CIHI’s Annual Report, 2015–2016 Charting a New Course

Dr. Brian Postl Board Chair and David O’Toole President and CEO
David O’ToolePresident and CEO
Brian PostlBoard Chair

Message from CIHI’s Board chair and president

Throughout 2015, our Board of Directors, our executive leadership and our employees considered the role our organization should play in the health sector in Canada in the next 5 years. We consulted extensively across Canada to develop a renewed mandate and vision for CIHI — one that reflects the evolution of health information needs in this country and that will take us into the next decade.

Moving forward together

The Board of Directors of the Canadian Institute for Health Information (CIHI) recently approved our new strategic plan, setting out our direction to 2021. We have a renewed mandate, goals and priorities, all linked by our commitment to meaningful engagement with the people and organizations we work with across the country.

This annual report highlights what we accomplished in 2015–2016 and the impact that CIHI is making across Canada, and it sets the stage for our new direction for the next 5 years.

We have an ambitious plan to help transform and accelerate improvements in health care, health system performance and population health across the continuum of care.

The health information landscape has changed significantly since CIHI began in 1994, and we are changing with it. Inevitably, the priorities of our partners will shift, the availability of resources will fluctuate, and the technologies of health care and health information will evolve. But the essential themes and direction set out here will continue to guide our thinking and decisions as we manage those developments.

Better data. Better decisions. Healthier Canadians. We look forward to working with our stakeholders as we take action and deliver this plan.

Signature Dr. Brian Postl Board Chair

Dr. Brian Postl Board Chair

Signature David O’Toole President and CEO

David O’Toole President and CEO

CIHI data in action

It was a year of consultation at CIHI as we moved from the 3 strategic goals that have guided us for the past several years to our refreshed strategic directions that look to the future. We have worked closely with our stakeholders and our staff to plan for our future.

This annual report provides a snapshot of what we accomplished over the past 12 months, according to our original goals:

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.

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

You ask. We answer.

At CIHI, we continually strive to improve access to our data and information. Over the past few years, we’ve implemented a successful strategy for enhancing access to health system performance data through our Your Health System web tool and its In Brief, In Depth and Insight sections. Data related to international comparisons and patient costs has also been made available through our new web tools and products.

Ann Chapman

There are other ways in which to access CIHI’s data. Ann Chapman, Manager, Programs Strategic Initiatives, explains a few of them:

Who requests data from CIHI?
More than 200 organizations receive CIHI data through the custom data request process each year, including health delivery organizations, government organizations and educational institutions. We also provide access to CIHI data free of charge to qualifying graduate students to help build capacity in health service research.
What are the different ways in which someone can access CIHI data?
CIHI collects comparable, pan-Canadian data on various aspects of Canada’s health systems — from hospital, community and specialized care to pharmaceuticals, patient safety, the health workforce, spending, international comparisons, and access and wait times. This data is carefully maintained and organized in CIHI’s many data holdings so that it’s retrievable, informative and reusable over time. One way to access this data is through our public-use dashboards and web tools such as Your Health System, which allow users to easily view and filter information according to their needs. There are many examples of these types of public-use tools on our website.
What has CIHI done to assist researchers who want access to CIHI data?
Researchers can submit a request to CIHI for aggregate and record-level data. Usually, CIHI makes its data available once all of the submissions for a database have been received for a scheduled period of time (a fiscal year or calendar year, for example). This year, we began offering access to open-year data — data from a database that may still be receiving data. This data request program is available to researchers, as well as to health delivery organizations, government organizations and educational institutions.
Researchers are also able to access sample files of CIHI’s acute care data through Statistics Canada’s Data Liberation Initiative and its network of post-secondary institutions. And researchers who are funded by the Canadian Institutes of Health Research (CIHR) under the pan-Canadian Strategy for Patient-Oriented Research (SPOR) initiative have access to data sets focused on high users of health care.
  • We continued to make available and enhance web tools that allow users to examine the performance of health systems and to inform international comparisons.
  • Working with the Canadian Association of Paediatric Health Centres (CAPHC), we focused on child and youth health by helping create a set of updated pediatric dashboards on emergency department visits, and on wait times for emergency department asthma visits and for surgeries.
  • We made it easier for users to access the data tables behind all of our analytical products.
  • We made some of CIHI’s data available through the federal government’s Open Data initiative.

Surveying our data

Quality data is at the heart of everything we do at CIHI, and we take our leadership role in this area seriously.

Over the past year, we have been developing data surveillance techniques similar to those used in the finance and insurance sectors. We are looking for any anomalies or outliers that will help us identify potential data quality issues.

Building on our existing strong culture of data quality, we are evolving our quality management practices to meet the needs of changing environments.

Streamlining from 4 to 1

In May 2015, CIHI took 4 systems that were 15 years old and integrated them into 1 new Classifications Information Management System. It’s all about making data collection easier for our clients: the new system reduces the burden of data collection. A great example of this is the development and maintenance of pick-lists, which capture specific information at the point of care.

On a related note, CIHI, Statistics Canada and similar organizations in other countries are actively contributing to World Health Organization (WHO) activities by providing input into International Statistical Classification of Diseases and Related Health Problems, 11th Revision (ICD-11) content and the new coding rules to support its use. We want to ensure that this new standard will meet Canada’s needs.

