DHIC 29 – Intergovernmental Collaborations to Drive Interoperability – v2

Elizabeth Toller: I think the digital health community is one of the most collaborative in terms of the federal, provincial, territorial relations

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 we are live at the eHealth Conference and Trade Show, so hopefully we’re getting a little bit of that conference buzz and energy. Today we’re excited to bring two guests into the studio for a chat about interoperability and health policy, because Canada’s digital health landscape is shaped not just by technology, but by the relationships between governments, communities, and the people delivering care Today, our guests will guide us through partnerships and policy, care and collaboration, and how we can move healthcare forward together.

And we are thrilled to welcome Elizabeth Toller, Director General of Healthcare Strategies at Health Canada, and François de Wet, Territorial Chief of Staff from Nunavut.

Shelagh Maloney: That, you know, it’s, it’s so much fun because there’s so much buzz around, but… And all of our podcast listeners know the first question we always ask our guests is to tell us about your career journey.

So maybe, François, why don’t we start with you? Tell us sort of where you started and how you got to where you are sitting here today.

Dr. François de Wet: Yeah, so, um, grew up in South Africa, came to Canada in 1993. Left South Africa in 41 degrees and got off in -20 in St. John’s, Newfoundland. And then after that, I was SMO and then Chief of Rural Medicine, and eventually I moved to Nunavut, and I’m now Chief of Staff overseeing physician services in Nunavut.

Elizabeth Toller: You know, when I was young, I had aspirations of being a, a doctor, like a mid-science, the whole style, style doctor. But I think over time I realized sciences wasn’t really for me, and that social science path was much more up my alley.

Katie Bryski: Relatable.

Elizabeth Toller: Yeah. And I sort of stumbled into a, a social anthropology degree here in Halifax, actually, at Dalhousie, and, uh, ended up sort of studying the ways in which companies can use regulation in their competitive strategies and how they may work between the, I’ll say, the gray zones of our regulatory system to, to leverage for, like, marketing and things like that.

And it really kind of helped me get a lens for how things actually work in practice versus what’s written in the letter of the law or the regulations. And that’s what kind of fueled me into being very passionate about health policy and to get into Health Canada. So I’ve spent about 10 of my 17 public service years in Health Canada, starting more in that kind of health products and food policy space, and now in the broader healthcare policy space.

Most of my last five years has been really focused on digital health, which has been my new real passion, uh, which is, uh, super fun.

Shelagh Maloney: Sucks everybody in. It’s just once you get there. And, and one of the things, and you and I were talking about this a little bit briefly yesterday, is as the federal government role. A lot of your time is spent on federal, provincial, territorial relations. I’m interested in both your perspectives around what are the opportunities and the challenges, and what does that look like?

Elizabeth Toller: Maybe I can first just sort of describe the federal role. You know, I sort of see it in three ways within a digital health space.

First, we play sort of a funder role, right? Like, we provide funding to the provinces and territories to support them in their responsibility for care delivery and administration, and to focus on shared priorities. A example of which is healthcare funding provided in 2023 that supports shared priorities like digital health in Canada, for example.

But then, as you mentioned, Shelagh, a huge role in being a convener and facilitating that Pan-Canadian collaboration. Which I think really crystallized during the pandemic where we really had to come together to make sure that people could get care when we were stuck at home. Lots has emerged from that in terms of shared work plans and shared sort of North Stars that we’re all working towards, creating a community where best practices can be shared as each province and territory advances their own journey.

And then the third role is the role of being a regulator. If Bill S-5, the Connected Care for Canadians Act, actually becomes law and we develop regulations, then we would be playing a role of setting standards and, um, prohibiting data blocking among vendors. And creating a bit of a shared space, right, where we create a minimum framework that the provinces and territories can adapt within their legislative regimes, and sort of creating guidelines for them to be able to use.

So, you know, it’s sort of that representation of the federal government setting the expectations and sort of clear rules while giving the implementation flexibility to the provinces and territories.

Dr. François de Wet: I agree.  I mean, you know, a couple of years ago they built a new hotel in Iqaluit, and, um, what they did was, it was interesting to watch it because the way that they put it was they put up the structure first, and then all the rooms arrived on a ship, and they were slotting these rooms in one after another into this building.

