The federal government is moving legislation forward to connect Canada’s notoriously fragmented health information systems, a weakness that has left many Canadians repeating medical histories and doctors struggling with incomplete records.

Bill S-5, the Connected Care for Canadians Act, received first reading on Feb. 4.

The legislation is meant to address what the government calls a fundamental structural flaw in allowing Canadian’s health information to be more securely and seamlessly shared between clinics, doctors, hospitals and provincial health systems. Essentially, today’s digital health tools do not communicate with each other.

As a Health Canada spokesperson told TechNX in an email exchange, Bill S-5 will “enable a connected health care system in Canada, where health information can be shared with patients and their health care providers, easily, effectively and securely across health IT systems.”

Overcoming the silo problem

While health care technologies have rapidly advanced and electronic medical records are now common, the systems used amongst hospitals, clinics and provincial health care providers are too often incompatible. Health and patient information is trapped in siloed systems that do not communicate with each other.

“Doctors, hospitals and health authorities record patient information using software products whose varying coding makes exchanging information across points of care, health organizations, provinces, and territories difficult, if not impossible,” the spokesperson added. “As a result, even though about 95 per cent of physicians use electronic records, fax machines and paper referrals are still common because systems cannot communicate with each other.”

The impacts of such disconnected systems are felt by Canadians, with 17 per cent reporting seeing a health care provider who did not have access to important medical records needed for their care. Eight per cent said delays in accessing critical records led to worse health outcomes, the spokesperson added.

“This fragmentation can put patient safety at risk when providers do not have a complete medical history, especially for people receiving care in multiple locations.”

Pushing for new standards

The goal of this legislation is to push health care technology providers to adopt common interoperability standards. These standards would govern how patient and health information is structured, accessed and exchanged.

It would ensure new technologies can access and use critical information in older systems, “without costly rewrites or data errors, as well as help ensure data within those systems have the same meaning,” the spokesperson said.

The legislation also looks to overcome another hurdle - what the spokesperson called data blocking - “where health IT vendors intentionally or unintentionally make health information inaccessible, further limiting access, use and exchange of electronic health information.

"This is especially problematic, for example, when patients wish to access their own information or clinicians change system providers.”

Working with provinces, protecting privacy

Because provinces control health care, the federal government insists this legislation is not about overriding provincial control or systems. By focusing on technology vendors, the legislation is meant to create a set of Canada-wide standards without mandating how provinces manage their health care systems.

“While the legislation is focused on a mandate for health IT vendors, it provides provinces, territories, and other health organizations with assurance that the digital tools they procure will support connected care. It also provides more consistent and harmonized rules for health IT vendors across jurisdictions,” the spokesperson said. 

“In the lead up to, and during any potential regulatory development process, the federal government will continue working closely and collaboratively with provinces and territories to support their own approaches to improving health data access, exchange, and use. The federal approach would serve only as a backstop in provinces and territories where there is an absence of similar legislation and regulations.”

When asked about issues of privacy around Canadian health information, the spokesperson said while the legislation puts technical standards in place to support the exchange of information, it does not compel the sharing of that data.

“Existing privacy rules and legislation will continue to apply,” the spokesperson said. “The government intends to work collaboratively with provinces, territories, partners and stakeholders to support the implementation of these standards, including phased timelines and sufficient lead time for vendors to develop, test and roll out solutions.”