Real-time nursing data

If you can’t measure it, you can’t improve it. That’s the theory behind Canadian Health Outcomes for Better Information and Care (C-HOBIC). C-HOBIC generates real-time reports that link data on staffing, finance, length of stay and readmissions. This information can help an organization assess performance and clinical outcomes. At a research level, the data can help answer questions about the impact of nursing practices on broader clinical practice. At the health care system level, C-HOBIC empowers better health system management decision-making as information is shared across practice settings.

C-HOBIC is a standardized data set that captures 48 different patient measures — 24 on admission and 24 on discharge. The measures are calculated using data CIHI already collects in the Discharge Abstract Database (DAD), supplemented by additional information gathered through Special Project fields. To date, 2 pilot acute care sites in Ontario and Manitoba have signed on to collect data to support C-HOBIC’s evaluation.

More and better data

CIHI will enhance the scope, quality and timeliness of our data holdings. There are 5 dimensions of data quality: accuracy, timeliness, comparability, usability and relevance.

Comprehensiveness of CIHI’s data holdings

CIHI is working to enhance the scope and availability of our data for analysis and decision-making. The table that follows provides a snapshot of the comprehensiveness of CIHI’s 31 pan-Canadian data holdings.

10 of CIHI’s data holdings are receiving complete data from all provinces and territories. An additional 4 have 100% jurisdictional participation when submissions of partial data are considered.

18 of the data holdings have 80% or more participation from provinces and territories, and 12 noted progress toward increased uptake by jurisdictions compared with the previous fiscal year.

What’s new
  • 1 new data holding was added this fiscal year — the Canadian Patient Experiences Reporting System (CPERS). 4 jurisdictions — New Brunswick, Ontario, Manitoba and Alberta — are preparing to submit data in 2016–2017, with 2 more in discussion to submit data.
  • New data and analytical components were added to the National System for Incident Reporting to support the pilot project for tracking and reporting on incidents related to radiation therapy. 16 cancer centres were registered and approximately 300 radiation therapy incidents were submitted this fiscal year.
An easier approach to data collection and submission
  • On April 1, 2015, the new customizable National Ambulatory Care Reporting System (NACRS) Clinic Lite application was launched to make it easier to submit clinic data to CIHI and to enrich CIHI’s outpatient data supply. CAPHC’s Paediatric Rehabilitation Reporting System adopted NACRS Clinic Lite for data collection and submission, and the Ontario Ministry of Health and Long-Term Care is sponsoring a NACRS Clinic Lite pilot for outpatient rehabilitation visits.
  • Data collection for the Canadian Organ Replacement Register (CORR) was simplified and streamlined by switching from paper- to web-based data submissions. More than 115 users were given access to submit data using the new secure web form in 2015–2016, including facilities that had not submitted CORR data for several years. Better data quality and more efficient data handling resulted in improved timeliness and reporting of organ replacement information.
Increased availability of data
  • Among the data holdings that noted progress or plans toward increased data availability and uptake by jurisdictions compared with the previous fiscal year were the databases or reporting systems for ambulatory care (emergency department data), rehabilitation, home and continuing care, incidents, patient costs, and physicians and other health workforce personnel. CIHI also continued to receive and work with a growing set of patient-level physician billing data.

CIHI is reducing the burden of data collection and filling data gaps through increased availability of data in a standardized and comparable fashion that supports decision-makers and other health care stakeholders.

Download Comprehensiveness of CIHI’s data holdings as of March 31, 2016 (Accessible PDF)

Comprehensiveness of CIHI’s data holdings as of March 31, 2016

Confronting a public health crisis

Prescription drug abuse (PDA) is considered a public health crisis. That’s why Health Canada asked CIHI to lead a program to improve pan-Canadian data on the issue, including developing standards and indicators, and identifying and enhancing data sources. The goal is to support a coordinated approach to monitoring and surveillance. Work on the program so far includes the following:

  • We’ve extensively engaged with stakeholders to identify their priority needs. This exercise, which included a scan of PDA-related programs and information, led us to develop materials to support PDA-related research using CIHI data; it also formed the basis of the initial draft of Priorities for Pan-Canadian PDA Monitoring and Surveillance, which articulates key policy questions and provides sample indicators. This document will help guide PDA work in Canada for years to come.
  • We’re supporting Health Canada’s development of the Canadian Surveillance System for Poison Information. We’re providing input on data standards and system requirements as the country moves toward national collection of poison control centre information.
  • In October 2015, CIHI hosted a face-to-face consultation with coroners and medical examiners to help draft guidelines for investigating and classifying drug-related deaths. We are pleased to be working with Nova Scotia’s chief medical examiner, Dr. Matthew Bowes, on this project, and we anticipate that the draft guidelines will be endorsed at the next national meeting of chief coroners and medical examiners.
  • Finally, CIHI is leading the first study to look at pan-Canadian trends in hospitalization — and emergency department visits, where there is sufficient data — due to opioid poisoning. The results will fill an immediate information gap in research and policy, while establishing a baseline for subsequent analyses.

Read more on this story and other successes at www.cihi.ca/en/land

Quality data yields quality results

CIHI’s Canadian Patient Cost Database provides detailed patient-level data for a facility. When a patient leaves the hospital, there is a record of all of the costs associated with the stay. Patient costing is an important component of local decision-making. Nationally, it is used to respond to analytical questions and develop various products, including case mix weights and the Patient Cost Estimator. We are working with data providers to ensure the data is the best it can be.

