Developing e-health in Quebec: opportunities and challenges for patients, health professionals and
A symposium held in Montreal in 2013 gathered healthcare providers, health organization
managers, researchers, and communication professionals to identify opportunities and
challenges related to e-health. This article presents a summary of key issues surrounding ICT
use and its impacts on patient-provider communication, access to medical information across
healthcare organizations, and diffusion of evidence-based practices. The conference provided
opportunities to share on innovations and revealed that their promotion, implementation and
integration are slow. Indeed, the development of e-health systems does not only produce new
forms of communication, it transforms professional practices, roles and identities and raises
several ethical issues.
Christine Thoër, Ph.D., professor, Social and public communication department, University of Quebec in
Marie-Thérèse Lussier, Md and associate professor, Family medicine department and emergency medicine,
University of Montreal
Claude Richard, PhD, associate researcher, Primary health care research team, Laval Health and social
Sophie Galarneau, MD, clinical adjunct professor, Family medicine department and emergency medicine,
University of Montréal
Marie-Josée Levert, Ph.D., psychologist, Faculty of nursing, University of Montreal
Joseph J. Lévy, Ph.D., professor, Department de sexology, University of Quebec in Montréal
Bernard Millette, MD, MSc, professor, Family medicine department and emergency medicine, University of
Marie-Claude Vanier, BPharm, professor, Faculty of pharmacy, University of Montreal
Jean Dumas, Ph.D., coordinator and researcher, Strategic group on Internet and Health, Quebec Population
Health Research Network
With the development of the Internet, many studies have shown over the years that a growing number of
individuals look for health-related information online before and after meeting with a health professional,
using various websites including online communities. Information and communication technologies (ICT) are
also used by health professionals in collaborative manners, to improve access and transmission of
information within health care networks and to improve knowledge dissemination. These developments are
characterized by the term e-health, and also referred to as medicine 2.0 or health 2.0 in which patient-
centered clinical consultations are at the heart of health care. E-health is more than a technical
development, it implies a genuine renewal in the field of health care. Eysenbach (2001) defines it as:
[...] an emerging field in the intersection of medical informatics, public health and business,
referring to health services and information delivered or enhanced through the Internet and related
technologies. In a broader sense, the term characterizes not only a technical development, but also
a state of mind, a way of thinking, an attitude and a commitment to networked, global thinking, to
improving healthcare locally, regionally and worldwide by using information and communication
E-health provides new opportunities but also challenges in communication between patients, health
professionals and health systems, especially as ICT systems are not necessarily used or if used, not
effectively, or even meaningfully by actors. Exploring these communication challenges was the objective of
the International Francophone Symposium entitled “Communication at the heart of e-health: opportunities
and challenges for patients, health professionals and organizations”1. This event was organized by a
multidisciplinary scientific committee composed of health care professionals, specialists in primary health
care research and from various social science disciplines such as anthropology, communication, psychology
The symposium gathered 133 health professionals, managers, researchers and students from various
regions of Quebec, Canada and other countries where French is the most common language. The main
objective of the event was to mobilize actors around issues of health care communication, research and
teaching in the field of e-health. A total of 19 conferences including workshops and 2 round tables (the
program can be accessed here and most videoconferences are available here) provided participants with
opportunities to review and discuss issues associated with e-health development in Quebec, Canadian
provinces and other countries.
We provide a summary of the issues raised during the conference under the three following headings:
1) How are ICT, and especially the Internet, used to facilitate communication between health professionals
and patients and within and between institutions?
2) How do populations and patients use the Internet and what are the challenges encountered and impacts
on resource utilization and relationships with health professionals?
3) What are the ethical and deontological issues in the field?
1. Using ICT and the Internet to facilitate communication between health professionals and patients
and within and between institutions
1.1. Implementation of standard electronic medical records (EMR) within clinics
1 « La communication au coeur de la e-santé: opportunités et enjeux pour les patients, les professionnels de
la santé et les organisations », October 3rd & 4th, 2013, University of Quebec in Montreal, Montreal,
Many studies have demonstrated the benefits of EMR but also barriers to their implementation. For
example, in a systematic literature review, Lau et al. (2012) have identified 48 individual, professional,
organizational, economical, legal and sociopolitical factors related to their adoption. In Quebec, a survey
(Paré et al. 2013a) reaching out to a representative sample of 780 doctors measured the rate of use of
EMR, the intention to implement such forms of ICT or not, software and functions which are most or least
used and for what reasons, level of satisfaction with each functionality, as well as perceived benefits and
barriers to their adoption. For example, 20 % of doctors have no intention of implementing an EMR but
nearly 50 % are actually involved in various stages of its implementation. One of the most satisfying
functionalities of EMR for doctors is accessing patients’ files from any site. Among the conclusions of the
study, like those of many other studies worldwide, it is obvious that time is needed to reach efficient EMR
use that may lead to increased productivity and satisfaction. Also, attitudes towards the EMR tend to
become more positive with time after successful completion of the implementation and initial use phases.
