president’s quarterly report - cihi quality a clinical chart review study –– to compare...

President’s Quarterly Report

and

Review of Financial Statements

as at June 30, 2015

Final Report

August 2015

Table of contents

Introduction ................................................................................................................................ 3

President’s update ..................................................................................................................... 4

Financial highlights and statements ..........................................................................................15

Quarterly performance report ....................................................................................................22

Appendix A – Health environmental scan ..................................................................................34

President’s Quarterly Report and Review of Financial Statements August 2015 as at June 30, 2015

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Introduction

This document provides an overview of some of the significant accomplishments achieved

during the first quarter of fiscal 2015–2016 (i.e., April 1 to June 30, 2015), as well as a review of

CIHI’s financial statements as at June 30, 2015. This document includes the following sections:

President’s update: Highlights some of the recent developments and updates affecting

CIHI-identified priority initiatives and select major programs for the first quarter of fiscal

2015–2016, as well as other items of interest.

Financial highlights and statements: Presents CIHI’s financial situation as at June 30,

2015.

Quarterly performance indicators: Describes a series of performance indicators relating to

CIHI operations for the first quarter of fiscal 2015–2016.

Appendix A – CIHI’s regular external environmental scan.


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President’s update

The following are the major accomplishments for the first quarter in 2015–2016 for each of the

corporate priorities in the Business Plan, 2015 to 2018.

Corporate updates

Strategic planning An effective Board strategic planning session was held in June 2015, which included review of the proposed strategic plan and presentations by international guests. A follow-up Board teleconference meeting was held in July to review the new strategic goals. Further review is planned at a meeting with the Board in early fall.

Work is under way to review and align performance indicators with the new strategic plan. As a first step, an international scan was completed.

CIHI hosted a Strategic Planning Day with Statistics Canada on April 22, 2015, and participated in the director general/assistant deputy minister-level Health Data Strategy meeting on June 23, 2015, with Statistics Canada, the Public Health Agency of Canada, the Canadian Institutes of Health Research (CIHR) and Health Canada.

Corporate governance and accountability

KPMG completed the annual audit of financial statements (2014–2015), in preparation for the release of CIHI’s annual report in July 2015.

The 2015 biennial CIHI Employee Survey was conducted in June. Overall, the response rate was 93%. This year’s survey reflected an Employee Effectiveness Survey model and focused on employee engagement and enablement.

Bilateral agreements

Following discussion at the June Board meeting, provincial and territorial deputy ministers were advised that the bilateral agreements will be extended by 1 year (2016–2017) at the same level of funding.

Goal 1: Improve the comprehensiveness, quality and availability of data

Priority 1: Provide timely and accessible data connected across health sectors

Data access and integration strategy

The Data Liberation Initiative with Statistics Canada was renewed to March 31, 2016. An agreement was signed with Statistics Canada for the disclosure of CIHI data from home care, long-term care and mental health data holdings.

The CIHI Portal was enhanced to give clients the ability to create maps in the National Ambulatory Care Reporting System (NACRS) project and 2 Canadian Association of Paediatric Health Centres (CAPHC) custom dashboards were added to support CAPHC’s annual report deliverable. 2015–2016 pricing information was distributed to all Portal clients.

The new standard for the Client Linkage methodology was released internally.

Data quality A clinical chart review study –– to compare information related to patient safety available in hospital patient health records with data submitted to the Discharge Abstract Database (DAD) –– on approximately 1,200 charts from 2 teaching hospitals and 2 large community hospitals in Ontario and Alberta was completed.


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Data sharing agreements

Work on the following agreement was initiated:

o Data Sharing Agreement with the Government of the Northwest Territories to reflect legislative changes.

The following agreements were signed:

o No agreements were signed in Q1 2015–2016.

Classifications The new Classifications Information Management System (CIMS) was released on May 28, 2015. This new system streamlines many business processes, moving from 5 15-year-old systems used to build and maintain the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada (ICD-10-CA) and Canadian Classification of Health Interventions (CCI), to 1 integrated system (CIMS). The new system will improve quality and timeliness and enhance efficiencies in updating ICD-10-CA and CCI classifications and specification tables for vendors, case mix and DAD and NACRS abstracting.

Discharge Abstract Database (DAD)

As part of the Acute and Ambulatory Care Information Services (AACIS) data supply enhancement strategy, several healthcare organizations and vendors were engaged to demonstrate the feasibility of using more efficient methods of obtaining DAD data. For example, a data extract sourced in an automated manner from North York General Hospital’s point of care clinical information system was provided to support the analysis of the feasibility, timeliness, quality and potential of sourcing data directly from electronic health record/hospital information system sources. More work in this area is planned with the goal of making data collection easier.

In response to stakeholder requests to improve the timeliness of DAD and NACRS data, National Clinical Administrative Databases (NCAD) Steering Committee members were engaged to move the year-end submission deadline from July to June in 2016, with the goal of moving it to May in future years. In Ontario, the deadline is already May 31. NCAD representatives from Newfoundland and Labrador and Alberta confirmed their interest in advancing the deadline to June 30 for 2015–2016 data. CIHI is continuing to engage with the other jurisdictions to make progress toward this June timeline; however, health coding resource constraints are limiting progress in some regions.

2 pilot sites (1 in Ontario and the other in Manitoba) confirmed their participation in the provision of Canadian Health Outcomes for Better Information and Care (C-HOBIC) data. This includes standardized measures on the impact of nursing inputs and interventions in inpatient care. Data will be captured in the special project fields in the DAD, representing an innovative data capture method sourcing data from point-of-care systems. This is a joint CIHI/Canadian Nurses Association (CNA) project that is supported by the hospital system vendors in the 2 pilot hospitals.

Data from surveillance infections programs were requested across jurisdictions to validate cases identified in the DAD for C. difficile, methicillin-resistant staphylococcus aureus (MRSA) and surgical site infections. Preliminary results were shared with clinical experts and the Quebec analytical team.


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Emergency department and ambulatory care data — National Ambulatory Care Reporting System (NACRS)

A new data submission option in NACRS –– Clinic Lite –– was launched on April 1, 2015. This is an efficient, low-cost and rapid implementation option that can leverage data already captured in clinical information systems to provide basic patient-level ambulatory care visit information. Suitable and customizable for many clinic types, NACRS Clinic Lite has been adopted as the data collection and submission method for the Canadian Association of Paediatric Health Centres Paediatric Rehabilitation Reporting System as well as for a pilot sponsored by the Ontario Ministry of Health and Long-Term Care on outpatient rehabilitation visits and on selected procedures performed in independent health facilities. NACRS Clinic Lite was developed in response to new client demands and is expected to grow over time, which will enrich CIHI’s outpatient data supply.

Priority 2: Support new and emerging data sources, including electronic records

Primary health care (PHC)

Terms of reference were confirmed, and project charters and funding agreements are under review for 2 PHC Demonstrations projects that aim to test elements of the PHC Electronic Medical Record (EMR) Content Standard v3.0.

Jurisdictional consultations were initiated on a readiness assessment for accelerating the availability of structured EMR data. This work is being completed for the Conference of Deputy Ministers.

Priority 3: Provide more complete data in priority areas

Financing and funding data

CIHI received the first patient costing data submission from the former Capital District Health Authority (now part of Nova Scotia Health Authority).

Physician and health workforce information

CIHI successfully applied 1 of the physician Full-Time Equivalents (FTE) methods used by the ministère de la Santé et des Services sociaux du Québec to Alberta Patient-Level Physician Billing data and calculated physician FTEs in Alberta. The findings were presented to the federal, provincial, territorial Physician Advisory Group in May. The group was very interested in alternative FTE methods and looks forward to further application of this methodology and other variations.

