Measurements for Improved Quality in Healthcare
The Canadian healthcare system is composed of several systems, since each province and territory has the responsibility for the delivery and organization of the services in its own jurisdiction. Since the 1990s, when the quality of healthcare was perceived as having deteriorated and especially the wait times for care were considered unacceptable, several initiatives, federal and provincial, have been taken to increase both the quality and access of care. In conjunction with these activities, initiatives on the sharing of information between the jurisdictions and federal organizations were agreed upon and the development of a comprehensive framework for reporting, using comparable indicators, was initiated.
Many databases and registries exist in the country, with the Canadian Institute of Health Information (CIHI) hosting 24 databases and 5 registries, most of them pan-Canadian. The majority of the information is collected using administrative data, such as hospital discharge databases, and in addition to CIHI most jurisdictions, especially the provinces, will collect and analyze the information.
The concern for the quality of the healthcare in the country has resulted in a very large number of organizations, both provincial (the territories have not been active in this area so far) and federal, that report health measurements, including health indicators. In addition, many different types of indicators are used and for different purposes, resulting in a state that by some is called an “indicator chaos”.
Even though a pan-Canadian privacy law exists, the Personal Information Protection and Electronic Documents Act (PIPEDA), each jurisdiction has its own law, resulting in different regulations between the jurisdictions and sometimes even within provinces. This complicates the existence of pan-Canadian registries.
The implementation of electronic health records (EHRs) is of high priority in the country, but has so far had limited success. Most physicians have not adopted EHRs in a meaningful way and CIHI is currently working on new national standards on meaningful use of EHRs for primary care. CIHI is prioritizing EHRs over the creation of new registries, with the goal that certain data may get extracted from the EHRs for a specific purpose, for example a disease such as diabetes. The data would then be used to create data sets that resemble a diabetes registry.
The healthcare systems and their approaches to quality measurements in the provinces of Ontario, Saskatchewan and Quebec are presented in more detail in this report. Ontario and Saskatchewan were chosen since they were mentioned as good examples during the many interviews performed during the course of this project, and indeed proved to have implemented several healthcare quality measurements initiatives. Quebec was chosen since it applies a different approach to evaluating healthcare quality, heavily involving its citizens in the process.