I recently attended the ON 26 conference hosted by Digital Health Canada
This event is a great event to plug into the Canadian digital health ecosystem, especially around interoperability, data sharing, and research. This year promised more of the same, and it absolutely delivered.
However, the real talk wasn’t on the main stage, it was a massive government announcement that dropped mid-event, with the potential to completely change the game for primary care doctors. From a brilliant federated data vision to real-time health data initiatives, here is the inside scoop on what went down.
A Federated Approach to Health Data Sharing
The opening session set a high bar. Matthew Anderson, CEO of Ontario Health, showed off their Provincial Data Utility. Instead of forcing all EHR data into a single physical repository, they are proposing a federated approach. The data stays where it is, but organizations can access it in a standardized way through an analytic hub.
I really like this vision. It sidesteps the massive headache of moving data and lets us focus purely on interoperability. Plus, this federated data can help train AI engines to optimize Ontario’s healthcare system much faster.
Single EMR Announcement Overshadowed ON26
But an hour later, big news dropped that became the talk of the conference. The Ontario Government announced an additional $3.4 billion for their primary care action plan, which now includes funding for a proposed province-wide primary care medical record.
If this means “one system to rule them all,” I am profoundly disappointed. We tried a single EMR approach back in 2002, and after seven years and over a billion wasted taxpayer dollars, we had nothing to show for it.
Over the years, I’ve come to realize that a single longitudinal health record is like the mythical jackalope: we’d all love to see one, but it’s just a figment of our imagination. Why? Because we are learning that there are so many contributors to health. The air quality in our homes, where we work, what foods we eat, income levels, dental health, etc. A decade ago, it would have been ridiculous to think about including dental records or SDOH data as part of someone’s health record. Today I would argue that a health record without either of these things is incomplete.
Expecting a single EHR to cater to all this data is not realistic. Can you imagine a dentist using the same system as a family doctor?
I’m crossing my fingers they look to Alberta’s Netcare model instead, which mandates a single repository but gives clinics the freedom to choose their own EMR.
Encouraging Initiatives from CIHI
The Canadian Institute for Health Information (CIHI) provided some major bright spots. In my video recount below, I included two mini-interviews with the CIHI team:
- Real-time Hospital Data: I spoke with Tanya Khan, Manager of Hospital Data Advancement & Engagement and Tetyana Maniuk, EM Physician & Senior Clinical Advisor at CIHI about transitioning hospital data from latent, legacy systems to near real-time access by March 2028. The goal is to reduce wait times and optimize resources without adding a single click to frontline staff.
- International Interoperability: I also caught up with Shannon O’Connor, Manager of Data Standards at CIHI to discuss how they are collaborating with the U.S. and Australia to establish the Canadian core data for interoperability (CA-CDI). Alongside the upcoming Bill S5 to prohibit information blocking, this could be a game-changer for digital health in Canada.
Delivering on the Promise of Digital Health Canada
Overall, ON 26 delivered exactly what it promised. It was great to catch up with friends and see the exciting projects pushing Canadian healthcare forward.
What Health IT Leaders Are Asking
What is a federated approach to healthcare data sharing? A federated approach allows healthcare data to remain securely in its original source systems while making it accessible through a standardized analytic hub. Instead of taking on the massive, costly challenge of physically moving and consolidating data into a single repository, organizations simply connect to the hub to share and query information. This method accelerates interoperability, reduces friction, and creates high-quality datasets to help train AI engines much faster.
Why are single-system EMR mandates so controversial? Mandating a single electronic medical record (EMR) system across an entire province rarely works because primary care is incredibly diverse. A “one system to rule them all” approach struggles to meet the unique, day-to-day workflow needs of different specialties—from family docs to physical therapists and dentists. Historically, forcing a single-vendor approach has resulted in wasted taxpayer dollars and low adoption. The reality? A better solution is to let market forces determine the best software for the practice, while using government power to strictly mandate interoperability and data sharing.
How will Bill S5 and CA-CDI impact Canadian healthcare interoperability? Bill S5 (the Connected Care for Canadians Act) and the Canadian Core Data for Interoperability (CA-CDI) are designed to prohibit information blocking and require vendors to adhere to a common set of data standards. Once implemented, these initiatives will ensure that a patient’s health information can travel seamlessly across provincial borders and different sectors of care. This standardized approach lowers the heavy lifting for vendors and ultimately empowers patients with better access to their own health records
Learn more about Digital Health Canada at https://digitalhealthcanada.com/
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