Regulated Nurses, 2014 was released on June 23, 2015. The report and supporting products highlight current trends in regulated nursing practice for registered nurses (RNs), including nurse practitioners (NPs), licensed practical nurses (LPNs) and registered psychiatric nurses (RPNs). Key findings include that the supply of regulated nurses in Canada declined for the first time in 2 decades, that the growth of the regulated nursing workforce in Canada remained stable over the last 10 years, and that the number of regulated nurses not renewing their registration exceeded the number of nurses entering the profession.


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National Prescription Drug Utilization Information System (NPDUIS)

Prescribed Drug Spending in Canada, 2013: A Focus on Public Drug Programs was released on May 28, 2015. Public-sector spending on prescribed drugs in 2014, which represents 42% of total prescribed drug spending, is forecast to be $12.1 billion. 6 of the top 10 drug classes were used to treat conditions related to either the cardiovascular system or the nervous system. A biologic drug class used to treat rheumatoid arthritis and Crohn’s disease accounted for the highest proportion of spending. Savings from generics between 2008 and 2013 were largely offset by increased spending on other drug classes.

Prescription drug abuse (PDA)

Meetings were held with key PDA stakeholders to better understand their activities and PDA information needs (e.g., Health Canada, provincial and territorial drug programs, the Canadian Centre on Substance Abuse, Prescription Monitoring Programs in Nova Scotia and Alberta, researchers at the University of Toronto and the University of British Columbia).

Reviews were conducted of PDA-related data currently available from CIHI data holdings and PDA indicators used in published literature and in surveillance systems.

Rehabilitation, mental health and community mental health

Consultations continued with the Ontario Stroke Network and the Ontario Ministry of Health and Long-Term Care (MOHLTC) to support collection of new “rehab intensity” data elements, and with the Rehabilitative Care Alliance for development of a national ambulatory rehabilitation data set.

Several engagement and consultation activities were completed, including for improved integration of National Rehabilitation Reporting System (NRS) data into Rick Hansen Institute research and indicator work. Presentations were delivered at the Greater Toronto Area (GTA) Rehab Network’s Best Practices Day, New Brunswick’s Heart and Stroke Conference and New Brunswick Department of Health’s Planning Day.

Home and Continuing Care (HCC)

Various engagement and consultation activities were completed, including

o Promoting the HCC program, products and services at the eHealth and Ontario Association of Community Care Access Centres conferences and to the Manitoba Nursing Informatics Association and the Canadian Federation of Nurses Unions;

o Promoting the use and upcoming public release of quality indicators related to long-term care at the Seniors Quality Leap Initiative (SQLI) meeting;

o Facilitating a session on the use and public reporting of quality indicators related to long-term care at Schlegel Villages’ Innovation Summit in Guelph, Ontario; and

o Presentations on public reporting for the long-term care sector at conferences for the BC Care Providers Association, Ontario Association of Non-Profit Homes and Services for Seniors and Ontario Long-Term Care Association.

Canadian Joint Replacement Registry (CJRR)

A feasibility analysis –– to allow collection of CJRR data via CIHI’s clinical administrative databases in order to decrease the burden of data collection and increase the uptake in jurisdictions where the cost of data submission is a barrier to expansion –– is on target for completion by September 2015.


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Canadian Organ Replacement Register (CORR)

The CORR Annual Report: Treatment of End-Stage Organ Failure in Canada, 2004 to 2013 and supporting Quick Stats were released on April 21, 2015.

The CORR team met with the CORR Board and representatives from provincial renal programs to initiate discussion on the future of renal data collection in CORR.

2 process-mapping sessions were held with Canadian Blood Services (CBS) to review CORR processes related to data collection for the CIHI–CBS transition of transplantation and donor data collection project.

Canadian Multiple Sclerosis Monitoring System (CMSMS)

Clinic data quality reports were developed and distributed to participating multiple sclerosis (MS) clinics. MS Advisory Committee members and data providers submitted the data request for the study of post-discharge outcomes for MS patients admitted to inpatient care. Consultations were held with the British Columbia Ministry of Health regarding potential submission from the University of British Columbia MS clinic, and with the MS Society of Canada.

Goal 2: Support population health and health system decision-making

Priority 1: Produce relevant, appropriate and actionable analysis

Deliver corporate analytical plan

Releases in Q1

Wait Times for Priority Procedures in Canada, 2015 was released on April 14, 2015. Key findings include that approximately 8 out of 10 patients consistently have had their priority surgery performed within the approved benchmark time frame every year since 2010. New data is available comparing Canada’s wait times with those of other countries. In comparison with its peers, Canada performs well on cataract and joint replacement surgeries.

Continuity of Care With Family Medicine Physicians: Why It Matters was released in April 2015. Key findings were that on average, patients visited the same family medicine physician 60.2% of the time in Alberta and 56.2% of the time in Saskatchewan. Continuity of care was highest among older patients. Patients with high continuity of care were the least likely to be hospitalized for an ambulatory care sensitive condition or to visit an emergency department for a family practice sensitive condition.

Physician Follow-Up After Hospital Discharge: Progress in Meeting Best Practices was released in April 2015. The results show that the majority of patients in Alberta and Saskatchewan followed up with a physician 30 days after hospital discharge. However, fewer followed up after 7 days.

Care for Children and Youth With Mental Disorders was released on May 7, 2015. This report and supporting data tables examine trends and patterns over the past 6 years in the use of hospital-based services and psychotropic medications among children and youth with mental disorders. The results were presented at the Mental Health Care in the Hospital Setting conference hosted by Longwoods.


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Deliver corporate analytical plan (cont’d)

Releases in Q1 (cont’d)

Bariatric Surgery in Canada: An Update was released on May 22, 2015. Key findings include that approximately 6,000 bariatric surgeries were performed in Canadian hospitals in 2012–2013, almost 4 times as many surgeries as the 1,600 performed in 2006–2007. Complication rates are declining.

Health Indicators ePublication was released on May 25, 2015, jointly by CIHI and Statistics Canada. This release included 2013–2014 results for the 27 CIHI indicators.

Recent and upcoming releases

Drug Use Among Seniors on Public Drug Programs in Canada, 2012 (July 14, 2015, Longwoods Healthcare Quarterly).

Factors Predicting Return Home From Inpatient Rehabilitation Following Hip Fracture Surgery (July 2015).

Defining High Users in Acute Care: An Examination of Different Approaches (July 2015).

Anaphylaxis and Severe Allergy in the Emergency Department (September 2015)

Comparison of Outcomes for Simultaneous and Staged Bilateral Total Knee Replacement Surgeries (November 2015).

Capacity-building A presentation –– Using In-Person Modular Workshops to Build Capacity for Health System Improvement in Regions Across Canada –– was delivered at the Canadian Association for Health Services and Policy Research conference in May 2015.

A post-workshop web conference for the Manitoba Health System Performance School attendees was delivered on June 23, 2015. Participants shared how they have applied workshop learnings in their organizations and regions. A Community of Practice Forum is being piloted via a web board called Yammer so that participants can continue to collaborate and share best practices.

CIHI is hosting a series of High Users web conferences, starting in September 2015. This virtual conference approach will allow CIHI to connect with high-user leaders and speakers and to take part in an informative dialogue across Canada. The purpose of these web conferences is to identify the practical implications of using different approaches to define high users, to showcase leading-edge approaches to understanding and predicting high use across Canada, and to highlight concrete examples of using data to inform intervention strategies.


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Priority 2: Offer leading-edge performance management products, services and tools

Health system performance (HSP) measurement

A major enhancement to the Your Health System: In Depth web tool occurred on June 10, 2015, which included the addition of facility-level reporting for 9 long-term care indicators and 8 contextual measures, as well as other updates. There was a good degree of media uptake on this release, particularly for the long-term care indicators.

Confidential results for the Q3 hospital standardized mortality ratio (HSMR) 2014–2015 (without Quebec) and 2013–2014 (with Quebec) were released on April 30, 2015.

Readmissions indicators were released into the Your Health System: Insight web tool on June 30, 2015, completing Phase 1 of this initiative. As of June 30, the tool had 248 registered users from 130 organizations in 9 provinces.