As for implementation rates, Quebec is the slowest in Canada and Canada the slowest among many
industrialized countries (Beauschene, 2013). Various reasons for this were outlined, including the
complexity of the implementation process and the costs associated with it. To speed the implementation
process, the Quebec government launched a financial support program in 2012 (PQADME2) which seems to
have contributed to a significant increase in adoption rate by clinics (Fortin, 2013). Indeed, the adoption rate
rose from 15 % in 2007 to 42 % in 2013 (Paré et al., 2013a). But to convince doctors to adopt an EMR one
needs to demonstrate that it is more than an electronic version of the paper medical chart. Among other
means of promoting EMR use in the province, a team of knowledge brokers (Gagnon & Roy, 2013) has
offered physician workshops province wide with evidence of their benefit, created a blog (InfoDME.org)
offering short information bulletins but also video testimonies of a variety of health professionals about their
successful and satisfying (but not without challenges) experiences with implementing and using the EMR.
1.2 Innovative forms of EMRs
The symposium also provided examples of EMR innovations such as the “Intelligent medical record”
(Turcotte, 2013) which is a prototype called DaVinci developped in a Family Medicine Group of the city of
Laval in collaboration with the Primary Care Research Team. It includes more features than the standard
EMR to help health professionals engage in reflective and collaborative practices and compare and learn
from their own experience. Such changes can help increase clinic productivity and quality of care, especially
for patients with chronic diseases.
1.3. Implementation of a provincial centralized EMR
Called the “Dossier santé Québec” (DSQ), this system is intended to provide access to patients’ information
on prescribed medications, lab results and medical imagery. It will be accessible by various categories of
health professionals (each having a different level of access to the data) anywhere in Quebec. The
objectives are to improve quality of care, for example by reducing time to access information, to avoid
harmful medication interactions, same tests being performed twice, etc., thus reducing costs for the
healthcare system (Ministère de la Santé et des Services sociaux, 2012).
Yet the development of an efficient access to the DSQ is slow: doctors’ satisfaction with the system is
therefore limited for now (Paré et al., 2013a) and there has been public controversy surrounding security of
data and the explosion of total costs for the province since 2001. In some provinces like Alberta (Alberta
Health Services, 2013), patients will soon have access to this kind of electronic medical record (Paré et al.,
2 Programme québécois d’adoption du dossier médical électronique.
1.4 Data collection from EMRs at the federal level
Other initiatives were presented during the symposium which can help demonstrate the usefulness of
EMRs. The Canadian Primary Care Sentinel Surveillance Network (cpcssn.ca), a project supported by the
Public Health Agency of Canada has created a centralized database, that automatically extracts medical
information entered in ten different EMRs used by 475 sentinel family physicians from eight provinces (600
265 patients in 2014). This data is used for surveillance and epidemiological research (Beauchesne, 2013;
Greiver & Brousseau 2013).
