Listening and Learning
CIHI Annual Report, 2014–2015
Listening and Learning CIHI Annual Report, 2014–2015
Message from Board Chair and President
We’re listening. In fact, this past year, we’ve focused on just that — listening to our funders, to those working on the front lines, to system decision-makers and to our employees.
As we began to work on renewing our strategic plan, we wanted to know 2 things: how are we meeting our customers’ current needs, and what are their emerging priorities?
In talking with our stakeholders from coast to coast — both internally with our staff and with those working in the sector — a number of key themes emerged:
Data timeliness, the continuum of care and standards
While we’ve made progress on the timeliness of our data, there’s still room for improvement. Increasingly, care is provided outside of acute care settings. Our data holdings should reflect this. Just as important, with new sources of data emerging, CIHI is in an excellent position to lead in the development of standards, which are essential in order for information to be considered relevant and comparable.
Engaging our stakeholders
Our stakeholders are very keen to work with us. They want to tap into our expertise to get more meaning from our work. Over and over, we heard that collaboration with a wide variety of players is critical to increasing the impact of our data, as well as our products and services.
With time remaining on our current strategic plan (which runs from 2012 to 2017), you may be wondering “Why renew it now?” The need for health information has evolved significantly over the last 20 years and continues to change at a faster pace than ever before. We need to keep up to remain relevant. The conversations with our stakeholders provided a great deal of insight into their needs and our work, and our future priorities will reflect what we’ve learned. You’ll be hearing more about where we’re headed as we launch our new strategic plan in the coming year.
While strategic planning has been an important focus over the past few months, we also accomplished a number of other things that are worth celebrating. In this report, you can read about these and other successes:
- We’re supporting a number of federal initiatives related to prescription drug abuse.
- We’ve expanded our data holdings to include information from the patient’s perspective.
- We launched 2 major initiatives related to the Your Health System web tool.
- We were recognized internationally for our data security and privacy practices.
We’re very proud of the work we do and look forward to collaborating with our partners in the health care system to achieve our vision:
Better data. Better decisions. Healthier Canadians.
CIHI data in action
At CIHI, we’re connecting. We’re collaborating with our partners to gather the right data. We’re linking with our clients to provide the data they need. And ultimately, we’re connecting with Canadians, providing better information to improve care.
Better data. Better decisions. Healthier Canadians.
As we enter the fourth year of our 2012 to 2017 strategic plan, we believe we’re on the right track. This annual report provides many examples of what has been accomplished over the past year.
Our 3 strategic goals will continue to guide us in the coming year as we transition to our refreshed strategic goals and directions in 2016:
1Improve the comprehensiveness, quality and availability of data
- We will provide timely and accessible data connected across health sectors.
- We will support new and emerging data sources, including electronic health records.
- We will provide more complete data in priority areas.
2Support population health and health system decision-making
- We will produce relevant, appropriate and actionable analyses.
- We will offer leading-edge performance management products, services and tools.
- We will respond to emerging needs while considering local context.
3Deliver organizational excellence
- We will promote continuous learning and development.
- We will champion a culture of innovation.
- We will strengthen transparency and accountability.
Goal 1: Improve the comprehensiveness, quality and availability of data
Data is at the heart of everything we do at CIHI. Every day, we build on our strong data quality culture, continually enhancing the data we provide.
Several data quality initiatives in the past year illustrate this commitment:
- CIHI has been exploring data surveillance techniques, taking cues from the finance and insurance sectors. More sophisticated data mining methods are being developed to detect anomalies and outliers that we don’t normally identify in regular analysis. It’s this type of cutting-edge work that will help provide more timely identification of potential data quality issues.
- Each year, CIHI prepares provincial/territorial data quality reports for deputy ministers of health across Canada. The reports provide a snapshot of the quality of data being submitted to CIHI’s various data holdings. This year, we added a new report on day surgery, one of many improvements we made to the reports.
- British Columbia recently started reporting to the National Ambulatory Care Reporting System (NACRS). As part of its implementation, B.C. became the first jurisdiction to have physicians and nurses capture clinical data as part of the delivery of care. CIHI took an in-depth look at the quality of the emergency department data B.C. reported to the database, including the data captured by clinicians.
- We completed the first phase of an assessment of the quantity and quality of financial and statistical data submitted by long-term care facilities to the Canadian MIS Database (CMDB). This initiative supports the future reporting of this information.
- We launched a 2-year project working with the Western Patient Flow Collaborative to develop standards for consistently defining alternate level of care (ALC) in acute care hospitals and to improve the ALC information reported to the Discharge Abstract Database (DAD).
In addition to these initiatives, CIHI achieved 100% electronic data submission across all data holdings. Less manual processing and faster and more efficient submissions will result in improved data quality.
We have also made important progress in understanding and validating long-term care financial and statistical information submitted to the CMDB from more than 1,500 facilities, totalling approximately $18 billion. This work will serve as the foundation for reporting on the provision of long-term care in Canada, a growing sector of our health care system.
Data Access and Integration Strategies
CIHI’s Data Access Strategy does just that — improves access to data. This year, the strategy was augmented with new components:
- Post-secondary libraries across Canada continue to house more of CIHI’s inpatient data as part of Statistics Canada’s Data Liberation Initiative, available at no cost.
- CIHI is collaborating with the Canadian Institutes of Health Research to provide a data set on high users of the health system in order to support work on the Strategy for Patient-Oriented Research (SPOR).
