GOVERNING DIGITALLY By contrast, a National Health Data Charter – and the underlying infrastructure to enable its value, necessitates an interoperable infrastructure and integrative action plans underpinned by collective political will and shared accountability. With such an overarching national governance framework in place, there are at least four priority areas calling for urgent and concerted attention: i) integrative workforce planning and skills development tied to digital health capacities; ii) shared solutions for digitizing health records and data management systems; iii) combatting health misinformation online and building cyberresilience; and iv) emerging technological capacities for wider health innovation, notably Artificial Intelligence. In terms of workforce and skills, beyond the intense competition for frontline healthcare professionals, there is a dire need for nurturing digital skills on a national scale, and for a common understanding of public sector skills requirements now and going forward. As governments compete with industry, and as Canada competes with the world, a holistic lens is essential. Not surprisingly, workforce planning is a key component of Australia’s national strategy for digital health. With respect to shared solutions for digital health records and data management, here is where the role of the Canada Health Infoway can be expanded and better utilized. Rather than each Province and Territory creating separate data systems and vendor agreements to maintain such systems, a shared governance architecture - featuring the aforementioned Digital Health Charter, could strengthen readiness, improve efficiency, and better engage the public in addressing societal trade-offs between privacy protection and data-sharing. Indeed, the Infoway has already provided a detailed ‘path forward for data sharing in Canada’ which provides a basis for such a coordinated approach. Similarly, Ontario’s own Health Data Council has devised a complementary vision for an emergent health data eco-system. Embracing a national approach, in turn, is not about constitutional change but merely a willingness on the part of Provinces to shift their mindset from control to meaningful collaboration, and for the federal government to become a strategic and supportive partner. With regards to online misinformation – a challenge obviously transcending any set of domestic political boundaries, a recent panel formed by the Council of Canadian Academies ‘estimates that misinformation cost the Canadian healthcare system at least $300 million during nine months of the COVID-19 pandemic in 2021.’ At the same time, the growing risks of cyber-breaches and nefarious ransomware attacks on hospitals and clinics are a national security concern – one that also reinforces the importance of workforce and skills development in order to ensure collective resilience across all facets of health care governance. Lastly, with growing Artificial Intelligence experimentation, governments must be agile and intelligent in balancing innovation, privacy, and trust. Openness and public engagement are essential in doing so. With roots in Canada, organizations such as the Responsible A.I. Institute are leading the way. Yet as smaller Provinces and Territories struggle to finance current priorities – let alone invest in emerging ones, the risks of deepening cleavages between jurisdictions escalate. With a national prism, the Australian Alliance for Artificial Intelligence in Health Care provides a detailed roadmap to ‘implement AI seamlessly and successfully across the healthcare system at a local, state and federal level to help create a resilient healthcare system’. A Canadian equivalent is a crucial element of next generation reforms. The bottom line is that as with everything else, health care is going digital. In a world of some eight billion people, thirteen separate frameworks for digital health for less than forty million citizens is simply an absurd and harmful notion. It’s long past time for political leaders to step up, catch up, and work together. Jeffrey Roy is professor in the School of Public Administration at Dalhousie University and member of NS-TAG (roy@ dal.ca). 24 / Canadian Government Executive // Spring 2023 Lastly, with growing Artificial Intelligence experimentation, governments must be agile and intelligent in balancing innovation, privacy, and trust. Openness and public engagement are essential in doing so.
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