DHiC 20 – Transforming Health Data, Transforming Canada

This transcript was generated by AI and may contain minor errors.

Dr. Anderson Chuck: We can’t outspend here. We have to out-innovate.

Katie Bryski: Hello and welcome to Digital Health in Canada, the Digital Health Canada podcast. I’m Katie Bryski.

Shelagh Maloney: And I’m Shelagh Maloney.

Katie Bryski: And for our 50th anniversary of Digital Health Canada, we have 50 different reasons for you to listen to the show. Reason number 36: our guests aren’t just enabling better data, they’re enabling better futures.

In today’s episode, we explore what is possible if we unlock the full potential of health data in Canada. Across the digital health sector, organizations are striving to move us from silos to seamless systems. Today we welcome two leaders to share what excites them about this transformation, what’s at stake and what it means for our health and our health systems.

We are very pleased to welcome to the podcast Dr. Anderson Chuck, president and CEO of the Canadian Institute for Health Information; and Dr. Fahad Razak, co-founder GEMINI, and the Canada Research Chair of Health Care Data and Analytics at the University of Toronto.

Shelagh Maloney: One of the things that we do to start off the podcast and we wanna find out from you about your leadership journey, and this is often, uh, one of the things that we get most comments about.

And maybe we’ll start with you. Just tell us about where you started and how you ended up being the president and CEO at CIHI.

Dr. Anderson Chuck: Oh, man. Yeah. I, from a young age always knew I wanted to work in health care. My parents immigrated to Canada when I was about two and a half, and my father was a GP surgeon in the Philippines.

And when we arrived in Edmonton, he worked in the medical examiner’s office. So at a really early age I was surrounded by stories around health, health systems service, and I had originally thought I was gonna aspire to be a physician, but one day I was an undergrad and I was working at an Alzheimer’s care facility, and I really became interested in research, service delivery, and health systems functions.

And then from there I did a master’s in a PhD where I met a professor of health economics that pulled me into the world of health policy, service delivery, and system improvement. And from there I really became a strong believer in evidence informed decision making. And it made my mission to improve health systems in ways that respect to operational realities of care.

And that operational reality focus then took me to Alberta Health Services, where I wanted to learn firsthand and experience what service delivery and operational service delivery really looked like. There I was in financial planning and as Chief Health Economist, uh, we worked to develop the value-based resource allocation frameworks and trying to understand how you really actually run complex health system sustainability.

And then about 16 months ago, I took the leap to come over to CIHI because it represented something I thought was really, really unique. Which was a Pan-Canadian mandate in health data with a mission to improve the health of all Canadians. And it was just an opportunity that I felt that had the kind of scale where you could contribute, not maybe just at a hospital or a region or a province, but across the country.

And I felt that CIHI had that ability and the responsibility to use data to improve health systems and quality across the country. And so, in any ways, right, be Canada’s health storyteller. And that sense of impact really resonated with me. And the rest is history.

Shelagh Maloney: So far. I think the medical school’s loss is, the Canadian health care system’s gain.

I’d like to come back to that health and economics, but before we do that, Fahad, how about you? How did you get from where you started to where you are today?

Dr. Fahad Razak: I always had some level of interest in health care, but don’t have any physicians or clinicians in the family. So I wasn’t strong enough to really commit to it and I, I did an engineering degree as my starting degree, but had the chance one of the summers as a co-op to work with a research group that does incredible global health work and was just really inspired by it.

Spent time setting up some of their on-the-ground-work in Asia and actually went and lived in Asia for nine months as part of one of their studies, and caught the bug, did a graduate degree in that area of statistics and epidemiology. And then looked at where Canadian health care was going, and really realized that a lot of the action driving forward research in Canadian health care came from within the health sector itself.

So unlike the United States where a lot of the critical health research is done by people outside the system. A lot of the work here is done by people within the system, and that really to me was a pivotal turning point applied to medical school, went to the University of Toronto and once you’re in that tunnel, it’s a kind of a 10-year commitment.