- Enhancements to CIHI’s Access Data web page make it easier for health system and policy stakeholders and the general public to obtain data.
- CIHI provided data sets for use in the federal government’s Canadian Open Data Experience (CODE) 2015 hackathon.
In addition, CIHI continued to meet its stated service standards for our ad hoc data request service.
CIHI’s Data Integration Strategy takes a person-centred approach that will enable analysis of data along the health care continuum.
By investing in emerging technologies and the evolution of our analytical environments, CIHI is positioned to promote automation and efficiencies in the delivery of our business objectives.
Prescription drug abuse database
Health Canada recently announced that CIHI will receive $4.28 million in funding over the next 5 years to support federal initiatives related to prescription drug abuse (PDA).
CIHI will establish and run a new program to improve pan-Canadian PDA data and create agreed-upon data standards and indicators.
CIHI will work with stakeholders to understand what can be learned from existing data sources and where there are gaps. From there, we can support stakeholder access to and use of the PDA data and provide leadership around standards, analysis and reporting.
This is an opportunity for CIHI to create awareness, share knowledge and build capacity for better monitoring of abuse.
Patient experience survey/database and PROMs Forum
The first phase of the Canadian Patient Experiences Reporting System (CPERS) project was finalized in May 2014.
CIHI worked with representatives from Canadian jurisdictions to develop the Canadian Patient Experiences Survey — Inpatient Care, along with survey procedure standards. The second phase of the project, completed in March 2015, focused on developing a pan-Canadian reporting system as well as preliminary indicators and measures. CPERS supports the collection and reporting of patient experiences in the acute inpatient sector and is now ready to receive data. CIHI is also assessing options for measuring experiences in the emergency department and long-term care sectors.
CIHI’s Patient-Reported Outcome Measures (PROMs) Forum was held in February. The 60 participants included senior policy-makers from federal/provincial/territorial governments, senior health system decision-makers, international guests and selected clinicians and senior researchers. The event confirmed a high level of interest in aligning PROMs initiatives across Canada to better understand the patient’s perspective on health outcomes.
In response to the strong support from our stakeholders, CIHI has launched a new PROMs program of work.
Together, we are exploring opportunities for advancing common approaches to PROMs in Canada.
CIHI data in action
Eating disorders in women and girls
CIHI data supports standing committee’s work on eating disorders in women and girls
Read more on this story www.cihi.ca/landand other successes at
How Canada compares
The Commonwealth Fund survey
More than 5,000 Canadians age 55 and older were surveyed in 2014 as part of The Commonwealth Fund’s international survey.
The results highlight how experiences with health care vary across Canada and how they compare with those in other countries.
This past year, CIHI became a Canadian partner of this annual survey along with the Canadian Institutes of Health Research, taking over from the former Health Council of Canada. We worked with provincial partners to increase sample sizes and to adjust and enhance questions to meet Canada’s information needs.
In January, we released How Canada Compares: Results From The Commonwealth Fund 2014 International Health Policy Survey of Older Adults. The report shows where Canadian and provincial results are significantly different from the international average.
One finding is that older Canadians have longer wait times and more difficulty seeing a doctor or nurse when they need medical attention than older people in 10 comparator countries.
However, the survey results were generally positive for many aspects of care received by older Canadians when they do see their doctor.
The 2015 survey will focus on primary health care physicians and their views on the health care system. We will continue to apply our data quality methodologies to the survey data and make it more accessible to researchers.
We’re collecting more data than ever
CIHI data holdings
This table pdf provides a snapshot of CIHI’s national data holdings.
As can be seen, in 2014–2015, progress was made in the participation of jurisdictions in CIHI’s data holdings.
Plus, we added a new one: The Commonwealth Fund Survey.
CIHI data in action
Using data to plan care
A new project is helping health regions better understand — and plan for — the burden of disease in their region
Read more on this story www.cihi.ca/landand other successes at
Follow the money
NHEX turns 40
If you need to know about health spending in Canada, look to CIHI’s National Health Expenditure Database (NHEX).
The annual NHEX report outlines how much money is spent, in what areas and on whom, and where the money comes from.
Since 1975, the NHEX report has compared expenditure data at both provincial/territorial and international levels. The information supports policy planning, decision-making and research.
The 18th edition — National Health Expenditure Trends, 1975 to 2014 — was released in October in a more contemporary online format.
Findings show that health expenditures in 2014 reached $215 billion, while growth, at 2.1%, hit its slowest rate since 1997.
NACRS Clinic Lite
CIHI’s National Ambulatory Care Reporting System (NACRS) now has a “Clinic Lite” submission option, which provides a low-cost, rapid implementation method to collect patient-level information from outpatient clinics.
NACRS Clinic Lite is suitable for capturing information on community mental health, ambulatory care treatment for chronic heart failure/cardiac disease, chronic obstructive pulmonary disease/respiratory conditions, multiple sclerosis, stroke, renal failure/dialysis, cancer care and other priority services. The new submission option is generic enough to support multiple clinic types, both hospital- and community-based, and provides the capacity for customized data collection of interest to specific clinics.
The Mental Health and Addictions Data and Information Guide was released in March 2014 as a one-stop guide for individuals and health care organizations accessing mental health and addictions information through CIHI’s data holdings and publicly available products.
