Carolyn Steele Gray holds a Canada Research Chair in Implementing Digital Health Innovation at the Science of Care Institute and Lunenfeld-Tanenbaum Research Institute at Sinai Health, and is an associate professor at the Institute for Health Policy, Management and Evaluation at the University of Toronto.
The introduction of Bill C-72, or the Connected Care for Canadians Act (announced by Health Minister Mark Holland in June), marks a pivotal moment for the interoperability of health-information systems in Canada.
The bill is intended to help improve information sharing between health care entities, and thus help improve co-ordinated care for Canadians. It does this mainly by requiring health technology vendors operating in Canada to stop blocking efforts by health care providers to share patient data amongst themselves and with patients, and for vendors to adhere to standards that make information easier to move. Among the many major issues facing health systems across the provinces is the need to address siloed care in order to better meet the needs of Canada’s aging population.
As our population grows older, we’re seeing more folks with multiple chronic illnesses and intersecting health and social care needs. Patients often need to access services from many different providers, including hospitals, specialists and primary care offices. Being able to share patient information easily from one place to another, and having that information made accessible to patients and their families and caregivers, is essential to co-ordinating care.
Having spent a good amount of my academic career as an implementation scientist studying digital health in relation to integrated care, I’ve reflected on the responses to Bill C-72 from colleagues working in the field. I agree with many of them that this legislation marks an important step toward addressing the policy and regulatory barriers to information sharing in the Canadian health system. We have built, deployed and tested digital tools that aim to support information sharing and integration at our institute, and have many times run up against the roadblocks Bill C-72 is aiming to dismantle. If the bill passes, it will have a chance to meet its goals of preventing data blocking and improving access to health information.
But will this bill help with co-ordinating care? On its own, I don’t think so.
To be fair, it helps address one key factor of co-ordination: information sharing. But we have to acknowledge that having access to information is not the same thing as co-ordinating care. While I don’t think the bill really claims to fully take care of co-ordination, suggesting that it can is too big of a logical leap for me – this bill is not a panacea for all that ails the co-ordination of health care in Canada. For co-ordination to really occur, information not only needs to be available, but it needs to be understandable by those who read it (including patients), while being available when it is required, and actually fitting in with how our already-overtaxed clinicians and health staff do their work. I wouldn’t necessarily say that the number of steps between making information available and actual co-ordination of care is comparable to the staircase that winds its way up the CN Tower, but I’m not not saying that either.
In my opinion, Bill C-72 is necessary, but not sufficient. In a federalist system like ours, this is likely a good step for the federal government to take (though I would also like to see them tackle problems like data ownership and governance in interoperable systems, which are related and challenging problems). If Bill C-72 gains Royal Assent, it will be up to the provinces to establish how they will go about implementing this policy.
There is an opportunity to use this momentum to set up partnerships, funding models, care delivery networks and engagement strategies to ensure information sharing actually leads to the proper co-ordination of care for Canadians. But there is also a risk that a policy aimed at health-tech vendors might hit stumbling blocks. Such vendors are by and large good partners, but they tend to be most successful when they have a focused scope, as they are attuned, by nature, to solving technical problems.
Since co-ordinating care is also a relational problem, it requires collaboration between people and processes, and even values. Care co-ordination requires a collaborative approach, with patients, caregivers and clinicians all working in tandem with the managers and leaders guiding the process, and with the organizations and provincial bodies funding, regulating and governing the system.
There will be an implementation problem to tackle next. The federal government has taken steps to dismantle one of the barriers to co-ordination by introducing this bill, but it will be up to the provinces, health networks and care organizations to work with providers, patients and families in mapping out the roads that allow our patients to get where they need to go.