This year, a data quality assessment framework was developed for Nova Scotia and implemented in that province. CIHI worked closely with the IWK Health Centre to assess its data using the 5 dimensions of our quality framework and to provide feedback and guidance for moving forward. Better data means better results.

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

A rolling picture

CIHI’s Analytical Plan provides a big picture view of CIHI’s new reports and indicators. The goal is to ensure that our work is aligned with our strategic directions, relevant to the needs of our stakeholders and transparent to our partners.

Tracy Johnson

Tracy Johnson, Director, Health System Analysis and Emerging Issues, explains:

How does the Analytical Plan align with CIHI’s new strategic plan?
We’ve been looking at the big themes of patient experience, quality and safety, outcomes and value for money. And now we’re beginning to look at specific populations identified by our stakeholders: seniors, children and youth, recipients of mental health and addictions care, and First Nations, Inuit and Métis. It’s exciting because the research we’ve done to develop our new strategic plan tells us that this is what our stakeholders want and need.
We’re hearing a lot about knowledge translation/exchange. How does that fit in?
A number of new initiatives are under way, including providing more relevant information for local use, conducting webinars and hosting forums to promote dialogue. For example, we developed 2 interesting reports that looked at the connections between strong primary health care and hospital use. CIHI analysts and regional office staff collaborated to offer virtual seminars for stakeholders in British Columbia, Alberta and Saskatchewan to look at how the results could be understood and applied in their provinces.
What’s the end goal?
We want to keep our stakeholders informed about where we’re going and ensure they can help shape our reports, and then use the knowledge once the analysis is done. The more we do that, the more relevant and helpful we’ll be.

Happy birthday, NHEX!

In October, CIHI celebrated the 40th anniversary of the National Health Expenditure Database (NHEX) with a birthday bash in Ottawa. The Economic Club of Canada and CIHI hosted close to 150 people who listened to a lively conversation about curbing Canada’s health spending growth. The Globe and Mail’s André Picard moderated the panel and also wrote a column reflecting on 40 years of health expenditures. The panel included

  • Don Drummond, Adjunct Professor, School of Policy Studies, Queen’s University
  • Dr. Cindy Forbes, President, Canadian Medical Association
  • Dr. David Naylor, physician, medical researcher and immediate past president, University of Toronto
  • Brent Diverty, Vice President, Programs, CIHI

NHEX allows us to look back in order to look forward, with 4 decades of valuable information to draw on.

Demonstration of a published infographic and a report related to National Health Expenditure Trends

There are more spending discrepancies within Canada’s provinces than between Canada and other countries.

Don Drummond, Adjunct Professor,
School of Policy Studies, Queen’s University

If we truly want to deliver better care, we need to be prepared to invest in care provided in the community, better management of chronic illnesses as well as long-term care, which will free up hospital beds in the acute-care system.

Dr. Cindy Forbes, President, Canadian Medical Association

We need to unbundle why drug spending discrepancies occur between provinces.

Dr. David Naylor, physician, medical researcher and
immediate past president, University of Toronto

Read more on this story and other successes at www.cihi.ca/en/land

The impact of income on health

Canada has made little progress in closing the gap between the health of richer and poorer Canadians. In fact, this gap has generally persisted or widened over time.

In November 2015, CIHI released its first-ever Trends in Income-Related Health Inequalities in Canada report and the supporting Health Inequalities Interactive Tool. The release looked at 16 indicators of health and health care by income level. The Canadian population was divided into 5 equal groups, allowing us to look at gaps in health from the lowest to highest income groups.

Key findings show that income-related inequalities widened over the past decade for 3 indicators: Smoking, Self-Rated Mental Health and Chronic Obstructive Pulmonary Disease (COPD) Hospitalization for Canadians Younger Than Age 75. This type of data will support jurisdictions as they look to improve health among all population groups.

The interactive tool provides an additional layer, allowing stakeholders to drill down and explore the data by province and sex. Initial feedback on and traffic to the web tool demonstrate its value.

Demonstration of a published infographic related to the Health Inequalities Interactive Tool

Data. Impact. Solutions.

In Canada, the number of emergency department visits and hospitalizations by children and youth with a mental disorder continues to increase, despite a lack of evidence that mental disorders are becoming more prevalent.

In May 2015, CIHI released Care for Children and Youth With Mental Disorders at a policy symposium hosted in conjunction with the Mental Health Commission of Canada, Children’s Mental Health Ontario and the Ontario Hospital Association. The event was attended by a variety of stakeholders who could use this data, including doctors and nurses, youth advocates and families, and policy-makers and health care system planners. This report describes hospital service use, for both emergency department visits and inpatient hospitalizations, as well as use of mood/anxiety or antipsychotic medications. This release has been used by our partners, stakeholders and Canadians to inform policy development, build recommendations, facilitate an ongoing dialogue and support quality improvement initiatives, in both hospitals and the education sector.

CIHI later worked with our partners at the Mental Health Commission of Canada and Children’s Mental Health Ontario to release an update to our Child and youth mental health in Canada infographic:

Demonstration of a published infographic related to the report: Care for Children and Youth With Mental Disorders

Getting the right people in the room

Convening and knowledge sharing is about working with stakeholders to develop a deeper understanding of how to use health care data and information to support their decision-making. Perhaps our biggest contribution may be getting the right people in the room to support knowledge translation/exchange.