CIHI continues to actively participate in the Mental Health and Addictions Information Collaborative, with partners from the Mental Health Commission of Canada, the Public Health Agency of Canada and Statistics Canada. CIHI data was included in the Mental Health Commission of Canada’s new dashboard of mental health indicators, and work continues to enhance this resource.
Home and continuing care
CIHI collects information about community care services in Canada, including long-term care and home care, and sets Canadian data and information standards to ensure that information is comparable across the country.
Work in this area has been advanced on several fronts, including the following:
- We’ve significantly expanded the community data received from Alberta, Saskatchewan, New Brunswick and Newfoundland and Labrador.
- CIHI receives pilot community care data from several First Nations communities in Alberta. The home care pilot project is now being expanded to include all communities in Alberta over the next 3 to 5 years.
- CIHI is working with jurisdictions to prepare for implementation of the new suite of interRAI instruments, which includes the newest community care data standards. Training was offered on the new home care instrument in Ontario and is planned for the new long-term care instrument in New Brunswick.
- We are providing leadership in identifying client experience surveys (or data standards) for use in long-term care facilities in Canada.
Understanding high users
Case mix tools: Population grouping methodology
In April 2013, CIHI launched a project to develop a population grouping methodology unique to Canada.
The population grouping method helps us understand, among other things, how to risk adjust and compare performance and outcomes across populations. It can also be used to help with disease tracking, population segmentation and funding allocation decisions. Ministries of health, regional health authorities and health researchers are interested in these methodologies for many reasons, including the study of “high users” of health care.
CIHI data in action
Reducing wait times for breast cancer surgeries helps maximize the chance of survival
See how 1 province is improving outcomes for patients
Read more on this story www.cihi.ca/landand other successes at
Goal 2: Support population health and health system decision‑making
Raising the bar
Health system performance: In Depth and Insight
CIHI’s 3-year plan to strengthen health system performance (HSP) reporting is aggressive, and it’s being noticed.
Initiatives such as our enhanced reporting tools are receiving international recognition. CIHI was among a group of health care organizations recognized for their outstanding websites and digital communications during the 18th Annual Healthcare Internet Conference. CIHI’s Your Health System web tool placed in the Best Interactive Site category. In addition, a recent impact evaluation shows that our key stakeholders rated the relevance of our HSP work to their organization’s priorities as 4 out of 5. As well, 70% reported that CIHI’s products directly informed initiatives in their organization.
The In Depth section of Your Health System was launched in September 2014. It provides easy access to an expanded set of aligned indicators and contextual measures that reflect health system results at both the population and facility levels. Key features include peer group comparisons, benchmarking and top results, trend information, enhanced mapping functionality and exporting capability.
In March 2015, Your Health System: Insight — a secure, web-based analytical tool — was released to designated users. It allows them to “slice and dice” their information in customized ways to look at which patient populations are driving their results. They can also look at open-year data to understand how their current performance relates to their past performance. And they can see comparative information for hospitals across Canada. In the first phase, a small number of indicators related to emergency and acute care were included.
The big picture
Corporate Analytical Plan
One of CIHI’s key goals is to answer the most critical health care system questions that our stakeholders are asking.
To meet this goal, we travelled the country to hear from them. We want to ensure that our priorities are aligned with their needs and that this is reflected in our corporate Analytical Plan.
The plan provides a consolidated overview of what we are working on. It is a rolling picture that helps to ensure that our reports, products and indicators are aligned with our strategic directions, and that they are relevant to our stakeholders and transparent to our partners.
The plan also identifies opportunities for collaboration. CIHI works with many partners across the country and internationally to develop our new reports and indicators. This year, we collaborated with our key partner, Statistics Canada, on projects in priority areas such as mental health, cancer, health inequalities and high users of health services. We continue to encourage and seek partnerships for new analytical work.
Back to school
Capacity-building, HSP schools, CMF school
Capacity-building is a buzzword these days, but at CIHI, it’s really about ideas and experiences.
We want stakeholders to be able to use CIHI’s health data and information to support their decision-making. So we engage them through a series of learning opportunities. Here are a few examples from the past year:
- For the first time in Canada, a Case Mix Funding School was held in Toronto — hosted by CIHI. Canadian and international experts came together to discuss health care funding and how to do more with fewer resources. The concept was based on an international school run by Patient Classification Systems International. There were 2 key components: funding system design and implementation, and funding analytics. One delegate wrote, “Kudos to CIHI and the team responsible for organizing this forward-thinking event! I sincerely hope CIHI has plans to repeat this event at least annually to support continued skills and knowledge development across all regions and levels of the Canadian health care system.”
- Health Data Users Day was held in November in Halifax. 100 participants shared their experiences and successes in using data effectively for better decision-making in the health system.
- We also held Health System Performance (HSP) schools in Ontario and in Manitoba. These sessions are designed to build capacity for teams working in health system performance roles by helping them build data and evidence into their everyday work. The 3-day curriculum incorporates presentations and experiences from experts and peers, panel discussions and hands-on activities to address regional issues and apply HSP concepts. Woven throughout the session is a comprehensive case study based on key priority health issues. Participants tell us that the program hits the mark.
Excellence in all
Goal 3: Deliver organizational excellence
Privacy and security
ISO certification and prescribed entity status
CIHI is committed to protecting the privacy of Canadians and ensuring the security of their personal health information.
In September, for the first time, we received International Organization for Standardization (ISO) 27001: 2005 certification of our Information Security Management System. This achievement is an important milestone in the continual improvement of our privacy and security practices.
