Twenty-five years after Canada committed to building a national electronic health-record system, more than 70 per cent of electronic health information is still not shared among health-care providers — despite the fact that more than nine out of 10 physicians use electronic medical record (EMR) systems.
Fortunately, the technology to fix this is not the problem. Several EMR systems are already in use, and tools for interoperability (allowing different software platforms to communicate with each other) have been developed. Most recently, the Health Application Lightweight Protocol known as HALO was developed by Canada Health Infoway in partnership with Ontario Health, British Columbia’s Health Services Authority and Hamilton Health Sciences.
The HALO protocol is designed to cut through Canada’s fragmented medical record systems — connecting physicians to their patients’ complete health information across platforms, avoiding duplicate testing, reducing delays and preventing medical errors.
So the tools to improve access to care, reduce administrative burden and ensure timely treatment already exist. The question is whether anyone is making sure they are used.
A tool without a mandate
In March 2023, the Conference of Deputy Ministers of Health endorsed the Pan-Canadian Interoperability Roadmap, a strategic plan to enable hundreds of incompatible EMR systems to communicate securely with each other, so that, for example, a physician in Hamilton can access what a specialist in Toronto already knows about their shared patient.
On paper, this is exactly what Canada has needed for decades. In practice, however, there is a question the roadmap does not adequately answer: how will we ensure these tools are actually used — especially when provinces are allowed to make participation voluntary?
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On Feb. 4, the federal government reintroduced Bill S-5 — the Connected Care for Canadians Act — which would prohibit data blocking by health IT vendors and require all health IT to be interoperable. This meaningful step ensures that technology vendors cannot obstruct the flow of patient information between systems.
However, this does not resolve the adoption and co-ordination problem. While tech vendors can be made compliant, provinces are not always compelled to join a national interoperability system. Under Bill S-5, a province that passes its own substantially similar legislation is exempt from the law entirely.
Ontario’s troubling history with health IT investments illustrates why this matters.
The province’s first major attempt at building a shared health-records infrastructure, Smart Systems for Health, spent $650 million between 2002 and 2008 — then was quietly shut down without producing anything of lasting value.
The next attempt, eHealth Ontario, fared no better. The CEO was dismissed shortly after its 2008 launch, and the minister of health resigned shortly before the Auditor General of Ontario concluded that taxpayers “had not received value” for the more than $1 billion spent on electronic health-records initiatives since 2002.
By 2016, Ontario’s ongoing spending on electronic health-records projects had passed $8 billion, according to an audit, with significant components still not operational.
Meanwhile, Alberta recently rolled out its ninth and final launch of Connect Care, becoming the only province to mandate a unified clinical-information system across its provincial health services. In just over five years, Alberta Health Services (AHS) has ensured that health information across all AHS programs and services is integrated, giving physicians a more comprehensive health history for patients and ensuring centralized access to health information across institutional care settings.
Unlike Ontario’s voluntary approach, Alberta made participation in Connect Care mandatory for physicians and staff working within AHS facilities.
Alberta committed to a mandate; Ontario has not.
Ontario goes its own way — again
On March 19 of this year, continuing a pattern of decisions, piloting and spending that keep producing the same result, Ontario Health Minister Sylvia Jones announced the province would develop its own provincewide Primary Care Medical System.
Describing the new system as voluntary for family physicians, the announcement emphasized a competitive bidding process to identify and contract a new technology vendor. Curiously, it made no reference to HALO — the interoperability tool that was already being piloted within the province.
When I contacted Ontario’s Primary Care Action Team to ask about any plans to work alongside the existing HALO initiative, I received a media release. When I followed up with Canada Health Infoway with questions about cross-provincial clinician representation, adoption planning, and Ontario’s plans to build its own system, I was redirected to the same officials who had sent me the media release.
This is not a minor administrative oversight. It is the fragmentation problem made visible in real time.
Ontario is not just ignoring a federally funded tool, it’s ignoring one that it helped build. Despite having a protocol under development in Ontario, the province has once again chosen to develop new technology rather than invest in the mandate and strategy to adopt what already exists.
Mandate what we already have
The solution is not another voluntary tool, nor is it another electronic medical-record system. What’s needed is the political will to mandate what already exists and to stop building parallel systems every time a province decides it prefers its own protocols and process.
Bill S-5 needs to be passed. Without it, vendors are under no federal obligation to ensure their systems are compatible with others — and when systems can’t communicate, provinces default to making adoption voluntary. In Canadian health IT, voluntary frameworks have consistently failed. British Columbia’s earlier EMR interoperability standard was never meaningfully adopted or enforced. Ontario spent decades and billions arriving at the same destination it started from.
But passing Bill S-5 alone is not sufficient, because provinces can still opt out by passing their own version of legislation — which is exactly what Ontario’s March 19 announcement risks becoming.
Rather than pursuing a third attempt at a provincewide system, Ontario should adopt and mandate HALO — a solution that already exists, that it helped build, and that does not require starting over.
Unlike a new provincewide system, HALO would not require physicians to abandon their existing EMR platforms. It functions as a connector layer on top of what already exists, giving clinicians a single point of access to complete patient health information across systems.
The EMR stays. What changes is the full scope of patient information that physicians can see.
Rather than invest in a new system that isn’t needed, Ontario’s money should instead be directed toward implementation of what exists — vendor compliance, physician training, and transition support to ensure the tool is used across the province.
This is not a technology problem. It is a co-ordination and accountability problem. Until governments acknowledge that and build the mechanisms to address it, we will keep spending billions to stay in the same place.