Kathleen Morris

Kathleen Morris, Vice President, Research and Analysis, reflects on this important work:

Can you share some successes from the past year?
There are many, so I’ll tell you about just a few of them! CIHI’s Health System Performance (HSP) Schools — this year offered in Alberta and Saskatchewan — continued to make an impact. The schools help those working in the field build their knowledge of performance measurement and use data to take action for health system improvement. We also stay in touch with those who participated in earlier schools, using web conferences and a Community of Practice forum to enable them to share what they learned and stay connected. Another initiative used a virtual approach to connect thought leaders with people across the country who were interested in understanding high users of health care services. Interactive discussions helped identify the practical implications of using different approaches to address this challenge.
What about the HSU?
We collaborated with Canada Health Infoway to welcome 125 delegates to the 2-day Health System Use Summit in February 2016. The event showcased the value of health analytics — both at the front line and for informing system decisions — and initiated a lot of discussion on how to move this agenda forward. In fact, some of the best lessons came from those outside of health care. Really, we were hosting a conversation, not a conference. Now we want to keep it going.

Meaningful data

It’s not just about health care. By taking a broader health system approach, we start to see the connections between inputs, outputs, outcomes and social determinants. CIHI is working hard to integrate performance reporting initiatives to do just that.

Here are a few highlights:

  • We developed a framework to guide our understanding of how to measure performance. The framework starts with an overall view of the health system and cascades down to hospitals and even long-term care facilities. This helps us understand what it means to measure performance at these levels, too.
  • The private Your Health System: Insight tool that launched in March 2015 allows users to slice and dice their information in customized ways. Health care providers and analysts can use this tool to dig deeper into indicator results.
  • In a major enhancement to the Your Health System: In Depth web tool, we added facility-level reporting for 9 long-term care indicators and 8 contextual measures using data from 2010 onward.
  • Workshops across the country are helping to build local capacity to use our data and web tools for measuring and monitoring health system performance at the local level

We don’t want to just flood the market with massive amounts of data. We want to provide more targeted, meaningful information.

The patient’s perspective

Patient-reported measures provide insight into the effectiveness of care from a patient’s perspective, providing essential information to support patient-centred care. Through standardized data collection, jurisdictions will be able to access comparative performance measurement reports that support their quality improvement efforts.

Patient-reported experience measures (PREMs) capture the patient’s views about care experiences. Data is collected using a standardized survey, and our CPERS database is ready to receive data from facilities across Canada. To date, Manitoba, Alberta, Ontario and New Brunswick are on board and will soon be able to see comparative reporting on measures such as overall satisfaction, care coordination and other measures of quality from the patient’s perspective.

Canada does not currently have a standardized program for the routine collection and use of patient-reported outcome measures (PROMs). CIHI is taking a leading role in developing a pan-Canadian strategy to enable comparable information, including standards for data collection and reporting. Demonstration projects have been launched in the priority clinical areas of renal care and hip/knee replacement surgery.

CIHI has also linked with international sources to see what we can learn. We have shared our work with people from the New South Wales Bureau of Health Information as well as the National Health Performance Authority, both in Australia.

Read more on this story and other successes at www.cihi.ca/en/land

A giant puzzle

CIHI’s population grouping methodology combines the clinical information available for an individual over multiple years and across health sectors, and then uses it to create a clinical profile and assign indicators of health risk and burden of illness. Health regions can then better understand — and plan for — the burden of disease in their region.

In 2015, we shared 2 initial versions of this grouper with a few Canadian stakeholder representatives who are familiar with the use of population grouping methodologies. Their feedback on the methodology was very positive, and we are looking forward to releasing a revised version to a much wider audience of stakeholders in 2016–2017.

International spotlight

Comparing health systems from different countries can help us understand how well Canada’s systems are working. International comparisons provide broader context for benchmarking and peer learning. As a leading partner with the Organisation for Economic Co-operation and Development (OECD), CIHI updated its web tool that compares Canada and its provinces with 34 OECD countries on 50 indicators of health and health care. A report focusing on diabetes explored Canada’s results on prevention and management of the disease.

In cooperation with The Commonwealth Fund, CIHI released results from the 2015 edition of The Commonwealth Fund International Health Policy Survey, which focused on the experiences of primary care physicians in 10 developed countries. The release included a companion report that highlights the Canadian story and examines how experiences vary, both across the country and relative to other countries.

OECD Interactive Tool: Compare the provinces with OECD countries

Have you met Maureen?

Since 2000, CIHI has been a co-sponsor of Canada’s only national e-Health Conference and Tradeshow. The event brings together users and system suppliers and highlights the important role that CIHI plays in supporting the greater e-health agenda. More than 1,500 delegates attend each year.

At this year’s conference, CIHI introduced “Maureen” to highlight the way an individual and her health data move across the entire system. This virtual persona helped delegates look at how data captures the type of care being received; how it can be shared across the continuum of care; and how it can be used for health analytics at the clinical, facility and system levels. This is all part of the “collect once, use many times” concept that CIHI’s national data standards and integrated reporting systems are championing. We are working together to ensure we are talking to one another in a coordinated, meaningful way.