And I came out out the other side still thinking I was gonna do global health, but at that point I was newly married. I had young children. And was thinking about the idea of traveling across the world every month for long stretches of time, and it just wasn’t appealing and shifted my interest towards Canadian health care and thought really about where I could harness my engineering statistics background and what Canadian health care needed and data was the kind of obvious opportunity.

At the same time, my closest friend and colleague from medical school, he was also interested in this area. So we joined together to create, at that point, what was a very small platform called Gemini. We worked at just seven hospitals and got some very basic data. This is the start of the rapid digitization wave that was occurring.

So over a decade ago in Canada, we were able to get just a few hundred data points that were digital, really poor quality, but that. Point allowed us to catch, I think a rapid digitization wave that happened over the last decade, and we grew to become the largest hospital research platform in the country.

Our platform now employs more than 50 people. It covers 25% of all of Canada’s beds, and it’s the major engine for research and innovation. In that area in possible data analytics. I’ll say one other critical turning point for me was the pandemic. I did not have any background in policy or really an interest in policy.

I was a member of a science advisory group in Ontario called the COVID-19 Science Advisory Table that ended up playing a critical role in translating science to policy, and I became the director of that table for the second half of its journey. And that ended up putting me in the room often with decision makers and policy makers, and it really opened up my interest to think about how to.

Translate my experience as a clinician, my work as a scientist, to helping with good policy for the country and for the province.

Katie Bryski: I find it really interesting that you referred to the term turning points a few times because I was thinking about that for both of you: that seems to be a pattern.

Dr. Fahad Razak: You know, one thing I tell students, or trainees or people that I work with who are starting their career is many or if not most of the people that I know who are happy in their work and do interesting things, have had big transitions in their career.

I think it’s really about finding what excites you in the moment. Believing that it’s going to make a difference. Committing to learning about that area, the skills, the approach, the philosophy, and doing the best you can, and that process itself, even if you’re not working in that area five years later, is incredibly helpful.

I tried to be a good engineer when I was an engineer. I tried to learn about global health and statistics and data. When I did that, I tried to learn about clinical medicine when I was training and all the little pieces of that come back and give me a lot of value now, kind of 20 years later in ways that I would’ve never anticipated.

Katie Bryski: That interest in that breadth of experience is also something that many Digital Health Canada members would be familiar with. And as I think about our audience, like they know that our health data system is siloed, that our health data is underutilized, especially for research and other secondary uses.

So I’m wondering, as we move into the health data part of the conversation, what do you think is essential for people working in digital health to understand about our landscape that maybe gets overlooked?

Dr. Anderson Chuck: You know, the thing is that what I’m about to sort of share with you? I’m not sure whether it’s something that would surprise people, but I think one of the biggest challenges to digital health and its adoption and its implementation is understanding that this is not necessarily a technology problem.

This is not so much that the technology’s not available. This is really more around it being a culture problem, right? I think there is already existing governance in legislation that allows for organizations to share data, but it comes down to whether organizations really trust each other, right?

Whether there’s clear governance and whether their incentives align. And so technology is not the rate limiting step. The hard work is really the legal, the policy, the organizational alignments, that social license. And so for me, I think about digital health as really this big. Culture project for the country.

If mindsets remain risk averse, siloed, there’s no amount of technology that’s gonna transform the system. But if the mindsets shift to trust and shared purpose and embracing data as sovereign national asset for the country, then I think we do unlock enormous prosperity for Canadians and for the country.

So at the end of the day, digital health is much more, at least to me, a people, a governance, a purpose, and a trust, um, issue than it is really about platforms. But if we get it right, prosperity for Canadians is within a striking distance.

Dr. Fahad Razak: I’ll just add – I’ve said this to Andy privately – I just feel that this is fundamentally a culture issue at this point.

And to have Andy in his position at CIHI, and you know, we have a few other people in other key organizations who have that vision, who do understand that it’s culture. We’re incredibly fortunate in Canada at this moment to have this because fundamentally, I think what is happening right now is a question of our ambition and culture.

