It’s a little reassuring to hear we’re not the only ones who are struggling to get going with electronic patient records. The Canadians aren’t finding it easy either.

But the causes of their problems are slightly different. The Canadian government has set up a non-for-profit organization called Infoway to ensure the introduction of electronic patient records. But because most policy is governed by individual Canadian provinces, Infoway can’t make them do anything. All they can do is point out the benefits and hope people jump on board.

But 8 years and C$ 2 billion later, only 17% have taken up the offer. That’s far off their 50% aim by 2010.

It doesn’t help that Infoway are only offering part funding for the program, so that individual practices still need to fork out to make the changes. And many are unsure why they should. The software is expensive, and the disruption while it’s being set up is considerable. Moreover, as Moshe Pinhas, president of a Toronto-based clinical software provider explains,

While [electronic records] provide benefits to doctors, the majority of the benefits of using [electronic records] flows to the system and not to the individual physician who is required to purchase and use them.

Many of the benefits are in communication between providers, long-term planning and research. Doctors are immediately more interested in providing better care in a shorter amount of time, and they’re not sure that electronic patient records will deliver this. Even if doctors do see long-term benefits, it doesn’t make sense to change to an electronic system until other service providers are also using them – and most consultants and hospitals are still sending things on paper. While it might be in everyone’s interests to move towards compatible electronic patient records, it’s in no-one’s interests to be the first.

Some might take doctors’ reluctance to make the shift as evidence that electronic patient records are impractical and undesirable. But their reluctance doesn’t seem to stem from reasoned objections as much as lack of time and money, and a chicken and egg problem which results in a strange kind of collective irrationality. While there has been much debate about the downsides of our highly centralized system, it could be argued that the NHS is at least in a position to take a larger and longer view of the common good.