The implementation project leading to certification took more than 2 years as we developed a new governance model and risk management methodology for information security. We also enhanced processes and tightened controls and monitoring systems.
CIHI’s designation as a prescribed entity under Ontario’s Personal Health Information Protection Act, 2004 (PHIPA) has also been renewed. This means that health information custodians in Ontario, such as hospitals and long-term care facilities, may disclose personal health information to CIHI without the consent of the individuals concerned. CIHI can then use this information for analysis or to produce statistics that will contribute to the planning and management of the health system.
This achievement is important in Ontario, but also across Canada, as ministries of health and other data providers can have confidence in CIHI’s sound privacy and security program.
We treat data protection seriously.
Empowering our employees
Promoting continuous learning and development
CIHI empowers its employees to take charge of their careers through a series of continuous learning and development initiatives. This year, advanced LEADS training, elearning resources and a new Career Planning Program are having an impact.
LEADS is a leadership capabilities framework that includes a review of skills and strengths as well as personal reflection. CIHI managers, and many employees, have benefited from the frequently offered courses. Now, that theory is being put into practice with the new Harvard ManageMentor® program. This online learning resource includes 25 modules that support the LEADS framework, which has 5 components: Lead Self, Engage Others, Achieve Results, Develop Coalitions and Systems Transformation.
5 elearning analytical courses were designed and developed internally this year. The modules use CIHI data and examples from our publications to illustrate key concepts. The goal is to introduce staff to quantitative health research methods.
Another online addition to support our healthy workplace is LifeSpeak. This program provides expert-led online streaming videos on a wide variety of topics such as mental and physical health, relationships and families, and personal finances.
With the launch of the Career Planning Program this year, employees have greater opportunities for career development than ever before. They are encouraged to plan, develop and measure their career path, taking the lead with support from their manager and the Human Resources team. Opportunities range from personal assessments and technical and skills training to job shadowing a colleague in another part of the organization.
Career development is a win–win for employees and CIHI. We know that engaged, motivated employees are productive and committed to the organization.
Stakeholder and impact surveys
At CIHI, we want to know what our clients are thinking. So we ask them.
For several years, we have engaged Nielsen Consumer Insights to conduct a biennial stakeholder survey. The goal is to evaluate satisfaction with CIHI’s products and services, and general performance. The results of the latest survey were strong, with overall satisfaction in the 90th percentile.
- Most stakeholders agreed that CIHI is a credible source of data and information and that it provides a balanced perspective on health data and analysis.
- A significantly higher proportion of respondents (than in 2012) said that CIHI meets or exceeds their expectations.
We are continually making improvements based on this feedback.
We also introduced an impact evaluation survey to determine the value of CIHI’s products and services. We want to know how they are being used to make decisions and to bring about change in the health care system. This survey was targeted to a smaller and unique set of stakeholders who are regular CIHI users.
- Overall, stakeholders rated the usefulness of CIHI’s analytical reports and tools fairly high and indicated that these tools are used in a number of ways that are helpful to their organization.
- However, not all respondents felt that their organization has the expertise and/or capacity to fully use these tools.
- In response, CIHI has launched a capacity-building program to assist stakeholders in developing these skills.
- The majority of respondents reported that CIHI’s analytical reports or tools have directly informed initiatives and efforts in their organization.
These survey results will serve as good baseline information moving forward.
Checks and balances
As part of its funding agreement with Health Canada, CIHI commissions a third-party performance audit.
The audit also assesses CIHI’s relevance and performance. The latest audit, which covers April 2012 to August 2014, was developed and conducted by KPMG.
The results are impressive, with the identification of a number of positive practices, including
- Active stakeholder engagement
- Consideration of stakeholders’ needs in investment decisions and product and service development
- Leveraging of partnerships for improved economy and effectiveness
- A strong information security policy and related procedures to guide the accuracy and safeguarding of data holdings
- An organizational structure that enables a high level of responsiveness to jurisdictional stakeholders across Canada by CIHI’s regional offices
The full results are used to continually improve overall organizational performance.
We want to ensure that federal funds are used with due regard for economy, efficiency and effectiveness.
With more than 700 employees located in offices across the country, CIHI’s work is governed by a Board of Directors that links federal, provincial and territorial governments with non-governmental health groups. Board members represent all health sectors and regions of Canada, and their strategic guidance steers the work we do.
Board of Directors members and committees
(as of March 31, 2015)
- Dr. Brian Postl Dean of Medicine University of Manitoba (Chair) (Winnipeg, Manitoba)
- Canada at large
- Dr. Verna Yiu Vice President, Quality and Chief Medical Officer Alberta Health Services (Edmonton, Alberta)
- Dr. Marshall Dahl Consultant Endocrinologist Vancouver Hospital and Health Sciences Centre (Vancouver, British Columbia)
- Region 1 (British Columbia and Yukon)
- Dr. David Ostrow Former President and Chief Executive Officer Vancouver Coastal Health Authority (Vancouver, British Columbia)
- Dr. Heather Davidson Assistant Deputy Minister, Planning and Innovation British Columbia Ministry of Health Services (Victoria, British Columbia)
- Region 2 (Prairies, Northwest Territories and Nunavut)
- Dr. Marlene Smadu Vice-President of Quality and Transformation Regina Qu’Appelle Health Region (Saskatoon, Saskatchewan)
- Ms. Janet Davidson Deputy Minister Alberta Health (Edmonton, Alberta)
- Region 3 (Ontario)
- Ms. Janet Beed Former President and CEO Markham Stouffville Hospital (Toronto, Ontario)
- Ms. Susan Fitzpatrick Associate Deputy Minister Ministry of Health and Long-Term Care (Toronto, Ontario)
- Region 4 (Quebec)
- The non-government Region 4 (Quebec) director position is currently vacant.