And that’s how kind of how I look at the relationship with the federal government is, you know, they provide us that framework, but we have to provide the different rooms and care delivery options that we do. Nunavut specifically, you know, when we talk about interoperability and where we fit in Canada, we deal with four different health systems in our territory because we have three different regions that go to three different places.

So we deal with Manitoba for the Kivalliq region, we deal with Ontario for the Qikiqtaaluk region, and we deal with Alberta and NWT for the Kitikmeot region. That funding that we get from, from Health Canada through Health Canada funding for Indigenous Services Canada, um, you know, we recently had money with a Working Together fund that they said, “We’re gonna give you so much money. Figure out a way you want to use it.”

And so we can adapt the funding models for what we want to do in the territory. So for example, we funded a new psychiatry program out of the Working Together funding And those things are not typically things that the provincial government would fund, but, but we can look for funding, uh, streams through Health Canada.

Um, Shelagh said yesterday about, you know, this is a quality of care issue, and Anderson says also a quality of life issue because right now people have to leave the territory for pretty much all of their external services. So I think that that framework, the infrastructure, you know, we saw during COVID for virtual care support is so important.

The other thing that’s close to my heart that I wish would come in at one point in time is licensing, you know, for physicians. Um, and I know there’s a lot of provincial responsibility with that as well, but in Nunavut We’ve gone ahead and we’ve put MOUs in place with four provinces and one territory.

That Canadian operation or Canadian cooperation, I should say, between the feds, between the provinces, and then between ourselves is so important.

Katie Bryski: It came up in a conversation we recorded yesterday with an international guest about the European health data space, right? And this level of harmonization that everyone can mostly agree to with local execution.

And I, I think it’s sort of an interesting model, especially when you think about the beginning of our constitution, right? I don’t think the division of powers as originally conceived could have imagined a context like we find ourselves. So I guess I’m also curious about where you see that kind of relationship and those, those strategic like intersections between the levels of government going.

Elizabeth Toller: Yeah, I think the, the EU is such a good example. The other day too, I got a request saying like, “Oh, the European data space is offering to share data with you in Canada.” And I was like, “Okay, they’re on an international scale.” And so, I mean, I think that as you describe it, like it’s exactly that. It’s that middle space of how can the federal government facilitate, set a signal, create the standards, the s- the frameworks, the conditions for interoperability to actually function within a city or a region or within a province and across the country.

And I think the Nunavut example is just such a strong one because as François said, so many people in that territory have to travel outside of their province to receive care. And, you know, the disconnectedness of that care is a real harmful thing for patients. And so I think it is an, a true example of that middle space where we can work together to set the broad conditions needed for things to, to work, and then the provinces have that implementation flexibility.

It would be impossible for us to know exactly what the residents of Nunavut need in a healthcare delivery perspective. We’re just, we’re too large as a country geographically and, you know. And I think that it’s that collaboration and that alignment around a common vision and a North Star that is important while giving that, that flexibility on the ground.

Dr. François de Wet: Yeah, and I think connectivity is such an important factor. You know, up until Starlink came around, you know, we were still relying on a wobbly satellite where… And I will add, we have had a territory EMR since 2012. So whether you get seen in Kugluktuk in the west or in Iqaluit on the east, you can access your records within the territory itself, um, which I want to put a plug in for our- That’s awesome.

Yeah. That’s great … community health team. Yeah. Yeah. Uh, definitely there. But, but now, you know, we’re starting to get limited by the connectivity. Echocardiograms take a massive amount of data to send up, you know, over a gigabyte worth of data for, for a study And to try and get that to the radiologist, which we don’t have in the territory, we rely on external radiology.

All our X-rays, CTs, ultrasounds go to Ontario to be read, but there’s no connection with Manitoba, NWT, or Alberta. So we sometimes rely on patients to carry their CDs with their studies with them when they go out of territory. Or, you know, it creates that situation where people have to get the study done again.

Shelagh Maloney: It’s interesting because we always talk about the remote regions of… You probably can’t get more remote than where you are. No. But you have some real pockets of innovation, and that’s really lovely to see. And, and so maybe you can talk a little bit about what happens when we don’t have those, um, what challenges that you’re facing, and especially in the north, I’m sure there’s lots of them.

Dr. François de Wet: So, you know, because people have to travel out in Nunavut, and there’s no roads, so everything is by flight. It could take literally thousands of kilometers and sometimes a couple of days to get from Resolute, for example, which is high up in the Arctic, to Ottawa. We put that burden of that communication sometimes on the patient to tell their story.

