Ottawa’s PrescribeIT program failed after nearly $300-million spent. What happened?

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When Kathleen Leach, an independent pharmacist in Hamilton, was invited to participate in a pilot for PrescribeIT in 2019, she had high hopes that the federally funded e-prescribing tool would help axe the fax in Canadian health care.

But it didn’t take long for her hopes to be dashed.

Ms. Leach found that the PrescribeIT interface in her pharmacy software would not sync with doctors’ electronic records if a patient’s name was not exactly the same on both ends. A nickname or middle name could throw it off.

What’s more, doctors could, and did, turn off their side of the two-way messaging system embedded in PrescribeIT, Ms. Leach said. That was a particular challenge when she came across seemingly obvious mistakes in auto-populated software fields that she couldn’t check against the original prescription, the way she could with a fax.

“I just didn’t trust it,” she said. “I was still getting prescriptions through PrescribeIT, but we treated them as if they were a fax. So, we printed them rather than letting them auto-populate.”

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Ms. Leach’s experience is one example that helps explain why PrescribeIT failed, despite Canada Health Infoway, a federally funded nonprofit, spending $298-million over a decade to give doctors and pharmacists something both groups said they wanted: a secure way of sending prescriptions over the internet.

Telus Health, the company that received about a third of that funding − $98-million − to build and maintain PrescribeIT, says it constructed a “world-class highway” for prescription traffic. Trouble was, the highway could succeed only if nearly all Canadian doctors and pharmacists used it, as they already did fax machines – a technology the medical industry has relied upon for decades.

PrescribeIT, which carried less than 5 per cent of the country’s prescription traffic, didn’t come close to achieving that scale.

Canada Health Infoway officially shut it down in most of the country late last week. After a disastrous April committee hearing in which Infoway chief executive Michael Green, who was paid nearly $900,000 a year, was unable to explain to MPs why the service failed, the nonprofit’s board of provincial and federal appointees dismissed him.

PrescribeIT’s downfall was “a bit of a chicken and egg thing,” said James Owen, the physician digital health co-leader at a large family health team in Toronto. “If we had more people adopting it, both from the pharmacy side and from the prescriber side, the system, I think, would have gotten better and better.”

The Liberal government of Justin Trudeau intended for widespread adoption to be the case when it asked Infoway to create a national e-prescribing solution in 2016. At the time, the opioid crisis was in its devastating early years, and one of the goals of the program was to cut down on forgeries that were easier to pull off with paper prescription pads.

Infoway’s leaders have said PrescribeIT struggled because it lacked buy-in from provinces, a perennial challenge in Canada’s fractured public health system. The federal non-profit didn’t have the authority to force pharmacies and doctors to use the system, nor did it have the money to pay them to adopt it.

“Every OECD country that has electronic prescribing as a national service has either mandated or used incentives, and that falls within the realm of the provinces and territories,” board chair Peter Vaughan told a parliamentary committee on May 5.

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Infoway’s program, however, had problems beyond the lack of provincial support. Dr. Owen, who liked PrescribeIT and is disappointed to see it go, was frustrated about the months it took to enroll new doctors in the system. Infoway’s practice was to hold a virtual meeting with each prescriber to verify their identity, rather than launch the software across a clinic in one fell swoop.

Sean Groves, a rural family doctor in La Ronge, a town in northern Saskatchewan, also characterized the process for joining PrescribeIT as “pretty clunky” for new prescribers, who first had to show their IDs on Zoom calls with Infoway officials.

But over time, he and his colleagues and the three pharmacies in their region adjusted to PrescribeIT. The key was having a local physician leader who was determined to break his colleagues out of their old faxing habits. Dr. Groves sometimes hopped in his vehicle and drove to the pharmacies to smooth over issues.

“There was a change management curve that they struggled with,” he said of the local pharmacists. “They would constantly blame PrescribeIT, but every time – because I was troubleshooting some of it locally – it was almost always not a problem with PrescribeIT. The software was pretty solid. It was actually just they needed to figure out their workflows.”