Now, what I’ll say in terms of specific missed opportunities, I think there are serious access issues. I think there are huge economic opportunities that we are leaving on the table. I think there are serious equity gaps. I think that there are under service communities. I think about my parents in Windsor, Ontario who’ve been there for more than 60 years and who are in their eighties now.

The level of digitization and access that they get. Is significantly different than what we get in downtown Toronto. And that strikes me as unfair to Canadians because so much of our population lives in smaller communities. The final thing I’ll say is that often we talk about this kind of data as think about the miraculous AI or other things that would happen if you roll this out.

And I, and I’m excited by those areas. Don’t get me wrong. But I think just the simple access to data, the linkage will reveal incredible opportunities in Ontario. We’ve just started recording across the system, simple data about length of stay at the individual provider level, at the hospital level, and it’s made a huge impact.

We’ve seen this turnaround in the way that physicians and hospitals have been able to use the data and then learn from best quality opportunities. Our estimate is something like 50,000 bed days served per year. Just by that simple provision of data, there is abundant low hanging fruit in the system. If we can move ambitiously forward,

Shelagh Maloney: This gets back to that health is an economic driver in Canada.

We’ve never really thought about it that way, and I think. Data is such an important part. And so Andy, CIHI has just launched their transformation agenda. If you could maybe just give us the highlights of that transformation agenda. What are you most excited about around it and where do you think the biggest challenges are?

Dr. Anderson Chuck: So the first thing I would say to set this up, I really think that data should be seen in this country as another one of Canada’s great significant natural resource. It is as important as energy, as steel, as agriculture, as all these other things that the country has. And so I really believe that it is just something that is just there to be un tap.

And so CIHI’s transformation agenda is the fact that, okay, look, CIHI has this trusted pan-Canadian steward, right? We’ve been around for 30 years. We are independent and we incredibly housed and steward health information. But the needs of health systems have fundamentally changed from 30 years ago.

We need the ability to see in real time system capacity, resource availability, and the emerging pressures across the system. So our transformation agenda is really about orchestrating that health data ecosystem of tomorrow, connecting the infrastructure across the country and enabling the timely linked, relevant information across the full continuum of care, which means primary care, all the way to continuing care and bringing together administrative as well as clinical to enable that discovery and innovation at that scale for the country.

This is what transformation is for CIHI, which is I think still fully consistent with CIHI’s mandate, but with the trust and governance needed to do it well, and I should really mention that there’s no single organization out there that can do this by themselves. This is why partnership is so incredibly important, and so partnerships across the entire ecosystems.

That’s Ps and Ts, the federal government, clinicians, researchers, technology partners, but also platforms like GEMINI, Vital, CanSPARK, and others. Then if we were to able to achieve that, the outcome is this modern pan-Canadian health data ecosystem that could really serve the needs of today, but also prepare us for all those future challenges as well in terms of being ready for opportunity or emergency

Katie Bryski: Love that framing, especially as it truly is that greater than the sum of our parts. I’m curious now, Fahad, from your perspective as a collaborator, as a researcher, what excites you about this transformation agenda?

Dr. Fahad Razak: I’ll say that to a truly remarkable extent, CIHI is presenting an open tent. I was just had the privilege of being at their board retreat a couple of weeks ago, and at the table you had clinicians, researchers, the private sector patients, and I think the overarching theme here is CIHI saying quite humbly, we can’t do this alone, but also being willing to step forward and say, but we can support a consortium in a way that is truthfully unique.

And so I think that idea of both, we are the right body to convene. We can’t do it alone, and we are welcoming you to help us with the skillset scenarios that you know well to me, strikes me as the right model for this moment. I really worry that the default Canadian model, especially with respect to health data, is 14 jurisdictions of data rather than a unified halt that looks out on the world as Canada and competes as Canada.

I just got back from Denmark a couple of weeks ago visiting the Danish government and the Health Authority and, and seeing how they’re using data. And I have often cited their example as the example we need to learn from. And one of the things that was transformational about the Danish model was the fact that they presented themselves as a unified asset to the world.