Your Health System Usefulness Evaluation interviews were completed. The results are being compiled into a report for review.

The timeline for release of the Hospital Harm Indicator (HHI) and report on patient safety was revised from October 2015 to March/April 2016 to incorporate stakeholder feedback and chart validation results.

CIHI met with representatives from the Canadian Nosocomial Infection Surveillance Program of the Public Health Agency of Canada to discuss CIHI’s development of a suite of infection indicators and to request data for validation purposes.

Canadian Patient Experience Reporting System (CPERS)

The new CPERS data holding was released on April 1, 2015. The first inpatient test data submission was received and processed. Future expansions may include emergency departments and long-term care settings.

CIHI and the Australian Bureau of Health Information shared information on their patient experience data capture initiatives.

Patient-reported outcome measures (PROMs)

The new PROMs program continued to evolve. The PROMs Forum proceedings and background reports were completed and released in July 2015. Recommendations for generic PROMs tools are in development. A PROMs Advisory Committee will be launched in September to ensure ongoing engagement and to inform CIHI’s work in this area. 2 supporting pilot projects are also being launched in the areas of renal care and hip/knee replacement surgery. These pilots will each be informed by a PROMs working group. Options for growing and scaling up CIHI’s PROMs data collection and reporting are being developed.

Population grouping methodology (POP)

The alpha version of the population grouping methodology was released on April 20, 2015, to the POP Expert Group and to the 4 ministries involved. A supporting web conference was delivered to instruct users on how to use the software.


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Canadian Population Health Initiative (CPHI)

The Canadian Public Health Association conference was held May 25 to 28, 2015. As a sponsor, CIHI hosted a booth, addressed the delegates, and planned and delivered a workshop and 2 other sessions. The response to the work was enthusiastic. The sessions included

o Trends in income-related inequality: A focus on smoking and chronic obstructive pulmonary disease hospitalizations;

o Understanding variations in health system efficiency in Canada: A descriptive multiple case study; and

o A workshop examining the link between early childhood outcomes, government spending and interventions supporting health child development.

Several other oral and poster presentations were presented at various conferences with very positive reception, including

o Quality, Safety and Performance Measurement Research Methods;

o Canadian Obesity Summit (Trends in inequality in obesity in Canada);

o Canadian Association for Health Services and Policy Research conference (Re-thinking traditional models of care: Mobile primary care in the North; Inequalities in early child development in Canada; Trends in income-related health inequalities in Canada: Alcohol-attributable hospitalizations; Understanding variations in health system efficiency in Canada: A descriptive multiple case study); and

o Canadian Society of Epidemiology and Biostatistics (Self-reported household-level income versus neighbourhood-level income for examining income-related inequalities in the prevalence of diabetes, obesity and smoking).

CPHI hosted a meeting of the CIHI Advisory Council on Population Health on June 25. A number of new members attended and topics included CIHI’s strategic directions, work by Statistics Canada and strategic advice on upcoming analytical projects.

International comparisons and benchmarking

On May 25, 2015, CIHI, in partnership with CIHR’s Institute of Health Services and Policy Research (IHSPR), delivered a pre-conference workshop on how to use Commonwealth Fund survey data for analytical work and research on international comparisons. The workshop, which was held prior to this year’s Canadian Association for Health Services and Policy Research conference, attracted graduate students, seasoned researchers and health organization directors.

The 2015 Commonwealth Fund survey was completed in the field. The analytical report is scheduled for release in Q4 2015–2016.

CIHI contributed to Health at a Glance 2015, which will be published by the Organisation for Economic Co-operation and Development (OECD) in the fall 2015.


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Priority 3: Respond to emerging needs while considering local context

Partnerships Preliminary analysis was completed for the CIHI–Statistics Canada initiative to examine the effect of different definitions for high users of the health care system.

CIHI held the initial meeting of the Choosing Wisely Canada Measurement Collaborative on June 22, 2015.

Targeted local initiatives

Atlantic Canada

The Newfoundland and Labrador Mental Health project was renewed for 2015–2016. Service agreements were signed with all health regions to allow access to comparative reports.

Prince Edward Island began submission of day surgery case data to NACRS (instead of the DAD), as it is more efficient, effective April 2015.

The New Brunswick Department of Social Development announced the expansion of interRAI to all long-term care facilities in the province.

The Nova Scotia Department of Health and Wellness completed a business case for province-wide implementation of interRAI in all long-term care facilities.

Quebec

Agreement was reached with Quebec on the process for third-party data requests.

Mapping rules for integrating 2014–2015 MED-ÉCHO data into the DAD were completed.

Meetings were held with the Institut national d’excellence en santé et en services sociaux (INESSS) to review and enhance the methodology for several cardiac care quality indicators.

Planning is under way to restart the NACRS Système d’information de gestion des départements d’urgence (SIGDU) project. Discussions were resumed with Quebec to receive and incorporate SIGDU emergency data into NACRS comparative reports.


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Priority 3: Respond to emerging needs while considering local context

Targeted local initiatives (cont’d)

Ontario

13 CIHI staff helped to facilitate approximately 20 out of 42 sub-acute sessions (on complex continuing care, and rehabilitation and mental health) held across the 14 local health integration networks (LHINs) as part of the Ontario MOHLTC’s 2015 Data Quality Blitz project. The workshops and sessions enabled knowledge exchange between participants resulting in a deeper understanding of the work undertaken at CIHI and an appreciation of the many challenges in collecting, managing and using data.

CIHI continued to work with the MOHLTC to finalize the 2015–2016 non-core services agreement including the Health Based Allocation Model (HBAM), Portal, Ontario Mental Health Reporting System (OMHRS) and Ontario Trauma Registry (OTR).

2014–2015 DAD and NACRS submissions from Ontario facilities were monitored to meet the MOHLTC deadline of May 31, 2015. This is the first year of alignment of CIHI and Ontario deadlines, which facilitated timely release of final closed-year DAD and NACRS data in Ontario.

Western Canada

A scorecard containing updated results for the high system users indicator was provided to the Western CEO Working Group.

A set of acute and alternate level of care (ALC) definitions and guidelines to support ALC designation by clinicians was drafted as part of the multi-year project to develop and implement ALC designation standards for Western health regions. This information was submitted to the Western Patient Flow Collaborative for broader clinician input.

A 5-day 1.5-credit graduate-level course was delivered for the Health Information Science program at the University of Victoria.

Several posters were displayed and presentations delivered, including Understanding Readmission Rates Following Radical Prostatectomy (Associations for Research in Cancer Care conference) and Care for Children and Youth With Mental Disorders (B.C. chapter of the Canadian Mental Health Association, as well as the Canadian Public Health Association and Canadian Association for Health Services and Policy Research conferences).

Discussions were held with the British Columbia Emergency Services Advisory Committee and the British Columbia NACRS Data Quality Working Group to examine the results of the British Columbia NACRS Data Review project and to identify opportunities to improve B.C.’s emergency department data quality.

Multiple engagements and consultations took place in the Western jurisdictions to discuss various initiatives, including the Your Health System implementation, Primary Health Care indicators and measurement, and CPERS.

Meetings took place with the Department of Health and Social Services (DHSS) in the Northwest Territories to support DHSS development of a business case for patient experience surveys, to review Panorama data standards and to discuss additional opportunities for working together.


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Goal 3: Deliver organizational excellence

Priority 1: Promote continuous learning and development

Leadership competencies

People management expectations in CIHI’s Leadership Framework were incorporated into the Performance Management Program.

Priority 2: Champion a culture of innovation

Innovation CIHI launched its first-ever Innovation Month in April 2015 with a tagline of Challenge. Change. Create. Staff took an opportunity to challenge the way they looked at things, to think “outside the box,” experiment, record great ideas and learn from colleagues.

Web solutions The Drupal open source platform was deployed to the intranet and to CIHI’s external website. The transition to Drupal will increase functionality and improve updating of content. As well, CIHI will be able to introduce new search engine optimization techniques to make pages easier to find and more accessible.


