Article

Foundational Interoperability refers to establishing a layer where data is transmitted by one HIT system and received by another. For example, a patient's hospital records should be accessible to their outpatient practice, and providers should be able to access data from a patient's wearable device. Access to this data is crucial for providing comprehensive and timely patient care. Currently Canada does not have a national network connecting EMR vendors and other clinical data systems across provinces. This issue was addressed in Bill C-72 the Connected Care for Canadians Act on June 6th, 2024. Parliament recognized the increased mobility of Canadians and health care professionals within Canada. Canada Health Infoway estimates that improved interoperability would save as much as $2.4 billion annually. The purpose of this article is to explore the current state of foundational healthcare interoperability in Canada, identify the challenges that exist, and discuss potential solutions to ensure better data sharing across the country’s healthcare system.

The Current State of Healthcare Interoperability in Canada

Canada's healthcare system is provincially managed under federal guidelines with significant funding. However, regional service delivery varies, and inconsistent digital health integration creates data exchange gaps. Challenges such as disparate EHRs, incompatible systems, and lack of standardized protocols, result in the hinderance of information sharing. A 2020 CIHI report noted progress in some provinces but highlighted that Canada largely lags in comprehensive, interoperable health information systems.

A significant barrier to healthcare interoperability in Canada is the lack of national standards for health data exchange. Without proper standardization, healthcare organizations use proprietary solutions that may not be compatible with other systems. This complicates data integration and hinders real-time, accurate decision-making. Currently, Canada Health Infoway is working through a FHIR implementation guide to define a patient’s profile that EMRs can use for data transfer. Though standards in the Pan-Canadian Interoperability roadmap are due for finalization in 2027, it will take time for EMRs and other systems to adopt these standards, potentially delaying the implementation of nationwide interoperability.

Potential Solutions to Enhance Healthcare Interoperability

There are a few approaches taken to promote nationwide interoperability in several areas:

• HIE (Health Information Exchange): In this approach, healthcare systems store clinical data in one central location. This makes it easy to access all a patient’s information from one place. For example, Malaffi, an HIE in the Middle East, uses this method. However, storing large amounts of data for millions of people can be expensive and hard to scale, especially in countries like Canada with a much larger population.
• Network Approach without EMPI and RLS: This model uses a network where each healthcare system has a directory of patient data but does not store any demographic details. When a request is made, the system searches for patient data within a specific area (e.g., a 50-mile radius). Carequality in the U.S. uses this method. It doesn't require long-term storage of patient information but rather depends on accurate patient matching, with a risk of missing data outside the search radius.
• Network Approach with EMPI and RLS: This approach stores only patient demographics (such as name and address) and uses an EMPI (unique patient identifier) and an RLS (service indicating where a patient's data is stored). When a request is made, the system locates the patient's data and sends the request to those locations. CommonWell Health Alliance in the U.S. uses this method. As a result, this approach makes finding patient data easy but requires maintaining the EMPI and RLS systems.

Conclusion

Improving healthcare interoperability in Canada may be challenging but is essential to a comprehensive healthcare system that benefits all Canadians. Efficient data exchange will enhance patient care, reduce administrative burdens, and minimize medical errors. All patients will benefit from accurate, timely, and coordinated care.

By tackling fragmentation with standardized data formats and national strategies, Canada can achieve a more connected healthcare system. The goal is to ensure healthcare providers have the necessary information to deliver optimal care, leading to a healthier, more efficient system for all Canadians.