Connected Care for Canadians Bill

Honourable senators, as we express our support at third reading for Bill S-5, the connected care for Canadians act, I am compelled to ensure a northern perspective is placed on the record for our colleagues in the other place to consider.

We have several senators with medical backgrounds and those who have intimate knowledge of the health care system. These senators have expressed their support for Bill S-5, lauding the interoperability of health care records and the benefits to physicians and patients alike.

My experience is in administration, including the interoperability of health care services at the territorial level and including the intersection of non-insured health benefits for First Nations and Inuit.

By way of background, my family moved to the Yukon in 1964. My Glaswegian father had a new job as the administrator of insured hospital services. His career in public service advanced to the director of medical services. He was the public servant behind the drafting and implementation of the Yukon Health Care Insurance Plan Act of 1972, the implementation of medicare and our own Yukon provincial health care number, known as “PHN” to the territory. Remember, the two territories at that time were very much “outposts” funded annually by Ottawa. A certified general accountant and Scottish to his core, my father always said that you should spend the taxpayer’s nickel as though it were your very last.

My first Western Premiers’ Conference in May 2000 was chaired by Manitoba’s Premier Gary Doer. At the top of the agenda was health care funding. Quelle surprise.

It was Premier Doer’s first conference, also. He made two statements that remain with me to this day. The first was in reference to the tension between Alberta’s Premier Ralph Klein and British Columbia’s Premier Ujjal Dosanjh regarding Alberta’s Bill 11. Bill 11 was felt by some to threaten the publicly funded health care system, to which Premier Klein wagged his finger and asked, “Before you utter those statements, have you read the damn bill?”

Upon this, Gary noted that it was his first conference as chair, and a hockey fight had broken out. It was also May and the hockey playoffs.

The second point Premier Doer noted — and I have repeated it many times in my work at the Senate National Finance Committee and elsewhere — was that Canada is the fourteenth province at the table when it comes to health care. Canada has a responsibility to First Nations, Inuit and Métis as well as the Canadian Armed Forces, and it must pay the costs.

My travels as premier with then prime minister Jean Chrétien on Team Canada flights overseas also included discussions on health care. At one point, the then prime minister relayed his frustration that his dear friend and political colleague had been in the hospital — I believe it was in British Columbia. Physicians treating this patient were unable to access medical records from Quebec. Canada’s health system was the focal point of the premiers’ meetings, but funding discussions with Ottawa had not addressed this very basic exchange of patient medical information.

Upon leaving elected politics in 2006, I continued my public service as the manager of registration claims and medical travel at Insured Health Services for the Government of Yukon, in effect, the modern-day equivalent of my dad’s old job.

As an aside, I would like to share that his granddaughter — my niece — is now serving as the CEO of the Yukon Hospital Corporation, and my daughter is a lead X-ray fluoroscopy technologist at the Whitehorse General Hospital. Our family tradition in health care and health care administration continues.

During my work at Insured Health Services, I represented the Yukon at the Interprovincial Health Insurance Agreements Coordinating Committee meetings. That committee’s tasks included confirming the daily hospital rates for every hospital in Canada, which are the amounts that could be reciprocally billed between provinces and territories for stays and services at the hospitals. Our discussions also included the systems that were purchased and advances in technology for the billing systems and electronic medical records. If I were to dig through the archives, I am certain I would find discussions that the technology the digital health records purchased must also be interoperable between the provinces and territories.

A quarter of a century later, we are still trying to achieve digital health care systems everywhere and interoperability between our jurisdictions. I would suggest to you, colleagues, that Bill S-5, the connected care for Canadians act, is not only incredibly important, but it’s more than 25 years overdue.

Colleagues, I appreciate that this may be considered by some to be too far into the actual administration of health care — into the weeds, so to speak.

Another piece of political advice I have received is that you do not need legislation for what you can do; rather, you need legislation for what you cannot do. Clearly, provinces and territories have not been able to enact Canadian interoperability for health care services. Bill S-5 helps provinces and territories translate the interoperability of health care from “cannot do,” as witnessed in my work career, to “can do.”

When we fully consider what the implementation of Bill S-5 can mean for provinces and territories, there are some benefits and costs that should also be taken into account by our colleagues in the other place.

The provincial health care number, or PHN, is the key to the health care of every Canadian and those entitled to be in Canada. An unintended consequence may also occur as we progress to digital health systems everywhere and their interoperability. We might take the opportunity to ensure that every Canadian is registered with a valid provincial health care number. Not everyone already has one. As we move further forward with digital systems, we must reach out to the chronically unhoused without a fixed address and those who fail to confirm their continued residency in a province or territory or even Canada to ensure they have a valid PHN.

Most important are the patient records associated with that health care number. It is the key to information on Canadians accessing health care, no matter where in Canada they access that care.

Others have noted how important the access and exchange of information is, so I do not need to belabour that point. I do need to point out, though, that this is especially important to Northern residents, such as those in the Yukon, the Northwest Territories and Nunavut, many of whom frequently travel outside of their ordinary place of residence for medical treatment.

Again, if you will allow me a real-life personal example, my physician recently ordered a fairly routine test that is not available in the Yukon. I suggested that I could perhaps get it done while on one of my stays in Ottawa, to which my physician said, “Well, you can try. However, I have no idea how I will get the results.”

That personal example is a minor inconvenience. A Yukon doctor recently shared with me a far more dire example of failing to receive information on a treatment for end-of-life pain care for a cancer patient. This patient lived in rural Yukon and is served by a health centre without the appropriate technology and systems for the exchange of information with his care providers through BC Cancer.

The Yukon is focused on efforts to improve the interoperability of health data systems within the territory. Bill S-5 aligns with this work by eliminating technological barriers and practices that limit the ability to share this vital data within and between jurisdictions.

