Yes, and I can comment a bit on the consent piece, as well.
Given its role around health system performance management and statistical analysis, CIHI is able to collect a lot of data without patient consent and primarily for that purpose, governed under either health information, related privacy legislation in the provinces, or public sector legislation. The whole idea of flowing patient consent from private settings to an organization such as CIHI or any other organization is challenging right now. I don't think we really have those options.
The Canadian joint replacement registry is a joint and hip replacement registry. It started out based on surgeon participation, so it was voluntary at that time, and we struggled with coverage, to be honest, in the early years, because there was no mandate. It was only when several provinces began mandating data submission on these surgeries to CIHI that we saw coverage climb up to about 73% or 74%. Understandably, without sufficient coverage, even using the data for signalling is ineffective, and obviously not enough if there's no full participation for a safety recall.
It's all tied together. It's a complex problem to get consent from the patient, to get providers' infrastructure set up to collect consent, maintain consent, and manage the withdrawal of consent if patients decide to switch out their decision. Then, how that governance is going to flow through, from the patient to the private surgeon to the organization that hosts the data, is challenging to figure out.