One of the fundamental reasons why I think they’ve been able to move in this way is something that I think. Build on a theme that Andy highlighted earlier, which is that they don’t treat health data as simply the delivery of health care. And I think when they think about data, they have multiple areas of excellence in mind and they think about it as industrial policy.

And it’s interesting, if you look at the position statement that they’ve just put out about the use of data, it is a joint statement between four ministries and four ministers who jointly led it. One of course is the health minister makes sense. One is a minister for higher education. We, we have the equivalent of that provincially.

We don’t have that federally, it makes sense. But number three, in that equally holding position was their industrial, economic and finance minister. Who is talking about the use of health data. And the fourth is their Foreign affairs minister. So it is the brand of Denmark to the world to say our health data is excellent, do innovation here.

It’s part of their branding. I think there’s a lot we can learn from that more than just about health care delivery, really about innovation.

Shelagh Maloney: That’s a great point. And Harting back to your now famous, I think, Globe and Mail article. You talk about, and I’ve heard you say this before, about the diversity of the Canadian population and the data that we do have.

What would it take for Canada to be on that global stage in the same way that Denmark is on that global stage?

Dr. Fahad Razak: So thanks for the kind words about the Globe and Mail article. Let me talk about the fundamental argument here. So step back and ask yourself, if I was thinking of the best data set in the world to do innovation in health data, what attributes would it have?

So the first is that it would have diversity within it. Why is diversity important? We know that for clinical trials that harness this kind of data for health AI algorithms, they perform better for in terms of the scientific insights and precisions of that data if they are run on more diverse populations.

So for example. If you run a trial or develop a health AI algorithm in the 6 million person homogeneous population of Denmark, your ability to translate that both scientifically but also economically to China or Africa or India, is low, whereas you run it in Canada, the most diverse high income society on earth.

Your ability to translate out the scientific insights is better than any other place in the world. So the first is diversity, the second is population size. So these algorithms are data hungry. The larger the population you have available to you, the better you can develop these algorithms or run trials quickly and, and gain, uh, scientific insights quickly.

Denmark is 6 million people. Canada, if we could unify our assets, is 42 million people. That is an enormous population. If you put us together. The third is the quality of the data that’s being generated itself. So many systems are fragmented in terms of people with insurance, without insurance, different electronic health providers, some uh, some that are not digitized, some that are Canada, fundamentally is a single payer system.

So we have the ability to capture essentially everyone across this country. And we are essentially completely digitized for many important parts of the health system now. So we have high quality, comprehensive data. Then finally, scientific talent. So Nobel prize and Turing prize in AI in the last 24 months.

If you look across those four areas that I mentioned, diversity, population size, single payer, comprehensive capture, and digitization and scientific talent. My argument to anyone in this would be, who’s better? Who has the better combination of those assets than Canada? But to harness that opportunity, you need to have the data governance and linkage across this country.

You can’t harness all of those other advantages without that. And so that is the question before us, at this time of geopolitical crisis, will we step forward culturally because it’s not a technology problem, will we push the culture forward to harness that opportunity

Katie Bryski:  It really strikes me. It’s as though culture is this upstream challenge, right? If we can solve that, it sounds like many of the other, like technology platform integration almost follow like a waterfall quite naturally from there.

Dr. Fahad Razak: I would say that this is an area where the natural flow of water will not get us to where we need to go because the natural flow right now in Canada is one of regionalization siloed data, fractured governance that is part of the political origin of what Canada is as a, as a federated political structure.

That is why I think this moment where you’re seeing provinces trying to work together flattening barriers, but they’re talking about it as alcohol. Transport, trucking ports, oil, that analogy of flattening the barriers must be extended to health data for this to work. So the idea of a one Canadian ecosystem, one project, one approval, that nimbleness is not just about oil, it’s also data.

Imagine that we have a unified access process that is nimble, that is fast for 42 million people. That is truly a globally leading asset. And I think that’s the opportunity and, and what you’re seeing at the federal level is the desire to help what you’re seeing in organizations, I think like CIHI is the ability to lead and hopefully what we’ll see at the provincial level is the, that recognition that the 13 provinces territories, and then I say 14, because the federal governments own data holdings that independently fragmented, they are simply not globally competitive.

