Harb Gill

“Mr. Speaker, I think there is broad agreement in this place about the problem this bill is trying to address. Canadians should be able to access their own health information, and when they seek care, the people treating them should be able to get the information they need securely and with the appropriate privacy protections. I support interoperability. In fact, I have spoken about this in the House before. In the previous Parliament, the former member for Cypress Hills—Grasslands brought forward Bill C-294. It dealt with the Copyright Act and interoperability, and it eventually became law. I congratulate that member, and I spoke in favour of it at the time. The example I used in that debate was pretty straightforward. It was about a farmer who could own a tractor or combine and buy an implement made by a different manufacturer. It could hook up just fine. Mechanically, there would be no reason it should not work, but technological protection measures could prevent the two pieces of equipment from communicating with each other. I said at the time, “real competition pits products and services against one another, rewarding innovation and productivity, not copyright and exclusivity.” I also said that the right to interoperability was critical for consumers. I stand by that. I still believe it today. However, health care is obviously different and considerably more complicated. I want to be very clear: I believe in the importance of interoperability. Canadians should be able to access their personal medical information, and health care professionals should be able to get the information they need to care for their patients safely and with respect for privacy. However, we need to make a distinction: Making software interoperable and making our health care system truly interoperable are two different things. I have some concerns in this regard about this bill. Bill S-5 is principally about health information technology vendors. It would require the technology covered by the legislation to be interoperable according to established requirements, and it would prohibit data blocking by vendors. Those sound like very reasonable objectives to me. If a vendor is deliberately preventing health information from moving simply to keep a customer locked into its ecosystem, there is a legitimate role for Parliament, but I think we need to be careful about what happens next. Canada does not just have one health system. We have provincial health care systems, and within those systems, there are health authorities, hospitals, laboratories, primary care providers and other organizations that have brought in different technologies at different times under different contracts to do different things. Some of those systems are relatively new; some are not. Some communicate reasonably well, and some require people to find workarounds just to move fairly basic information. If there were one health care system, one purchaser and one set of specifications, establishing common technical requirements might be simpler, but there is not. I do not think the answer is to turn the federal government into the health care technology purchaser for the entire country, although I am sure there are some members on the opposite side who would enjoy that. Health care is principally administered and delivered by the provinces, like it or not. The federal government needs to respect that. I will be fair about the legislation. There are provisions in the bill that recognize that reality. The federal requirements would not simply apply uniformly, regardless of what a province or territory is already doing. The bill would provide a mechanism that takes into account whether a province or territory has a substantially similar or stronger requirement. I think that is completely sensible, but it also points to a larger problem. The federal government does not run the health care system. I hope we can all agree on that. Some Canadians might reasonably respond that they are not entirely convinced the provinces are running it either. We have seen in Nova Scotia and, more recently, in my home province of British Columbia that the Conservatives of those provinces actively ran for and won majority governments despite the old logic that Conservatives cannot speak to health care issues and only run away. In my home province, there are wait times at the ER, that is if it is actually open. I heard from the daughter of 90-year-old woman that her mother had been kept in the hallway of the Kelowna General Hospital ER for days. She was literally unable to sleep with all the incoming patients, and the first responders and health care professionals trying to do their job while her mother was waiting for a bed. Constitutionally and practically, the provinces administer and deliver health care regardless of how badly. They are dealing with hospitals, health authorities, physicians and procurement decisions, and much of the information is already in place. Therefore, I think this House should ask a fairly basic question: Why should we assume that the federal government knows best when it comes to procuring and implementing complex information technology when its own record does not exactly inspire confidence? Let me give an example. We all remember ArriveCAN. The Auditor General of Canada could not even determine exactly what the application cost because the government’s financial records and controls were so poor. She estimated the cost at approximately $59.5 million. She found that federal organizers repeatedly failed to follow good management practices in contracting, development and implementation, and concluded that the application did not deliver the best value for the taxpayer dollars spent. That deserves some reflection. The federal government is now entering into another debate involving sophisticated information technology and procurement, yet in the case of ArriveCAN, or arrive scam depending on who we talk to, the Auditor General of Canada could not even establish the precise cost of the government’s own application because the records were inadequate. That is not