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Financial highlights and statements

The following section provides an overview of key financial considerations and results regarding

recent developments and accomplishments achieved during the first 3 months of the fiscal year.

In March 2015, the Board approved for 2015–2016 an operational plan and budget of up to

$108.8 million, consisting of an annual operating budget of $102.4 million, $1.5 million in capital

expenditures and $4.9 million in contributions to the CIHI Pension Plan. Our primary sources of

funding are provided by Health Canada for the Health Information Initiative ($78.5 million) and

by the provincial/territorial ministries of health relating to the Core Plan ($17.4 million).

Management continues to effectively deliver on its core program of work and is making solid

progress on its key initiatives identified in the Business Plan, 2015 to 2018. (Refer to the

President’s Update.)

The following represents the significant known financial variances to the approved budget based

on the recent review and first-quarter results:

Additional funding of $177,000 from the B.C. Ministry of Health to develop a costing and

reporting roadmap and implementation plan to strengthen B.C.’s cost management

systems and reporting capacity, to perform a pharmaceutical study to determine the

impact and outcome of pharmacist-led, community-based medication reviews and to

further other projects.

Portal revenues are anticipated to be $70,000 lower than the budget of $1.1 million.

Interest income is anticipated to be $60,000 lower than budget as a result of decreased

interest rates.

CIHI reallocated funds from the corporate provision to offset emerging issues: $100,000

to accelerate the adoption of the Primary Health Care Electronic Medical Record

Content Standards and $155,000 to accelerate work related to Integrated eReporting.

Although the actual results for the 3-month period ended June 30, 2015, are slightly different

than the approved budget, these differences are largely due to timing. Annual results are

expected to be relatively in line with the budget. Management will monitor the budgets and

ensure that resources are best re-allocated between the operating and capital budgets or CIHI

Pension Plan cash contributions to meet this fiscal year’s deliverables and commitments. It

should be noted that a thorough year-end projection will be prepared as part of the mid-year

review exercise.

The financial statements included in the following section present CIHI’s financial position as at

June 30, 2015, and detailed results of its operations for the first 3 months of the fiscal year. The

notes to the financial statements provide details related to specific lines of the respective

statement. The working capital ratio, which measures CIHI’s ability to discharge its current

liabilities in a timely manner, remains positive and satisfactory at 2.1:1 (2.0:1 as at March 31,

2015). The closing balances of the balance sheet accounts in the following section are

reasonably in line with the organization’s operating cycle.


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Balance sheet ($000) as at June 30, 2015

June 30, March 31,

2015 2015 Notes

(audited)

Current assets

Cash and short-term investments $ 9,051 $ 10,017 1

Accounts receivable 9,257 7,346 2

Receivable — Health Information Initiative 700 - 3

Prepaid expenses 3,637 3,855 4

22,645 21,218

Long-term assets

Capital assets 8,544 9,153 5

Accrued pension benefits 5,333 6,501 6

13,877 15,654

Total assets $ 36,522 $ 36,872

Current liabilities

Accounts payable and accrued liabilities $ 4,931 $ 5,586 7

Unearned revenue 6,441 4,767 8

11,372 10,353

Long-term liabilities

Deferred contributions — Expenses of future periods 1,877 2,646 9

Deferred contributions — Capital assets 6,247 6,747 10

Lease inducements 2,031 2,178 11

10,155 11,571

Net assets 14,995 14,948

Total liabilities and net assets $ 36,522 $ 36,872


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Notes to balance sheet as at June 30, 2015

1. Cash and short-term investments: Presented net of outstanding cheques as at June 30, 2015. Short-term investments include $8.5 million in term deposits, which will yield 1.10% and mature within 93 days.

2. Accounts receivable: Relate to the sale of products and services, including the provision of the Core Plan through provincial/territorial bilateral agreements. Also included in receivables are provincial/territorial contributions for specific programs, including $455,000 from the Ontario Ministry of Health and Long-Term Care for the Ontario Trauma Registry, the Ontario Mental Health Reporting System and the Ontario Health Based Allocation Model. The government refunds receivable as at June 30, 2015, is $28,900. Subsequent to quarter end and up to July 16, 2015, approximately $165,000 of receivables has been received.

3. Receivable — Health Information Initiative: Related funding is recognized as revenue in the same period as the related expenses are incurred. Funding recognized but not received at the end of the period is recorded as Receivable — Health Information Initiative. Contributions received from Health Canada but not yet recognized as revenue are recorded as Deferred contributions — Health Information Initiative.

4. Prepaid expenses: Represent payments that have yet to be recognized as expenses, consisting of $2.8 million in software and maintenance, $359,000 in rent deposits to landlords for office space, and $478,000 in other expenses.

5. Capital assets: Presented net of accumulated amortization, including $4.6 million of computers and telecommunications equipment, $1.1 million of furniture and $2.8 million of leasehold improvements. The capital assets are amortized over their estimated useful lives using the straight-line method: 5 years for computer hardware/software and office/telecommunications equipment; 10 years for furniture; and lease term for leasehold improvements. All assets acquired during the year are amortized beginning in the month of acquisition.

6. Accrued pension benefits: Represent the accumulated cash contributions made by CIHI net of the sum of the current and prior years’ accounting pension expense for both the registered and supplementary retirement plans. Employer contributions to the CIHI Pension Plan are made in accordance with the January 1, 2014, actuarial valuation. In November 2014, a decision to wind up the pension plans effective December 31, 2015, was approved by CIHI’s Board of Directors. The next valuation will be as of December 31, 2015.

7. Accounts payable and accrued liabilities: Operational in nature. The accounts payable of $2.9 million is mostly current (less than 30 days). The accrued liabilities represent an estimate of $2.0 million for goods received and services rendered up to the end of the quarter (e.g., external professional services, advisory groups, printing, travel), as well as payroll and benefit accruals. The government remittances payable as at June 30, 2015, is $1.0 million.

8. Unearned revenue: Includes contributions received, for which expenses have not yet been incurred. The contributions are recognized as revenue in the same period as the related expenses are incurred. The balance consists of $1.8 million of funding contributions from the B.C. Ministry of Health for the National Ambulatory Care Reporting System 3-year implementation project and other special projects, $4.6 million in Core Plan and Portal billings related to the second quarter, and less than $100,000 for a few small projects.

9. Deferred contributions — Expenses of future periods: Represent unspent restricted contributions. The funding is recognized as income to match the occurrence of specific expenditures for projects and activities, including the pension accounting expense.

10. Deferred contributions — Capital assets: Represent contributions provided for the purpose of capital assets acquisitions. The deferred contributions are recognized as revenue on the same basis as the amortization of the related capital assets.

11. Lease inducements: Represent leasehold improvement allowances, other inducements and free rent received/provided over the years for Toronto, Ottawa, Montréal and Victoria offices. The inducements are amortized over the period of their respective leases.


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Operating budget ($000) for the 3-month period ended June 30, 2015

Approved Approved

Actual budget budget

Revenues YTD YTD Variance Notes (12 months)

Sales $ 555 $ 554 $ 1 1 $ 2,534

Core Plan 4,348 4,348 - 2 17,391

Funding — Health information 20,835 21,293 (458) 3 80,028

Funding — Other 679 563 116 4 2,185

Other revenue 45 63 (18) 5 246

Total revenues 26,462 26,821 (359) 102,384

Expenses

Compensation 20,727 20,307 (420) 6 77,443

External and professional services 1,059 1,495 436 7 5,556

Travel and advisory committee expenses 740 1,044 304 8 3,158

Office supplies and services 137 166 29 9 635

Computer and telecommunications 1,664 1,585 (79) 10 6,239

Occupancy 2,088 2,224 136 11 9,103

Corporate provision - - - 12 250

Total expenses 26,415 26,821 406 102,384

Surplus (deficit) $ 47 $ - $ 47 $ -


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Notes to the operating budget for the 3-month period ended June 30, 2015

1. Sales: Include products and services of CIHI over and above those sold as part of the Core Plan (e.g., fee-for-service basis).

