Disconnected at the Point of Care: Why Canadian Physicians and Pharmacists Operate in Silos — and What It Costs Patients

In an ideal healthcare system, the physician who writes a prescription and the pharmacist who fills it would share a continuous, accurate view of a patient's medication history. They would know what has already been tried, what failed, what caused adverse reactions, and what other drugs are currently in play. In Canada, that ideal remains frustratingly out of reach for the majority of patients — not because the technology is unavailable, but because the systems, incentives, and professional cultures surrounding prescribing and dispensing have not yet converged.

The result is a persistent and consequential gap at the very point where medication safety is most critical.

Two Professions, Two Information Ecosystems

Canadian physicians typically document patient care within electronic medical record (EMR) systems tied to their clinic or hospital network. Pharmacists, meanwhile, maintain their own dispensing records within pharmacy management software. These two ecosystems rarely communicate in real time. A family physician in Saskatoon may have no reliable way of knowing that a patient filled a prescription at three different pharmacies in the past six months, or that a specialist added a new anticoagulant to their regimen last week.

This is not a marginal problem. A 2022 report from the Canadian Institute for Health Information noted that medication-related incidents remain among the most frequently reported patient safety events in the country. Many of these incidents trace back not to prescribing errors in isolation, but to information failures — situations where one clinician simply did not know what another had already done.

Dr. Miriam Osei, a family physician practising in Hamilton, Ontario, describes the frustration plainly: "I'll see a patient for the first time, review what I have in front of me, and write what I believe is an appropriate prescription. Later I learn from the patient — not from any system — that they tried that same medication two years ago and stopped because of side effects. That information should have been available to me before I picked up my pen."

The Duplicate Therapy Problem

One of the most clinically significant consequences of this disconnect is the prescribing of duplicate therapies — situations where a patient ends up on two medications from the same drug class, either because a new prescriber is unaware of an existing prescription or because a lapsed prescription was never formally discontinued in any shared record.

Pharmacists are often the last line of defence against this kind of overlap, and many catch it. But their ability to do so depends on whether the patient fills all their prescriptions at the same pharmacy, whether they accurately report their current medications, and whether the pharmacist has time for a thorough review during a busy dispensing shift. None of these conditions are guaranteed.

At Canadian Pharmacy Online HQ, pharmacists conducting medication reviews through our platform consistently identify patients who are managing conditions with therapeutic duplications that went undetected for months. These are not rare edge cases. They are a predictable output of a system that does not yet require its two most medication-focused professions to share information routinely.

Why the Gap Persists

The barriers to integrated prescribing and dispensing records in Canada are layered and not easily resolved by any single intervention.

Jurisdictional fragmentation is perhaps the most significant structural obstacle. Healthcare in Canada is a provincial and territorial responsibility, meaning that data-sharing frameworks, privacy legislation, and health information infrastructure vary considerably from one province to the next. A national prescription drug information network has been discussed for decades, but progress has been uneven. British Columbia's PharmaNet system, which links prescribers and dispensers across the province, is frequently cited as a model — yet comparable systems do not exist in every jurisdiction.

Legacy technology compounds the problem. Many physician clinics and community pharmacies operate on software platforms that were not designed with interoperability in mind. Connecting these systems retroactively requires investment, standardisation, and in many cases, the replacement of infrastructure that healthcare providers have built workflows around.

Professional culture and accountability structures also play a role. Prescribing has historically been understood as the physician's domain, while dispensing belongs to the pharmacist. Formal mechanisms for bidirectional communication — where a pharmacist's clinical observations routinely inform the prescriber's next decision — are not yet embedded in most practice environments.

"There's an assumption built into the system that communication will happen informally," says clinical pharmacist Renée Tremblay, who works within a collaborative care clinic in Montréal. "And sometimes it does. But informal communication scales poorly. It depends on personal relationships, geography, and time — and none of those can be relied upon across an entire healthcare system."

Where Progress Is Being Made

Not every corner of Canadian healthcare is standing still on this issue. A number of forward-thinking models are demonstrating what integrated care can look like when the structural conditions support it.

In primary care networks across Alberta, embedded pharmacists — practitioners who work alongside physicians within the same clinic — have become increasingly common. These arrangements eliminate much of the communication gap by design: the pharmacist has access to the same patient records as the prescribing physician and contributes directly to medication planning decisions.

Digital health initiatives are also advancing. Canada Health Infoway has invested significantly in electronic prescribing infrastructure, and the uptake of e-prescribing in provinces such as Ontario and Nova Scotia has created new opportunities for real-time data sharing between prescribers and dispensers. When a prescription is transmitted electronically rather than printed on paper, it creates a digital record that, in principle, both parties can access and act upon.

Online pharmacy platforms are contributing to this evolution as well. Services like Canadian Pharmacy Online HQ maintain comprehensive medication histories for patients who fill prescriptions through the platform, enabling pharmacists to identify patterns and flag concerns that might not be visible to a physician reviewing only clinic records. Patients who centralise their dispensing through a single trusted provider benefit from a more complete medication profile — one that is actively reviewed before each order is processed.

What Patients Can Do Now

While systemic change continues to develop, Canadian patients can take practical steps to reduce their own exposure to the risks created by this communication gap.

Maintaining a personal medication list — including the name, dose, frequency, prescribing physician, and start date of every medication currently in use — and sharing it at every clinical encounter is a simple but powerful intervention. Patients should not assume that their physician and pharmacist are already comparing notes. In most cases, they are not.

Filling all prescriptions through a single pharmacy or online pharmacy service is equally important. Consolidated dispensing records give pharmacists the information they need to catch interactions, duplications, and contraindications before harm occurs.

Finally, patients should feel empowered to ask their pharmacist directly: "Is there anything in my current medications that my doctor should know about?" That question, asked routinely, can open clinical conversations that the system itself is not yet structured to initiate.

A Gap That Cannot Be Ignored

The communication divide between Canadian prescribers and dispensers is not a minor administrative inconvenience. It is a structural vulnerability at the heart of medication safety — one that affects patients managing complex chronic conditions, those who see multiple specialists, and anyone whose care crosses organisational boundaries.

Closing it will require coordinated investment in interoperable health information systems, clearer provincial frameworks for data sharing, and a professional culture that treats prescribing and dispensing as genuinely collaborative acts. The building blocks exist. What remains is the collective will to assemble them.