“Unlocking Health Care: How to Free the Flow of Life-Saving Health Data in Canada”: An appeal from Canada’s Public Policy Forum
The Canadian Public Policy Forum’s (PPF) recent report entitled, “Unlocking Health Care: How to Free the Flow of Life-Saving Health Data in Canada” has received a lot of media attention since its release last week. It included some important recommendations relating to the need to ensure personal health information is accessible digitally to all patients and health care providers in a timely, and privacy and security protective manner.
For context, it’s the third report in a three-part study that sought to address what it described as “the shortcomings in Canada’s precious health-care systems.” The first report dealt with accessibility to health services. The second report focused on the delivery of primary care.
Our office is a proponent of secure, privacy protective health information systems that enable secure and appropriate retention, access, use and disclosures of personal health information. We appreciate that there is great value in interoperable digital health records for all residents of Canada. Moreover, we know that privacy is not a barrier to innovation.
Long before the PPF wrote about the value of privacy-protective digital health innovations, Canadian privacy authorities passed a resolution entitled, “Securing Public Trust in Digital Healthcare” calling for concerted effort, leadership and resolve in implementing a modern, secure and interoperable digital health communications infrastructure.
The PPF paper is noteworthy because it explained how better health outcomes for Canadians can be achieved with “a high functioning, data- and digital rich system.” The paper uses a series of case studies illustrating how technology can support timely and efficient health care delivery.
The paper also provided examples of how antiquated communications systems can frustrate timely and appropriate health care services. Not surprisingly, the PPF included a number of examples relating to the use of fax machines to communicate. In one example, a physician working in a family clinic and in a number of hospitals in their province, explained how test results intended for them are regularly sent by fax to the wrong clinic or office.
The PPF paper noted that one consequence of these types of incidents or privacy breaches is the psychological impact on patients and physicians who are frustrated spending time chasing down faxes. It stated:
Canada’s continued reliance on phone calls with no return number, paper letters and fax machines impede critical referrals and prescriptions, potentially lifesaving acts of care. Our seeming inability to move beyond outmoded forms of communication delays vital treatments and extracts a psychological toll on patients and the people caring for them, who often must chase down a misdirected or overlooked fax. We cannot state it strongly enough: lives depend on this information.
The paper reported that in one study, e-referral systems shaved 21.4 days off wait times for Canadian orthopaedic surgeons compared with paper-based referrals, such as faxing.
Our office has had its own experience that illustrates how a paper-based system poses a serious risk to privacy. Since 2018, our office has opened approximately 84 files and issued 18 investigation reports involving misdirected faxes. Many of the reports involved multiple misdirected faxes.
For example, Investigation Report 045-2021, et al, involved 23 misdirected health records originating from four different trustees and Investigation Report 164-2023, et al, involved 86 misdirected health records. As there is no requirement to report breaches to our office, we would have no idea how many privacy breaches have resulted from misdirected faxes in Saskatchewan.
In Ontario, the former Information and Privacy Commissioner noted in his 2021 Annual Report, that his office received 4,848 breach reports related to misdirected faxes.
The PPF paper concluded with twelve recommendations as to how governments and partners can work towards making all health records accessible digitally by 2028. While the recommendations are presented as key to achieving these goals, I was particularly pleased to see that among the recommendations is a recommendation that Canada prioritize national safeguards for the collection, analysis, sharing and use of health data.
According to the report, this included ensuring that privacy and security of health data must be preserved in a way that maximizes the benefits for individuals and for the community at large.
The report also recommended a commitment to being paperless, interoperable and with seamless user access by 2028, starting with eliminating transmission of medical information by fax machines in 2024.
Finally, it recommended that e-consultations, e-referrals and e-prescriptions between all clinical service providers should be made available through fully interoperable digital health platforms.
We commend the PPF for its work and encourage you to read the report.
For any questions, contact firstname.lastname@example.org