1.5 Online resources to improve circulation of scientific knowledge and interprofessional collaboration
With the development of the Internet came an array of online resources for health professionals looking for
scientific knowledge and best practices. Among them are specialized medical websites such as Medscape,
Epocrates, Pepid and Dynamed. Experienced users at the symposium recommended the adoption of an
information management strategy including three specific methods (Labrecque & Beaupré, 2013). The
passive approach (push) which consists in registering to various websites (for example Physician’s first
watch, Evidence updates, various medical associations) to receive email alerts on medical topics, critical
reviews, recommendations for practices, etc. The second approach is active (pull) and calls for different
steps in information management: structuring clinical questions (PICO – population, intervention,
comparison, outcome); looking for meta-analytical reviews or practitioner guides instead of isolated specific
articles. The third approach is interactive and calls for discussion of information with colleagues by means of
various tools such as wikis, blogs, Twitter and Facebook. There are also tools like email networks, Google
drive and professional networks like LinkedIn. Beside using their personal computer, many health
professionals are now using mobile devices to access scientific information. Experienced users recommend
installing top ten applications on their smart phones or tablets such as medical calculators which allow to
choose the right medication dosage for a patient, evaluate cardiovascular risk profiles, and calculate a Body
Mass Index. But according to Beauchesne (2013), one of the most beneficial ICT systems for the patients is
telehealth. Its use has grown substantially during the past few years: in Canada, 350 000 uses were
documented in 2012. For example, telepathology is used to seek second opinions for biopsies, thus
reducing delays for diagnostics and resulting in quicker treatment. Telehealth also allows health
professionals living in foreign regions to benefit from various forms of live video training, consultations, etc.
Another resource for health professionals for circulation of scientific knowledge and interprofessional
collaboration are communities of practices (CP). Defined as “a group of people that do not necessarily work
together usually but who share common issues, problems or passion for a topic and who wish to deepen
their knowledge and expertise by encouraging continuous interactions” (Gabbay, J., et al. 2003). At the
Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), a team of professionals
in social integration of people with disabilities use a shopping centre as an experimental environment for
integration with the collaboration of clinicians, managers in health organizations, staff from stores, family
members and staff from community organizations (click here to visit the “Rehabilitation Living Lab” website).
An online CP was created to facilitate learning partnership, mutual recognition, and potential of helping each
other when needed. It is moderated by a facilitator, a coordinator and a consultant, and to foster
interactions, each participant (40 people) is expected to contribute for a half an hour per week. An
evaluation protocol including activity logs, analyses of discussions, longitudinal surveys and interviews on
the benefits and challenges for users has been developed to measure the impact of this online CP.
2. Populations’ and patients’ health-related use of the Internet, challenges and impacts on resource
utilization and relationships with health professionals
In Quebec, many studies in the last decade have shown the important growth of the number of people
looking for health-related information by using the Internet. A survey shows that 40 % of participants have
done so occasionally in 2011 and 30 % consult such information regularly. Women, often at the center of
health concerns in the family, are more frequent users as well as younger people (Statistics Canada, 2011).
People visit websites offering health-related information (for example, Doctissimo is one of the most popular
websites for francophones worldwide) and spaces where synchronous or asynchronous communications
occur: discussion forums, Yahoo groups, bulletin boards, blogs, Facebook, Twitter, chatrooms, and a
relatively new trend, mobile applications (Thoër, 2013). But research also shows that the healthcare
provider often still remains the first source of information (Dolce, 2011).
Many speakers at the symposium discussed the potential benefits for the patients seeking online
information (Fostier et Milette, 2013). The information can help a patient in many ways: finding relevant
information on diseases, their symptoms and treatments, sharing experiences, getting social support, having
discussions in lay language, providing or reading personal evaluations of health professionals and services,
etc. As for the impacts of such Internet use on the relationship between healthcare providers and patients,
studies have shown both positive and negative impacts. As for the positive ones, the information can
promote dialogue, provide reassurance, improve clinical outcomes and generate empowerment. As for
negative impacts, examples are tension generated by the patient who questions the professionals’
competence (how come you’re not aware of this?), unreasonable expectations (why can’t I get this
treatment?), undue stress caused by stories read that are not representative of patients’ experience in
general or controversies discussed online that can influence a patients’ decision to accept a professional’s
advice (ex. a particular treatment or vaccine) (ibid). But the literature also underlines that patients, for
example those with chronic diseases who share together online about their daily experiences, are
developing their own method of appropriation of the medical information found online or discussed with
health professionals. This can generate lay discourses and practices (experience knowledge) that can
positively complement the patient-provider communication (Pols, 2014).
Various solutions to reduce the negative impacts of health-related use of the Internet were discussed during
the symposium. Among them, prescribe information and provide a list of recommended websites to patients.
In health care institutions, university medical faculties and even some public libraries, specially trained
librarians can assist patients and health professionals for this purpose. Also, explanations on how to
evaluate the quality of the information found online and the credibility of a website can be provided
(Perreault, Clar & Rose, 2013).