an ideological argument, but the Auditor General’s finding. Then we come to PrescribeIT. This example is arguably even more relevant because it was a health information technology project. The objective was straightforward. It is 2026; why are we still sending prescriptions around by fax? The goal of PrescribeIT was to move prescriptions electronically from prescribers to pharmacies. According to public reporting, more than $250 million was spent on PrescribeIT since 2017, yet fewer than 5% of Canadian prescriptions were being transmitted through the system. The centrally operated service ended this year after Canada Health Infoway concluded that national adoption had not been reached to the scale necessary for long-term sustainability. The organization has moved toward an open national e-prescribing standard instead. Let us think about that for a moment. The problem was not that no one could figure out how to make an electronic prescription. They could. The difficult part was getting a complicated health care system to use it. Adoption mattered. Existing information systems mattered. Costs, I would hope, mattered. Provincial participation absolutely mattered. The day-to-day practices of doctors and pharmacists mattered. Implementation mattered. ArriveCAN could teach us something about federal procurement. PrescribeIT should teach us something about health care technology implementation. Both should give the Liberal government a warning to show a little humility. I am not saying the federal government has no role here. It does. Preventing genuine data blocking can be a legitimate federal role. Working with provinces on common technical standards makes sense. Removing legitimate federal barriers makes sense. The federal government can certainly demand results when it is spending taxpayer money. However, the Liberals on the government benches should be very careful about assuming that because they can pass a law about interoperability, they therefore know how to procure, integrate and operate health information systems better than the people delivering the care. Writing requirements in Ottawa is considerably easier than making technology work on the ground, and Canadians have paid enough money over the years to understand the difference. I have been thinking of all of this because of two conversations I had on my Finding Solutions podcast. One was with Dr. Stuart Edmonds of the Canadian Cancer Society. We were talking about clinical trials and why they matter to cancer patients. I think most Canadians understand generally what a clinical trial is, but it looks rather different when we think about it from the perspective of somebody who has cancer and may be running out of treatment options. There may be a clinical trial available for that person, but somebody has to know that patient exists. They have to know what kind of cancer that person has. They have to know what treatments have already been tried. They may need pathology results, diagnostic information or other testing. Then they have to determine whether that patient might qualify for the trial. At that point, interoperability stops being a debate about software and becomes a question of whether the right information can get to the right people when it matters. With cancer, I do not think I have to tell members, time matters. I had another conversation on finding solutions with Louise Binder, a long-time patient advocate working with the Save Your Skin Foundation. We talked about the postal code lottery in cancer care. We talked about clinical trials, access to new medicines, families travelling to receive treatment and what that all means for someone who is already dealing with a serious illness. We discussed this legislation on interoperable health information and the importance of a care team being able to see the full picture of the patient. That, to me, is the most persuasive case for what the government is trying to accomplish. A cancer patient should not have to become the human interface between computer systems that cannot communicate. If someone from my communities in the Okanagan has to go to Vancouver for specialized treatment, that person should not have to reconstruct their medical history every time they encounter another part of the health care system. If someone has to travel to another province for care, that gets even harder. The relevant health information should not simply disappear because people cross the provincial boundary. The technology should work for the patient. The patient should not have to work for the technology to work. I want to come back to the patient, because this law should exist for them. If I am a cancer patient, I do not care which company developed the software used in my hospital. I do not care what government bought the system. I want to know whether my doctor has the information he needs to treat me. That is all. If I need to go to another region or another province to obtain care, I want important information to follow me. I therefore support interoperability. That said, passing an interoperability act and creating a truly interoperable health care system are two different things. The government itself says that only 29% of health care providers share electronic information securely and seamlessly outside their offices. Obviously, that is not good enough, but that statistic also raises an uncomfortable question. We have been talking about digital health in Canada for years. We have spent money, billions of dollars. We have developed strategies. We have established organizations. We have announced initiatives. We have negotiated funding agreements. Where are the results? This is not an argument against doing more. It is an argument for understanding why what we have already done has not produced the results Canadians reasonably expected. It comes down to this old political trap. There is a problem, something must be done and this is something. Therefore, we must do this. That does not mean Bill S-5 is inherently bad legislation. It means Parliament should not confuse legislative activity with health care results. Passing