The Canadian government recently introduced Bill C 72 Connected Healthcare Act in Canada (Law) to promote the secure transmission of health data and to prohibit the blocking of this data. The law, which supports the government’s plan to build an interoperable healthcare system, will allow the Minister of Health to issue new regulations, establish a system to receive complaints, ensure compliance and impose administrative penalties for non-compliance.

The scope

Health information technology includes any computer hardware, software or integrated technology or intellectual property or upgrade designed to create, manage, use, exchange or access electronic health information to support these activities. The law applies to all health information technology providers (who sell, provide or license such technology). The goal is to facilitate the creation of a common pan-Canadian technical standard for information sharing – a feat in itself given the diversity of provincial and territorial health systems that deliver Canadian health services.

The Act applies only in provinces and territories that do not have requirements that are substantially similar to or exceed those of the Act and Canada’s federal privacy framework. Currently, most provinces and territories do not have regulations as restrictive as those proposed. Consequently, we must expect a broader application of the law than we have seen in the case of the law Law on the Protection of Personal Data and Electronic Documents.

Standards and requirements

To enable the protected and secure exchange of electronic health information between different systems, all providers must adopt common standards. The law regulates interoperability and prohibits data blocking.

• Interoperability refers to health information technology that “enables the user to easily, fully, and securely access, use, or exchange electronic health information with other health information technologies.” ¹.
• Data blocking is broadly defined as a practice or action “that prevents, discourages, or interferes with the use or exchange of or access to electronic health information.” ². Restricting the sharing of patient information or limiting the amount of time a provider has access to the information are two examples of prohibited practices.

The consequences

• The regulatory framework imposed by the bill, the scope of which could be very broad, remains to be defined. Since the law aims to implement the standards developed in the directive Common Roadmap for Pan-Canadian InteroperabilityThe latter could provide guidance for future interoperability standards, which would form the basis for new regulations ³.
• An interoperable health system provides the ability for different health data systems and entities to exchange information so that health care providers can access, use, and exchange electronic health information. Please note, however, that this access, use and sharing remains subject to federal, provincial and territorial laws regarding the protection of personal health information.
• Given expected interoperability requirements, such a commitment will likely require technology providers and healthcare providers to review their respective privacy and cybersecurity practices.
• If the law is passed, significant changes may be required to the contracts governing agreements between health information technology providers and healthcare organizations to comply with the law. Due to its relatively wide scope, the law could also target service providers that are not currently subject to a health and personal data protection framework.

We will continue to monitor the progress of this bill as it awaits its second reading in the House of Commons. Sector stakeholders will have the opportunity to express their views on the direction of the legislation and the development of the regulations if adopted. Meanwhile, the Canadian Institute for Health Information (CIHI) and Canada Health Infoway are working on interoperability requirements. CIHI is developing a Pan-Canadian Health Data Content Framework and is currently asking for feedback on it ⁴.