Demonstration of cartoon representation of Maureen

Image Description: Meet Maureen. A retired and active 62 year old. On a hiking trip, she experienced a fall that resulted in a fractured right hip. Her injury sent her on a journey through the health care system.

Excellence in all Goal 3: Deliver organizational excellence

A staff snapshot

93% of CIHI staff participated in the biennial employee survey, giving us a clear snapshot of our staff’s views. The survey allows us to identify areas of improvement based on employees’ perceptions. We are then able to provide formal feedback and measure future progress against the provided baseline.

Results continued to paint a picture of a highly effective organization, with overall engagement at 78% and enablement at 76%, exceeding both public-sector and high-performing organization norms.

We know that engaged and enabled employees contribute to our success.

Challenge. Change. Create.

CIHI launched its first-ever Innovation Month for staff in April 2015. Speakers, panel discussions, analyst forums, videos and online quizzes sparked conversations among employees about changing the way we work to be more innovative in what we do and how we do it.

It wasn’t about being the next individual to develop a brilliant idea — it takes a team to generate, filter, implement, champion and connect ideas to create meaningful change. Innovation Month is an opportunity to challenge each other to think outside the box, experiment and learn. Innovation is key to meeting our clients’ needs — and each other’s needs, as well.

Digital deep dive

CIHI’s digital strategy is all about business transformation. We want to understand our stakeholders’ digital information consumption and interaction preferences. By collaborating with them, we will be better prepared to design and deliver relevant and timely digital assets. To remain current, we will be guided by evolving technology trends.

As part of the digital transformation project, we are redeveloping our principal website to deliver a seamless user experience with our information and tools. We are actively engaging with our stakeholders as part of the iterative design process to provide an integrated information-centric environment.

Representation of responsive web design across all platforms: desktop, tablet and smartphone.

Our organization

Board of Directors members and committees

(as of March 31, 2016)

Chair
Dr. Brian Postl Dean of Medicine University of Manitoba (Chair) (Winnipeg, Manitoba)
Canada at large
Ms. Janet Davidson Former Special Advisor and Deputy Minister Alberta Health (Vice Chair) (Nanoose Bay, British Columbia)
Dr. Verna Yiu Interim President and Chief Executive Officer Alberta Health Services (Edmonton, Alberta)
Dr. Vivek Goel Vice-President, Research and Innovation University of Toronto (Toronto, Ontario)
Territorial representative
The territorial director position is currently vacant.
Region 1 (British Columbia)
Dr. David Ostrow Former President and Chief Executive Officer Vancouver Coastal Health Authority (Vancouver, British Columbia)
Mr. Stephen Brown Deputy Minister of Health British Columbia Ministry of Health (Victoria, British Columbia)
Region 2 (Prairies)
Dr. Marlene Smadu Vice-President, Quality and Transformation Regina Qu’Appelle Health Region (Regina, Saskatchewan)
Ms. Susan Antosh Chief Executive Officer eHealth Saskatchewan (Regina, Saskatchewan)
Region 3 (Ontario)
Ms. Janet Beed Former President and CEO Markham Stouffville Hospital (Toronto, Ontario)
Ms. Nancy Naylor Associate Deputy Minister, Delivery and Implementation Ministry of Health and Long-Term Care (Toronto, Ontario)
Region 4 (Quebec)
Dr. Denis Roy Vice-President, Science and Clinical Governance Institute national d’excellence en santé et en services sociaux (Montréal, Quebec)
Mr. Pierre Lafleur Assistant Deputy Minister, Direction générale de la coordination réseau et ministérielle Ministère de la Santé et des Services sociaux (Québec, Quebec)
Region 5 (Atlantic)
Ms. Catherine Gaulton Vice-President, Quality and System Performance, and Chief Legal Officer Nova Scotia Health Authority (Halifax, Nova Scotia)
Ms. Beverley Clarke Deputy Minister Department of Health and Community Services (St. John’s, Newfoundland and Labrador)
Statistics Canada
Ms. Jane Badets 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 2015, July 2015, October 2015, November 2015 and March 2016.



Dr. Brian Postl
Dean of Medicine,
University of
Manitoba
Dr. Denis Roy
Vice-President,
Science and Clinical
Governance, Institut
national d’excellence
en santé et en
services sociaux
Dr. Marlene Smadu
Vice-President,
Quality and
Transformation,
Regina Qu’Appelle
Health Region
Ms. Nancy Naylor
Associate Deputy
Minister, Delivery
and Implementation,
Ontario Ministry
of Health and
Long-Term Care
Dr. David Ostrow
Former President
and Chief
Executive Officer,
Vancouver Coastal
Health Authority
Ms. Catherine Gaulton
Vice-President,
Quality and System
Performance, and
Chief Legal Officer,
Nova Scotia
Health Authority
Mr. Pierre Lafleur
Assistant Deputy
Minister, Direction
générale de la
coordination réseau
et ministérielle,
ministère de la Santé
et des Services
sociaux du Québec
Dr. Verna Yiu
Interim President
and Chief
Executive Officer,
Alberta Health
Services


