Being well informed about what’s going on in healthcare and its outcomes is in everybody’s interest. Provincial, Territorial, and the Federal governments need the information to manage their “systems”. Providers need it to assess their effectiveness. The public needs it to know if their interactions with hospitals, doctors and others are efficiently conducted and consistent with high standards. Few ask but they also should know if they are getting their money’s worth. And Canada as a whole needs information to know how we stack up against other countries. Currently we can hold nobody accountable for providing that information because there’s nobody in charge. Health information management has no leadership, no governance.
Canada Health Infoway, established in 2001 as a federal:provincial initiative funded by the federal government, was never intended to be a governance. Its mission was to develop the technologies, standards, and other ingredients necessary to tie together the widely diverse health information systems used by Canada’s individual and institutional providers, provinces, territories, and the federal government. Despite its diligent efforts and the expenditure of over $2 billion, Infoway’s vision of a unified “digital health ecosystem” remains off on the far horizon. Why? Largely because collectively we have shied away from establishing that most key of other ingredients, a governing body we can hold accountable for tying together those still diverse health information programs into a single interconnected digital system that meets all our needs. There will be no unified digital health ecosystem in Canada without leadership. Governance is essential.
How can governance over an integrated Canadian health information system be established? First let’s acknowledge some realities that are not going to change:
- Healthcare is primarily a provincial/territorial responsibility
- There will continue to be fourteen healthcare “systems”, one in each province and territory, each with its differences, and one, somewhat different again, run by the federal government
- Dominance, much less direction, by a single government, especially the federal one, is unacceptable
- In the absence of an integrated health information system, every jurisdiction will suffer increasingly from the absence of the collective processes and outcome measures essential to improve its own healthcare system, render it more affordable, better able to meet the needs of the people it serves, and to assure taxpayers’ that their money is being well spent.
- Absent a functional national health information management system, Canada will continue its slide to the bottom of international comparisons of the efficacy of comparable countries’ health systems
The Council of the Federation (CoF) offers a way to provide that system with leadership. Established in 2003 as part of their joint commitment “to play a leadership role in revitalizing the Canadian federation and (build) a more constructive and cooperative federal system”, the Council is a joint endeavor of the Provinces and Territories. It is entirely feasible for it to invite the federal government as a participant in a process, conducted under the Council’s aegis, to establish a neutral, independent, a-political body charged with creating, leading, and governing a coordinated Canadian health information management system. It should be small, made up of perhaps 8 to 10 respected leaders drawn from across Canada, broadly experienced in the application of information derived from digital systems to manage large enterprises including health, and none of them ‘representative’ of any government. It would derive its authority and be accountable to the CoF and its invited federal participant.
With apologies to the songwriter Jimmy Webb, our situation is somewhat analogous to the cake ruined in the rain. We know what we want to bake – an integrated health information management system that benefits us all. We have misplaced the recipe but can draw on people in Canada and elsewhere who have baked cakes like this before. We have most of the ingredients – the various unconnected digital systems out there throughout Canada; the few technologies we may not have are readily available off the shelf. And we have the bakers – CIHI, Statistics Canada, and Canada Health Infoway. It remains for the Council of the Federation with the added participation of our national government to create the missing master chef, a governance, the authoritative leadership of an information management system, and put it to work.
Authored by members of the Queen’s Health Policy Council: