If we dared to measure ourselves | The Press

Negotiations between Ottawa and the provinces on health are like a bad puppet theatre.

The actors change, but the text remains the same. The provinces unite to demand more money and the federal government says it is open, but the suspense is nil. Everyone knows how the story will end. Ottawa will break the common front by concluding piecemeal agreements. It will provide less money than is needed and will encroach on provincial jurisdictions by imposing conditions.

This time it’s a little different.

Federal Health Minister Jean-Yves Duclos has at least one legitimate request: that the provinces develop and publish common indicators in order to create a pan-Canadian data system.

He has not filed an official proposal. We guess, however, what this could mean. A doctor could consult the complete medical file of the patient in front of him. Managers would know how much an operation costs in one region compared to another. And researchers could compare them to identify best practices.

At the federal level, an advisory committee has tabled three reports on this subject since 2020^⁠1. One of its members, the D^r Ewan Affleck, summarizes the findings in one image. “Imagine an airplane pilot in his cockpit. Suddenly, half of the indicators on his dashboard are erased. As a passenger, would you still feel safe? asks the physician, who practices in Alberta and the Northwest Territories, and who was named to the Order of Canada for his work with electronic patient records in rural areas.

The D^r Affleck tells me about Greg Price, a Calgary man who died at age 31 of a blood clot following surgery^⁠2. At every stage of his treatment for testicular cancer, information got lost. Diagnostics were delayed and red flags were ignored. In short, it was the system that killed him. His story has become a textbook case taught to future doctors.

In Quebec, experts have been deploring the lack of data for years.

Doctors themselves do not have the complete medical file of their patient, and researchers cannot consult a central information base. The information is scattered between the National Institute of Public Health, the National Institute of Excellence in Health and Social Services and the Régie de l’assurance maladie. To consult these figures, they must contact the Commission d’accès à l’information. And this, even if the information is anonymized.

In 2015, the chief scientist of Quebec deplored that researchers spend “more time in administrative procedures […] than to analyze it”. This finding was echoed in 2018 by the Quebec consortium on access to data for research purposes.

Quebec is so lacking in credibility that it is excluded from the cancer statistics of the Canadian Institute for Health Information. His figures are not reliable enough…

A priori, Christian Dubé seems little interested in the idea of ​​Mr. Duclos. If the federal government wants statistics, Quebec already has a “dashboard”, mocked the CAQ Minister of Health.

This is both a negotiating position and an understandable mistrust. Quebec is sending a clear message: the federal government must not use this data to impose national standards, with the bureaucracy that entails.

This risk does exist. But it does not justify maintaining the current flawed system. A compromise is possible: share the data in order to identify the best practices, then let the provinces inspire themselves.

Moreover, that corresponds exactly to Mr. Dubé’s approach. Since his appointment, he has repeated that to improve something, you must first have measured it.

This is what he tried to do last spring with his Bill 19, which would have made it easier to share a patient’s file between doctors and establishments, in addition to facilitating access to information for researchers.

The project died on the soap opera, but its study will resume in the coming months when it returns to the National Assembly. It is one of its two legislative priorities. The other consists in decentralizing the management of the health system by creating an agency where the heads of the CISSSs and CIUSSSs will be both more autonomous and “accountable”. To play this role, they need to know what works elsewhere.

Quebec would benefit from being able to compare itself to its neighbours. Let’s take the example of waiting for a hip operation. British Columbia has managed to reduce its delays, while it is still difficult in Ontario.

For the debate on the amount of health transfers, a new confrontation is brewing between the federal government and Quebec, and we know in advance who will lose. But for data sharing, it’s different. For once, their ideas come together. All they have to do is realize it.