As it develops the NHII, the United States is fortunate to have an excellent, comprehensive model in the Canadian Health Infostructure. 32 The purpose, process, substance, and overall level of commitment of the Canadian initiative are highly pertinent examples for the United States. The similarities begin with the basic concept. The 1999 report launching the project explains that the term "the Canada Health Infoway or health infostructure . . . refers not just to the use of information and communications in health . . . [but also] to the health information the technologies create, the policies governing the use of this information, and the people and organizations who create the information and use this infrastructure." The Infostructure is composed of elements provided by provincial, territorial, and Federal health infostructure initiatives. The vision is to "allow these diverse initiatives to complement each other in improving the health of all Canadians." 33
Like the NHII, the Infostructure is a work in progress; however, its implementation is much further along. The initiative has been under development since 1998, with significant and growing support from the Canadian government. The initiative set out four strategic goals: empowering the general public, strengthening and integrating healthcare services, creating the information resources for accountability and continuous feedback on factors affecting the health of Canadians, and improving privacy protections within the health sector. The early years were devoted to consultations with stakeholders around Canada. Specific projects have since taken shape. In some provinces, such as British Columbia where HL7 messages and standardized codes are used for all drug prescribing and in development for linking laboratories, effective infrastructures are developing.
Canadian Infostructure efforts focus on the three areas covered by the dimensions of the NHII. To improve population health statistics, the initiative developed a Health Information Roadmap that provides "an action plan for the 21st century." 34 Its activities have served as an example for the 21st-century health statistics visioning initiative described above. And CDC, in its documents on the Public Health Conceptual Data Model, cites the Canadian Infoway as one of the "inputs" to the CDC model. For consumers, the Canadian Health Network (CHN) was established on the Web, following the U. S. healthfinder® and National Library of Medicine models, as a national, bilingual Internet-based health information service (www.canadian-health-network.ca/customtools/homcc.html). To improve health care, the Canadian government funded an independent corporation, the Canada Health Infoway, Inc. 35 Its objectives are to develop mechanisms to enable consumers to access health information that they can use, to facilitate the work of healthcare providers through technology, and to create a unified network of electronic health records across the continuum of care. It will identify investment opportunities with vendors and systems integrators and accelerate the development and implementation of computerized health information networks.