Canadian Bill Would Require Interoperable Health IT

New legislation would require health information technology (IT) to be interoperable across the country, thus allowing patients and healthcare providers to access health data from different electronic medical records.

The Connected Care for Canadians Act, also known as Bill C-72, says, “data blocking by a health information technology vendor is prohibited.” This language targets healthcare institutions and IT vendors that don’t foster easy or secure sharing.

Although the legislation is deemed “crucial” and estimated to save as much as $2.4 billion each year due to better interoperability of systems, there’s a long road ahead in terms of implementing change, according to a new analysis in the Canadian Medical Association Journal (CMAJ).

“Almost every patient and provider in Canada has experienced the negative effects of electronic health record systems that are not interoperable,” senior author Andrew Pinto, MD, associate professor of medicine at the University of Toronto and director of the Upstream Lab at Unity Health Toronto, Toronto, told Medscape Medical News.

“Everyone can relate to having to repeat their medical history or not having test results from a different institution available when they see a specialist or trying to remember their list of medications when they go to an urgent care clinic or emergency room,” he said. “Every family physician and nurse practitioner has wasted hundreds of hours of time on tracking down results or trying to find something in old records. The time for change is now.”

The analysis was published online on December 9 in CMAJ.

Moving Toward Interoperability

The Canadian federal government introduced Bill C-72 in June 2024 to prevent data blocking and promote secure access to health information. To do this, the legislation allows for regulations related to standards for health IT vendors, compliance measures, and financial penalties for violations.

Looking at electronic medical records in particular, Pinto and colleagues noted that interoperability would reduce medical errors, duplication of health services, and healthcare costs. In turn, it could improve medical research, healthcare innovation, and patient care.

The proposed legislation also could help establish appropriate health data governance in Canada, minimize the influence of the commercial determinants of health on patients, and prevent the financialization of health data, the authors wrote. 

Of course, several challenges remain. If the legislation passes, health systems will need the capacity to coordinate information sharing and new policies will need to minimize additional strain on healthcare institutions. They especially will need to help clinicians who already are struggling with administrative burdens, the authors wrote. The initial short-term stress of adapting to a new system should be worth the long-term gain in interoperability, they said.

In addition, a new system will require a new data governance model in which healthcare organizations or clinicians are no longer the custodians of health information who “allow” access to patients. Instead, a patient-centered model would give individuals the ability to control their information and delegate authority to others. For instance, the Canadian Institute for Health Information’s Pan-Canadian Health Data Strategy proposal could be a promising model, said Pinto and colleagues.

Finally, new legislation should ensure that commercial interests aren’t prioritized over Canadians’ health, they wrote. Under the current system, dominant vendors don’t favor interoperability due to economic incentives, but under a new system, vendors will need to be consulted — but not prioritized — in developing policies and regulations that foster data sharing.

To support public engagement, Pinto and colleagues at the Upstream Lab are launching OurHealthData.ca, which features educational resources, recent research, and ways to get involved.

“We are at a crucial moment — in Canada and in many other countries — to envision a new system to govern our health data,” Pinto said. “Bill C-72 is a short piece of legislation with the potential for big impact. It needs everyone’s input to make it more specific and enforceable, and we need to ensure that this happens now.”

Improving Indicators for Interoperability

Successful implementation of Bill C-72 will require all parties to agree on the same objectives and indicators of interoperability, said Michael Wolfson, PhD, a population health researcher at the Centre for Health Law, Policy, and Ethics at the University of Ottawa, Ontario, Canada. Wolfson, who retired as assistant chief statistician at Statistics Canada in 2009, wrote an accompanying commentary in CMAJ.

“Canada suffers from what I call ‘indicator-itis,’ by which I mean there’s interest in having indicators of success, but people don’t understand what’s actually useful,” Wolfson told Medscape Medical News. “We have a fundamental need for valid, probing measures of interoperability rather than Mickey Mouse measures that don’t mean anything.”

In the commentary, Wolfson proposes the following three important indicators of interoperability: the proportion of a province’s or territory’s population that can access and read their entire electronic medical record; provider access to elements of patient data; and secondary uses of data for statistical, health quality, and research purposes. 

“What information would we really like to have? I need to be able to know how many other doctors my patient is seeing, what drugs have been prescribed, and what happened if they went to the hospital,” he said. “Interoperability isn’t just a nice-to-have feature for statistics or health quality control. It’s something that saves lives.”

Pinto and Wolfson reported no relevant financial relationships. 

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape Medical News, MDedge, and WebMD.