Connecting Canada: Interoperability, AI, And The Future Of Equitable, Citizen-Centric Care Perspectives On Health And Tech podcast

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Connecting Canada: Interoperability, AI, and the Future of Equitable, Citizen-Centric Care

5d ago 19:06

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In this episode of Perspectives on Health and Tech, Oracle Health welcomes Shelagh Maloney, CEO of Digital Health Canada, for a forward-looking conversation about how Canada can build a more connected, equitable, and digitally empowered healthcare system. From advancing interoperability and clinician mobility to exploring the role of artificial intelligence in care delivery, Shelagh shares insights from Digital Health Canada's AI in Action initiative — including the "winning conditions" needed to deploy AI responsibly and inclusively. Together, we explore how technology, policy, and collaboration can unite care across provinces, empower citizens with access to their data, and help clinicians deliver smarter, more human-centered care from coast to coast to coast. ------------------------------------------------- Episode Transcript:

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Welcome to Perspectives on Health and Tech podcast, brought to you by Oracle Health. In this series, we have conversations on creating a seamless and connected health care world where everyone thrives. Let's get started. Welcome to the Perspectives on Health and Tech Podcast, brought to you by Oracle Health. I'm Larry Sylvestre and today we're exploring one of the most defining challenges and opportunities in Canadian health care: interoperability.

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From enabling clinicians to practice across provincial lines to giving Canadians direct access to their health records, interoperability is key to building a truly connected health system. Joining us today is Shelagh Maloney, the CEO of Digital Health Canada, an organization at the heart of advancing digital health, professional development, and policy collaboration across the country. Shelagh, thank you for being here.

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Before we dive in, could you tell us a bit about your vision since taking on the CEO role earlier this year? Well thanks, Larry. First, let me start by saying how thrilled I am to be on your podcast. I'm looking forward to the conversation. And yes, I did join Digital Health Canada. It's been almost a year. I joined at the end of January 2025 and it's been a whirlwind.

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And Digital Health Canada, like other, you know, national associations that we really want to provide value to our members. We have networking events and we have influence health policy. We look at advocating for the profession. And, you know, one of the things that I'm excited about is that we've just launched a strategic plan to 2030.

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And so a big component of that is going out and asking our members what Digital Health Canada means to them and what they're looking for. We're doing some work in the governance space. I think education is trauma, endless possibilities now, and particularly as AI is getting so big. And I know we're going to talk about that later.

00:02:22:08 - 00:02:47:10

And of course, advocacy for both professionals and the profession at large. That's a perfect set up for our discussion, Shelagh. How can Canada move forward from our fragmented systems to a pan-Canadian model of care that's equitable, citizen centric, and digitally connected? One of the biggest conversations right now in health care is around nation building, breaking down barriers between provinces and territories.

00:02:47:12 - 00:03:14:01

What are you seeing from your standpoint at the leadership role at Digital Health Canada? You know, this is such a timely question and I'll tell you why. Yesterday we had a conversation with, Doctor Anderson Chuck, the CEO of CIHI and Doctor Fahad Razak, who is the among other things, does a role at Unity Health, in Toronto, but also is the Canada research chair and data informed health care improvement.

00:03:14:03 - 00:03:34:00

And it was really interesting. And one of the things we talked about was, and, you know, you and I know this, it's not a technology issue that we're dealing with in terms of interoperability and connected care, but it's a cultural issue. And it's really interesting that, that's a different sort of change in our thinking a little bit.

00:03:34:02 - 00:03:58:22

But certainly, one of the big challenges in a federated system, having a national perspective and doing things at that large national scale is more of a challenge than we would hope that it would be. Yeah. Certainly the landscape is full of different perspectives on how to proceed. And sometimes some of these conversations do get politicized.

00:03:59:00 - 00:04:27:16

But certainly it's great to see, I think some of the federal government perspectives and agencies coming together to try and be facilitators in this discussion. And I think, Canadians in general are ready for us to meet that challenge head on. So it's really inspiring to hear how we're aligning policy and technology and how those things could potentially unlock the possibilities for clinicians and ultimately, better continuity of care for patients.

00:04:27:18 - 00:04:51:01

Let's turn a little bit to the citizen side of the discussion. How does a citizen first approach align with work happening in Canada now? Well, you know, it's kind of interesting in like 2012. So a while ago and this was all the rage when, when patient engagement and patient partners were just sort of, I think coming into mainstream.

00:04:51:07 - 00:05:09:00

Some may argue they're not quite mainstream yet, but that was where the hype really started. And it was Leonard Kish who was an IT strategist in the US. And I remember and you might remember this, Larry, there was a famous quote that he said if patient engagement was a drug, it would be the blockbuster drug of the century.