2. Core Plan: Represents subscription revenue from the bilateral agreements with provincial/territorial governments.

3. Funding — Health information: Represents Health Canada current-year funding allocation recognized as revenue to match the operating expenses incurred. As well, it includes deferred contributions received in prior years recognized as revenue to match the capital assets amortization and the accounting pension expense.

4. Funding — Other: Represents contributions from provincial/territorial governments and other agencies for special projects (e.g., The Commonwealth Fund International Health Policy Survey) or specific programs (e.g., Ontario Mental Health Reporting System, Ontario Trauma Registry, Ontario Health Based Allocation Model). The funding is recognized as revenue in the same period as the related expenses are incurred.

5. Other revenue: Includes interest income generated from the bank accounts and ad hoc short-term investments, as well as miscellaneous income.

6. Compensation: Includes salaries, benefits and pension accounting expenses for both full-time employees and agency/contract staff.

7. External professional services: Include accruals for services rendered to date. At the end of June, the unrecorded contractual commitments pertaining to this fiscal year are in the order of $1.3 million.

8. Travel and advisory committee expenses: Include travel expenses for staff, Board of Directors and advisory committee members, as well as facility costs relating to CIHI’s education sessions and externally hosted meetings.

9. Office supplies and services: Include printing, postage/courier/distribution, office equipment and supplies, as well as insurance.

10. Computer and telecommunications: Include supplies, software/hardware support and maintenance, minor software costs and upgrades, telecommunications line charges and long distance charges, as well as depreciation of computers and telecommunication assets.

11. Occupancy: Includes rent, facility maintenance and depreciation of furniture and leasehold improvements.

12. Corporate provision: Set aside by management; essentially a contingency for emerging issues and year-end adjustments (e.g., benefits/pension costs, revenue shortfall).


20

Capital budget ($000) for the 3-month period ended June 30, 2015

Note

The above excludes $291,000 of commitments up to July 3, 2015.

Approved Approved

Actual budget budget

YTD YTD Variance (12 months)

Furniture and office equipment $ 7 $ 6 $ (1) $ 6

Leasehold improvements 3 35 32 200

Information technology and

telecommunication 180 220 40 1,266

$ 190 $ 261 $ 71 $ 1,472


21

Operating expenses by core function ($000) for the 3-month period ended June 30, 2015

Approved

Actual Budget budget

YTD YTD Variance (12 months)

More and better data

Health services $ 3,992 $ 3,911 $ (81) $ 14,815

Health human resources 1,049 1,289 240 4,802

Clinical registries 765 823 58 2,990

Health expenditures 1,199 1,321 122 4,759

Pharmaceuticals 1,113 1,154 41 4,481

Standards 1,764 1,874 110 7,087

Subtotal 9,882 10,372 490 38,934

Relevant and actionable analysis

Health indicators 1,915 1,975 60 7,492

Canadian population health initiative (CPHI) 705 713 8 2,743

Health reports, special studies and analysis 3,612 3,704 92 13,934

Subtotal 6,232 6,392 160 24,169

Improved understanding and use

Access to data and analysis 2,370 2,500 130 9,620

Delivery of education and capacity-building initiatives * 4,216 4,333 117 16,265

Outreach and other activities 3,715 3,224 (491) 13,146

Subtotal 10,301 10,057 (244) 39,031

Corporate provision – – – 250

Total operating expenses $ 26,415 $ 26,821 $ 406 $ 102,384

Notes

Indirect costs included in this analysis are allocated to programs/projects on the basis of direct costs. These costs include corporate functions

such as human resources, finance, procurement, administration, facility management, libraries, distribution services, information technology

support, telecommunications, planning and project management, privacy and legal services, communication, publishing/translation services,

executive offices and Board secretariat. This allocation method is in accordance with the accounting/financial reporting guidelines.

* CIHI’s education programs help facilities and their staff use the various CIHI products for effective management. Various methods of delivery

are used (e.g., distance-learning tools, workshops, self-learning products, blended delivery modes).


22

Quarterly performance report

The organization’s strategic goals for 2012–2013 to 2016–2017 are to

1. Improve the comprehensiveness, quality and availability of data;

2. Support population health and health system decision-making; and

3. Deliver organizational excellence.

In support of these strategic goals are the core functions that underpin CIHI’s work:

More and Better Data: CIHI will enhance the scope, quality, access and timeliness of our

data holdings.

Relevant and Actionable Analyses: CIHI will continue to produce quality information and

analyses that are relevant and actionable.

Improved Understanding and Use: CIHI will work with stakeholders to help them better

understand, access and use our data and analyses in their day-to-day decision-making.

Deliver Organizational Excellence: CIHI promotes continuous learning and development,

fosters an engaged workforce and strengthens accountability.


23

Performance measurement outcomes

The following table shows the 2015–2016 first-quarter results for the performance indicators that

measure progress in achieving CIHI’s strategic goals, mapped against CIHI’s core functions.

Performance indicator

Q1 2015–2016 Change from

Q1 2014–2015* Notes Target Actual

1. More and Better Data: CIHI will enhance the scope, quality and timeliness of our data holdings.

Performance measures for this strategic goal are measured on an annual or other periodic basis and are therefore not a part of this quarterly report.

2. Relevant and Actionable Analysis: CIHI will continue to produce quality information and analyses that are relevant and actionable.

Total downloads of top 20 analytical reports

10,500 8,031 ↑

Unsolicited media interest 200 404 ↑

Ad hoc media requests for information 62 59 ↑

New social media subscribers 1,560 1,186 N/A New indicator in 2015–2016.

Social media mentions 1,800 3,893 N/A New indicator in 2015–2016.

3. Improved Understanding and Use: CIHI will work with stakeholders to help them better understand, access and use our data and analyses in their day-to-day decision-making.

Standard and complex data requests completed

75 67 ↓ An additional 17 very complex requests were completed in Q1 2015–2016.

Standard and complex data requests completed within service standards

85% 81% ↓ Efforts are under way to reduce completion time for aggregate requests in order to meet the service standard target.

Education sessions delivered 304 252 ↓ The decrease is the result of the cancellation of some sessions with low enrolments and changing plans in program areas and jurisdictions.

Satisfaction with education sessions (good or excellent)

96% 97.2% ↑

4. Deliver Organizational Excellence: CIHI promotes continuous learning and development, fosters an engaged workforce and strengthens accountability.

Central Client Services response rates (within 2 days)

100% 95%–100%

→ Standard response time for Client Support was extended to 4 days due to high volume and resourcing issues.

Note

* Trending is not filled in for indicators reporting for the first time or where data from 2014–2015 is not available.


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More and better data

CIHI will enhance the scope, quality and timeliness of our data holdings.

Performance measures for this strategic goal are measured on an annual or other reporting

basis. Therefore they are not a part of the quarterly reports.

Relevant and actionable analysis

CIHI will continue to produce quality information and analyses that are relevant and actionable.

Downloads of analytical products (Top 20) from external website

The number of downloads depends on the type of product releases and the overall website

traffic that may draw clients and stakeholders to specific products in any one quarter.

Q1 Q2 Q3 Q4 Total Target

2014–2015 6,232 6,322 9,115 8,973 32,386 42,000

2015–2016 8,031 8,031 42,000

Media

Unsolicited media interest by type

Unsolicited media interest relates to those media mentions not associated with a traditional CIHI

release or advisory. A change in media monitoring services means that fiscal years may not be

entirely comparable.

Number of unsolicited mentions

In Q1 2015–2016, CIHI averaged more than 4 unsolicited mentions per day.

Unsolicited mentions

Print and online Broadcast Total Target

Q1 2014–2015 388 69* 457* 313

Q1 2015–2016 339 65 404 200

Note

* Underestimate due to broadcast coverage limitations (we do not have comprehensive coverage of radio broadcasts, although this issue is being addressed).


