Although the Canada federal government has invested over $3.1 billion developing health information technology (HIT), all 10 provinces still have their own separate HIT systems, which are non-interoperable, expensive, and inconsistent. After first reviewing how these systems operate, this paper analyzes the costs and savings of integrating the common billing, lab results, and diagnostic imaging (BLD) functions of these separate systems using free and open-source software and proposes a system for this, HermesAPI. Currently, 8 provincial governments representing over 95% of Canada’s population allow private companies to create their own electronic medical records (EMR) system and integrate with provincial BLD systems. This study found the cost to develop and maintain HermesAPI would be between CAD$610,000 to CAD$740,000, but would prevent CAD$120,000 per company per province in development costs for a total savings of $6.4 million. HermesAPI would lower barriers to entry for the HIT industry to increase competition, improve the quality of HIT products, and ultimately patient care. The proposed open-source approach of the HermesAPI is one option towards building a more interoperable, less expensive, and more consistent HIT system for Canada.

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