Whether you’re in, in, uh, Iqaluit, whether you’re in, uh, Resolute, or whether you’re in Ottawa, your story should be already available so you don’t have to tell it again and again. Because we put that burden on patients rather than just to the system to say, “Well, here’s your data. This is why you’re going to be seen,” or, “This is why, you know, this person is sitting in front of you.”

And again, like I said, the, the problem with the, um, transmission of, of our imaging, it creates a situation where patients have to get imaging redone. You know, if you look at the radio- radiation associated with CAT scans and stuff like that, it, it could put potential harm in that. You look at the cost to the system where the ultrasound was done and read in the north.

If that same patient has to get that scan now again in Ontario, it’s gonna take them extra travel, extra time away from community, extra time away from their family.

Elizabeth Toller: I think those are just such strong illustrations of the real harm that disconnected care can have on, on patients and on families and people writ large.

And that’s something that I’ve really observed in the last five years of my journey in digital health, is sort of seeing the narrative shift away from interoperability being viewed as just this technical problem that needed to be solved, to a real issue that has true impacts on people, on ourselves as patients.

And that’s kind of the key message that I’ve really been trying to deliver over the last several years, especially with, you know, the introduction of Bill S5, is that this is truly a patient safety issue in that it can cause misdiagnosis, medication errors, frustration, longer wait times, and in some rare cases it can even cause death, right?

The, the story we’ve all heard about very often, um, you know, Greg Price’s story where he died of testicular cancer, largely because he kind of fell through the cracks of the health system.

Katie Bryski: I think storytelling, first of all, is a really important tool to help people connect. Because François and I were talking before, I think sometimes where we sit in the health system, we are those few levels removed from what people are actually experiencing. I don’t know, like when we’re chatting with our international folks again yesterday, like they were talking about Patient accessible health records in the early 2010s, François, you said 2012. Mm-hmm. I don’t think it’s a technology issue so much as it is a culture issue-

and a people issue. So I’m wondering, yeah, about those levers that, okay, if it’s not the technology, like what do we need to drive this forward? And what role does do the governments, plural, play in that?

Elizabeth Toller: Yeah. Yeah, you know, as part of this conference, I was sort of alluding to this yesterday in, in remarks that I made, that we can have these standards but not actually have alignment, and we can have common agreement on a vision, but still have such challenges with disconnected implementation.

And I think that that’s the hardest part of the job now is that implementation focus and needing to work together to align the policy levers with things like incentives to make sure that the providers have the tools that they need to have interoperability and share data, that they have the right training and support and change management on the ground to understand how to use the tools, that we’re actually equipping patients with the right tools to be able to interpret their data and to have conversations with providers, while continuing to focus on some of the basic infrastructure issues as well.

Like we have done a, a lot in the country to invest and build, you know, digital health infrastructure, but there’s some even like basic things in the territories in the north where there’s still broadband issues, right? Yeah. Like how can we have connected care without even those kind of basic things?

Shelagh Maloney: I, I think one of the things you said that it, it’s like in five years you’ve seen a shift in the conversation- Yes

from it’s not about technology. The Greg Price story, like people know that story. Yeah. And it’s a great example of this is what happens, and, and it should be a real catalyst for us to move. But the other thing you talked about is policy. Yes. And I think in my 100 years in this industry, I think like policy’s really getting the attention that it deserves.

And Bill S-5, we know legislation works. We’ve seen it in other jurisdictions. So I think that’s, to me, a change as well, the whole policy thinking around this.

Elizabeth Toller: Indeed. I mean, it sends, if anything, it sends a signal that interoperability is important for this country, and that standards must be followed, and that there shall not be data blocking or, you know, intentional forms of data blocking.

Katie Bryski: I’ve been thinking a lot lately about intervention hierarchies, right? So kind of education awareness at the one end of least effective, and then those forcing functions at the top end. But yeah, it feels like we’re moving more towards that, okay, we actually do need to get this done.

Dr. François de Wet: Yeah, I think, you know, for us specifically again, is because you have to deal with territorial government or provincial government. So, so any time that we wanted to add something, we have to go through the whole privacy aspect with our team, but also with Manitoba, with our team and with Ontario.

And so every time that you start a project like this, because we, we recently, uh, connected our PAC system, which is the x-ray system, to the Manitoba system. And, you know, it took a year and a half to get it done. And it’s because we have small teams on our side, but also, you know, we have to make sure that we, we comply with Manitoba standards.

