Here, we take a deep dive into the status of digital health in Canada, covering progress in areas such as electronic health records, emerging technologies, and digital health priorities.
In a message during digital health week, Mark Holland, Canadian Minister of Health and Ya’ara Saks, Associate Minister of Health and Minister of Mental Health and Addictions, shared an update on digital health in Canada. The message highlighted the promise of digital health in “transforming the delivery of care and improving health outcomes across Canada”, but also noted challenges, such as that only around one third of Canadians can currently access some of their health information online, and that clinicians “can’t easily access or share patient health information, because electronic health care systems don’t always connect”.
The message referred to some of the latest developments in Canadian digital health, including the adoption of the Joint Action Plan on Health Data and Digital Health, which committed to a number of actions including adopting common interoperability standards to better connect health care systems and allow citizens and providers to access electronic health information; and aligning provincial and territorial health data policies and legislative frameworks.
Here, we take a look at Canada’s progress across a number of different areas of digital health, including on virtual care, health data, and emerging technologies.
Health data and electronic health records
In a report titled “Pan-Canadian Health Data Strategy: Toward a world-class health data system“, an Expert Advisory Group highlights “the systemic fragmentation of health data, ineffective pan-Canadian health data governance and antiquated policies that have prevented timely data sharing”. The report further warns of the risk of “irreparable fragmentation of health data that will harm individuals, communities, and all of Canada due to unaligned and often competing interests that may erode the common values and principles” of the health system.
On the future of health records in Canada, the report states that the Expert Advisory Group does not favour the suggestion of a “single, consolidated, pan-Canadian EMR”, due to “challenges in coordination across provinces and territories, the long history of major investments in existing systems with unfulfilled interoperability potential, and the higher risk of over-reliance on a single vendor”. However, it does recommend that common integrated data standards and person-centred health data architecture are developed to ensure data from all health sources is linkable, to “ensure completeness of. the patients’ health record”.
Some examples of electronic health records across Canada’s provinces are outlined below.
In Alberta, MyHealth Records offers citizens of the province the opportunity to access personal health information including results, immunisations and diagnostic imaging reports online or through a mobile app. It also offers access to MyAHS Connect, which is a tool allowing patients to prepare and manage upcoming appointments, communicate with their care team, add images or documents to their health record, and request prescription renewals.
In British Columbia, citizens can access health records, lab results, imaging reports, medications, health visits, hospital visits and vaccination records through the Health Gateway website or mobile app.
In Saskatchewan, MySaskHealthRecord gives residents access to personal health information, including clinical visit history, lab test results, medical imaging reports, prescription history, immunisation history, measurements, appointments, and clinical documents such as discharge summaries or operative notes.
Virtual care
On virtual care in Canada, a report from the Canadian Institute for Health Information* on the expansion of virtual care in the country, noted the “sudden rise in demand for virtual care” since the onset of the COVID-19 pandemic. The report also highlighted that “Canada has historically lagged behind its international peers in its adoption of information technologies”. It invited representatives from provinces and territories across Canada to participate in semi-structured interviews, before looking at themes such as strategy, governance, direction-setting, programmes and initiatives.
From the interviews, four common themes emerged for virtual care: equity, data standards and interoperability, health human resource challenges, and patient and provider engagement. The report notes that “most jurisdictions are focused on interoperability within their own province or territory”, as “they recognize that a future priority must be broader Canadian interoperability”.
According to statistics from the Canadian government’s website, by April of 2020, around 60 percent of health care visits in the country were virtual, compared with 10-20 percent in 2019. Whilst these changes “significantly enhanced access to services during COVID-19” however, “virtual care tools were often implemented as temporary/stop-gap solutions, and were not integrated into provider workflows or designed with the patient experience in mind”. Moreover, the change was not sustained, with the percentage of virtual visits dropping back to 40 percent by August of 2020.
Three main areas of focus in virtual care have been identified by federal, provincial and territorial (FPT) governments: funding to provinces and territories through bilateral agreements with “shared priorities for technology and infrastructure” such as remote monitoring and video conferencing; evaluation of impact of virtual care to improve outcomes and evaluate new digital health investments, as well as the development of “a pan-Canadian approach through a digital health evaluation framework”; and the development of an FPT policy framework to identify barriers and opportunities for “longer-term adoption of virtual services within Canadian health systems”.