Dr. Anderson Chuck: I would even just, just to pick off off the water analogy, like water always travels in the path of least resistance, and that’s actually the fear that I have. The path of least resistance is to default into sort of like more historical ways of thinking and approaching this. It really is about the change of mindset to view health data as natural resource, as I mentioned earlier, as, as Brad mentioned, industrial policy.

This is as critical to the Canadian economy as well as resiliency and health systems as agriculture, energy, all of these other types of, um, assets that the country continues to focus on. Health data can’t be one of those things that we don’t capitalize on.

Shelagh Maloney: I think, and I’ve heard you both in different settings, you’re starting to get that message out and I think it’s building some momentum.

And so what does have to happen to get us to that next level? Like as people listening to this podcast and digital health professionals, what do we need to do and what does Canada need to do to get that critical mass so that we can truly make a difference here?

Dr. Anderson Chuck: So for me, one of the things, obviously, the first part is just to have that cultural awareness and that culture change.

It says, as I mentioned, this is like a culture project to view health data in this way. But then the other thing is to understand that in order for us to be able to compete globally in this space is around that one Canada approach. But to do that one Canada approach, we can’t continue to sort of sprinkle resources around and duplicate different types of capacities.

What I mean by that is that I think. For Canada to really be competitive is sort of adopting a principle around build once serve all that we need to have the kind of ecosystem that’s integrated, that provides the kind of scale and accessibility to data. That really leverages all 42 million Canadians health data.

So an example is you don’t wanna have compute capacity sprinkled over all over the place. You don’t wanna duplicate, you know, a hundred different places. You really want. I think for us to galvanize around this opportunity is to build it in a way that really leverages and gets the greatest bang for our dollar as it relates to that investment to enable the entire ecosystem.

So I really, in my mind, it’s this concept of, you know, you build one serve all opposed to building several times all over the place and not being able to really capture the kind of scale and critical mass that, uh, we could do this for across the country.

Dr. Fahad Razak: I think I of course totally agree with Andy’s point.

Lemme maybe advance some of the arguments that I would like to see more of a unified voice coming out to the Canadian public. Culture requires the public to change in terms of their perception of the risk benefit balance between the use of data and the continued fragmentation, siloed protections that we have along data now.

So the arguments that I would say is that there’s five of them. The first is the jurisdictions that are moving, the Denmarks, Spain, the United Kingdom. The jurisdictions that are moving are increasingly drawing away first access to the best new medical in innovations, which require data to evaluate them at scale.

The second is the economic case. You’ve heard Andy and I talk about it. This is a huge employer of people in other parts of the world. We have to look for opportunities where we can reap the economic benefits of our natural resources, and as Andy said. This is as important as our oil and timber as a natural resource that will bring, without any exaggeration, billions of dollars of value into the Canadian economy and tens of thousands of jobs.

The third argument is the equity case. Fundamentally, we have uneven access to care in this country. Smaller communities, northern communities, indigenous communities get less access than those who live within the catchment of large urban hospitals like my own in downtown Toronto. These digital technologies can extend out innovation to smaller communities, draw people in, in terms of access, allow them to participate in a way that we don’t have the human resources to do.

We can’t manufacture enough nurses and doctors to get them out to smaller communities at scale right now, but the digital technologies will allow those communities to participate in the rapid innovations in health care that are occurring. The fourth is a sovereignty imperative. If we do not do this ourselves, we become reliant on other countries technologies that will secede our data to their platforms and their laws.

The most worrying example of this is if you look at the large AI companies among the 50 largest, I think 80% are in the United States right now. Right now, if we don’t develop the rival economic base in this area within the country, we will be moving our data onto those platforms. We’ll be susceptible to the whims of American leadership, including examples that have already gone through the court system where.

The Trump administration has asked for and been given access to line level health data of people to do things like immigration enforcement. So imagine our Canadian data, our health data sitting within those repositories. And I think the fifth argument is that this is an opportunity and an area where Canada has these intrinsic strengths and has the ability to lead.