25

An example of unsolicited media interest:

April 20, 2015 — CBC News Ontario hospitals strive to cut C-section rates

In 2012, the national C-section rate was 27.2 per cent, according to the Canadian Institute for Health Information, up from 18.7 per cent in 1997. For three decades, the "ideal rate" for C-sections was considered to be between 10 per cent and 15 per cent, according to the World Health Organization.

Number of ad hoc media requests for information

Ad hoc requests for information are up slightly from the same quarter last fiscal year. In general,

the number of requests tends to fluctuate widely based on other stories and developments the

media may be focusing on at any point in time.

Ad hoc media requests Target

Q1 2014–2015 56 62

Q1 2015–2016 59 62

Here’s an example of an ad hoc request:

From: Sharon Kirkey (Post Media) Sent: June-11-15 10:41 AM

I'm working on a story on ICU survivors and wondering whether CIHI has data on how many people are admitted to an ICU each year in Canada?

Social media

The reporting of social media metrics is new in 2015–2016. Comparison data for Q1 2014–2015

is not available.

Social media subscriptions

Number of new social media subscribers

Twitter Facebook LinkedIn Other* Total† Target

Q1 2015–2016 619 93 445 29 1,186 1,560

Notes * Other includes YouTube and Pinterest.

† The rate of growth in CIHI’s social media communities is usually higher in Q3 and Q4 due to the Twitter and Facebook advertising campaigns that take place during these time frames


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Number of social media mentions

Number of social media mentions

Posts by CIHI CIHI mentions by others*

Twitter Facebook LinkedIn Total Target Brand

impressions†

Q1 2015–2016 425 30 7 3,893 1,800 9,430,675

Notes * Mentions by others are defined as any post that refers to either CIHI or the Canadian Institute for Health Information, or that

contains a link to CIHI content.

† Brand impressions are the number of times that CIHI content appears on social media — Twitter, Facebook, LinkedIn, blogs or comment boards. For example, if a person with 500 followers posts 1 tweet about CIHI, that tweet is published on 500 pages, resulting in 500 brand impressions.

Engagements by others are defined as clicks, shares, replies, likes and favourites.

The following post was the top Twitter performer in Q1. It was re-tweeted 25 times and received

a total of 175 engagements by others.


27

The following post was the top Facebook performer in Q1. It received 689 engagements, which

included 60 likes and 81 shares reaching at least 6,188 people.


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Improved understanding and use

CIHI will work with stakeholders to help them better understand, access and use our data and

analyses in their day-to-day decision-making.

Data request activity

An area of focus for the organization is improving access to CIHI’s data and reports for our

clients and stakeholders through the development of better access tools. The data request

tracking tool (DaRT) captures information on all custom data requests from external clients.

From April 1, 2015, to June 30, 2015, CIHI reviewed and processed 67 standard and complex

external data requests, compared with 90 in Q1 2014–2015. This represents a decrease of 25%

in the number of data requests processed this year. A total of 46 standard and complex

aggregate data requests were completed, down 15% from the previous year. In addition, 21

record-level standard and complex data requests were completed, down 42% from last year.

Service standards are CIHI’s commitment to provide good-quality services that incorporate the

principles of accessibility, responsiveness, timeliness and accountability. Service standards for

the External Data Request Program are based on the type of data request (i.e., aggregate or

record-level) and the complexity of the request. Data requested will be provided within the

following service standard:

Level of complexity

Service standard (85% completed)

Aggregate Record-level

Standard 10 working days 20 working days

Complex 20 working days 40 working days

Completed requests

Of the 67 completed standard and complex requests, 46 (69%) were for aggregate data and 21

(31%) were for record-level data. The 2015–2016 performance target is for 85% of external

custom data requests to be completed within the service standard. Overall, this target was not

met in Q1 2015–2016, with 81% (54 of 67) of data requests completed within the service

standard.

Note

The service standard covers the time period between receipt of a client’s completed data request form by the CIHI program area and release of the data to the client — the date of formal request until the date of data release.


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Summary of external data requests

Aggregate Record-level

2015–2016 2014–2015

Variance

2015–2016 2014–2015

Variance

# % # %

Q1 46 54 (8) (15%) 21 36 (15) (42%)

Total 46 54 (8) (15%) 21 36 (15) (42%)

Note

An additional 17 very complex requests were completed in Q1 2015–2016. Timelines for very complex requests are negotiated with the client on a case-by-case basis.

Data request turnaround time

Of the 46 aggregate requests, 82% were completed within the timelines set for standard

requests and 63% were completed within timelines set for complex requests. Of the 21 record-

level requests, 100% were completed within the timelines set for both standard and complex

requests. Efforts are under way to reduce completion time for aggregate requests in order to

meet the service standard target.

Type of request Q1

Number of requests

0–10 days

turnaround time*

11–20 days

turnaround time*

21 days and over

turnaround time*

Aggregate — Standard 2014–2015 23 3 3

2015–2016 18 2 2

Type of Request Q1

0–20 days

turnaround time*

21–40 days

turnaround time*

41 days and over

turnaround time*

Aggregate — Complex 2014–2015 25 0 0

2015–2016 15 7 2

Record-level — Standard 2014–2015 16 2 0

2015–2016 5 0 0

Record-level — Complex 2014–2015 18 0 0

2015–2016 13 3 0

Note

* Data request turnaround time is calculated as the time period from the date of request to the date of release.

Information on very complex data requests is not included in this report.

Source

Data request tracking tool (DaRT).


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Education

It is important to illustrate the value of CIHI’s Education program as part of CIHI’s ability to

deliver on and respond to clients’ needs.

Education and outreach sessions delivered by modality

For Q1 2015–2016, the planned target was delivery of 304 sessions. A total of 252 sessions, or

17% fewer, were delivered. This is a result of changing program area and jurisdictional plans as

well as cancellation of some sessions with low enrolments.

Number of sessions delivered

Target† Workshop

Web conference Self-study Outreach* Total

Q1 2015–2016 8 22 222 0 252 304

Total 8 22 222 0 252 304

Notes

* Outreach includes products that are not considered a formal Education course.

† Target is the number of sessions that should go ahead as planned, anticipating <5% cancellation.

Education evaluation — all modalities

The chart below summarizes client evaluations for CIHI Education courses delivered in Q1

2015–2016. CIHI’s Education program continues to receive very strong ratings in client

satisfaction across all modalities.

Evaluation rating*

Q1 2015–2016 YTD

Workshop Web

conference Self-study All

modalities†

All modalities

Recommend to others 100% 94.8% 94.0% 96.3% 96.3%

Practical 100% 97.0% 97.0% 98.0% 98.0%

Relevant 100% 97.0% 97.9% 98.3% 98.3%

Essential 100% 93.1% 95.6% 96.2% 96.2%

Average 100% 95.5% 96.1% 97.2% 97.2%

Notes

* Percentage of respondents rating CIHI’s educational offerings as good or excellent.

† All modalities include workshops, web conferences and self-study.


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Organizational excellence

CIHI promotes continuous learning and development, fosters an engaged workforce and

strengthens accountability (response to client needs).

ITS responsiveness to client needs

Response rate of Central Client Services

The target is 100% initial response rate within 2 working days.

Client service

Number of requests

Response rate Q1 2014–2015 Q1 2015–2016

Client Support 11,770 44,490 95% (in 2 days)

100% (in 4 days)*

Order Desk 621 736 100%

Education 1,649 1,114 100%

Note

* The standard response time was extended to 4 days in Q1 due to high volume and resourcing issues. High volumes were due to a large increase in access granted due to the eQuery release (27,993) and for the new access to media embargoes.

