Evidence map›Paper›PMID 42082412›Full record

ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2026

The current state of electronic health records across Canada: an environmental scan and interoperability maturity assessment.

Sunand Kannappan, Stephanie Hastings, Alan Forster, Stafford Dean, Grant Hollett, Simon Hagens, Bobby Gheorghiu, Ewan Affleck, Claire Snyman, Owen Adams and 2 more

Erratum issuedAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Correction to "The current state of electronic health records across Canada: an environmental scan and interoperability maturity assessment".CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Sunand KannappanDepartment of Medicine (Kannappan, Hastings, Manns), Cumming School of Medicine, University of Calgary, Calgary, Alta.; McGill University Health Centre (Forster); Department of Medicine (Forster), McGill University, Montréal, Que.; Alberta Health Services (Dean), Calgary, Alta.; Canadian Institute for Health Information (Hollett), Toronto, Ont.; Telfer School of Management (Hagens), University of Ottawa, Ottawa, Ont.; Hagens Consulting (Hagens), Toronto, Ont.; Canada Health Infoway (Gheorghiu), Toronto, Ont.; Networked Health (Affleck, Snyman); College of Physicians and Surgeons of Alberta (Affleck), Edmonton, Alta.; Canadian Medical Association (Adams), Ottawa, Ont.; Department of Community Health Sciences (Williamson, Manns), and O'Brien Institute of Public Health (Williamson, Manns), and Libin Cardiovascular Institute (Williamson, Manns), and Alberta Children's Hospital Research Institute (Williamson), and Centre for Health Informatics (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
Stephanie HastingsDepartment of Medicine (Kannappan, Hastings, Manns), Cumming School of Medicine, University of Calgary, Calgary, Alta.; McGill University Health Centre (Forster); Department of Medicine (Forster), McGill University, Montréal, Que.; Alberta Health Services (Dean), Calgary, Alta.; Canadian Institute for Health Information (Hollett), Toronto, Ont.; Telfer School of Management (Hagens), University of Ottawa, Ottawa, Ont.; Hagens Consulting (Hagens), Toronto, Ont.; Canada Health Infoway (Gheorghiu), Toronto, Ont.; Networked Health (Affleck, Snyman); College of Physicians and Surgeons of Alberta (Affleck), Edmonton, Alta.; Canadian Medical Association (Adams), Ottawa, Ont.; Department of Community Health Sciences (Williamson, Manns), and O'Brien Institute of Public Health (Williamson, Manns), and Libin Cardiovascular Institute (Williamson, Manns), and Alberta Children's Hospital Research Institute (Williamson), and Centre for Health Informatics (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
Alan ForsterDepartment of Medicine (Kannappan, Hastings, Manns), Cumming School of Medicine, University of Calgary, Calgary, Alta.; McGill University Health Centre (Forster); Department of Medicine (Forster), McGill University, Montréal, Que.; Alberta Health Services (Dean), Calgary, Alta.; Canadian Institute for Health Information (Hollett), Toronto, Ont.; Telfer School of Management (Hagens), University of Ottawa, Ottawa, Ont.; Hagens Consulting (Hagens), Toronto, Ont.; Canada Health Infoway (Gheorghiu), Toronto, Ont.; Networked Health (Affleck, Snyman); College of Physicians and Surgeons of Alberta (Affleck), Edmonton, Alta.; Canadian Medical Association (Adams), Ottawa, Ont.; Department of Community Health Sciences (Williamson, Manns), and O'Brien Institute of Public Health (Williamson, Manns), and Libin Cardiovascular Institute (Williamson, Manns), and Alberta Children's Hospital Research Institute (Williamson), and Centre for Health Informatics (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
Stafford DeanDepartment of Medicine (Kannappan, Hastings, Manns), Cumming School of Medicine, University of Calgary, Calgary, Alta.; McGill University Health Centre (Forster); Department of Medicine (Forster), McGill University, Montréal, Que.; Alberta Health Services (Dean), Calgary, Alta.; Canadian Institute for Health Information (Hollett), Toronto, Ont.; Telfer School of Management (Hagens), University of Ottawa, Ottawa, Ont.; Hagens Consulting (Hagens), Toronto, Ont.; Canada Health Infoway (Gheorghiu), Toronto, Ont.; Networked Health (Affleck, Snyman); College of Physicians and Surgeons of Alberta (Affleck), Edmonton, Alta.; Canadian Medical Association (Adams), Ottawa, Ont.; Department of Community Health Sciences (Williamson, Manns), and O'Brien Institute of Public Health (Williamson, Manns), and Libin Cardiovascular Institute (Williamson, Manns), and Alberta Children's Hospital Research Institute (Williamson), and Centre for Health Informatics (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
Grant HollettDepartment of Medicine (Kannappan, Hastings, Manns), Cumming School of Medicine, University of Calgary, Calgary, Alta.; McGill University Health Centre (Forster); Department of Medicine (Forster), McGill University, Montréal, Que.; Alberta Health Services (Dean), Calgary, Alta.; Canadian Institute for Health Information (Hollett), Toronto, Ont.; Telfer School of Management (Hagens), University of Ottawa, Ottawa, Ont.; Hagens Consulting (Hagens), Toronto, Ont.; Canada Health Infoway (Gheorghiu), Toronto, Ont.; Networked Health (Affleck, Snyman); College of Physicians and Surgeons of Alberta (Affleck), Edmonton, Alta.; Canadian Medical Association (Adams), Ottawa, Ont.; Department of Community Health Sciences (Williamson, Manns), and O'Brien Institute of Public Health (Williamson, Manns), and Libin Cardiovascular Institute (Williamson, Manns), and Alberta Children's Hospital Research Institute (Williamson), and Centre for Health Informatics (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
Simon HagensDepartment of Medicine (Kannappan, Hastings, Manns), Cumming School of Medicine, University of Calgary, Calgary, Alta.; McGill University Health Centre (Forster); Department of Medicine (Forster), McGill University, Montréal, Que.; Alberta Health Services (Dean), Calgary, Alta.; Canadian Institute for Health Information (Hollett), Toronto, Ont.; Telfer School of Management (Hagens), University of Ottawa, Ottawa, Ont.; Hagens Consulting (Hagens), Toronto, Ont.; Canada Health Infoway (Gheorghiu), Toronto, Ont.; Networked Health (Affleck, Snyman); College of Physicians and Surgeons of Alberta (Affleck), Edmonton, Alta.; Canadian Medical Association (Adams), Ottawa, Ont.; Department of Community Health Sciences (Williamson, Manns), and O'Brien Institute of Public Health (Williamson, Manns), and Libin Cardiovascular Institute (Williamson, Manns), and Alberta Children's Hospital Research Institute (Williamson), and Centre for Health Informatics (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