- Mr. Luc Castonguay Assistant Deputy Minister, Planning, Performance and Quality Assurance Ministère de la Santé et des Services sociaux du Québec (MSSS) (Québec, Quebec)
- Region 5 (Atlantic)
- Mr. John McGarry President and Chief Executive Officer Horizon Health Network (Miramichi, New Brunswick)
- Mr. Bruce Cooper Deputy Minister, Department of Health and Community Services Government of Newfoundland and Labrador (St. John’s, Newfoundland and Labrador)
- Statistics Canada
- Mr. Peter Morrison Assistant Chief Statistician Social, Health and Labour Statistics Statistics Canada (Ottawa, Ontario)
- Health Canada
- Mr. Simon Kennedy Deputy Minister of Health Health Canada (Ottawa, Ontario)
The Board met in June 2014, November 2014 and March 2015.
We would like to recognize the contributions of several departing Board members:
- Ms. Helen Angus, Former Associate Deputy Minister, Ontario Ministry of Health and Long-Term Care
- Dr. Luc Boileau, President and Director General, Institut national de santé publique du Québec
- Mr. George Da Pont, Former Deputy Minister, Health Canada
- Mr. David Hallett, Former Associate Deputy Minister, Ontario Ministry of Health and Long-Term Care
Human Resources Committee
The Human Resources Committee assists the Board in discharging its oversight responsibilities relating to compensation policies, executive compensation, senior management succession and other key human resources activities.
Governance and Privacy Committee
The Governance and Privacy Committee assists the Board in improving its functioning, structure, composition and infrastructure. This committee exercises the powers and duties of the nominating committee, in accordance with our bylaw. The Governance and Privacy Committee also reviews and makes recommendations on the direction of the privacy program, and on our privacy and data protection practices.
Finance and Audit Committee
The Finance and Audit Committee reviews and recommends approval of the broad financial policies, including the yearly operational plans and budget, and reviews the financial position of the organization and our pension plan. This committee also formulates recommendations on the financial statements, the public accountant’s report and the appointment of the forthcoming year’s public accountants, and it provides direction and review of our internal audit program.
CIHI data in action
Improving surgical wait times in pediatric health centres with CIHI tools and data
Read more on this story www.cihi.ca/landand other successes at
|Finance and Audit (FAC)||
|Human Resources (HR)||
|Governance and Privacy (GPC)||
|Anne-Mari Phillips||Chief Privacy Officer|
|Barbara McLean||Director, Central Operations and Services|
|Brent Diverty||Vice President, Programs|
|Cal Marcoux||Chief Information Security Officer|
|Caroline Heick||Executive Director, Ontario, Quebec and Primary Health Care Information|
|Chantal Poirier||Director, Finance|
|David O’Toole||President and CEO|
|Douglas Yeo||Director, Methodologies and Specialized Care|
|Elizabeth Blunden||Director, Human Resources and Administration|
|Francine Anne Roy||Director, Strategy and Operations|
|Georgina MacDonald||Vice President, Western Canada and Developmental Initiatives|
|Gregory Webster||Director, Acute and Ambulatory Care Information Services|
|Jean Harvey||Director, Canadian Population Health Initiative|
|Jeremy Veillard||Vice President, Research and Analysis|
|Kathleen Morris||Director, Health System Analysis and Emerging Issues|
|Kathryn Hendrick||Director, Corporate Communications|
|Kimberly Harvey||Director, Integration Services|
|Kira Leeb||Director, Health System Performance|
|Louise Ogilvie||Vice President, Corporate Services|
|Mark Fuller||Director, Health Information Applications|
|Mea Renahan||Director, Clinical Data Standards and Quality|
|Michael Gaucher||Director, Pharmaceuticals and Health Workforce Information Services|
|Michael Hunt||Director, Health Spending and Strategic Initiatives|
|Scott Murray||Vice President and Chief Technology Officer|
|Stephen O’Reilly||Executive Director, Atlantic Canada and Integrated eReporting|
At CIHI, we’ve been listening. Extensive consultation across the country has been a priority over the past year. These connections with our stakeholders will help guide us as we finalize our next set of goals and priorities, leading to a new strategic plan in 2016.
Our first 20 years have provided a solid foundation. We are ready for the decade ahead and beyond.
CIHI recently presented to Health Canada’s Advisory Panel on Innovation, and our message was simple: information is critical to enabling health care innovation. We need a strong information base — and a strong information base is created by adopting pan-Canadian data content standards.
Health system use
Every time someone has contact with the health care system, some type of data is created. That information is used for clinical purposes but also to support management of the health system overall.
The data is valuable at several levels: clinical practice; system review; population and public health trending; and research and surveillance. As electronic medical records (EMRs) and electronic health records (EHRs) evolve, there will be even more data to inform decisions.