This is truly one of those areas because of those advantages that I described in the Canadian population. Its diversity, its size, et cetera.

Dr. Anderson Chuck: If I could add even another imperative. So you know, there’s also the health system sustainability imperative that’s in play here. So, you know, our health system now, from a public government point of view is, is investing around 280 billion a year, right?

And it’s growing at about 4%. That’s about 10 billion per year. So think about that in five years, that’s 50 billion. In 10 years, that’s a hundred billion. But here’s the kicker. Population growth, aging, and inflation is also growing at 4% a year. So, you know, that’s a lot of investment, but it’s really paying for more of the same system we have today.

There’s no real capacity improvement. And the other kicker is the fact that health spending is also growing faster than the economy, which means that it’s getting harder and harder for governments to afford the system in the long term. So the point I’m trying to make is that we can’t outspend here either.

We have to out-innovate in order for us to out-innovate. It is the things that we’re talking about around looking at data as a national asset to enable the kind of scale of enablement for the country to start innovating. So if you were to innovate in digital health, interoperability, AI ready, infrastructure, et cetera, et cetera, even if, let’s say it’s, it’s a $1 billion investment, that’s a fraction of the yearly increase in government spending in health care.

If these infrastructure investments reduce annual growth by even half a percentage or a percentage point, this is gonna pay for itself many times over and over and over. This is real resources. The projected growth over the next five to 10 years is significant from a fiscal or a health system sustainability point of view.

That imperative right now is also staring us right in the face that if we don’t out innovate, we’re gonna be 150 billion, a hundred billion. In looking back and thinking, oh right, we already missed that opportunity. So there, so from from that point of view, there’s also that urgency as well.

Katie Bryski: I feel like we’ve come a bit full circle. When we asked about your career journey, as in Fahad, you mentioned you were an engineer and you bring in that perspective. I know other guests we’ve had on the podcast may have started in urban planning and actually applied some of those lessons. To system design. So, Andy, as you’re enumerating these imperatives, it also strikes me this is where those relationships and those collaborations and the diversity of our digital health workforce could also have a role to play by bringing in those other perspectives and lessons learned from other systems.

Dr. Anderson Chuck: Yeah, absolutely. As I mentioned before, there’s no single organization that can do it itself. It really requires partnership across an ecosystem. But I think the main feature for the future of Canada is that there be clear, first of all, trust. Amongst those players, but also clear roles, responsibilities, and governance around this.

I think one of the things that we wanna avoid is sort of the internal competition and false starts, right? We really need organizations to work together towards a common purpose, and so a unifying approach that’s built across several places, but all working towards that same goal. We need clear agreement and understanding of all the respective worlds.

Because Canada suffers enough from the fragmentation. It is so key that the ecosystem actually form an ecosystem, if I’m making sense. That really, yeah. All works towards a singular kind of objective.

Katie Bryski: You’ve actually just given me a fantastic segue, so thank you. I’m curious for both of you, if there’s a particular example of a collaboration that you’ve seen that stands out to you and maybe what set it apart?

Dr. Anderson Chuck: I would say that, you know, one of the, the more recent collaborations and examples of this kind of working together was more recently with the ISED AI strategy for Canada, right? It was born from an idea that, you know, for health to get on the AI radar, so to speak. Wouldn’t it be useful if the key organization across the sector, not just in health, but also even in Ised, come together and start saying and sort of have some joint positioning on the opportunity as it relates to health ai.

And so within a two week period, 30 plus organizations came together to provide a joint submission into that. I said AI call. And I think if that doesn’t signal that Canada’s ready and the organizations are willing. To start working together towards that common purpose. I don’t know what could have been a different, better signal, but that to me gives me a lot of optimism that the ingredients are starting to come together for this capability for the country.

It’s just now the culture piece for us to really be able to break through and create the kind of enablement across that ecosystem.

Dr. Fahad Razak: I’ll add to that, that, so I think that’s a great example. Uh, it sort of related to that is I had a conversation with one of our former deputy ministers, Stephen Lucas, recently.

