Over a sandwich on the exhibit hall floor and a white chocolate chip cookie the size of my head, I had an interesting conversation about national health IT initiatives with a radiologist attending from Hamilton in Ontario, Canada, David A. Koff, MD. What is interesting are the parallels between the Canadian and the US efforts to built a functional national EMR. The level of financing and its source are very much the same. Canada is spending about $2 billion on its effort, the Canada Health Infoway, and the US, with about 10 times the population, has allocated close to $20 billion in the stimulus package. Both efforts are government financed. The big difference is that Canada has expressly reserved about $400 million, almost a quarter of the total, to build a nationwide Digital Image Repository that will hold images and reports. Part of that funding will also go towards financing up to 50% of a PACS purchase for a hospital that requires one. The DIR will be composed of 18 or 19 storage vaults and will contain images and reports for the life of the patient. Most provinces have anointed a preferred PACS vendor. “It is either the most stupid or the most brilliant idea I’ve ever heard,” Koff commented. “I’m not sure which.” Several more questions occur. Why has Canada reserved almost a quarter of its EMR budget to finance imaging informatics when the US stimulus bill did not even mention radiology by name?