We have to com- also make sure that Manitoba comply with our standards

Elizabeth Toller: That’s the challenge we face in our country. Every province and territory is trying to achieve similar goals, but doing it slightly differently, focusing on different things. Or they’re doing similar things, but doing it slightly differently, like repeating.

Yeah. There’s a lot of duplication to our work. Not only is that challenging from a Canadian’s perspective, because we are not benefiting consistently from, you know, the, the different efforts that are happening across the country, but even think about it from, like, an innovation standpoint, like our digital health sector, right?

They have to customize their solutions 13 different times- Yes … or even more so at the local level, and it creates a disconnected market for them to do business, right? Like, so we want a more unified pan-Canadian market, especially since we are such a small population and geographically dispersed population.

We need to treat ourselves like we are one unified market that is aligned with the international standards as well for us to be able to have a thriving innovation ecosystem.

Katie Bryski: François, it looks like you wanted to jump in on something.

Dr. François de Wet: It’s, because what you’re talking about the different standards.

So, so we get pushed all the time, can you switch to Epic?

Elizabeth Toller: Yes.

Dr. François de Wet: It would be great to switch to-

Elizabeth Toller: That is not the solution.

Dr. François de Wet: I know, I know, but, but that’s not the solution because if we switch to Epic because TOH, the Ottawa Hospital, runs on Epic, it means we lose that cohesion within Nunavut. Yes. You know?

Because, because then, you know, Qikiqtaaluk would be on Epic, but the rest of the, the territory will still be on Meditech. That standards is needed to be able for all the systems to talk to each other, rather than trying to force us to go into a project that we can’t do- Yeah … to change our operating system to align with another province or territory.

Elizabeth Toller: Yeah, I read a great article recently that talked about the debate of, you know, to centralize or not to centralize the-

Katie Bryski: For Canada, I feel like why not both?

Elizabeth Toller: Right. And, and, and it was a very fair article. It said, like, in some instances it does make sense, especially for, like, a smaller province or a territory, it might make sense to have just one single integrated EHR.

But at the end of the day, if everybody goes in that direction, then you’re just creating so much consolidation. You’re cutting off innovation in the overall sector, and that’s exactly the vision that we have is that we want innovation to thrive, have lots of different systems, but, but have base standards so that information can flow.

You know, there’s been lots of excitement about Nova Scotia, and I’m super excited about what they do, but I also want to give a shout-out to New Brunswick. They were one of the first to actually have an app that came out that has, has a barcode that a patient can take wherever they go.

Katie Bryski: Yeah. So. At the, I was evangelizing the patient summary recently.

Yeah. The Pan-Canadian patient summary.. And people are saying, like, “You’re talking about this as though it exists.” Yeah. I was like, it does –

Elizabeth Toller: It does exist.

Katie Bryski: And it’s- mostly in New Brunswick. Yeah. But it, it, it does exist, though.

Elizabeth Toller: Well, and, and it’s thanks to the standards that- Yeah … you know, Canada Health Infoway is leading on and CIHI.

Those standards have enabled the different jurisdictions to be able to deliver those tools.

Katie Bryski: The spirit of, I think, success begetting success and learning from things that have worked or not worked. Like, are there other examples that you can think of that, that sort of either intergovernmental or Pan-Canadian collaboration?

Dr. François de Wet: Yeah, I mean, intergovernmental, you know, we rely on the kindness of strangers in Nunavut because of all our tertiary care is provided out of territory. We started one of those pilots that, that Ash was talking about a couple of years ago with virtual critical care. So we have virtual critical care from, uh, the Ottawa Hospital that provided any health center in Kivalliq region could dial in or could connect to this.

They provide this for us. When we started looking, well, we wanted equity across the territory, so how do we supply that same service in the Kiv- Kivalliq region? Um, we reached out to British Columbia and, uh, the RCBC, uh, group out there, RTVS group, uh, real-time video support. They’re like, “Yeah, we’ll help you.”

I was like, “Well, what is this gonna cost?” “We’ll do it for free for now, you know, and see how it works.” Awesome. And, uh, you know, that kind of cooperation and their willingness to support us is, is so important. And I mean, we have that same relationship with Health Canada as well. You know, Health Canada is always willing to listen to us and to try and support it to the best that they can within their frameworks.