He was highlighting that the pace of change with AI is one of the most challenging policy areas that he’s seen in his career. And he is been in the federal service for 30 plus years and a deputy minister at two different ministries. And the reason why it’s hard is that the ground is shifting beneath you literally on a timescale of months.

So if you think about our current challenge right now with large language models, even as someone in the space, I had very little concept of the importance of large language models two years. Of why they were so, such a critical technology and the potential for health and the, and the way that we’re going to be using this technology for innovation, for health care delivery.

So the point that he made there was that this is an area and you’re seeing some of this grow in various parts of government at I said, and Health Canada, where you need a very tight relationship between the people who are at the innovation edge, the scientists, the researchers, others who are working at the leading edge of these technologies.

The people who have to set policy, and it has to be essentially a back and forth that is iterating rather than waiting for a static policy approach that is going to be perfect. And I think of this quote, I think it’s apocryphal and attributed to Mark Twain, but probably not by Mark Twain, as most quotes in the world are not actually by Mark Twain, but it’s this idea that continuous improvement is better than delayed perfection.

And that is incredibly apt for the moment we are in right now. There is no perfection in this space. There is a lot of uncertainty, but there’s a lot of very valuable innovation that’s happening that will improve people’s lives in very tangible ways. And you have to have a system that can embrace that uncertainty, acknowledge that you have to have pragmatic policies that are going to rapidly change on the order of months probably, and move forward.

I think what I’m seeing is some green shoots within various parts of government that’s embracing that, and I hope we can fully realize that.

Shelagh Maloney: It’s almost a great conditions for the sort of that perfect storm in which we find ourselves is we can’t afford to wait, stop, and figure it all out before we work together.

And I think now more so than ever, I think people are recognizing that data stewardship and governance and policy. Are key to building the culture and the ecosystem and the learning health system that we all so keenly desire and frankly need to have in Canada right now. Katie, I’m waiting for you to do the pithy.

Katie Bryski: I was gonna say, we’ve, we’ve been opening the conversations with a consistent question for everyone, but as we reflect on our 50th anniversary of Digital Health Canada, we’ve been closing with a consistent question as well. In one word, what does digital health mean to you?

Dr. Anderson Chuck: If I had to pick one, it would be enabler, but if I could pick two, we’ll allow it.

It would be natural resource, like I really wanna emphasize that health needs to be seen as a natural resource, as important as those other industries, like it is an asset for Canadians to prosper from.

Katie Bryski: And I think that counts as a single term. And Fahad for yourself.

Dr. Fahad Razak: Since I can’t take natural resource, I’m gonna go with paradigm-shift, with a dash in between Paradigm and Shift so that it becomes one word on a word count.

This is a fundamental change. For us as a health system and as an economic model, and as a culture, I don’t think even all those of us who work on this all day every day realize the scope of what has changed because of these technologies. It means we need to fundamentally think about the world in a different way.

I don’t wanna overemphasize learning from Denmark because I think there’s a lot they could do better, but one of the things that was striking to me is that they deliberately. Essentially blow up their model of care on 10-year cycles because when technology changes in a dramatic way. The trap, the evolutionary trap in many ways is that you try and iterate rather than recognize that there is fundamentally something different now about the way the world works.

Digital data in health has fundamentally changed the way that the health system can work, should work, and can deliver value. In terms of health care and economic value for Canadians. So iterative solutions are not what is required. A paradigm shift, a transformational change is what’s required now to recognize how different this world is.

Like, look, I was writing notes at three in the morning with terrible handwriting. At the start of my career, which is only 10 years ago, 10 years ago, that is a crazy idea. Now to think that we were doing that we fundamentally now have access to the data of millions of people at scale in high quality. And how we use that data can’t build on iteratively.

The manual charting model, and I say this from a profession, as I mentioned, I’m the only person in health care in my family that is woefully behind in advancing digital technologies, right? 90% of us have fax machines in our office, or this is the product of an iterative change rather than a transformational or paradigm shift, which is what we really need here.

