Thank you, Mr. Chair.
On behalf of the Canadian Institute for Health Information, thank you for the opportunity to appear before the standing committee.
I am speaking to you today from the traditional territory of the Wendat, the Anishinabek first nation, the Haudenosaunee Confederacy and the Mississaugas of the New Credit. I recognize that this land is now the home of many first nations, Inuit and Métis people.
Since 1994, CIHI, as we're usually called, has been a leader in health data and information. CIHI is a not-for-profit independent body funded by the federal government and all provinces and territories. Our board of directors is made up of deputy ministers of health and other health system leaders, representing all regions of the country. CIHI has signed data-sharing agreements with every province and territory and several federal organizations.
Pan-Canadian health data is a shared responsibility between us and our partners at Statistics Canada, Health Canada and the Public Health Agency. Each organization has a defined role within the health ecosystem, with CIHI's focus on health care systems and their functioning.
For example, CIHI oversees data on hospitals and long-term care, health spending and workforce, and information on health system performance. Data is provided to us voluntarily by the provinces and territories. This allows the data to be aggregated and compared and for health systems to learn from each other. We also work closely with organizations that are international, such as the OECD and the Commonwealth Fund, which enables us to learn from other countries.
CIHI makes the data and information available to policy-makers, health system leaders, researchers and the public. Although we play an integral role in providing relevant and reliable data and analysis to policy-makers, we are neutral and objective in fulfilling our mandate. We neither create policy nor take positions on it. Ultimately, we work to help improve the health care system and the health of Canadians. Maintaining public trust is critical to our success. We're committed to protecting the privacy of Canadians and ensuring the security of their personal health information.
During COVID-19, CIHI's work has focused on three main priorities: first, maintaining the current data supply and looking for opportunities to improve; second, developing analytical products or services that assist with the COVID response; and third, to provide data and information quickly to those who need it.
Let me share one or two examples in each of those three priority areas.
In terms of maintaining and enhancing the data supply, we work closely with our data suppliers to mitigate disruptions to the data. We are pleased to report that hospitals and the majority of long-term care homes were able to complete data collection for the 2019-20 fiscal year within the normal deadlines. We also shared new standards to capture confirmed and suspected COVID cases in care facilities. This information will be critical as we look back at how our hospitals responded to the pandemic. We also created guidelines for race-based data collection in health in an effort to facilitate the collection of high-quality data, which I know was a focus of your earlier discussions.
The second goal is around providing analysis to support decision-making. During the early phases of the pandemic, we received many requests from those who were trying to project the need for hospital beds, for staff and for supplies such as ventilators and personal protective equipment. In response, we developed a tool to help those who are modelling to be able to deliver results at a local level. We also provided advice and facilitated the exchange of information among modelling teams working in different parts of the country. Most recently, we released a report that looked at Canada's pandemic experience in long-term care compared to that of other countries. The report found that early adoption of strict public health measures in long-term care was associated with fewer cases of COVID-19 and lower death rates.
Finally, our third initiative was around responding to requests. In addition, over the past few months CIHI has responded to more than 500 requests for information and data. The topics of these requests have changed over the weeks. Initially, they were very focused on describing the situation: how many cases, how many patients and how many hospitalizations. As time went on, we had more questions around long-term care. Most recently, the questions have focused on the reopening of the health system and ensuring that's done safely, and on the potential consequences of the shutdown on issues such as mental health, substance use and planned surgeries.
As we navigated the pandemic, working closely with our federal partners, it became apparent that there were several gaps in important data flows within and among health care systems in Canada. COVID-19 has highlighted some of these gaps, and we see them falling into one or more of three categories.
The first is gaps in data availability. These are real gaps. The data simply doesn't exist, as the panellists in the first half of this session may have highlighted. The gaps here could include information on supplies and equipment available in the system, or they could be gaps around the characteristics of long-term care homes, such as the number of patients to a room, the ownership models and the staffing ratios. We also saw significant gaps when we tried to examine some parts of the health workforce, such as the number of personal support workers and where they worked.
The second gap involves data that exists but that can't be accessed quickly enough to support decision-making. For example, we needed more timely hospital and emergency room data. This data is collected from hospitals across the country but does not flow in quickly enough to support pandemic-type decisions. To temporarily fill this gap and help the federal government understand whether hospitals were becoming overwhelmed with COVID cases, we created a dashboard report on the supply and use of hospital beds, ICU beds and ventilators. This report is updated manually on a daily basis by key contacts in the provinces and territories as well as CIHI staff.
Finally, some gaps exist because we can't integrate data. Information systems often can't speak to each other, sometimes because they use different standards, but sometimes the data doesn't include personal identifiers that allow this connection. For example, right now we can't follow a patient's full COVID experience from testing through to treatment and, hopefully, to recovery, because public health electronic medical records and health system records are fragmented.
CIHI is always working to enhance the scope and availability of Canada's health system data for analysis and decision-making. While there are many gaps, we recommend focusing on three.
First is comprehensive, timely and integrated health workforce data to support planning and policy.
The collection and analysis of health workforce data is fragmented and incomplete today. We need to capture additional professions in our current systems, such as respiratory technicians and personal support workers, to better understand both the mix of staff who provide front-line care and where they work. We also need to make sure that this data is linkable to data on the use of health services and to financial data systems. This could help identify infection rates in the health workforce, the use of overtime and the longer-term effects of COVID-19 on front-line workers.
The second gap is in the need for more complete and timely data on long-term care homes: the residents, the workforce and the facilities.
While there's excellent information on the clinical profiles of long-term care residents in most parts of the country, there are some significant gaps. We have little information about the residents' quality of life and care experiences before COVID, or how these might have changed during the pandemic. We also have limited information about the facilities themselves, the mix of staff who provide care, and the way infectious outbreaks are dealt with. It's important to recognize that while long-term care treats our most vulnerable seniors, many older Canadians live in a variety of different group care settings for which we have very little information.
The final area is a need for more timely and comprehensive data on hospital-based care and clinic services, both for COVID patients and for patients with other health conditions.
CIHI's hospital data provides deep insight into the number of Canadians treated and the type of care they receive, but this high-quality data is assembled by health information specialists after a patient is discharged from the hospital. To better manage our systems when they're facing emerging issues like COVID-19, but also the seasonal flu or the opioid crisis, we need to automate the flow of hospital data in real or near real time and have more information on patients when they're admitted.
Discussions around these actionable solutions are under way. The groundwork is there, but these solutions require the engagement of health system managers and health care providers, leadership from policy-makers and funding for the development and implementation of information systems.
Today we ask for your commitment and support. Better data allows for better decisions and, ultimately, healthier Canadians.
Thank you for the opportunity to present. I'd be pleased to answer any questions.