One thing I found moving to Nunavut is that although we’re different entities, there are always good people. There’s always good supports for people. There’s always that willingness to support in other provinces or territories that maybe do not have all the in-house support. Or I’ll put a plug in for housing.

One of our biggest problems in the territory is with housing. So our ability to hire people in territory to provide certain services is, is severely limited. And again, we, we had, uh, different initiatives to provide housing in territory that’s both territorial but also from the federal government. Um, so I think those kind of small things do not only make healthcare better, but people’s lives better is so important.

Elizabeth Toller: And perhaps, you know, at the macro level, I think the digital health community is one of the most collaborative in terms of the federal, provincial, territorial relations. I’ve always experienced this real desire amongst all of us in this community to come together and collaborate.

I think the pandemic was a really good case in point. The, it forced collaboration. We needed to enable virtual care, and we needed to come together to do it in a collaborative fashion. And, um, yeah, and it, it crystallized-

Shelagh Maloney: That was an incredible moment …

Dr. François de Wet: that we do not wanna go through again.

Shelagh Maloney: We don’t wanna do it again.

Exactly. But, but if we could have m- maintain that sense of collaboration- Yeah … that sort of, and so that’s interesting to, I definitely saw it, I felt it for sure, but it’s kinda come down a little bit. Like it-

Elizabeth Toller: Maybe, but it also created the foundation for ongoing collaboration. Coming out of that, there was the Pan-Canadian Data Strategy.

There was, like, an expert advisory group that came together, gave some excellent advice. Their recommendations were fundamental behind the Working Together to Improve Health Care for Canadians plan in 2023, you know, where the sharing of health data became a fundamental principle, and it became one of the shared priorities.

And then it then set the stage for a joint action plan that all the provinces and territories signed onto and sort of a shared work plan that continues to be our, our guiding star today.

Katie Bryski: And the shift sort of implicit in that great example, I think, is it’s from priority to expectation.

Elizabeth Toller: Yeah.

Katie Bryski: And I think, I think now it’s just this is how we work. This is expected.

Elizabeth Toller: Exactly. And that’s kinda been one of my favorite parts of my job is how do I facilitate that multilateral fora, but then also have those one-on-one bilateral relationships with each of the provinces and territories and figure out how can we be helpful? And it’s really rewarding when people show up, people wanna be there, and there’s a real good spirit of collaboration

Shelagh Maloney: Well, and that’s why we’re here at eHealth, really perfect example, right, of that collaboration and integration, people coming together.

Katie Bryski: Curious, like, again, kind of coming back to that real world impact, like seeing it on the ground, if in the course of your careers you’ve seen those sort of real stories that have affected you and maybe shaped your approach to your work.

Elizabeth Toller: Absolutely. Every single one of us as a patient has a personal story to share, right?

And, and I’m sure I could share lots of frustrations and things that I’ve gone through, but some of the privilege that I’ve had in my role is, has been collecting a lot of stories from people. And I had a conversation with a woman fairly recently that was, I think, a, a really touching and sobering story about the harm of disconnected care, especially disconnected across different jurisdictional lines.

So this woman, she lived with her husband on a Canadian border community, and it straddles two provinces, yet they share a sort of single municipal administration. And it’s a place where it’s absolutely perfectly normal to regularly and freely move between the two provinces.

So she and her husband lived on one provincial side of the city while the local hospital and their family doctor were located on the other side of the city. So when her husband got sick, he went to the local hospital, but all the follow-up referrals were to the specialist back in their home province.

And so care in your home province sounds good, but in this case it meant that none of those specialists had access to the scans, the tests, the notes from his time in the hospital that was located in the adjoining province. And so the lack of access to the information, it significantly delayed her husband’s care.

They had the normal wait times that everybody has to go through to begin with, but then when they’d get to the appointments, the specialists still wouldn’t have all the information, so they’d have to wait longer to track down that information. And so their solution, as François had spoke about, was to basically, like, carry around a paper folder with all their information so that it would travel with them when they went to the different physicians involved in their care.

And then her husband got progressively sicker, and he, he ended up needing to get a transplant. But after the transplant, the disconnected care continued. Because of the information on his medications took so long to get to his family doctor, there was actual medication errors in- that occurred. And so their solution to this was that they’d get a new family doctor in their home province, but that doctor was a lot further away.