Katie Bryski: Well, I’ll take all of that as a single noun phrase, and I also, as we close out the conversation, I have another apocryphal Mark Twain quote that I think is relevant to our conversation. The secret of getting ahead is getting started. And so to your point, yeah, moving away from the iterative, getting started with a transformational and new paradigm and a new future.

So thank you both for outlining what that future could look like. What’s at stake if we don’t move towards it and giving us both some very practical advice and inspiration to start to make that change happen.

Shelagh Maloney: Let me add that as well. And I, and thank you for your leadership and, and just that continued message.

And I think getting it out there and changing that mindset, it starts with, I can’t think of a Mark Twain or non-Twain quote that, that talks about that. But you know, maybe it’s the Margaret Mead, the single person can change the world that really appreciate you two in particular being spokespeople and really champions of, of this culture movement that is so important for us.

So thank you again.

Dr. Fahad Razak: Thank you. It should be here. Thank you.

Shelagh Maloney: Oh wow. That was. What a privilege to talk to those two gentlemen who are really leading the way in this thinking, and I don’t think it’s anything new, but just the way they focus the conversation and were very articulate about what we need. It’s, gosh, I just really enjoyed it.

Katie Bryski: Yeah, I think it’s helpful to be able to frame some of these concepts with such clarity and sharpness of messaging, right? Like the idea of health data as a natural resource. It’s one of these things that I’m like, “Oh yes, that makes intuitive sense.” And I think being able to, again, convey that message with such crispness is a big part of helping other people understand that, buy into that, and collaborate to make best advantage of that.

Shelagh Maloney: Yeah, and you know, why Canada has an advantage and the health as an economic driver. We’ve heard that before, but I don’t think, I’ve never heard it articulated so clearly and you know, and I love both of them were just like, “Okay, there are five reasons why we need to do this. Reason number one, equity. Reason number two, diversity.”

Like, I just love the way they were able to be so succinct in making that argument. And at the end of the day, we can’t do incremental change. We can’t do what we’ve always been doing. We can’t afford to do it the way we’ve been doing it.

Katie Bryski: Yeah. I don’t know who to even misattribute this quote to, but something to the effect of you can’t invent the light bulb by iterating on the candle.

Shelagh Maloney: There’s a Katie Bryski quote.

Katie Bryski: No, no. I’m stealing it. I’m stealing it from somewhere. I just – I don’t even know who to misattribute that quote to, but that’s what it is, right? Like there, it’s a fundamental jump in how we think about this, conceptualize it, deliver it.

Shelagh Maloney: Yeah, and you know, the Denmark example, and we hear a lot, well, yeah, they’re a small country and, but. We’re a large country in landmass, but we’re a relatively small country and if we could just really work together on some of this stuff in a, in a true way. But having said that, not being all negative, I think there are some good examples where we are, and I think that, you know, digital Health Canada, and I think there was 32 other organizations that prepared that health response to the Canada solution to AI acceleration.

Like I don’t know that we would’ve done that five or 10 years ago. And I think that is. A good example of we recognize we need to do this.

Katie Bryski: I was gonna say, I think even from a leadership perspective, if I can take a bit of a meta approach on the conversation we had, I think a really good example of how leaders can make clear the importance and the stakes of doing something while still inspiring and galvanizing people towards a vision.

Like I feel like I left that conversation with a good sense of the problem and the challenge, but also feeling quite motivated. Like, yes, there, there are ways forward we can do this.

Shelagh Maloney: And guess what? A shared vision.

Katie Bryski: Yeah. Yeah. And again, I think part of leadership is being able to see clearly the vision of the future you want to move into, and then bringing people along with you, as you have often said.

Yeah. Um, and of course that all comes with trust and relationships and culture. Again, both a practical but also deeply inspiring note to end 2025 on. So hopefully this conversation and many more to follow next year will continue to inspire you through 2026. Until then, as always, you can find resources linked in the show notes on Digital Health Canada’s website.

Thank you for tuning in, and we will see you next year – next month – right here on Digital Health in Canada, the Digital Health Canada podcast.

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