Internal Infoway documents viewed by The Globe and Mail show that as of February, 2025, only 31 per cent and 44 per cent of prescribers were enrolled in Alberta and New Brunswick, respectively.

Those were two of the four provinces where PrescribeIT was “fully rolled out,” for prescribers at the time, according to the documents. The same notes describe two provinces – British Columbia and Nova Scotia – as being in the “planning under way” phase, despite officials in both jurisdictions telling The Globe that they had no intention of joining PrescribeIT.

In a written statement, the B.C. Ministry of Health said it concluded in 2019-2020 that PrescribeIT duplicated parts of its PharmaNet system. “PrescribeIT also introduced data privacy and security risks, and its business model was cost prohibitive,” the statement said.

Nova Scotia’s Department of Health and Wellness told The Globe by e-mail that it, too, declined to join the federal platform because of concerns about the “funding-model sustainability” of PrescribeIT, among other reasons.

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PrescribeIT enjoyed more success in the other two provinces where it was fully rolled out for prescribers by early 2025: Prince Edward Island and Ontario.

In PEI, PrescribeIT integrated easily into the province’s pre-existing, single electronic medical record system, which was already run by Telus Health.

In Ontario, meanwhile, 92 per cent of prescribers and 94 per cent of pharmacies were enrolled in the program as of February, 2025, the documents say. It’s not clear how many of those Ontario prescribers used the system regularly, but the small share of total prescriptions sent over PrescribeIT nationally suggests high enrolment didn’t necessarily equal frequent use of the tool.

Still, some prescribers are sorry to see PrescribeIT closed.

“We heard nothing but positive things,” said Matthew Lawson, president and CEO of Georgian Bay General Hospital, which launched PrescribeIT in its emergency department last November. ER doctors “understood the benefit for patients, they understood the benefit from a clinical safety perspective. Everyone bought in.”

What Mr. Lawson and his staff didn’t know was that just as they were going live with PrescribeIT, Infoway’s board was voting to kill it.

The death knell had begun to sound as far back as 2023, according to committee testimony from Health Canada officials last month. They said Ottawa had agreed for only three more years of federal funding and then the service had to be self-sufficient.

Infoway’s board spent the following years looking at its options. Beginning Jan. 1, 2025, it started to charge pharmacies – but not doctors – a 20-cent fee for every transaction. The move provoked a backlash from the Canadian Pharmacists Association, which said pharmacists would quit PrescribeIT.

The charges were not enough: Infoway earned about $2.6-million in fees between January of 2025 and March of this year, well short of the nearly $11-million a year Infoway paid Telus Health.

“I think anyone in business will know that was just not going to fly,” said Ronan Segrave, a health care consultant who served as an interim chief operating officer for Health PEI last year.

Infoway’s board also looked for a private-sector partner to take over the service. But while more than a dozen organizations initially expressed interest, only a couple submitted formal bids.

In the end, the board decided to cut its losses. On Nov. 12, it voted to wind down PrescribeIT if provinces and territories wouldn’t agree by Nov. 28 to take on some of the costs. They wouldn’t.

Infoway now says it is moving to an “open standards” model in which it sets the rules for competing private providers of e-prescribing solutions.

Infoway did not respond in detail to The Globe’s questions. Instead, the organization touted the news that Ottawa and Quebec had agreed to a three-month extension of a PrescribeIT pilot project in the Eastern Townships. Quebec had been planning to expand the platform to 1,900 pharmacies in 2027-2028 before Infoway voted to wind it down. Quebec Health Minister Sonia Bélanger said in an announcement of the extension that she hoped discussions with the federal government could extend the program long-term.

Ms. Leach, the Hamilton pharmacist, thinks artificial intelligence may succeed where PrescribeIT failed. She removed PrescribeIT when the 20-cent fee kicked in. Since then, she’s adopted a cloud-based system from the Toronto software maker Box Labs Inc. that uses AI to read digital faxes and automatically enter the pertinent details into her system.