We are moving forward with 2 priorities in this area:
- CIHI is setting the standard regarding EMR data — what to collect and how to collect it. We want to ensure that critical health information can be transferred between systems to support care and be available for health system use. Through collaboration with Canada Health Infoway and partners across the country, CIHI is working to support a priority set of standardized primary health care data by 2017. EMRs and EHRs are more than just tools for clinicians; they are tools for Canada, to inform decision-making across the health system.
- We also have work under way to reduce the burden and cost of collecting and sharing data. We will continue to identify opportunities that support this goal, such as increased use of point-of-care data capture in hospitals.
We will continue to identify opportunities that support this goal, such as increased use of point-of-care data capture in hospitals.
Health system performance, eReporting
CIHI is building on more than 10 years of experience in strengthening pan-Canadian health system performance reporting.
Our new secure web tool — Your Health System: Insight — is already making a difference for decision-support managers, analysts and clinicians in emergency and acute care settings.
To further broaden the view we have of the health system, more indicators and measures will be added to integrate all hospital reporting information in 1 place. Expect more roll-outs shortly.
The strategy to integrate CIHI’s digital reporting — known as electronic reporting — started in concert with the Health System Performance initiative. As we move forward, we will adapt this strategy to consolidate and streamline the number of digital reporting products, based on client input and feedback.
The intention is to create a truly integrated suite of information that is user-friendly, that can be updated quickly and often, and that presents a complete system view.
When I grow up
Mentorship program launch, employee survey
CIHI has grown significantly over the past 20 years, and CIHI staff tell us that they are changing too.
Every 2 years, we conduct an employee survey — to listen and to learn. What we’re hearing is that staff want even more information on career development. They want to take charge of their futures.
To deliver organizational excellence, we need to deliver to our employees. In addition to our extensive Career Planning Program, a new mentorship program is planned to roll out over the next year based on a pilot over the past year. It provides opportunities for one-on-one linkages, pairing mentees with mentors who match their interests and goals. For example, an IT consultant might be matched with a vice president. The program is supported by questionnaires, discussion guidelines and personal feedback mechanisms.
We want to foster a culture of support and engagement for future CIHI leaders. At the same time, current leaders can enhance their mentoring skills. It’s a win–win.
Just 1 click away
Web audit and redevelopment project
Websites must continually evolve and change to respond to user need and new technology.
Our website is no different. We’ve been listening to our stakeholders’ feedback — good and bad. And a recent web audit has provided insight into how best to redevelop the site.
We want it to be one of CIHI’s core assets, giving stakeholders the information they need at their fingertips.
CIHI data in action
How does Canada compare?
Results for people age 55 and older from 11 countries
Read more on this story www.cihi.ca/landand other successes at
Management discussion and analysis
This section provides an overview of our operations and an explanation of our financial results. It should be read along with the financial statements in this annual report.
Who does what
- Management prepared the financial statements and is responsible for the integrity and objectivity of the data in them. This is in accordance with Canadian accounting standards for not-for-profit organizations.
- CIHI designed and maintains internal controls to provide reasonable assurance that the financial information is reliable and timely, that the assets are safeguarded and that the operations are carried out effectively.
- The Board of Directors carries out its financial oversight responsibilities through the Finance and Audit Committee (FAC), which is made up of directors who are not employees of the organization.
- Our external auditors, KPMG LLP, conduct an independent audit in accordance with Canadian generally accepted auditing standards and express an opinion on the financial statements. The auditors meet on a regular basis with management and the FAC, and have full and open access to the FAC, with or without the presence of management.
- The FAC reviews the financial statements and recommends their approval by the Board of Directors. For 2014–2015 and previous years, the external auditors have issued unqualified opinions.
This section includes some forward-looking statements that are based on current assumptions. These statements are subject to known and unknown risks and uncertainties that may cause the organization’s actual results to differ materially from those presented here.
CIHI receives most of its funding from the provincial/territorial ministries of health and the federal government.
- The proportion coming from these 2 levels of government has evolved over time but has been stable over the last few years.
- Our total annual source of revenue averaged $105.6 million between 2011–2012 and 2014–2015. This pays for our ongoing program of work related to our core functions and priority initiatives.
|Revenue source ($ millions)*||2011–2012 Actual||2012–2013 Actual||2013–2014 Actual||2014–2015 Planned||2014–2015 Actual||2015–2016 Planned|
|Federal government — Roadmap/Health Information Initiative||$86.6||$83.0||$77.7||$77.7||$79.4||$78.5|
|Provincial/ territorial governments — Core Plan||$16.4||$16.7||$17.1||$17.4||$17.4||$17.4|
|Total annual source of revenue||$111.0||$108.2||$99.7||$100.3||$103.5||$101.0|
Since 1999, Health Canada has significantly funded the building and maintenance of a comprehensive and integrated national health information system. Funding has come through a series of grants and contribution agreements referred to as the Roadmap Initiative or Health Information Initiative (HII).
- The 3-year HII funding agreement was put in place with Health Canada in 2012–2013.
- It included a phased-in 5% reduction over 3 years. As a result, the annual base funding went from $81.7 million in 2012–2013 (same as 2011–2012 ) to $77.7 million in 2014–2015.
- The HII agreement was recently renewed for 2015–2016 at the same level as 2014–2015.
- It was amended to include a new 5-year program of work on prescription drug abuse (PDA), for a total of $4.28 million.
- The first 2 years presented in the table include funding from the Roadmap agreement for $5.0 and $1.3 million, respectively.