Mr. David O’Toole
President and CEO,
Canadian Institute for
Health Information
Ms. Susan Antosh
Chief Executive
Officer, eHealth
Saskatchewan
Ms. Janet Beed
Former President
and CEO, Markham
Stouffville Hospital
Ms. Janet Davidson
Former Special
Advisor and
Deputy Minister,
Alberta Health
Ms. Jane Badets
Assistant Chief
Statistician, Social,
Health and Labour
Statistics, Statistics
Canada
Dr. Marshall Dahl
Vancouver Hospital
and Health
Sciences Centre
Ms. Beverley Clarke
Deputy Minister of
Health, Newfoundland
and Labrador
Department of Health
and Community
Services

We would like to recognize the contributions of several departing Board members:

  • Dr. Marshall Dahl, Consultant Endocrinologist, Vancouver Hospital and Health Sciences Centre
  • Dr. Heather Davidson, Former Assistant Deputy Minister, Planning and Innovation, British Columbia Ministry of Health Services
  • Ms. Susan Fitzpatrick, Former Associate Deputy Minister, Ontario Ministry of Health and Long-Term Care
  • Mr. Luc Castonguay, Assistant Deputy Minister, Planning, Performance and Quality Assurance, Ministère de la Santé et des Services sociaux du Québec
  • Mr. John McGarry, President and Chief Executive Officer, Horizon Health Network
  • Mr. Bruce Cooper, Former Deputy Minister, Newfoundland and Labrador Department of Health and Community Services
  • Mr. Peter Morrison, Former Assistant Chief Statistician, Social, Health and Labour Statistics, Statistics Canada

Board committees

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.

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.

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.

Membership (as of March 31, 2016)
Committee Member Met
Finance and Audit
  • Susan Antosh (Chair)
  • Brian Postl
  • David Ostrow
  • Nancy Naylor
  • Catherine Gaulton
  • Beverley Clarke
  • June 2015
  • November 2015
  • February 2016
Governance and Privacy
  • Janet Davidson (Chair)
  • Brian Postl
  • Vivek Goel
  • Stephen Brown
  • Pierre Lafleur
  • Jane Badets
  • Simon Kennedy
  • May 2015
  • July 2015
  • October 2015
  • December 2015
  • March 2016
Human Resources
  • Brian Postl (Chair)
  • Janet Davidson
  • Verna Yiu
  • Marlene Smadu
  • Janet Beed
  • Denis Roy
  • October 2015
  • March 2016
Senior management (as of March 31, 2016)
Name Title
David O’Toole President and CEO
Kathleen Morris Vice President, Research and Analysis
Brent Diverty Vice President, Programs
Georgina MacDonald Vice President, Western Canada and Developmental Initiatives
Louise Ogilvie Vice President, Corporate Services
Corbin Kerr Vice President and Chief Information Officer
Caroline Heick Executive Director, Ontario, Quebec and Primary Health Care Information
Stephen O’Reilly Executive Director, Atlantic Canada and Integrated eReporting
Cal Marcoux Chief Information Security Officer
Anne-Mari Phillips Chief Privacy Officer and General Counsel
Francine Anne Roy Director, Strategy and Operations
Kira Leeb Director, Health System Performance
Tracy Johnson Director, Health System Analysis and Emerging Issues
Jean Harvey Director, Canadian Population Health Initiative
Michael Gaucher Director, Pharmaceuticals and Health Workforce Information Services
Douglas Yeo Director, Methodologies and Specialized Care
Greg Webster Director, Acute and Ambulatory Care Information Services
Keith Denny Director, Clinical Data Standards and Quality (Acting)
Vacant Director, Corporate Communications and Outreach
Chantal Poirier Director, Finance
Elizabeth Blunden Director, Human Resources and Administration
Herbet Brasileiro Director, ITS Product Delivery
Kimberly Harvey Director, Integration Services
Michael Hunt Director, Health Spending and Strategic Initiatives
Angela Dosis Director, Digital Strategy

Looking ahead

Start your engines

This is an exciting time at CIHI. We have a new path, clearly mapped out in CIHI’s Strategic Plan, 2016 to 2021.

Through extensive consultation, we have reflected on who we are and our unique role in Canada’s health sector. We continue to believe that better data contributes to better decisions, ultimately improving the health of Canadians. And we are committed to making our information more accessible and easier to use.

Working collaboratively with our stakeholders is critical to achieving our goals. Our strategic plan highlights the importance of responding to our stakeholders’ needs quickly, with innovative tools and approaches. We are committed to fostering these relationships.

Ultimately, the plan will drive health system transformation and improvement across the continuum of care.

CIHI’s future centres around 3 strategic goals and a commitment to stakeholders. As we look ahead, we want to share our thinking behind each of these goals, as well as our priorities for the next 5 years:

1 Be a trusted source of standards
and quality data

It’s about having the right data for our stakeholders’ work and our work. We will collect data in priority areas, driven by the priority themes of our stakeholders. And we will continually review our data holdings to ensure they meet the needs of our stakeholders.

Over the next 5 years, CIHI will

  • Increase the use of health data standards to achieve quality data
  • Make data collection easier and improve timeliness
  • Close the data gaps in priority areas
  • Make data more accessible

2 Expand analytical tools to support measurement of health systems

We want our reporting tools, methods and information to prompt our stakeholders to make improvements in health care, health system performance and population health. It’s about enriching our information infrastructure to enrich the health of Canadians.

