A neurosurgeon in Saskatoon removes a brain tumour from a patient flown in from northern Saskatchewan. The operation was successful. Days later, the patient returns home.
But the clinicians caring for that patient in the north may not be able to access the records from the tertiary care centre where the operation took place. The neurosurgeon may not easily access records from the northern facility that first referred the patient south.
In modern medicine, this should feel unimaginable.
Across Canada, clinicians still navigate a fragmented maze of electronic systems that often cannot communicate with one another, with data difficult for patients to access and for providers to share between facilities. According to Canadian clinicians, the leading barrier to improving connected care is the lack of universal adoption of exchange standards. As a result, patients often repeat their medical histories, carry paper records and reports between appointments or rely on memory to recall medication lists, while physicians log into multiple platforms to piece together a basic clinical picture.
One clinician appearing before the Senate committee studying Bill S-5 recently described using nine separate health information systems to care for patients.
Nine.
For many Canadians, these breakdowns appear as an inconvenience: another form to complete, another test repeated, another story retold in another waiting room. Inside the health system, however, fragmentation carries heavier consequences. Delayed diagnoses. Medication errors. Missed follow-up, hence missed opportunities. Unsafe transitions between hospitals, provinces and care teams.
The burden falls unevenly.
A health system organized around institutions asks patients to bridge the gaps between them.
Patients living in Canadian rural and remote communities often move across multiple systems simply to access basic care. Indigenous patients encounter additional barriers as federal, provincial and territorial structures struggle to communicate with one another. Patients experiencing homelessness, newcomers navigating unfamiliar systems and older adults with multiple chronic illnesses are frequently left carrying responsibility for information that the health system itself should be able to access.
That model is hard to sustain and becoming harder still in the face of inaction to harness tools that can connect health records.
Care increasingly happens across distance. A family physician consults virtually with a specialist hundreds of kilometres away. A patient discharged from the hospital follows up through a video visit. Diagnostic imaging is reviewed in another province. Artificial intelligence tools are beginning to assist with triage, interpretation and clinical decision-making. Yet much of the infrastructure beneath Canadian health care still reflects an earlier era, one in which care was delivered primarily within the walls of a single institution.
Information, meanwhile, remains trapped where it was first collected.
Canada speaks often about digital innovation and the future of virtual care. Yet clinicians still fax records between institutions, and patients still carry paper summaries from one appointment to another.
Bill S-5, the Connected Care for Canadians Act, is an attempt to address part of this problem by establishing interoperability requirements for health information technology vendors and prohibiting what is known as “data blocking,” practices that interfere with the exchange and use of electronic health information.
The legislation is technical. Its implications are not.
At stake is a basic question about how care should function in a modern health system: Should information follow institutions, or should it follow patients?
From a public health perspective, fragmented information limits our ability to understand how health is shaped across populations, identify inequities, evaluate interventions and generate the evidence necessary to inform meaningful system change. The consequences extend beyond individual clinical encounters and influence how health systems learn, adapt and respond to the needs of populations.
From an individual perspective, it becomes especially visible during moments of transition. A patient relocates from Nova Scotia to New Brunswick and arrives without a reliable medication history. A trauma patient enters an emergency department unconscious. A specialist attempts to follow a patient virtually after discharge into a remote community. In each case, clinicians are often forced to reconstruct fragmented histories manually, relying on faxed forms, incomplete records and memory.
Medicine has advanced dramatically. In many places, the information systems supporting it have not.
Bill S-5 will not solve this overnight. Nor should interoperability be mistaken for a purely technological challenge. The barriers are equally institutional, political and jurisdictional. Health information in Canada exists within a complex landscape of provincial systems, vendor contracts, privacy legislation and custodial arrangements that have evolved independently over decades.
Still, the bill matters.
It signals recognition that fragmented information is no longer a peripheral administrative problem. It is increasingly a patient safety issue and, in many settings, an equity issue.
That recognition arrives at an important moment.
Canada’s health system is under growing strain from an aging population, workforce shortages and rising demand for chronic disease management. Expanding bricks-and-mortar infrastructure alone will not be sufficient to meet these pressures. New models of care will increasingly depend on hybrid systems that combine in-person and virtual services, particularly for populations living far from tertiary centres.
Those models cannot function effectively if health information remains inaccessible across systems.
The pace of technological change is adding urgency to addressing interoperability. Artificial intelligence is playing an increasingly significant role in data management, data distribution and data analysis. The choices made today regarding interoperability will shape whether emerging technologies strengthen continuity of care and population health or simply amplify existing fragmentation.
The challenge is not a lack of innovation. Canadian clinicians and researchers already are building sophisticated virtual care platforms that connect specialists with underserved communities across enormous geographic distances. Indigenous-led initiatives such as Saskatchewan’s Virtual Health Hub point toward what more distributed models of care could look like in the future. But even the most advanced virtual systems become limited when clinicians cannot securely access the information required to support continuity of care.
The conversation around interoperability must also address legitimate concerns surrounding privacy, consent and Indigenous data sovereignty. The principles of ownership, control, access and possession (OCAP) remain essential in conversations involving Indigenous health information.
Public trust cannot be treated as secondary to innovation.
Neither can equity. While artificial intelligence enabled digital systems carry the potential to improve access for some Canadians, it may deepen exclusion for others if issues such as broadband access, health literacy and digital literacy remain unaddressed.
These, however, are not arguments against interoperability. They are reminders that health systems are human systems before they are technological ones.
Bill S-5 represents an important first step toward addressing a problem that Canadian patients and clinicians navigate every day. The legislation alone will not create a connected health system. But it establishes something increasingly difficult to postpone: the expectation that health information should move safely and efficiently wherever care occurs.