- The results presented for 2013–2014 and 2014–2015 reflect delays encountered with a few key projects in 2013–2014; the projects were completed in 2014–2015. Health Canada had approved the associated carry forward of $1.6 million from 2013–2014 to 2014–2015.
Through bilateral agreements, the provincial/territorial ministries of health continued to fund our Core Plan (a set of products and services provided to the ministries and identified health regions and facilities).
- These agreements provided $17.4 million in funding in 2014–2015.
- They have been renewed for 1 year, through 2015–2016, at the same funding level.
Management’s explanation of results
|Operating expenses ($ millions)*||2011–2012 Actual||2012–2013 Actual||2013–2014 Actual||2014–2015 Planned||2014–2015 Actual||2015–2016 Planned|
* Reflects operating expenses; therefore, includes amortization of capital assets and accounting pension plan costs.
|Salaries, benefits and pension expense||$71.3||$76.8||$75.6||$79.8||$78.7||$77.4|
|External professional services, travel and advisory committee expenses||$14.9||$11.2||$8.8||$10.8||$11.0||$8.7|
|Occupancy, information technology and other||$17.6||$17.3||$16.3||$16.1||$16.0||$16.3|
|Total operating expenses||$103.8||$105.3||$100.7||$106.7||$105.7||$102.4|
Total operating expenses, 2014–2015: $105.7 million
- These include compensation costs, external professional services, travel expenses, occupancy and information technology costs required to deliver on several key project initiatives undertaken in 2014–2015, including project activities carried forward from 2013–2014.
Total remuneration, 2014–2015: $5.1 million
- This includes any fee allowance or other benefits to our senior management team involved in the accomplishment of our 3 strategic directions.
Total expenses variance relative to planned 2014–2015 activities: $1 million
- This relates primarily to a reduction in salaries and benefits expense due to the adoption of a new pension accounting standard.
- The annual pension plan expense for accounting purposes is based on the underlying methodology and interest rates prescribed by the Chartered Professional Accountants of Canada.
As a proportion of the total operating expenses, our actual investments in our 3 core functions remained relatively in line with the planned expenses.
Actual operating expenses by core function, 2014–2015
- $38.4 million — More and better data
- $41.3 million — Improved understanding and use
- $26.0 million — Relevant and actionable analysis
|Capital investments ($ millions)||2011–2012 Actual||2012–2013 Actual||2013–2014 Actual||2014–2015 Planned||2014–2015 Actual||2015–2016 Planned|
|Furniture and office equipment||$0.1||$0.1||—||—||—||—|
|Computers and telecommunications equipment||$2.4||$1.8||$2.3||$0.7||$1.2||$1.3|
|Total capital investments||$2.5||$2.3||$2.4||$0.7||$1.3||$1.5|
Acquisition of capital assets, 2014–2015: $1.3 million
- This is a decrease from prior years. Fewer investments in hardware, software and telecommunications-related equipment were required.
- Capital investments for 2014–2015 were higher than planned due to acceleration of capital investments from 2015–2016 resulting from resource availability.
- Our registered defined benefit plan offers our employees an annual retirement income based on length of service and final average earnings. It is being funded by both the employees and CIHI.
- As of March 31, 2015, the plan assets were $153 million for 951 members, 76% of whom are active participants.
- In addition, we supplement the benefits of employees participating in the plan who are affected by the Income Tax Act’s maximum pension limit.
- This supplementary plan is not pre-funded and we make benefit payments as they become due.
- These benefits are accrued and recognized in our financial statements in accordance with applicable accounting rules.
- In November 2014, CIHI’s Board of Directors approved a decision to wind up the CIHI Pension Plan effective December 31, 2015.
- Beginning January 1, 2016, CIHI employees will join the Healthcare of Ontario Pension Plan (HOOPP), the British Columbia Municipal Pension Plan or the Group RRSP.
Contributions (current plan)
- Contributions to the CIHI Pension Plan are determined by actuarial calculations and depend on employee demographics, turnover, mortality, investment returns and other actuarial assumptions.
- CIHI’s and employees’ contributions are pooled, invested and professionally managed by Standard Life Investments Inc.
- In light of the upcoming wind-up, the plan administrator instructed Standard Life Insurance Company of Canada (the custodian of the funds), in late November, to liquidate the investments and invest in a Canadian customized bond fund.
- The new fund is based on the CIHI Pension Plan characteristics.
- The investment manager’s performance and the investment policy are reviewed annually.
- In order to reach the employer–employee cost-sharing ratio of 55%–45%, employees’ contribution rates were increased by 0.3% on January 1, 2014, and by 0.45% on January 1, 2015.
Actuarial valuations (current plan)
- 2 actuarial valuations are prepared at different times and use different methodologies and assumptions:
- For accounting purposes (see note 7 of the financial statements)
- For funding purposes (this is also used for regulatory purposes and management of the plan)
- Per the January 1, 2014, actuarial valuation (for funding purposes), the plan reported a $17.7 million funding excess to the regulatory authorities.
- The next actuarial valuation for funding purpose will be as of December 31, 2015. The plan must be fully funded prior to the wind-up.