Over the next 5 years, CIHI will

  • Compare health systems in priority areas
  • Expand our analytical products using innovative approaches, including data linkage and predictive modelling
  • Enrich the information infrastructure, grouping methods and decision-support tools
  • Transform CIHI’s digital presence into a core strategic asset

3Produce actionable analysis and
accelerate its adoption

We want our stakeholders to put CIHI’s products and services into action. And we want to give them the tools they need to do that. We are going to engage the public as well, to truly drive health system improvements.

Over the next 5 years, CIHI will

  • Produce analyses that contribute new information and insights, working with external partners and with intended end-users to create a culture of co-development
  • Engage with stakeholders to enable better use of health data and information
  • Provide customized products and services to support local decision-making needs

As our strategic plan unfolds, there will be exciting changes and new initiatives at CIHI. We have defined our role, we have built a solid foundation and we have engaged our stakeholders. The course is set. It’s going to be an exciting journey!

Over the next 5 years, our focus is clear:

Health system performance themes

  • Patient experience
  • Quality and safety
  • Outcomes
  • Value for money

Priority populations

  • Seniors and aging
  • Mental health and addictions
  • First Nations, Inuit and Métis
  • Children and youth

CIHI’s strategic plan at a glance 2016 to 2021

Vision

Better data. Better decisions. Healthier Canadians.

Mandate

Deliver comparable and actionable information to accelerate improvements in health care, health system performance and population health across the continuum of care

Strategic goals

Be a trusted source of standards and quality data

Deliver more timely, comparable and accessible data across the health continuum

Expand analytical tools to support measurement of health systems

Deliver reporting tools, methods and information that enable improvements in health care, health system performance and population health

Produce actionable analysis and accelerate its adoption

Collaborate with stakeholders to increase their ability to use data and analysis to accelerate improvements in health care, health systems and the health of populations

Priority themes and populations

Themes
  • Patient experience
  • Quality and safety
  • Outcomes
  • Value for money
Populations
  • Seniors and aging
  • Mental health and addictions
  • First Nations, Inuit and Métis
  • Children and youth

Foundation

  • Our people
  • Stakeholder engagement and partnerships
  • Privacy and security
  • Information technology

Values

  • Respect
  • Integrity
  • Collaboration
  • Excellence
  • Innovation
CIHI’s strategic plan at a glance 2016-2021

Leading practices

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 2015–2016 and previous years, the external auditors have issued unqualified opinions.

Disclaimer

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.

Funding

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 $103.1 million between
    2012–2013 and 2015–2016. This pays for our ongoing program of work related to our core functions and priority initiatives.
Annual sources of revenue
Revenue source ($ millions)* 2012–2013 Actual 2013–2014 Actual 2014–2015 Actual 2015–2016 Planned 2015–2016 Actual 2016–2017 Planned

Notes

  • Reflects annual revenue on a cash basis; therefore, excludes depreciation and CIHI pension plan accounting expenses-related revenue.
  • Includes contributions from provincial/territorial governments for special-purpose programs/projects as well as lease inducements for 2012–2013, 2015–2016 and 2016–2017 (planned).
Federal government — Roadmap/Health Information Initiative 83.0 77.7 79.4 78.5 77.7 78.7
Provincial/territorial governments — Core Plan 16.7 17.1 17.4 17.4 17.4 17.4
Other 8.5 4.9 6.7 5.1 5.7 5.4
Total annual revenue 108.2 99.7 103.5 101.0 100.8 101.5

Funding agreements

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).

  • A 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, annual base funding went from $81.7 million in 2012–2013 to $77.7 million in 2014–2015.
  • The HII agreement was renewed for 2015–2016 at the same level as for 2014–2015; it was later amended to include a new 5-year program of work on prescription drug abuse, for a total of $4.28 million over the 5 years.
  • The funding for 2016–2017 reflects an additional 1-year extension of the existing funding agreement with Health Canada at the same funding level.
  • The first year in the table includes funding from the Roadmap agreement for $1.3 million. The agreement ended in 2012–2013.
  • The results presented for 2013–2014 and 2014–2015 reflect an approved carry forward of $1.6 million, related to a few key projects planned for 2013–2014 but completed in 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 2015–2016.
  • They have been renewed for 1 year, through 2016–2017, at the same funding level.

Management’s explanation of results

Operating expenses
Operating expenses ($ millions)* 2012–2013 Actual 2013–2014 Actual 2014–2015 Actual 2015–2016 Planned 2015–2016 Actual 2016–2017 Planned

Note

  • Reflects operating expenses; therefore, includes amortization of capital assets and accounting pension plan costs.
Salaries, benefits and pension expenses 76.8 75.6 78.7 77.4 78.6 77.0
External professional services, travel and advisory committee expenses 11.2 8.8 11.0 8.7 7.0 8.2
Occupancy, information technology and other expenses 17.3 16.3 16.0 16.3 16.0 16.3
Total operating expenses 105.3 100.7 105.7 102.4 101.6 101.5
Total operating expenses, 2015–2016: $101.6 million
These include compensation costs, external professional services, travel expenses, occupancy costs and information technology costs required to deliver on several key project initiatives undertaken in 2015–2016.
Total remuneration, 2015–2016: $5.3 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 2015–2016 activities: $800,000
Delays in certain key project activities produced savings that will be carried forward to 2016–2017 ($800,000), as approved by Health Canada.
Capital investments
Capital investments ($ millions) 2012–2013 Actual 2013–2014 Actual 2014–2015 Actual 2015–2016 Planned 2015–2016 Actual 2016–2017 Planned
Furniture and office equipment 0.1 none none none 0.1 0.1
Computers and telecommunications equipment 1.8 2.3 1.2 1.3 1.1 1.2
Leasehold improvements 0.4 0.1 0.1 0.2 0.2 0.2
Total capital investments 2.3 2.4 1.3 1.5 1.4 1.5