Also there is the ECPHP (efficient collaboration between patients and health professionals) project
developed by the same Primary Care Research Team and called Capsana. It intends to help patients
prepare for the next consultation and foster patient participation during the medical encounter, facilitating
doctor-patient communication, and ultimately improving health outcomes. This web application is to be
launched in October 2014, offering tools for both the professional and the patient. The project also has an
evaluation protocol (Lussier & Richard, .2013).
Another field of e-health is the active presence of health professionals online. For example, a doctor creates
a blog where questions are answered and advice given to users about various health topics. This has the
advantage of reaching a larger number of individuals than during one to one consultations and can become
an effective tool for prevention and health promotion (Vadeboncoeur & Bernard, 2013).
3. Ethical and deontological issues
A number of ethical and deontological issues were discussed during the symposium. First, access and
usage of to the Internet varies within the population and is influenced by socioeconomical factors such as
age, income, gender and level of education (Renahy, 2012). It is therefore important that traditional sources
of information remain available. Speakers have also underlined the importance of taking into account the
literacy levels of their patients (Dorval & Kavanagh, 2013). Indeed, the Public Health Agency of Canada
states that 60 % of adults and 88 % of the elderly do not have the skills to find, understand and use
information in order to take proper decisions for their health (Canadian Public Health Association, 2008)
Also, too often, neither health professionals nor librarians have the tools or skills to evaluate the literacy
level of patients. Some simple solutions can be used. For example, when prescribing information, the health
professional can ask the patients if they prefer basic, intermediate of advanced level of information and also
refer to a growing a number of websites offering literacy level adapted information (Perreault, Clar & Rose,
Another issue is the availability and quality of the information available online. Among the risks associated
with availability are self-diagnosis and self-medication, access to erroneous or even harmful information or
advice which can occur as quality and comprehensive websites often rank low in search engine results
(Modave et al., 2014). The poor quality of the information can also impact on the professional-patient
relationship: misinformation (ex. information found on a commercial website about a miracle treatment of
some sort) results in the provider having to take time to explain and correct false beliefs. To improve the
quality of the information available online, there is the possibility for website managers of having their
websites evaluated and accredited. For example, after evaluation, the Health On the Net Foundation allows
the use of their logo as a quality indicator, the HON code, and the website is listed in their database (Thoër,
Health professionals online also comes with issues. Although some consider it is a duty to be online and
answer questions, some fear being on the web for deontological reasons. For example, a doctor cannot
associate himself to a product or discuss a specific persons’ case. He also has a duty of reserve meaning
that when providing information, he has to first explain the medical state of knowledge on the health topic
raised and only then can he provide the patient with personal opinion (Blain et al., 2013). For health
professionals who decide to engage online, several guides are now available (see for example the Royal
College of Medicine’s guide).
E-health with its opportunities and challenges, is here to stay. In Quebec, benefits continue to be
demonstrated in this field by numerous evaluations and other kinds of studies, but not all stakeholders are
either active or convinced users. For example, standard EMR and the DSQ are slow to be implemented in
Quebec. An adoption program seems to have interesting results so far, but there is no intention to allow
patients access their medical information yet, as opposed to other provinces like Alberta. However, in the
interest of patient-centered care, collaboration, empowerment and improvement of clinical outcomes, there
are a growing number of interesting innovations in e-health like intelligent medical records or
interprofessional collaboration tools, although the most important challenges remain promotion, adoption
and interoperability of the systems.
As for health-related use of the Internet among patients and the population in general, studies show a
majority now consult this information, but challenges like accessibility, quality of the information and poor
health literacy level of the population remain, as well as the need for NET education to improve use of the
information and impacts of use, either positive or problematic, on communication with healthcare
Present and future developments of the field are promising yet also come with new challenges (Fassier,
2013). For example, evolution of mobile technologies in which a patient can use various measurement
devices (ex. glycemic contgrol) that plugs directly into the smart phone and produce charts; connected care
in which machine to machine communication happen without human intervention. For example, intelligent
clothing with measurement devices in the fibers (for cardiac rate and rhythm and body temperature) are
used by sport fans at the moment but could be used in hospitals for many purposes. One of the most
important challenges that comes these devices is that it produces a huge amount of data that must be
managed to provide information for diagnosis, treatment, epidemiology and research.
A second international symposium on e-health is schedule for 2016 and will be organized in collaboration
with the Quebec Society of Biomedical and Health Informatics (SoQibs).