Bobby GheorghiuDepartment of Medicine (Kannappan, Hastings, Manns), Cumming School of Medicine, University of Calgary, Calgary, Alta.; McGill University Health Centre (Forster); Department of Medicine (Forster), McGill University, Montréal, Que.; Alberta Health Services (Dean), Calgary, Alta.; Canadian Institute for Health Information (Hollett), Toronto, Ont.; Telfer School of Management (Hagens), University of Ottawa, Ottawa, Ont.; Hagens Consulting (Hagens), Toronto, Ont.; Canada Health Infoway (Gheorghiu), Toronto, Ont.; Networked Health (Affleck, Snyman); College of Physicians and Surgeons of Alberta (Affleck), Edmonton, Alta.; Canadian Medical Association (Adams), Ottawa, Ont.; Department of Community Health Sciences (Williamson, Manns), and O'Brien Institute of Public Health (Williamson, Manns), and Libin Cardiovascular Institute (Williamson, Manns), and Alberta Children's Hospital Research Institute (Williamson), and Centre for Health Informatics (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
Ewan AffleckDepartment of Medicine (Kannappan, Hastings, Manns), Cumming School of Medicine, University of Calgary, Calgary, Alta.; McGill University Health Centre (Forster); Department of Medicine (Forster), McGill University, Montréal, Que.; Alberta Health Services (Dean), Calgary, Alta.; Canadian Institute for Health Information (Hollett), Toronto, Ont.; Telfer School of Management (Hagens), University of Ottawa, Ottawa, Ont.; Hagens Consulting (Hagens), Toronto, Ont.; Canada Health Infoway (Gheorghiu), Toronto, Ont.; Networked Health (Affleck, Snyman); College of Physicians and Surgeons of Alberta (Affleck), Edmonton, Alta.; Canadian Medical Association (Adams), Ottawa, Ont.; Department of Community Health Sciences (Williamson, Manns), and O'Brien Institute of Public Health (Williamson, Manns), and Libin Cardiovascular Institute (Williamson, Manns), and Alberta Children's Hospital Research Institute (Williamson), and Centre for Health Informatics (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
Claire SnymanDepartment of Medicine (Kannappan, Hastings, Manns), Cumming School of Medicine, University of Calgary, Calgary, Alta.; McGill University Health Centre (Forster); Department of Medicine (Forster), McGill University, Montréal, Que.; Alberta Health Services (Dean), Calgary, Alta.; Canadian Institute for Health Information (Hollett), Toronto, Ont.; Telfer School of Management (Hagens), University of Ottawa, Ottawa, Ont.; Hagens Consulting (Hagens), Toronto, Ont.; Canada Health Infoway (Gheorghiu), Toronto, Ont.; Networked Health (Affleck, Snyman); College of Physicians and Surgeons of Alberta (Affleck), Edmonton, Alta.; Canadian Medical Association (Adams), Ottawa, Ont.; Department of Community Health Sciences (Williamson, Manns), and O'Brien Institute of Public Health (Williamson, Manns), and Libin Cardiovascular Institute (Williamson, Manns), and Alberta Children's Hospital Research Institute (Williamson), and Centre for Health Informatics (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
Owen AdamsDepartment of Medicine (Kannappan, Hastings, Manns), Cumming School of Medicine, University of Calgary, Calgary, Alta.; McGill University Health Centre (Forster); Department of Medicine (Forster), McGill University, Montréal, Que.; Alberta Health Services (Dean), Calgary, Alta.; Canadian Institute for Health Information (Hollett), Toronto, Ont.; Telfer School of Management (Hagens), University of Ottawa, Ottawa, Ont.; Hagens Consulting (Hagens), Toronto, Ont.; Canada Health Infoway (Gheorghiu), Toronto, Ont.; Networked Health (Affleck, Snyman); College of Physicians and Surgeons of Alberta (Affleck), Edmonton, Alta.; Canadian Medical Association (Adams), Ottawa, Ont.; Department of Community Health Sciences (Williamson, Manns), and O'Brien Institute of Public Health (Williamson, Manns), and Libin Cardiovascular Institute (Williamson, Manns), and Alberta Children's Hospital Research Institute (Williamson), and Centre for Health Informatics (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
Tyler WilliamsonDepartment of Medicine (Kannappan, Hastings, Manns), Cumming School of Medicine, University of Calgary, Calgary, Alta.; McGill University Health Centre (Forster); Department of Medicine (Forster), McGill University, Montréal, Que.; Alberta Health Services (Dean), Calgary, Alta.; Canadian Institute for Health Information (Hollett), Toronto, Ont.; Telfer School of Management (Hagens), University of Ottawa, Ottawa, Ont.; Hagens Consulting (Hagens), Toronto, Ont.; Canada Health Infoway (Gheorghiu), Toronto, Ont.; Networked Health (Affleck, Snyman); College of Physicians and Surgeons of Alberta (Affleck), Edmonton, Alta.; Canadian Medical Association (Adams), Ottawa, Ont.; Department of Community Health Sciences (Williamson, Manns), and O'Brien Institute of Public Health (Williamson, Manns), and Libin Cardiovascular Institute (Williamson, Manns), and Alberta Children's Hospital Research Institute (Williamson), and Centre for Health Informatics (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
Braden MannsDepartment of Medicine (Kannappan, Hastings, Manns), Cumming School of Medicine, University of Calgary, Calgary, Alta.; McGill University Health Centre (Forster); Department of Medicine (Forster), McGill University, Montréal, Que.; Alberta Health Services (Dean), Calgary, Alta.; Canadian Institute for Health Information (Hollett), Toronto, Ont.; Telfer School of Management (Hagens), University of Ottawa, Ottawa, Ont.; Hagens Consulting (Hagens), Toronto, Ont.; Canada Health Infoway (Gheorghiu), Toronto, Ont.; Networked Health (Affleck, Snyman); College of Physicians and Surgeons of Alberta (Affleck), Edmonton, Alta.; Canadian Medical Association (Adams), Ottawa, Ont.; Department of Community Health Sciences (Williamson, Manns), and O'Brien Institute of Public Health (Williamson, Manns), and Libin Cardiovascular Institute (Williamson, Manns), and Alberta Children's Hospital Research Institute (Williamson), and Centre for Health Informatics (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta. bjmanns@ucalgary.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCanada has achieved near-universal adoption of electronic health records (EHRs) and yet interoperability, the secure exchange and use of health data across different systems and settings, remains limited. We aimed to describe the current state of EHRs in 10 provincial and 3 territorial jurisdictions in Canada and evaluate the maturity of their interoperability using a structured interoperability assessment model.