Research
From research on electronic health data in Canada, a study published in BMC Health Services Research, titled “The current and potential uses of Electronic Medical Record (EMR) data for primary health care performance measurement in the Canadian context: a qualitative analysis”**, looked at the use of electronic medical record data in measuring and improving quality of care.
Main findings included that “while jurisdictions remain at varied stages, recognition of the importance and potential secondary uses of EMR data is common”, but that “nonetheless, while nearly 15 years since the initial launch of a pan-Canadian PHC indicator set and almost a decade since its updating to include EMRs as a possible source, EMR data is used in only a handful of initiatives for performance measurement”. The study also highlighted how “patients and the public are not among EMR data users at present, as the reporting across initiatives is not publicly available, nor is consistent patient access to their EMRs common practice”.
A separate study published in Healthcare Management Forum, titled “Virtual care: Enhancing access or harming care?”***, analysed virtual care models in Canada to better understand their implication and impact on access to health services.
This study generated three recommendations for policymakers. The first is that given the “uncertain custodianship and ownership of the data generated under these models”, it is “essential that policy-makers wait for privacy impact assessments before proceeding with virtual care so that it is implemented in a manner that complies with privacy laws”. The second is that because of the “convenience” of virtual care, “policy-makers should prioritize virtual models that facilitate electronic access to one’s own doctor over virtual walk-in clinic doctors with whom patients do not have an established relationship” and should be cautious to address the fact that “virtual models will naturally exclude some groups”. The final recommendation is that “policy-makers must ensure the public understands the significant limitations on AI-generated health recommendations”, and that Health Canada should be sure that its regulatory approach “keeps pace with these emerging technologies”.
Emerging technologies
When it comes to emerging technologies, what steps are the Canadian government and health sector taking to embrace and regulate new technology such as AI?
Back in 2021, the Canadian government also published guiding principles on good machine learning practice for medical device development. These principles included leveraging multi-disciplinary expertise throughout the product lifecycle, implementing good software engineering and security practices, placing focus on the performance of the human-AI team, monitoring deployed models for performance and risk, and ensuring clinical study participants and data sets are representative of the intended patient population.
In a news release from September of 2023, the government announced the launch of Canada’s Voluntary Code of Conduct on the Responsible Development and Management of Advanced Generative AI Systems. The code “identifies measures that organizations are encouraged to apply to their operations when they are developing and managing general-purpose generative artificial intelligence (AI) systems”. It forms a “critical bridge” for the introduction of the Artificial Intelligence and Data Act (AIDA), which was introduced as part of Bill C-27 in June of 2022. It sets out six core principles: accountability, safety, fairness and equity, transparency, human oversight and monitoring, and validity and robustness.
Canada’s Drug and Health Technology Agency (CADTH) regularly completes horizon scans and reviews of emerging health technologies and their implications for the health sector. Some of the most recent publications include a horizon scan on AI decision support tools for end-of-life planning, a review of ChatGPT in radiology for appropriate imaging and workflow efficiencies, and a review of Canadian medical imaging inventory from 2022-2023.
Priorities
Health Canada’s Departmental Plan for 2023-24 outlines a range of priorities in health, including “putting digital health and virtual care at the heart” of collaboration with partners, and working toward a “modern and connected, world-class health system where Canadians can interact digitally with the health system and access their own health data electronically; where health professionals can share data to improve safety, quality, and care; and, report on how the system is working”.
Other priority areas include advancing the interoperability of digital health solutions, e-prescribing, and sharing learning and best practices on equitable adoption of virtual care and digital health solutions.
*Canadian Institute for Health Information. The Expansion of Virtual Care in Canada:
New Data and Information. Ottawa, ON: CIHI; 2023.
**Barbazza, E., Allin, S., Byrnes, M. et al. The current and potential uses of Electronic Medical Record (EMR) data for primary health care performance measurement in the Canadian context: a qualitative analysis. BMC Health Serv Res 21, 820 (2021). https://doi.org/10.1186/s12913-021-06851-0.
***Hardcastle L, Ogbogu U. Virtual care: Enhancing access or harming care? Healthcare Management Forum. 2020;33(6):288-292. doi:10.1177/0840470420938818.