Engaged workforce

CIHI conducted its biennial employee survey in June 2015. The survey was modified this year to

enhance our understanding of how we are optimizing the effectiveness of employees, as

engaged and enabled employees contribute to our success. The survey allows us to identify

areas of improvement based on employees’ perceptions, provide formal feedback for

employees on engagement and enablement, and measure future progress with the provided

baseline.

The results are expected in Q2 2015–2016 and will be shared with all employees.


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CIHI Performance measurement framework, 2015 to 2018

Appendix A – Health Environmental Scan August 2015 as at June 30, 2015

33

Appendix A

Environmental Health Scan


34

Health environmental scan 2015–2016 First quarter

Contents

1. Federal/provincial/territorial

2. Trends/innovation

3. Pharmacare

4. Seniors

5. Data

6. Pan-Canadian/other organizations

7. International

8. Selected transitions

Federal/provincial/territorial

Fiscal Sustainability Report 2015

The fiscal sustainability of Canada’s federal government, sub-national governments and public

pension plans is assessed annually in the Fiscal Sustainability Report. Its goal is to evaluate

whether policy changes are required to correct the long-term path of public debt, after

considering the economic and fiscal impacts of population aging.

This year’s report concluded that health care spending has slowed, noting that spending growth

in 2014 is estimated to have reached its lowest level in 2 decades and sub-national

governments cannot meet the challenges of population aging under current policy. The

parliamentary budget officer estimates that permanent policy actions amounting to 1.4% of

gross domestic product are required to put sub-national government debt on a sustainable path.

Carter v. Canada: Physician-assisted suicide panel announced

Ministers Ambrose and MacKay announced the establishment of a 3-person external panel to

conduct consultations and ultimately report on options for a legislative response by the federal

government to the Supreme Court decision in Carter v. Canada. The panel, chaired by

Canadian palliative care physician Dr. Harvey Max Chochinov, will undertake a comprehensive

consultation of key stakeholders, including medical authorities, interveners in the legal case and

interested members of the public. Other panel members include Catherine Frazee and Benoit

Pelletier. The panel’s report is expected in the late fall.

Defeat of Bill C-356: A national strategy for dementia

Bill C-356, which called for a national dementia strategy, has been defeated. Put forward by

NDP MP Claude Gravelle, the bill would have required involvement of all levels of government

and the introduction of benchmarks, standards of care and time frames. It would have also

given other levels of government and stakeholders a forum to point out the need for resources.

300 municipalities had passed resolutions supporting the bill.


35

Ottawa has recently earmarked up to $42 million over 5 years in the 2015 budget for Baycrest

Health Sciences to establish a Canadian centre for aging and brain health innovation. The

federal government is also working with the Alzheimer Society to develop a community-based

awareness and training program.

Council of the Federation

The Council of the Federation met in St. John’s, Newfoundland and Labrador, from July 15 to

17, 2015, and discussed a range of topics including health care, the economy and pharmacare.

Below are some of the highlights.

Health care

The Premiers’ Health Care Innovation Working Group continues to place health care as a top

priority, with a focus on pharmaceuticals, appropriateness of care, and seniors’ care and

dementia. Regarding pharmaceuticals, over the past year, partnerships have achieved

significant cost savings on drugs where the annual combined savings from provincial/territorial

collaboration on both brand and generic drug pricing initiatives are estimated at $490 million.

The pan-Canadian Pharmaceutical Alliance (pCPA), a body that conducts joint

provincial/territorial negotiations for brand name drugs in Canada, is working to increase access

to drug treatment options, achieve lower drug costs and consistent pricing, and improve

consistency of coverage criteria across Canada.

Census information

Premiers discussed concerns about the quality of information provided by the voluntary National

Household Survey compared with that provided by its predecessor, the mandatory long-form

census. Concerns also exist over the hampered ability of governments to evaluate and

implement key programs and services for Canadians, including those that

Measure economic performance;

Address poverty;

Target barriers for persons with disabilities, minority groups and Aboriginal peoples;

Identify labour market needs; and

Identify needs for community programs and services (e.g., housing, school enrolment,

specialized programs for vulnerable groups).

Newfoundland and Labrador: Launch of the Strategic Health Workforce Plan

The Government of Newfoundland and Labrador released the Newfoundland and Labrador

Strategic Health Workforce Plan, 2015–2018. The plan is a comprehensive, fiscally responsible

approach to addressing priority issues facing the provincial health workforce.

The plan establishes a framework to ensure a stable and consistent supply of health

professionals for the long term. It is designed to meet the challenges facing the province’s

health system and its workforce and is guided by 5 overarching strategic directions, including


36

Building quality workplaces;

Establishing appropriate workforce supply;

Strengthening workforce capacity;

Enhancing leadership and management; and

Maintaining robust planning and evidence.

New Brunswick

The provincial government will hold a summit in Moncton on October 7, 2015, to address

alternate levels of care in New Brunswick hospitals. Key stakeholders from the regional health

authorities, health care professionals, and the nursing home, special care homes and

community-based care sectors will be invited to participate in the summit to share their views on

how to improve access to alternate levels of care. Speakers from outside of New Brunswick will

discuss how other jurisdictions have overcome similar challenges.

Saskatchewan: New public health information system

Saskatchewan patients and health providers are now benefiting from a new, electronic

integrated public health information system: Panorama. It allows public health care providers to

manage vaccine inventories and immunizations, and enhances their ability to deliver services to

residents.

Alberta: Bill 3 reverses proposed cuts to health care

Bill 3, the Appropriation (Interim Supply) Act, reverses cuts to health care and invests in stable,

predictable funding for the vital public services crucial to Alberta’s communities.

Reversing proposed cuts to the health budget brings stability to health care delivery. The interim

supply budget will save more than 1,500 nurse and health care positions from being cut. It is the

first step in ensuring that front-line workers have what they need to deliver the health care that

Alberta families rely on. The Alberta budget is expected to be tabled in the fall.

Trends/innovation

Advisory Panel on Healthcare Innovation releases report

The Advisory Panel on Healthcare Innovation released its report Unleashing Innovation:

Excellent Healthcare for Canada on July 17, 2015. The report summarizes the work undertaken

by the panel, as well as its recommendations. Of interest, the panel recommends the creation of

a new agency — the Healthcare Innovation Agency of Canada (HIAC) — which would

consolidate the Canadian Foundation for Healthcare Improvement, the Canadian Patient Safety

Institute and Canada Health Infoway (after a transition period).

In its mandate, HIAC would be “dedicated to catalyzing change in real-time, evaluating the

impacts of those changes, and accordingly rejecting, revising and re-evaluating, or scaling-up

the resulting innovations.” The panel also recommends that a Healthcare Innovation Fund be

set up to enable the work of the agency. Both the new agency and the fund would be

considered the federal lead and important enablers for the report’s recommendations.

http://www.healthcanada.gc.ca/innovation

http://www.healthcanada.gc.ca/innovation


37

The report’s recommendations centred around 5 themed areas where federal action was

important to promote innovation and enhance both the quality and sustainability of Canadian

health care:

Patient engagement and empowerment;

Health systems integration with workforce modernization;

Technological transformation via digital health and precision medicine;

Better value from procurement, reimbursement and regulation; and

Industry as an economic driver and innovation catalyst.

The panel identified that the Canadian Institute for Health Information (CIHI) would

1. Be supported to provide greater transparency about health care in Canada and to lead

“open data” efforts;

2. Pursue more intensive data-gathering on 3 fronts:

i. The 30% of health care spending that flows from private sources;

ii. Health services for and the health of First Nations and Inuit, working in

partnership with the proposed First Nations Quality Council and a parallel liaison

committee for Inuit representatives; and

iii. Patient-oriented outcome measures.

3. Partner with the new agency (HIAC) and with the provinces and territories to develop

information appropriate to support integrated health care delivery models, including

different forms of bundled payments; and

4. Ensure greater dissemination of the information it gathers to a range of audiences,

particularly the general public.

Pharmacare

Pharmacare for Canada?

