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In the much-discussed federal budget there was only one passing reference to the health-care system.

Enjoy the respite.

Governments are now trying to spend their way out of a recession, but it won't be long before the cuts start coming.

Health care is the single biggest expense in every provincial budget, so there will be a big bull's eye on the $172-billion in health spending.

After all, health spending has risen unfailingly (often outpacing the rate of inflation) since the advent of medicare nearly half a century ago.

But there is enough bad news around these days without adding to the grief by anticipating health-care cuts and trying to envisage what horrors politicians and policy-makers may inflict on medicare.

Let's focus instead on the new health dollars: the $500-million boost to Canada Health Infoway, the non-profit agency whose role is to promote electronic health record systems.

This is an investment in "virtual" infrastructure that is expected to create about 5,000 jobs over the next two years.

Job creation aside, developing electronic records is of vital importance for the health system. This is an investment that should have happened, stimulus package or not.

We should not fool ourselves into thinking that $500-million is anywhere near enough for the task at hand. The new influx of money brings the investment in Canada Health Infoway to about $2-billion.

Realistically, about $10-billion is required to get the job done.

And what exactly is the job?

Simply put, the goal is to record and track every health "transaction" - be it a vaccination, a prescription, a Pap test, a visit to the emergency room for stitches or heart surgery.

These transactions, now recorded principally on paper, would instead be registered electronically. This would result in a patient file (an electronic health record) that is accessible to health-care providers and, ultimately, to individuals. The data could also be used, anonymously, to track everything from outbreaks of food poisoning to trends in cancer diagnoses, and it would be a gold mine for health researchers.

It sounds like a relatively simple task - one that has been likened to the switch from paper bank books to plastic cards and online accounts.

But health transactions are infinitely more complex than financial ones.

Consider that there are an estimated 2,000 health-care transactions every minute in Canada. At a bank, there are about a dozen standard types of transaction - deposits, withdrawals, mortgage payments and so on - but in the health-care setting there are thousands.

There are also about 400,000 health professionals in Canada, including nurses, physicians and pharmacists. They toil in more than 700 hospitals, 1,600 long-term-care facilities, and countless clinics and retail outlets.

How do you create an electronic health record that is simple, accessible and secure? And how do you do so when there are hundreds upon hundreds of computer networks already operating that need to be integrated?

We cannot pretend the transition will be easy. Take just one example - family doctors. Who will pay for their computers? Research shows that, as inefficient as paper records seem, it takes significantly more time for individual doctors to type their records than to write them by hand. And if these records are going to be shared, there needs to be a common language - often complex codes from the International Statistical Classification of Diseases and Related Health Problems. The ICD-10 - the current standard - has 155,000 codes.

And how do you ensure that a patient who is rushed to the ER after a drug interaction from a prescription he just filled has the up-to-the minute records the emergency staff need?

Despite the expense and grief that creating electronic health records will cause, there are large potential payoffs in safety and time saved.

Consider that for every 1,000 hospital admissions, 75 people suffer an adverse drug event, often the result of something as banal as poor handwriting. Similarly, of every 1,000 laboratory tests performed, about 150 are unnecessary, but repeat tests are common because of an inability to track results.

One of Canadians' biggest frustrations is long waits in the emergency room, but studies have shown that for every 1,000 visits to the ER, 320 patients will be lacking crucial information in their files, which adds, on average, 1.2 hours to the wait.

Finally, according to Canada Health Infoway, when electronic health records are implanted - the current target date is 2016 - there will be cost savings in the order of $6-billion annually.

Before we start talking about cuts to health care, let's invest in efficiencies and in safety, beginning with an electronic health record.

For Canadians, that should be a stimulating idea.

apicard@globeandmail.com