The Health-care Information Super Highway

How Canada Health Infoway’s Dennis Giokas is helping drive the technical architecture that allows clinical information to flow freely across the country

When Dennis Giokas joined Canada Health Infoway as chief technology officer in September 2002, he had little experience in the health-care industry and, being American, knew little about the Canadian health-care system. However, it didn’t hold him back; he’s since managed to drive forward a $2.1 billion project.

“When I came on board, someone gave me a tour of what was going on around the country, explaining how health care is delivered in Canada, and how IT had been used to enable the health-care system,” Giokas says. “I’m good at seeing the breadth of a problem and was able to determine how the moving parts intersected, and I used that to develop the original blueprint for how we’d deliver the electronic health record [EHR] in Canada.”

“We were originally tasked with creating the blueprint for how we’d deliver the electronic health record in Canada; today, the core components are in place and available in every province and territory.”

Prior to the existence of Canada Health Infoway—which is a federally funded, not-for-profit organization tasked with accelerating the development of EHRs across Canada—clinicians, hospitals, and pharmacies all used different record-keeping systems. This created two challenges: some settings didn’t have any electronic record-keeping systems at all, and those that did were in silos, disconnected from other systems. “Something as basic as getting a hospital discharge report back to the patient’s family physician involved typing up a document, then mailing or faxing it,” Giokas says. “Even in a large city like Toronto, we had challenges getting information across the street, let alone across the province. So our objective was to connect those silos so key pieces of clinical information could flow freely across the continuum of care.”



Community physicians who now have electronic medical records


Amount of funding to date to implement Canada’s EHR


Benefits the EHR has produced for Canadians since 2007


Amount added to Canada’s GDP for every dollar invested by Canada Health Infoway

Giokas’s first steps were to establish the guidelines for system design, craft the requirements for privacy and security, and develop the standards for interoperability. The organization also created the investment programs. Through these channels, money could flow to provinces and territories so that they could procure, implement, and operate the health-sector-connecting systems.

It was no small project: initial funding of $500 million grew to $2.1 billion. “We figured, at the time, we had one shot to get it right, to maximize return on investment to the health-care system,” Giokas says.

To accomplish that goal, Giokas and his team focused on several key areas. First they created client and provider registries, and then they created databases for key clinical information such as diagnostic-test results and medication histories, which then could be shared by many clinicians. Giokas and his team also designed the consumers’ access to their EHR. “We wanted them to be able to access all that information, and we also wanted them to have a better experience, for example, by being able to book appointments online,” he says.

To keep improving, Canada Health Infoway has started to invest in analytics. “You can’t manage what you can’t measure,” Giokas says. “Analytics will play a key role in helping inform decision-makers in the health-care system, from frontline clinicians to researchers,” Giokas says. Those analytics, he explains, can take the form of looking at data retrospectively over time, but there’s also an interesting opportunity to do analytics in real time.” A stream of data from a patient in the ICU could be analyzed as it’s created and used to inform the clinician of the patient’s status, perhaps even predicting when the patient might decline so the clinician can take action.”

According to Giokas, the risk-averse nature of the health-care industry was a challenge. “Doctors want to deal with what they know and evidence, so we had convince them that the EHR was trusted data and that it would support safer, more efficient health-care delivery,” Giokas says. “We’ve made a lot of progress. Today, virtually all provinces and territories have all aspects of the EHR implemented, and 77 percent of community physicians now have electronic medical records.”