methodsWe conducted an environmental scan of EHR use and interoperability across all provinces and territories using Canada Health Infoway documents and structured interviews with 23 subject matter experts. Using a rigorously designed interoperability maturity model, we evaluated jurisdictions across 4 enabler dimensions (governance, legislation and standards, incentives and capacity-building, and technical infrastructure) and 4 interoperability status dimensions (community EHRs, hospital EHRs, patient portals, and system analytics).

resultsWe found that, although EHR adoption was high, maturity of EHR interoperability was low and uneven across Canada. Integrated EHR health data exchange was limited, and nearly all jurisdictions lacked EHR interoperability between hospitals, community specialists, and primary care. Data exchange between primary care and specialists, and between hospitals and community settings, was heavily dependent on fax (traditional or online) or mailed letters in every jurisdiction. Patient portal contents and system-level analytics using EHR data were underdeveloped nationally. No jurisdiction was advanced in all dimensions. Although most jurisdictions showed strength in at least 1 area, they also exhibited many areas for growth. We identified 8 key barriers to interoperability, each of which can be overcome.

interpretationCanada has widespread EHR adoption, but maturity of EHR interoperability and the enabling conditions required for true interoperability are low and inconsistent across jurisdictions. Strengthening governance, legislation, standards, incentives, and technical infrastructure - supported by national legislation to mandate interoperability across different EHRs - will be essential to advancing connected care across Canada and realizing widespread benefits for patients, clinicians, and health systems.

Indexed as

Electronic Health RecordsHealth Information InteroperabilityCanadaDigital HealthHumans

Identifiers

PMID42082412
PMCPMC13155890

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.