Healthcare IT

Health IT in Four Countries

How have different countries developed their health IT systems? A paper by Adler-Milstein et. al in Health Affairs provides some insight. I summarize their findings below.

  • Australia. In the 1990s-early 2000s, the government supported the adoption of EHRs through federal incentives to general practitioners. These efforts focused primarily on EHRs with e-prescribing. In 2005
    the national and state governments established the National E-Health Transition Authority (NEHTA) to develop a national EHR system, which included unique identifiers for patients and providers. The national EHR system that developed is a shared record that relies on national interoperability standards that enable access to health-relevant administrative data and will enable providers to populate records with data from locally controlled EHR systems.
  • Canada. Canada Health Infoway is an independent, federally funded, non-profit organization that coordinates national EHR efforts across provinces. The personally owned EHR draws from local EHR systems. Ontarios Electronic Child Health Network,  gives authorized providers access to a patients entire medical history from birth to age 19.
  • Denmark. Danish efforts to promote EHR began in the 1990s, but the government only made electronic record adoption mandatory for general practitioners in 2004 and for specialists in 2006. National integration is led by MedCom, a publicly financed not-for-profit joint venture between public authorities and private companies. Beginning in 1994, MedCom developed national standards to promote the interoperability of patient data and payment systems. All providers (e.g., hospitals, pharmacies, labs and physicians) are connected to MedCom. MedCom is backbone of, which is “a public, internet-based portal that collects and distributes health care information among citizens and health care professionals.” The website gives patients online access to lab results, medication profiles, waiting lists, scheduling, and prescription renewals and also allows patients to email physicians.
  • United States. The US government has had little intervention in HIT and EHR until 2009 when the Health
    Information Technology for Economic and Clinical Health (HITECH) Act passed. The centerpiece of this legislation, known as the meaningful-use program, creates financial incentives in the form of cash payments from public insurers to providers if they demonstrate the use of certified EHRs to meet a set of meaningful-use criteria.  The stage 2 meaningful use criteria require providers to offer patients the ability to view, download, and transmit their health information online and eventually be able to submit amendments to their records.  The US developed BlueButton for VA and Medicare beneficiaries so that these individuals can access their medical records online.


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