Canadians value their health care system above any other social programme. Canada's system of health care faces significant financial and population pressures, relating to cost, access, quality, accountability, and the intergration of information and communication technologies (ICTs). The health-system also faces certain unique challenges that include care delivery within a highly decentralised system of financing and accountability, and care delivery to a significant portion of the population sparsely distributed across a land mass of 10 million square kilometres, in areas of extreme climatic conditions. All of these challenges are significant catalysts in the development of technologies that aim to significantly mitigate or eliminate these selfsame challenges. The system is undergoing widespread review, nationally and within each province and territory, where the bulk of care provision is financed and managed. The challenges are being addressed by national, regional and provincial initiatives in the public, private and not-for-profit sectors. The promise of e-health lies in the manner and degree to which it can mitigate or resolve these challenges to the health system and build on advancements in ICTs supporting the development of a health infostructure. Canada is actively developing and implementing technological solutions to deliver health information and health care services across the country. These solutions, while exciting and promising, also present new challenges, particularly in regard to acceptable standards, choice of technologies, overcoming traditional jurisdictional boundaries, up-front investment, and privacy and confidentiality. Many organizations and governments are working to address these challenges. Canada Health Infoway, a not-for-profit corporation, was founded by the first ministers in 2001 to accelerate the establishment of an interoperable, pan-Canadian electronic health record. It works with partners in the federal, provincial and territorial jurisdictions to define replicable solutions for establishment of the major elements necessary to achieve this goal. The Canadian Institute for Health Information (CIHI) will also continue to play an increasingly significant role in these initiatives, as the management of health information becomes a more crucial factor in the successful delivery of health care services in the new millennium.