But it was a positive change because at least that doctor could get the information That being said, they were still quite nervous about that solution because if her husband got sick again, he’d still end up having to travel two hours to get care. You know, this one just, I just, I thought this story was so powerful in that over the course of so many years, just continued to face these frustrations and real risks occurring to, for this couple because their information couldn’t seamlessly flow, in this case, between jurisdictions.

But we know that these examples happen even within our own cities. We go to our primary care doctor and the data doesn’t necessarily flow when we go to acute care or to see a mental health specialist or other sites of care. And at the end of the day, we all travel all the time. We, you know, we get sick whether we’re at home or whether we’re out visiting our child in university or whether we’re going on a trip.

I think we all expect that our providers are gonna have our data at their disposal, or at the very least, I think we should all expect that we as Canadians should have our own data to follow us wherever we go, so it’s there when we need it.

Dr. François de Wet: My story is a young lady that I happen to be in a community. I was doing my side hustle, which is medicine at the moment.

Shelagh Maloney: Most people’s side hustle is like, oh, they play cribbage or something.

Katie Bryski: Hey, my side hustle is podcasting. No judgement for François here.

Dr. François de Wet: So, so anyway, so she had two issues. She was in an accident, had a fractured jaw and a fractured arm You know, a lot of time with Inuit patients, they tend to be quiet.

Doesn’t necessarily mean that they agree with you, but they don’t necessarily say a lot of things. And I think a lot part of the colonial system is that people have been told where to go, what to do, what, where you’re gonna go for your treatment. So anyway, for one reason or another, our typical referral rates from that, or referral site from that community is down to Ottawa.

All our X-rays, CT scans, stuff flow to Ottawa. We did not have a provider in Ottawa that could fix the jaw, so we decided to send the patient to Winnipeg. She got in Winnipeg, she got her arm perfectly fixed. No one looked at her jaw because the patient had left the consult at home, so the consult wasn’t with her.

When they accessed the DI, they called the health center. Yeah, I know she had a broken arm. They forgot about the jaw. There’s no imaging available, so they couldn’t go and look at her images, so they had to repeat the X-rays on her arm and stuff like that. So she came back to the community without her jaw fixed, and so then we had to again try and get her back again, so we had to fly her back to Winnipeg.

And I think, you know, that’s a classic example where if they had full access to the full medical record, they could have looked at the note. They could have seen the imaging that was already done in territory. She had two or three different trips back. They had to rebreak the jaw because by the time she got back, there was already some growth there.

You know, so there was significant harm to this patient because of the fact that her, uh, record wasn’t available.

Elizabeth Toller: And think the, think about the harm to the system.

Katie Bryski: Yeah. The amount of wasted resources in re-flying out that person. The moral injury, I would imagine, to the clinicians when they realized you were here before- and now we have to rebreak your jaw.

Dr. François de Wet: Yeah. Exactly.

Katie Bryski: Like, that must contribute to burnout. Yeah.

Dr. François de Wet: Yeah, and the second, the second thing again, where it shows is that, um, like I said before, we have all fly-in communities. Yeah, so our– we have very classic referral rates to Ottawa, Winnipeg, or to, um, Yellowknife But every now and then, uh, we have this thing in the north you might not know about called weather.

So, so, uh- Heard of it … yeah, so but, you know, so we sometimes have patients ending up in Calgary because they couldn’t land- Yes … or in Thompson, Manitoba. So all the stuff was, uh, sent to Winnipeg, but now the patient’s in Thompson. We had that interconnected system where, where you’re in Thompson or you’re in Winnipeg or you’re in Ottawa, that you can immediately look at it, see it, it’s there.

That, that’s what, what’s so important.

Elizabeth Toller: I think what this makes me kind of really think about is that disconnected care impacts all of us. Yeah. But it’s those with the most complex conditions that live in rural, remote, or indigenous communities, you know, or, you know, if it’s an official language, m- minority community.

Whatever it is, it’s those populations that are the ones that are most impacted by disconnected care and who stand to benefit the most.

Dr. François de Wet: Yeah, and I’m glad you mentioned language, you know, because we have a lot of unilingual, especially elders in, in Nunavut. So if we have all these services in these hubs, but if you go to someplace else where that service is not available, let’s say for example, that elder did not have an escort that can speak English, then, you know, there’s that a- additional problem of communicating with the patient for them to tell their story.

So, so language, it can be a barrier in this situation as well.