In short, in plain language, advances in digital health and Bill S-5 will help health care providers provide their best care.

The computer systems and programs that support provincial health care systems are a significant financial investment in critical infrastructure by the provinces that have purchased, maintained and safeguarded against security breaches of their systems. Significant financial investments will be required to ensure their interoperability as contemplated in Bill S-5. I cannot speak for N.W.T. or Nunavut, but I can speak for the Yukon regarding the significant financial investments that are needed for the critical infrastructure of electronic health care records and to bring us up to contemplating interoperability as envisioned by Bill S-5.

For most of the Yukon’s history of responsible government, barring 2023 to 2025, the Yukon’s premier has also been the Minister of Finance. Thus, I speak from experience that I believe there isn’t a Minister of Finance in Canada who doesn’t wince every time the Minister of Health shows up with yet another budget request. Funding for health care dominates every discussion.

When considering the work of this bill, the technology contemplated in Bill S-5 to support interoperability should consider, I would argue, the unique challenges of the delivery of health care in Northern Canada and should be considered critical infrastructure.

Funding the access to digital health records and interoperability of systems presents a more challenging circumstance for the Ministers of Health and Finance in the territories than it does in the provinces. Provinces are simply further along in their access to and processes of digital health records. They also have a larger population and tax base to support their purchase and implementation.

Colleagues, while I profess some experience with the administration of health care records, I also sought the advice of the Yukon’s Minister of Health and Social Services, the Honourable Brad Cathers. He and his officials advised:

[The Yukon] Department of Health and Social Services encourages the Government of Canada to acknowledge and ensure equitable investments are considered through federal funding programs to support the Territories, recognizing the limits in fiscal and humans resource capacity while also supporting the opportunity to advance interoperable digital health platforms and technology to better connect people in rural and remote communities across Canada’s North to the health care services that every Canadian needs and deserves.

Earlier, colleagues, I noted Canada’s responsibility to First Nations, Métis and Inuit, as well as the Canadian Armed Forces. Ensuring health information technology is interoperable to promote a connected and secure health system — the stated summary of Bill S-5 — must also apply to Canada. Earlier, I noted my work as the Yukon Manager of Registration Claims and Medical Travel, and I referenced Non-Insured Health Benefits, which are the health care benefits available to Yukon First Nations. Senator Francis reminded us recently about Canada’s responsibility to ensure the availability of benefits to First Nations, Inuit and Métis. Canada’s responsibility for these benefits intersecting with the services provided under provincial health care systems and the inability of these governments to agree gave rise to Jordan’s Principle.

A 2021 Parliamentary Budget Officer report states that the First Nations and Inuit Health Branch, or FNIHB, also provides eligible First Nations and Inuit, regardless of where they live, with supplementary health benefits not covered by provincial or territorial health insurance or private programs, such as prescription drugs, medical supplies and equipment, dental and vision care, short-term mental health crisis counselling and medical transportation.

Indigenous Services Canada states itself on their “About Indigenous health care” web page that:

A coordinated approach to address the health needs of First Nations, Inuit and Métis, and health care delivery among all levels of government including Indigenous governments, remains an ongoing challenge.

Allow me to outline one of the challenges from an administrative level. Medical travel forms a large part of each of the three territories’ health care budgets. Medical travel is a medical evacuation by road, ambulance or an airplane from a remote area to a hospital in Whitehorse or a flight by commercial aircraft or medevac to Southern Canada to see a specialist if deemed necessary by a physician. This is paid for by the Government of Yukon for those on the Yukon Health Care Insurance Plan and holding a valid PHN. If you are Yukon First Nations or Indigenous from another territory, the Yukon government bills Non-Insured Health Benefits Canada for the cost of this transportation.

Sometimes, it can take a very long time for these bills to be sorted out and paid. That’s not a problem when you are recouping less than $500 from an Air North airfare to Vancouver. However, a medevac flight to a Vancouver hospital is upward of $30,000 one way. Patients who travel by medevac flight to a hospital are most often returned by medevac flight if they are not discharged. So, potentially, that is a $60,000 bill.

When a doctor locates a bed as well as an attending physician for the transfer of care to a hospital in B.C. and requests a medevac, there is generally not a discussion of which government is ultimately paying the bill, whether it’s the Government of Yukon or the Government of Canada. Several medevac flights over the course of a few months that are determined after the fact to be recoverable from Canada under the Non-Insured Health Benefits Program can start to add up very quickly.

The costs I have outlined are for transportation only and do not include the additional costs that governments — federal, territorial and First Nations — provide to these patients to help with the additional costs they incur by being out of the territory.

In the small budget of the Yukon, compared to the provinces, health care bill collection from Canada for Non-Insured Health Benefits and the cost to First Nations governments present yet another challenge for the Yukon’s finance minister and for First Nations governments.

The duplication of administration in medical travel is just one example of the challenges in providing health care and health care benefits.

The Yukon advises that digital health technology can enable safer and more coordinated care, reduce duplication and delays and improve access to services and information, particularly in communities.

With the implementation of technology, the interoperability that is anticipated in Bill S-5 and the participation anticipated by all provinces, territories and Canada — especially the support by Canada for the territories and Indigenous Peoples — I believe we can anticipate improved digital health care systems and, ultimately, better health care for all our citizens with the passage of Bill S-5.

Colleagues, I am truly grateful for the privilege of representing my region and, most especially, for your time and attention as I have addressed Bill S-5.

Thank you. Meegwetch. Shä̀w níthän.

Is it your pleasure, honourable senators, to adopt the motion?

Some Hon. Senators: Agreed.

An Hon. Senator: On division.

(Motion agreed to and bill, as amended, read third time and passed, on division.)