a bill is relatively easy. Writing regulations can be done. Holding a press conference can certainly be done. We know because we see it almost every day with the government. However, the difficult work comes after that. How does this work with the systems provinces already purchased? What happens to older systems? How much will it cost to make them compatible? What happens when standards change? What happens when one institution is capable of exchanging the information, but another is not? What happens when the barrier is not the vendor? What happens when the problem is an existing contract, an institutional practice, a procurement decision made 10 years ago or simply an old system that is too expensive to replace? Those are not reasons to abandon interoperability. They are reasons to be honest about what this legislation can and cannot accomplish. The federal government has a role to play, but having a role to play does not mean playing all the roles. The provinces administer their health care systems. They know their facilities. They make their own procurement decisions. They are responsible for delivering care. Ottawa can remove certain obstacles. The federal government can work with the provinces to establish common standards. It can prevent unwarranted data blocking. When it spends taxpayers’ money, it can certainly demand results. However, a national standard cannot replace co-operation. Federal legislation alone cannot solve all the problems that exist in our health care systems. There is another contrast that I think is worth considering. The federal government already knows how to sit down with provinces and reach agreements on specific health outcomes. The federal government has agreements with British Columbia, Manitoba, Prince Edward Island and the Yukon, covering a range of diabetes medications and contraception. Those are agreements with provinces and territories, yet there are only four. It seems to me that the government is pivoting away from the kind of approach that costs money and instead trying to find another problem to solve. Interoperability, as I said, is a problem, but is that the best use of everyone’s time? We need to start asking whether or not the Liberal government is seeking results or if it is just seeking to have announcements. I think the same approach should guide interoperability. What do I actually want to know about this bill? First, would it stop vendors from blocking information that would legitimately be available? If it does, good. Second, would these standards actually work with systems that provinces and health care providers already have? Telling everyone that tomorrow’s technology must comply does not necessarily fix the equipment and the software that were purchased five or 10 years ago. Third, how would the government work with provinces, not consult them so that someone can put a check mark beside consultation, but actually work with them? Finally, what would the patient notice? Can they access their information? Can their doctor get the information they need? If I live in the Okanagan and go to Vancouver for treatment, can the professionals treating me see the relevant records? If I end up in an emergency room somewhere else in the country, what happens then? If I have cancer and possibly qualify for a clinical trial, will the information needed to identify that opportunity actually be available? Those are the questions I care about. Frankly, I am less interested in whether a technology vendor can tell the federal government that it has complied with the regulation. I just want to know whether the thing actually works. Do not come back to Parliament in two years and tell us how many meetings were held. Do not tell us how many vendors submitted compliance paperwork. Do not tell us how many pages of regulations were published. Tell us what happened to the patient. That is how we should measure success. Can patients access that information? Can doctors? If a patient moves away, can their information follow them? If a treatment or clinical trial is available, can the necessary information be accessed in a timely fashion? Results are what matters. I do not just want to know if software is interoperable on paper. I want to know if the system works in real life. I would just mention an incident that I had an occasion to ask a former minister of health about. In 2022, the prime minister at the time, the premier of my province, John Horgan, and the health minister, who is still a member today, reached an agreement on health care information sharing. Billions of dollars were announced. Now, that was four years ago and what has changed? Zip. What I am saying to the government here is that it can make announcements and spend money, but that does not necessarily mean the job gets done. It should start to listen to the people who know the systems, start to put them in charge of the job and make sure that it is seen not only as an announceable, but a deliverable, and make sure the government is behind that. After speaking with people such as Dr. Stuart Edmonds and Louise Binder, I see a case for this bill in health care very clearly, but we have learned enough from previous digital health projects and, frankly, from federal IT procurement more generally, to know that passing legislation is the easy part. Making it work is the hard part. Let us make sure that doctors are not relying on faxes. Let us make sure that the government relies on facts. Let us not confuse passing the law with solving the problem. Patients do not need another announcement about interoperability; they need a system that works. When a physician has to make an important decision, they should have access to the right information at the right time. Patients should not have to act as a go-between for two computer systems that cannot communicate with one another. That is the outcome we should be working toward. Ultimately, this is not about databases. This is about people. I ask the government to really focus on the people more than the data and not to focus on the announcements, but on the actual results.”