List of symposium presentations
1. Beauchesne, L., MBA, regional executive director, Quebec, Canada Health Infoway (2013).
“Getting a better understanding of e-health for improved action and interaction” (Mieux comprendre
la e-santé pour mieux agir et interagir).
2. Bier, N., erg, PhD, adjunct professor, Programme d’ergothérapie, School of readaptation,
University of Montreal (2013). “Technologies for the elderly : present, future and impacts on health
professional’s practices” (Gérontotechnologies et système de santé: présent, futur et impacts sur la
pratique des professionnels de la santé).
3. Boutin, S. BScInf, MEd, MAdm, coordonnatrice projet santé, CEFRIO, centre facilitant la
recherche et l’innovation dans les organisations, à l’aide des technologies de l’information et de la
communication (TIC) (2013). “The self-management of patient in the numerical data usage context”
(L'approche d'autogestion du patient dans un contexte d'usage du numérique ?).
4. Bussière, J. F. Sc, MBA, FCSHP, professeur titulaire de clinique, Faculté de pharmacie, Université
de Montréal, Directeur, Département de pharmacie et Unité de recherche en pratique
pharmaceutique, CHU Sainte-Justine; (2013). “ICT and new opportunities for communication
between care takers and with patients” (TIC et nouvelles opportunités de communication entre
soignants et avec les patients).
5. Dorval, V., consultante et enseignante spécialiste de l’efficacité communicationnelle; Kavanagh, E.,
PhD, professeur agrégé, École de design, Université Laval (2013). “Literacy in the e-health era :
guiding principals for users’ adapted communications” (Les littératies à l'ère de la e-santé:
principes directeurs pour des communications adaptées aux usagers).
6. Fassier, S., conseiller principal, Cabinet de relations publiques, National (2013). “The future of e-
health” (L'avenir de la e-santé).
7. Fortin, J.P. MD, FRCP, professeur titulaire, Département de médecine familiale et médecine
d’urgence, Université Laval, CAUCSSS de la Vieille Capitale, Direction régionale et Institut national
de santé publique, Québec (2013). “Are the DSQ, DME, DCI and DPE systems part of solutions for
improving health communication” (Les systèmes DSQ, DMÉ, DCI, et DPÉ font-ils partie des
solutions pour améliorer la communication en santé ?).
8. Fostier, P., MD, Faculté de médecine, Université Toulouse-Rangueil; Millette, B., MD, MSc,
CCMFC, FCMFC, professeur titulaire de clinique, Département de médecine de famille et de
médecine d’urgence, Université de Montréal (2013). “Interacting with the web-informed patient :
from the annoying patient to the collaborative patient”. (Interagir avec le patient "Web-informé": du
patient dérengeant au patient partenaire).
9. Foucaud, J., Dr Sciences éducation, chargé d’expertise scientifique en promotion
de la santé, INPES, France; Zaffran, M., MD, écrivain en résidence, Université McGill, Étudiant à la
maîtrise, Programme de bioéthique, Université de Montréal (2013). “Therapeutic education of
patient (TEP) : what are the communication skills for the professionals ?” (Éducation
thérapeuthique du patient (ETP): quelles compétences communicationnelles pour les
10. Gagnon, M.P., PhD, titulaire de la Chaire de recherche du Canada Technologies et pratiques en
santé, professeure agrégée, Faculté des sciences infirmières, Université Laval, chercheure, Centre
de recherche du CHU de Québec; Roy, R., MScPol, co-responsable, Revue Perspectives,
CEFRIO, spécialiste du transfert de connaissances scientifiques, InfoDMÉ, Chaire de recherche du
Canada en technologies et pratiques en santé, Université Laval; (2013). “Communicating the
evidence-based data to help with Electronic Medical Record implementation” (Communiquer les
données probantes pour soutenir l'implantation des dossiers médicaux électroniques (DMÉ)).
11. Greiver, M., MD, MSc, CCFC, FCFP, professeur adjoint, Département de médecine de famille et
de médecine communautaire, University of Toronto; Brousseau, G., MD, CCMFC, FCMFC,
professeur associé, Département de médecine familiale, Université McGill, Directeur régional de
l’enseignement médical, CSSS de Gatineau, UMF de Gatineau et GMF Saint-Alexandre; (2013).