Internal audit program
Our internal audit program
- Provides independent and objective assurance to add value to and improve our operations
- Helps us accomplish our objectives by bringing a systematic, disciplined approach that both evaluates and improves our control and governance processes
- Is prepared using a risk-based methodology that targets our audit resources at areas of highest risk, significance and value for the organization
In 2014–2015, activities included
- An audit of procurement and payment compliance and controls
- Penetration testing and vulnerability assessments of the ITS network and server infrastructure and selected applications
- An audit of access rights by staff and consultants to CIHI networks and databases
- An internal audit of ISO 27001 version 2005 and a certification audit of ISO 27001 version 2005
- A compliance audit of 1 third-party data recipient regarding CIHI’s Data Request Form and Non-Disclosure/Confidentiality Agreement
Action plans were developed to address the areas for improvement recommended by the consultants contracted by us to specifically perform these activities.
In 2015–2016, the focus of the internal audit program will continue to be on information security and privacy.
Risk management activities
The goal of CIHI’s risk management program is to foster reasonable risk-taking based on risk tolerance. CIHI’s approach to risk management is to proactively deal with future potential events through risk mitigation strategies. This risk management program serves to ensure management excellence, to strengthen accountability and to improve future performance. It supports planning and priority setting, resource allocation and decision-making.
CIHI is committed to focusing on corporate risks that
- Cut across the organization
- Have clear links to achieving our strategic directions
- Are likely to remain relevant for the next 3 to 5 years
- Can be managed by the senior leadership of CIHI
CIHI’s Risk Management Framework consists of the following 4 cyclical processes that help us achieve our strategic directions:
CIHI’s Risk Management Framework
Achieving our strategic goals
- Assess the risks
- Identify strategic goals
- Risk identification
- Risk assessment
- Establish framework
- Policy framework
- Governance framework
- Process, methods, tools
- Monitor and communicate
- Review framework
- Managerial/board oversight
- Risk-management reporting
- Risk response and treatment
- Key risk indicators
- Strategy/action plans
- Risk champions
Risk management activities for 2014–2015
The executive management team assessed a number of key risks that could prevent CIHI from achieving its strategic directions based on their likelihood of occurrence and their potential impacts. 4 of these risks were identified as corporate risks due to their high level of residual risk (risk level after considering existing mitigation strategies).
The need for national/pan-Canadian data may become less relevant due to pressure on individual provinces and territories to deliver system transformation. Also, the increased availability of data from internal systems, including clinical registries, might focus system managers’ efforts inward rather than outward on cross-country comparable data. This could diminish CIHI’s importance as a source of data to identify areas for quality improvement. CIHI addressed this concern by releasing the Your Health System web tool, holding a national Consensus Conference to define priorities for future indicator development and holding a national forum on patient safety measurement (in partnership with the Canadian Patient Safety Institute). In addition, CIHI held multiple HSP and case mix schools to help stakeholders understand and use HSP data and information, and case mix products.
Electronic health records
Although the implementation of EMRs and EHRs presents CIHI with the potential to acquire data more easily and from new sources, a lack of standards for data captured electronically creates a challenge to generate comparable information. To address this, CIHI has developed a multi-year data supply/EHR sourcing strategy that involves sourcing information directly from EHR hospital information systems. This will yield data that is richer, more efficient and more timely. As part of this initiative, CIHI developed a low-cost, rapid implementation method to collect patient-level information from outpatient clinics: NACRS Clinic Lite. 2 pilot hospitals — 1 in Manitoba and the other in Ontario — will be collecting standardized patient outcome data related to nursing care via EHRs and submitting this data to CIHI in September 2015. Also that same month, a demonstration project in British Columbia will see a subset of inpatient and emergency department data flow to CIHI directly from the region’s EHR/eHealth Solution, reducing the collection burden on clinicians.
To address the slow progress toward making primary health care (PHC) data comparable across the country, CIHI delivered a new version (v3.0) of the EMR content standard. The standard consists of 45 priority data elements, 20 PHC Reference Sets and 8 Clinician-Friendly Pick-Lists (CFPLs). The focused scope of this new version aligns with jurisdictional priorities, addresses key gaps in PHC information and directly supports performance measurement for clinicians and decision-makers. CIHI is currently looking to engage in some demonstration projects to test the standard. In fall 2014, CIHI presented to the Conference of Deputy Ministers of Health on health system use. The federal/provincial/territorial deputy ministers agreed to adopt common content standards for primary health care EMRs by 2017 and to use their authority to accelerate adoption within their own jurisdictions.
CIHI continued to experience a progressive decline in funding over its 3-year Health Canada funding agreement, which came to term in March 2015. To meet financial pressures, CIHI maximized its use of available funding toward new priority investments and successfully managed the employee pension plan. We were able to secure 1-year extensions to funding agreements with provincial/territorial jurisdictions and Health Canada. We began consultation with our stakeholders regarding the renewal of our strategic directions, which will be supported by our funding request for future agreements. We also received targeted funding for a new 5-year program of work on prescription drug abuse.
CIHI led an inclusive consultation exercise to renew its strategic plan, asking stakeholders in all jurisdictions to help inform CIHI’s strategy for the next 5 years. The results of this consultation indicated broad support for CIHI and some concrete ideas to shape its priorities. Through our exploration of additional opportunities to engage federal/provincial/territorial sectors and key stakeholder groups, we were able to identify and act upon region-specific needs to develop or enhance our products and services. Examples include
- Holding a Health Data Users Day in Halifax and Toronto
- Operating Health System Funding schools in Ontario and Manitoba
- Supporting provincial and regional partners in submitting data to the Continuing Care Reporting System and Home Care Reporting System