The national conversation on pharmacare continues with the release of Pharmacare 2020, a

report that envisions all levels of government committing to the full implementation of a public

drug plan that is universal, comprehensive, evidence-based and sustainable. Evidence from

across Canada and around the world shows that pharmacare is the best system for achieving

Universal access to necessary medicines;

Fair distribution of prescription drug costs;

Safe and appropriate prescribing; and

Maximum health benefits per dollar spent.

The report recommends change in several key areas, including access, fairness, safety and

value for money, and fully implementing pharmacare by 2020.

Pharmacare 2020 was a collaborative initiative of the Pharmaceutical Policy Research

Collaboration (PPRC). Activities of the PPRC are funded by the Canadian Institutes of Health

http://pharmacare2020.ca/


38

Research (CIHR) through a CIHR/Health Canada Emerging Team grant on Equity in Access to

Necessary Medicines (2009–2014).

Health ministers discussed 2-tier payment approach to pharmacare

Canada’s provincial and territorial health ministers discussed ways of structuring a national

pharmacare program at a recent meeting in Toronto, including adopting a 2-tier payment system

that would see some drugs given away for free and a second tier of medicines that would be

paid for privately. A 10-page summary of the discussions, dated July 13, has been released to

all provincial health ministers.

Seniors

Health care services in Canada will come under strain due to an aging population with chronic

and degenerative diseases. To address the challenges facing seniors and their care in Canada,

a coordinated approach is needed between federal, provincial and territorial governments, as

well as other key health care stakeholders and communities, according to a new report from

The Conference Board of Canada. Understanding Health and Social Services for Seniors in

Canada identifies key challenges affecting seniors’ health and health care services including

Lack of timely and equitable access;

Restricted funding to support growing seniors’ health needs;

Limited senior-friendly mechanisms for redress; and

The current federal role in key health and social services for seniors.

Data

Quality Improvement Information Protection Act introduced in Nova Scotia

The Nova Scotia government introduced legislation on April 21, 2015, to give the existing legal

protection for patient safety and quality review information to the Department of Health and

Wellness.

Under the old system, each district health authority maintained its own data and review

information, without it being accessible to the province. Provincial access to this information will

make analysis more effective and improve the system.

The information available to the department will be aggregate data, with personal identifiers

removed. Indirect identifiers such as age and sex will be kept since they provide meaningful

information about particular populations. The legislation ensures that the information will have

the same legal protections against release as it does with the health facilities.

Pan-Canadian/other organizations

Canadian Patient Safety Institute: Online Patient Safety and Incident Management Toolkit

launched

http://www.conferenceboard.ca/e-library/abstract.aspx?did=7025

http://www.conferenceboard.ca/e-library/abstract.aspx?did=7025


39

The Canadian Patient Safety Institute has launched a new online Patient Safety and Incident

Management Toolkit that brings together evidence, resources and leading practices from

Canada and around the world in a practical and easy-to-use format. It was developed in

collaboration with an expert faculty, which included Accreditation Canada.

Canada Health Infoway: The ImagineNation Data Impact Challenge

In an effort to explore new ways to harness vast amounts of data more quickly and efficiently,

Canada Health Infoway (CHI), with multiple supporting partners, launched the ImagineNation

Data Impact Challenge. Drawing on the specific health care and data analytics expertise of

CIHI, the Canadian Association for Health Services and Policy Research and Choosing Wisely

Canada, CHI aimed to find a new way to deliver information to decision-makers more quickly. It

is hoped that the results of this survey will answer some pressing questions about duplication

rates for tests and exams, follow-up rates for abnormal tests, and the impact of prompt

discharge summaries on readmission, among others.

International

United States

Measuring Medicare quality and spending: The Commonwealth Fund’s new comparative tool

Health care quality and spending are national concerns, but the delivery of care is local. Quality

of care and spending vary widely across geographic areas, and more spending is not always

associated with higher quality of care or better health outcomes. To enable comparisons at the

local level, The Commonwealth Fund announces a new online tool, the Quality–Spending

Interactive (QSI).

Users first choose a health care setting (such as a hospital, home health, doctor’s office or

nursing home) and then select a quality measure (such as a 30-day readmission rate) to view

quality and spending performance for a given state or local area. The relationship between

quality and spending is displayed on a scatter plot and map. Locations can also be compared to

see how a region performs relative to the U.S. median.

Senators seek to address concerns about electronic health records

Concerns about a $30 billion federal program meant to encourage the adoption of electronic

health records are likely to be addressed in a Senate medical innovation bill later this year.

Lawmakers in both parties largely agree that the government’s 6-year-old Meaningful Use

Program, included in the 2009 stimulus package, needs improvements. The effort was intended

to incentivize doctors and hospitals to adopt electronic medical records, with the intention of

facilitating information-sharing and improving quality of care. But more than 250,000 physicians

have struggled to meet the program’s second phase of requirements and have begun losing 1%

of their Medicare payments as part of a penalty, according to the Centers for Medicare &

Medicaid Services. The final rule for the next stage of the program is expected later this year.

http://www.patientsafetyinstitute.ca/English/toolsResources/PatientSafetyIncidentManagementToolkit/Pages/default.aspx

http://www.patientsafetyinstitute.ca/English/toolsResources/PatientSafetyIncidentManagementToolkit/Pages/default.aspx

http://www.commonwealthfund.org/interactives-and-data/spending-vs-quality-interactive

http://www.commonwealthfund.org/interactives-and-data/spending-vs-quality-interactive


40

Selected transitions

Government

Sarah Hoffman was appointed minister of Health, Government of Alberta.

Carl Amrhein, former University of Alberta provost and administrator of Alberta Health

Services, will become Alberta’s new deputy minister of Health. Janet Davidson will move

from her role as deputy minister of Health to a special advisor role.

Dafna Carr was named executive lead, Online Centralized Public Reporting, Health Quality

Ontario.

Dr. James Talbot stepped down as Alberta’s chief medical officer of health.

Other organizations

Anne Lemay was appointed director general, Centre intégré universitaire de santé et de

services sociaux of Centre-Ouest-de-l’Île-de Montréal.

Dr. Sarah Muttitt, chief medical information officer at Alberta Health Services, was named

chief information officer and vice president of the Information Management and Technology

portfolio for The Hospital for Sick Children in Toronto.

The Honourable Michael H. Wilson is the new chair of the Mental Health Commission of

Canada’s board of directors, taking over the role from Dr. David Goldbloom.

Dr. Malcolm Moore is the incoming president of the BC Cancer Agency in Vancouver.

Michel Bilodeau was appointed interim chief executive officer of the Kemptville District

Hospital in Kemptville, Ontario.

Mark Casselman was appointed chief executive officer of COACH: Canada’s Health

Informatics Association in Toronto.

Dr. Brian Day was elected president of Doctors of BC in Vancouver.

Gilles Lanteigne has been named chief executive officer of Vitalité Health Network in New

Brunswick.

Dr. Charlyn Black was appointed associate director of Population and Public Health at the

University of British Columbia in Vancouver.

Dr. Duncan Sinclair and Dr. Andreas Laupacis were named to the board of directors of

Technology Evaluation in the Elderly Network, in Kingston, Ontario.

Kathy McPhail was appointed chair of Manitoba’s regional health authorities, in Winnipeg.

Tom Magyarody was appointed chief executive officer of the Ontario Medical Association.

Dr. Catherine Zahn was named chair of the board of directors of the Institute for Clinical

Evaluative Sciences, effective June 24, 2015.

Dr. Alan Katz was named director of the Manitoba Centre for Health Policy.


41

Robert Halpenny has announced his resignation from his position as chief executive officer

at British Columbia’s Interior Health Authority in Kelowna, effective fall 2015.

Lori Lamont was appointed as the interim president and chief executive officer at the

Winnipeg Regional Health Authority.

Jacques Turgeon has resigned as chief executive officer of the University of Montréal

Health Centre.

president’s quarterly report - cihi quality a clinical chart review study –– to compare...

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