GOVERNING DIGITALLY governance mechanisms enjoining federal and provincial governments in ways that are antithetical to the political structures of federalism. Rather than working jointly to lay the groundwork for a truly national architecture for collaborative innovation, Canadians have witnessed the engrained posturing of Provincial calls for more funding – without conditions, while federal Ministers seek to temper such demands and embellish their own spending and support. Tensions between traditional federalism and innovation are hardly a novel theme. As just one example, a prior Advisory Panel from 2015, which featured stronger buy-in from Provincial stakeholders, sought a National Health Care Innovation Agency to spearhead systemic change. Indeed, such an agency exists down-under, where the Australian Digital Health Agency leads and oversees the ‘National Digital Health Strategy and Framework for Action.’ Within such a framework, state governments work with one another - and with their federal counterparts, on a national framework for electronic health records and interoperable and secure data management capacities. The 2015 Panel articulates a renewed federal role in Canada that could spur national action of a similar sort: “The federal government must play a leadership role in collaborating with jurisdictional counterparts in the formation of a pan-Canadian health mechanism to identify, promote and advance needed healthcare innovation.” Writing in Policy Options during the pandemic, the University of Ottawa’s Mirou Jaana concurs: ‘The Canadian government can play an important role in advancing the digital health agenda through incentives and policies that can catalyze national changes to address the digital divide and current gaps.’ In contrast to Australia’s holistic efforts, Canada’s health ‘system’ remains a disjointed set of thirteen fiefdoms – all facing similarly escalating challenges in terms of costs and performance. Digitization is occurring, albeit in a ragtag manner detrimental to providers and patients alike. A recent study by the Commonwealth Fund ranked Canada tenth in a group of eleven countries (just ahead of the United States). A pivotal moment in health care governance? What about the billions in increased federal funding to Provinces, as well as additional bilateral agreements centred on ‘shared priorities’? Can this be a watershed moment in forging at least some of the groundwork for digital transformation for the country as a whole? While any potential basis for shared action cannot be dismissed as a positive, the major shortcoming with the current approach is the absence of any formalization of governance across provincial, territorial and federal levels, Most Provinces are intent on minimal commitments to secure additional funds, while otherwise seeking to preserve as much operational autonomy as possible. Digital transformation on a national scale, by comparison, means devising federated governance with both shared political will and integrative capacities for investments and actions. As the Privacy Commissioners have urged, developing a pan-Canadian, Health Data Charter offers a reasonable and overdue starting point. Such a charter could facilitate data-driven innovation and more modular and shared digital solutions - leveraging the foundational work of the Canada Health Infoway which presently lacks an operational mandate and implementation capacities. While data has been a central theme of recent funding discussions, the emphasis has mainly been on gathering and reporting otherwise separate data sources from Provinces to better compare and track varying jurisdictional indicators and performance outcomes. As the Privacy Commissioners have urged, developing a pan-Canadian, Health Data Charter offers a reasonable and overdue starting point. Spring 2023 // Canadian Government Executive / 23
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