The purpose of governance is to clearly define the process of decision making and implementation. In order to maintain credibility and trust, it is important that a company or organization has a process to share information effectively amongst stakeholders, function in a manner that is transparent, encourage participation, and strive to ensure inclusiveness. These are lofty goals, but it is the intent of CanadianEMR is to strive towards a governance structure that supports and ensures input from all parties.
There are a number of critical partners necessary for the successful operation of CanadianEMR as an aggregator and comparator of information on EMR systems:
- A national physician advisory group, whose role is to provide input and guidance;
- Provincial bodies that establish standards and conformance test systems, plus provide funding and support for system implementation such as OntarioMD, POSP (Alberta Physician Office System Program) and PITO (British Columbia Physician Information Technology Office);
- The EMR vendor community.
Each of these groups/organizations requires a mechanism to provide input to the development and operations of CanadianEMR.
Ongoing discussions will also take place with other stakeholders to ensure alignment and awareness, including the following: Canada Health Infoway, Non-EMR Vendors, Medical Associations, The College of Family Physicians of Canada, and Royal College of Physicians and Surgeons, Provincial licensing bodies, University Departments of Medical Informatics, Health Regions, Provincial Ministries of Health, Health Canada, Privacy Commissioners, and Clinic Managers.
This chart describes a suggested advisory structure. The groups (namely Physician Advisory, Provincial Bodies, and Other Stakeholders) will have a formalized mechanism to provide guidance and feedback, but will not be co-owners of CanadianEMR or have an official voting structure. The purpose of the advisory structure is to ensure an open and transparent process that will best support the needs of all parties.
Frequency of Meetings / Input
- Physician advisory input and guidance will occur on an ad hoc basis or via teleconference/webinar as needed;
- Provincial body input and guidance will occur on an ad hoc basis or at least twice yearly via teleconference;
- Vendor input (in conjunction with CHITTA) will occur on an ad hoc basis or twice yearly via teleconference. Vendor representation will be limited to senior management.
Physician Advisory Group
The physician advisory group will be made up of physicians with recognized expertise on EMRs drawn from provinces/territories across Canada. Physicians with any direct or indirect (holding company) share ownership in an EMR vendor, or who are members of the board of directors of an EMR company, will not be permitted to sit on the Physician Advisory Group.
It is clearly recognized that there are a number of additional individuals who use EMR systems or are delegated responsibility to select an EMR system for a medical practice. These include medical office assistants (MOAs), practice managers, administrators and nurses. Input and guidance will be sought from this group of individuals. As with physicians, individuals with any direct or indirect (holding company) share ownership in an EMR vendor, or who are members of the board of directors of an EMR company, will not be permitted to participate in an advisory capacity.
Appropriate funding will be required to ensure that services are continually enhanced while maintaining the site as a trusted third-party resource. Financial sustainability is a critical requirement for success. Flexibility and continuity will require a mixture of funding sources in the shorter and longer terms.
CanadianEMR will initially be supported through unrestricted sponsorship funding or income generated through the site. All efforts will be undertaken to maximize the level of unrestricted funding available in order to provide greater autonomy and flexibility.
- Sponsors who provide services that support overall growth of the EMR market will be sought;
- Sponsorship of CanadianEMR may be provided through financial funding or in-kind services;
- Vendors of EMR systems in Canada may not directly sponsor CanadianEMR;
- Additional and alternative sources of funding will be explored in order for CanadianEMR to maintain its status as a trusted independent third-party resource;
- As CanadianEMR becomes more financially stable, a compensation structure will be developed to recognize the input of physician and non-physician advisors.
Transparency of process and trustworthiness of CanadianEMR are critical to the ongoing sustainability of the site. As the EMR market in Canada is likely to evolve significantly, a potential exists for consolidation amongst existing vendors and for investment in companies by third parties. Should potential or actual conflicts of interest arise, CanadianEMR reserves the right to re-evaluate sponsor status on an ad hoc basis.