a country requires collaboration of the information sector, the public and the government. All parties should be focused on the same goal of electronically changing the information systems of the health care sector. Canada needed to catch up in its information systems in the health sector but the country has an opportunity of becoming the world leader in information management (Romanow, 2002, p. 185).

The report highlighted that paper records were increasingly becoming out of date and inadequate. They were considered to limit the dissemination of information by inadequately documenting patients’ health information. It also creates a barrier to research opportunities and limits the data available to the health care centers for decision-making. The system is time-consuming, 30% of nursing time is used in organizing papers records. Through the integration of electronic information, there is the likelihood of reducing the time that nurses spend on such manual activities as in the construction of charts. Additionally, there is also the resultant reduction in terms of human resource. Consequently, savings to the tune of $ 5 million could also be attained on an annual basis. Electronic Health Records have many advantages; this system improves diagnosis and treatment as the health care providers can access all the information on the patients. They can link the patient’s information to the clinical support tools (Montreal, 2002, p.2). Health care providers concurred with the idea that improving on how the information about a patient is shared is a potential advantage of Electronic Health Records. They also agreed that Electronic Health Records lead to improvement in medical processes, competence of workflow and follow-up of the patients. Further, electronic health records help in improved efficiency and service delivery and the various health care facilities.

Efficiency of the information system is also improved; less time is needed to retrieve electronically stored information than paper records. Electronic Health Records system can handle a lot of information, occupies less space in the storage devices as compared to paper recording. Using electronic records, it is possible to consolidate various kinds of information thereby facilitating health surveillance and research. Only authorized persons are allowed to access the patient’s health information, precautions are taken to ensure that the health records do not act as a hindrance to individuals seeking health services. The working environment is neat and easy to manage; there are no piles of papers on the shelf which easily get torn or go missing any time (Gunter & Terry, 2005, p. 89).

An inclusive Electronic Health record is paramount to all the parties involved. The public is able to access their individual health information online. This is to promote through the establishment of a website where the public can access their personal health information in the same way as online banking. Individuals would only be required to log in their identification numbers and at the click of a mouse they are able to access not only their personal health information but also general health issues that affect the country (Lang, 2006, p.3). Availability of this information encourages the public to take direct roles in addressing problems that affect their own health. Health officers are able to access all information about the patient at any instance of clinical encounter, availability of accurate information on the patient helps in management of complex health settings. This also improves the health care providers’ ability to have access to the latest data, choose the most appropriate cause of action and evidence to guide their health decisions for the patients (First Ministers of Canada, 2003, p. 23). Health researchers and policymakers can access aggregated health information that has been electronically compiled. The Roy Romanow commission clearly knew that the researchers preferred personal-oriented health records for research purposes in order to track particular illnesses and other health issues over time. Installation of safeguards would ensure that personal health information is protected from being accessed by unauthorized persons including the researchers; the consent of the patient must be sought. Adoption Electronic Health Records promotes the ability of health administrators and researchers to identify and address any medical errors emerging in the health care systems. This improves patients’ safety and general quality of health care services delivered to the public (Mc Cathy, 2007, p. 67).

Policy evaluation

The ministry of health Canada adopted the Romanow recommendations and decided to incorporate them into their health policy. All health institutions were required to start using electronic medical records to improve the efficiency of service delivery. The implementation of recommendations in the Romanow report enabled Canada to preserve its publicly funded health care systems. The key recommendation was on the development of Electronic Health Record which was meant to collect and store personal health information of all Canadians. This was one of the keys to modernizing Canada’s health care structure and improving accessibility and results of health to all Canadians. The recommendations also endorsed actions of the Canadian health information systems, the system was described as being independent and non-profit-making which aims at giving better health care to the public. Roy Romanow also recognized the need for accountability of large amounts of funds used on health care systems in Canada. The policy was strengthened by signing of an agreement with the Canadian people and the establishment of a health council to be responsible for securing the conditions of the agreement. This formed part of the recommendations in Romanow’s report. This has made it possible to deliver feedback on successes made on health care services to the Canadian public. The report addressed the most important concern of developing a wide health information system through the creation of Electronic Health records for each Canadian national. The recommendations were made available in 2002 but the Canadian health sector is continually undergoing transformation geared towards the realization of better health for all Canadian citizens. In June 2003, the Canadian Health Information Management Association was created to improve efficiency in health information organizations throughout Canada (Ministry of Health Canada, 2008, p.15). The association maintained and promoted privacy and quality of the information records in the whole of Canada. Advanced health information systems became a priority in Ontario following Romanow’s report. For instance Ontario was in a position to make proper use of the Romanow report to build on its Smart System for Health established in the mid- 1990s. To simplify, put together and streamline the health information records in the Ontario Ministry of Health a health outcome team was established. This promoted the establishment of strategies to rationalize and expand existing sources of information (Mc Cathy & Schafermeyer, 2007, p. 49).

The results of the Health Accord advocated for such suitable tools as the Electronic Health Record and other information systems. The tools also included important suggestions of the Romanow report; they enabled Ontario and other provinces of Canada to have a comprehensive way to a more sustainable health care system. The guidelines provided have enabled Ontario to establish transparent and more accountable governance in the health care system. The Health Care Accords efficiently addressed the issue of health system reforms in Ontario as pertains to Electronic Health Records. The recommendations have also contributed to the increase in efficiency of service delivery, promoted proper patients care management, enhanced realization of desired health results and enhanced access to health information of the patients. This ensures proper diagnosis and management of patients which encourages their participation in promotion of better health care systems (Romanow, 2002, p. 12).


Electronic Health Record provides information that is fundamental in the management of the health system. It improves the efficiency of diagnosis and management of patients as health care providers can access comprehensive information of the patients. It also allows networking among health care providers and they can help each other to make an informed decision in treating patients especially those presenting with complex conditions. Romanow’s recommendations on health informatics of Canada aided in development of individual health records of all Canadian citizens. The public can access its health information easily via online services. This also improved on accountability of funds used in the health sector as the information is readily available. Computer applications can be used to analyze data and at a click of a mouse figures showing how the funds have been spent are shown. The electronic health record is developed and maintained by an institution such as a hospital for efficient coordination and management. Collection and storage of health information electronically help in avoiding clinical errors. Electronic Health Record makes the workflows in the health care institution smooth, different departments can share information of a particular patient at the same time.

Reference List

Elaine, G. (2003). The Romanow Commission Proposal to Develop a National Electronic Health Record System. Web.

First Ministers of Canada. (2003). First Ministers’ Accord on Health Care Renewal. Canada. Web.

Gunter, T. D., & Terry, N.P. (2005). The Emergence of National Electronic Health Record Architectures in the United States and Australia: Models, Costs, and Questions. Web.

Lang, E. (2006).Impact of an electronic link between the emergency department and family physicians: a randomized controlled trial. Web.

Mc Cathy, R., & Schafermeyer, K. (2007). Introduction to health Care Delivery: a primer for Pharmacists. Sudbury, MA: Jones and Bartlett Publishers.

Ministry of Health Canada. (2008).Electronic Medical Records (EMR). Web.

Montreal, Q.C. (2002). Romanow report provide major boost to the development of Electronic Health Records. Web.

Romanow, J. (2002). Building on Value: the Future of Health Care in Canada. Web.

Westhues, A. (2006). Canadian Social Policy: Issues and Perspectives. Waterloo, ON: Wilfrid Laurier University Press.

Willison, D.J (2008). Access to medical records for research purposes: varying perceptions across research ethics boards. Web.

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