“ICT for the evaluation of health care quality. The Canadian Primary Care Sentinel Surveillance
Network” (Les TIC au service de l'évaluation et de la qualité des soins. Le projet Réseau canadien
de surveillance sentinelle en soins primaires).
12. Kairy, MD., PhD, professeure adjointe, Université de Montréal, chercheure, CRIR – site Institut de
réadaptation Gingras-Lindsay, Montréal (2013). “Communicatiing with other health professionals
on practices and knowledge whitin health communities of practice” (Échanger avec d'autres
professionnels sur les pratiques et les connaissances au sein de communautés de pratique en
13. Labrecque, M., MD, PhD, CCMFC, FCMFC, professeur titulaire, Département de
médecine familiale et médecine d’urgence, Université Laval; Beaupré, P., MD, CCMFC (MU),
FCMFC, CSPQ, FRCPC, professeur agrégé, Département de médecine familiale et médecine
d’urgence, Université Laval, Chef de service, Urgence, CSSS Alphonse-Desjardins (2013a).
“Quality clinical information for care takers : available online on finger tips” (L'information clinique
de qualité pour les soignants : accessible en ligne au bout des doigts).
14. Labrecque, M., Beaupré, P., (2013b). “How to find useful clinical information : from tools to
practice” (Comment trouver l'information clinique utile? Des outils à la pratique).
15. Lussier, M.T., MD, MSc, CCMFC, FCMFC, professeure agrégée, Département de médecine de
famille et de médecine d’urgence, Université de Montréal, Directrice du réseau de recherche en
soins primaires, Université de Montréal (RRSPUM), Directrice de l’Équipe de recherche en soins
de première ligne, CSSS Laval; Richard, C., PhD, MA, chercheur associé, Équipe de recherche en
soins de première ligne, CSSS Laval, président, ELL Inc, recherche et communication; (2013).
ECPHP : “For en efficient collaboration between patient and heealth professional” (CEPPS: pour
une collaboration efficace entre patient et professionnel de la santé).
16. Perreault, R., MD, FRCPC, professeur adjoint de psychiatrie, Faculté de médecine, Directeur,
Relations stratégiques, Clinical and Health Informatics Group, Université McGill, médecin-conseil,
Direction de la santé publique de Montréal; Clar, M., BSc, MLIS, bibliothécaire, Bibliothèque de
santé, Université de Montréal; Rose, D.B., BSc, MSI, bibliothécaire clinicienne, CSSS Laval
(2013). “Evaluate the quality of the information online and prescribe resources to patients” (Évaluer
l'information sur Internet et prescrire des ressources aux patients).
17. Thoër, C., PhD, professeure, Département de communication sociale et publique, chercheure,
ComSanté, Université du Québec à Montréal (2013). “Communicate with other patients like me :
the interactive spaces online” (Communiquer avec d'autres patients comme moi: les espaces
d'échange en ligne).
18. Turcotte, A., MD, directeur des services professionnels, CSSS Lac des Deux-Montagnes (2013).
“The intelligent medical record”. ( Le dossier médical intelligent (DMI)).
19. Vadeboncoeur, A.,; MD, CCMFC, CSPQ, Spécialiste en médecine d’urgence; Professeur agrégé
de clinique, Faculté de médecine, Université de Montréal; Bernard, O., BPharm, MSc, pharmacien
d’officine, blogueur (2013). “Raising population’s awareness about health in the media and online:
from one platform to another” (Sensibiliser le grand public à la santé dans les médias et sur le web.
D'une plateforme à l'autre).
20. Fortier, J., chef de pupitre, Naître et grandir, Giroux, C., BPharm, MA (comm. Pub.), coordonnateur
de la recherche en communication, Direction des communications, Ministère de la santé et des
services sociaux du Québec; Miller, H., e-patient (2013). “Health information online : how to
produce, evaluate it and use it ?” (L'information santé sur Internet: comment la produire, l'évaluer,
21. Zaffran, M., MD, écrivain en résidence, Université McGill, Étudiant à la maîtrise, Programme de
bioéthique, Université de Montréal; Blain, P., Robert, Y. (2013). “Ethical and deontological issues
related to the development of e-health” (Enjeux éthiques et déontologiques du développement de
Alberta health services (2013). An Overview of Alberta’s Electronic Health Record Information System.
Canadian Public Health Association (2008). A Vision for a Health Literate Canada: Report of the Expert
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