Katie Bryski: I appreciated what you said yesterday about admiring the problem and how we also just need to move forward. Like yes, it is a wicked problem. We are a large country, a federated system. So if you were to look three to five years into the future, what would your hope be?

Elizabeth Toller: I hope that in five years I will come back onto this podcast, and instead of telling you stories about disconnected care, I will be telling you stories about connected care.

Shelagh Maloney: Yeah. There you go. I’m really- We’ll mark the, we’ll mark the dates. Yeah.

Dr. François de Wet: For me, it would be, it would be similar. I mean, I would like to get to a place where every Nunavummiut can go anywhere in Canada and have access to their medical records immediately and on time.

Instead of having to, to tell their story again and again and again, they will be able to access, um, their own records anywhere in Canada. That would be my vision.

Elizabeth Toller: And I would

like- all 40 million Canadians- Amen. Yeah … in our country to have access to their own records. That’d

Katie Bryski: be awesome.

Elizabeth Toller: And- And

Dr. François de Wet: it doesn’t sound, it’s like- It’s not controversial

Katie Bryski: Let’s make it happen. No. I’ll add too, the however many millions of Canadians we have on top of that in five years.

Elizabeth Toller: Yes. Yes. Agree.

Katie Bryski: Yes. Great. Well, thank you. I mean, I think this really conversation has showed that interoperability is a human problem with a human solution, right? Absolutely. Which is all of us working together and continuing to collaborate.

So thank you for taking the time to be with us today. We really appreciate it.

Dr. François de Wet: No, thank you. Thank you.

Katie Bryski: I love a good policy conversation. I love a good people conversation. I love seeing the connection between the work that we do and the impact, I mean, collectively, all of us in the digital health sector, and then the, the actual, like, real world impact it has on people.

Shelagh Maloney: I think Elizabeth does a great job of those stories and, and, and articulating the impacts of disconnected care.

But also, you always have hope. And, you know, hearing François talk about, especially in Nunavut, like, they have all of the weather, the remoteness, the lack of connectivity, bandwidth, those kinds of things. Like, it’s a big problem to tackle, but they’ve had an EMR since 2012. So it can be done. We can do it.

Katie Bryski: Yeah, and then I think the other interesting thing about François’s examples is that it also shows that sometimes when you have a lot of challenges, it also forces innovation. Yeah. Right? Sometimes in a strange way, constraint begets creativity and commitment to just figuring it out because you have no other option, right?

Shelagh Maloney: Well, and that’s, that was COVID, right? Yeah. Like, we have to do this. It’s an urgent matter now, and we did it, and we rose to that challenge.

Katie Bryski: The platform is not just burning, it is ash beneath our feet. Yeah. Like, we gotta jump.

Shelagh Maloney: Yeah. So I, I thought that was really interesting. And, and again, you know, I talked about it a little bit, but that, um, just the importance of policy, ’cause I think it’s that convergence between technology, policy, urgency, and I think that’s one of the things that’s come through for me in the conference, is that we have now the perfect storm.

You know, we have a government that’s committed to this. We have a national AI strategy. We have some funding. We have the ability. We have a very strong innovation sector here in Canada, and there’s a buzz here. Yeah. I think there’s really a buzz here at, at the conference. And so- Gives me tremendous hope.

Katie Bryski: I don’t know. Part of me thinks, if not now, then when, right? Like, we had COVID, and yes, it advanced interoperability and connectivity in digital health in some aspects, and then backslid a little bit in some aspects. And I think now we’re from that sovereignty, uh, national strategic asset, like some of that positioning that, that an argument that CIHI has made very successfully, that our health data is a national asset, and we need to be strategic about it.

Like, part of me thinks if, if this all isn’t enough to move us forward, then what will be, barring another pandemic? But to François’s point, let’s, let’s not do that part again.

Yeah. We’re definitely not doing that. But how do we get that commitment?

Shelagh Maloney: So I, I agree 100%, and so it’s exciting to, to hear this and these guests and to be part of the conference, and it’s been fun.

Katie Bryski: Well, with that, there’s still a little bit of conference left to go. We still have another recording to go. So-

Shelagh Maloney: Let’s get out there on that conference floor and-

Katie Bryski: And you’ll-

Shelagh Maloney: Create the buzz

Katie Bryski: hear the next part of our buzz, uh, the next time you tune in right here on Digital Health in Canada- Right … the Digital Health Canada podcast.

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