Acquisition of capital assets, 2015–2016: $1.4 million

  • This is a minimal increase compared with 2014–2015 and slightly lower than planned capital spending.
  • Capital investments for 2015–2016 were slightly less than planned due to cost savings as well as some planned investments that were not required.
  • Capital investments from year to year are based on an ongoing roadmap of planned acquisitions and upgrades to ensure that equipment and software is robust and adequate to meet changing operational demands.

Pension plans

CIHI Pension Plan

  • Our registered defined benefit plan offers our employees an annual retirement income based on length of service and final average earnings and is being funded by both employees and CIHI.
  • As of March 31, 2016, the plan assets were $150.6 million for 989 members, 70% of whom are active participants.
  • In addition, we supplemented the benefits of employees participating in the plan who are affected by the Income Tax Act’s maximum pension limit.

Wind up

  • Following the November 2014 decision approved by CIHI’s Board of Directors, the defined benefit and supplementary retirement plans were wound up effective December 31, 2015.
  • Beginning January 1, 2016, CIHI employees joined the Healthcare of Ontario Pension Plan (HOOPP), the British Columbia Municipal Pension Plan or the Group RRSP.
  • In February 2016, the supplementary retirement plan was settled.

Contributions (CIHI Pension 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 Manulife Financial.
    • The primary goal of the minimum risk investment strategy adopted in 2014 is to reduce the fluctuations in the financial position of the plan and to provide its members and beneficiaries with the stipulated level of retirement income upon the wind up of the plan.
    • To exercise effective management and stewardship of the investment funds, the investment manager’s performance and the investment policy are reviewed annually.

Actuarial valuations (CIHI Pension 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)
  • The most recent actuarial valuation for funding purposes was prepared as of January 1, 2014. In accordance with regulatory requirements, a wind-up valuation report as of December 31, 2015, will be submitted to the Financial Services Commission of Ontario in June 2016.
Representation of promotional poster outlining pension wind-up timelines.

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 2015–2016, activities included

  • An audit of procurement and payment compliance and controls
  • Penetration testing and vulnerability assessments of the ITS network, 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 a third-party data recipient regarding CIHI’s Data Request Form and Non-Disclosure/Confidentiality Agreement

We developed action plans to address the areas for improvement that were recommended by the consultants we contracted to specifically perform these activities.

In 2016–2017, the focus of the internal audit program continues to be on information security and privacy. As well, we will initiate an internal audit on payroll and benefits.

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

Monitor and communicate

  • Review Framework
  • Executive/Board oversight
  • Risk managegment reporting

Establish framework

  • Policy framework
  • Governance framework
  • Process, methods, tools

Assess the risks

  • Identify strategic goals
  • Risk identification
  • Risk Assessment

Risk response and treatment

  • Key risk indicators
  • Strategy/action plans
  • Risk champions

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 2015–2016

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).

Remaining relevant

With the growing trend to increase access to health data, current and new organizations and groups are starting to integrate health information to support system management and research. Consequently, the need for national/pan-Canadian data could become less relevant as jurisdictions and regions have access to more granular and timelier data. CIHI addressed this concern through its extensive stakeholder consultations to inform the new strategic plan and by continuing to develop and implement strategies to improve the breadth and coverage of CIHI data, as well as the timeliness of public reporting and analytical products of priority data.

Health system use

Digital health solutions are being adopted more widely, which presents a challenge for health system use of data in the country. While the opportunity to access this “naturally occurring” data has many benefits, lack of data standardization in electronic records impedes our ability to fully make use of these new sources. As well, as services move from hospital settings to community-based clinics, data may be lost. This past year, CIHI worked to address these challenges by developing and sharing data content standards for priority systems such as physician electronic medical records and hospital information systems, by creating a data capture and reporting system suitable for community-based clinics and by raising awareness of health system uses of data with key leaders at the Health Analytics for Informed Decision-Making: Health System Use Summit in February 2016.

Funding

CIHI’s ability to meet existing operations and new priority initiatives continued to be a risk as funding from our major stakeholders (federal/provincial/territorial governments) remained at a constant level. By developing strategies with the Board of Directors and engaging Health Canada and the provinces/territories, CIHI maximized its use of available funding toward new priority investments by realizing efficiencies. As well, CIHI successfully transitioned to the new pension plans and retirement savings plan and is currently working with its actuaries to wind up the CIHI Pension Plan.

Building relationships

CIHI was at risk of losing stakeholder support as jurisdictions continued to increase their focus on local solutions to address their data/decision-support requirements and as new players emerged in health systems. To meet the needs of and to further engage stakeholders, CIHI is developing a coordinated approach to stakeholder engagement and communication, and we explored new relationships and partnerships (e.g., with vendors to raise awareness of our standards and the implication for their work, with health quality organizations). CIHI also acted in a convenor role to bring partners together to learn from one another while informing a pan-Canadian direction on specific activities (e.g., PROMs Forum).