00:05:09:02 - 00:05:43:05

And so that has been frequently, you know, bantered around. But the rest of the sentence that I really love is and it would be medical malpractice not to use it. And I know and you know, my former roles at Canada Health Info way and CIHI, we did a lot of research in this area. And we know that patients, when they are engaged, when they are part of their, has access to their health records and can see their information and know where they are in the queues, they are more informed about their health care, they are more confident in the care that they receive, and they have better relationships with their care

00:05:43:05 - 00:06:09:13

providers. And all those things together mean that their outcomes are better. So we know it is. There's evidence to demonstrate that engaging patients in the process and including them, as we're developing systems, etc., will make a difference to health care. Agreed. Certainly, when we look across the country and reflecting back on, you know, just the previous question to answer that we corresponded on.

00:06:09:15 - 00:06:32:04

As you look across every province and they have their own health legislation and different policies, procedures, approaches to health care delivery, etc. It really is a bit of a thicket and even the best facilitators in that have failed historically to move the needle and hopefully we're in a much better position now to understand what the challenge is, how we can move it forward.

00:06:32:05 - 00:06:54:23

What was fascinating to me is, as you and I were both at the Infoway Partnership Conference recently was a stakeholder from Portugal who was on stage talking about how they put the patient at the center of interoperability around consent and that they adjudicate which clinicians in the care team are going to have access to their records, and that they have the opportunity to even rescind that.

00:06:55:01 - 00:07:23:09

Do you see that having any potential in Canada? Maybe not in whole, but perhaps in part? My desired answer would be to say, absolutely yes. I think we are getting there, and I think we would love to have that. And I think, frankly, patients and their family, we're getting a little bit impatient, and asking the questions if they don't think that it's already there, it's like, what do you mean

00:07:23:09 - 00:07:55:15

my specialist and my GP are not exchanging information? What do you mean the emergency department and the clinic don't have the same information? And so, I think we're recognizing that we need to get there. And frankly, one of the things that we're seeing is patients increasingly are using ChatGPT and other models, and they're collecting their own information and creating their own health records, because nobody else is doing it and the system is failing them in that regard.

00:07:55:17 - 00:08:18:21

So, you know, if we don't do it for patients with patients, I'm afraid, and rightfully so, they'll find a web mechanism to do it on their own. And that, from a health system perspective, won't be helpful because, you know, the care providers, etc. may not have the information that they need to provide the best care that's available to a patient.

00:08:18:23 - 00:08:57:23

It's excellent point. And that draws me in to sort of another sort of another train of thought about the data is the data. And, you know, there are a lot of constituents across the care continuum who feel like they're living on little islands of data and perhaps not connected with others. And as we talk about building a pan-Canadian infrastructure to enable the mobilization of that data, you start to think about artificial intelligence in that conversation, not only for the sake of the institutions and clinicians who need to deliver care, but for the individuals themselves.

00:08:58:01 - 00:09:32:13

And that becomes particularly material in Canada, where we have one of the lowest population densities on the planet, and we have a very challenging time providing equitable care to this broad and diverse population and massive geography. And so moving the data to the clinicians becomes, you know, paramount to being able to deliver effective care and enabling the patient themselves to have access to their own data so they can leverage AI for their own purposes, might also be a complementary sort of perspective around the movement of data.

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Do you have any thoughts on that and how we're progressing as a country relative to those points? Really, we're in such interesting times, aren't we, with the AI? And one of the things that is challenging is the pace of change. And we hardly see that in healthcare. But the pace of change, we're accelerating on a timescale of not years but months.

00:09:54:03 - 00:10:16:13

And so we just have such a tremendous opportunity. And, you know, you make the case like Canada has one of the most diverse populations in the world. And when you think about AI, it runs on data. And so having a diverse population where you can scale and implement things in one region to another, you know, with some differences.

00:10:16:13 - 00:10:39:19

But that's a tremendous opportunity for us. And we've got, you know, a large country, 45 million. It's not huge. And then the data that we do have, it's a diverse data set. It's not just insured or uninsured. We don't separate data that way. And so there's so much opportunity in Canada. And, you know, the other thing that we have is, scientific talent here.

00:10:39:19 - 00:11:00:12

You know, we have a Turing Prize, a Nobel Prize winning for AI. They are Canadians. And so we've got so much potential in Canada. But one of the things that, you know, one of the big five consulting firms did a study a few years ago, and they looked at about 47 countries, and they looked at AI literacy and training for their populations.

00:11:00:17 - 00:11:26:00

And they looked at trust in AI. And Canada scored, you know, 42, 43 out of 47. So we're way down at the bottom. So I think that's what, you know, trust comes up in these conversations all the time and culture comes up. So we need, I think, as a nation to really empower everybody and build trust in AI and use it effectively.

00:11:26:06 - 00:11:51:14

And so, you know, we just the federal government has introduced the minister of Artificial intelligence. That's a really significant move. Let's see what happens with that. So I think there's tremendous opportunity in Canada. But there are other countries who are leapfrogging above us. And we need to really think strategically, about how we do this. And I think that collaboration and partnerships and a singular focus is going to help us and get there.

00:11:51:16 - 00:12:15:23

It will help significantly. Absolutely agreed. And well said, Shelagh. I've heard you mentioned in the past a winning conditions report for AI adoption. And I also know that Digital Health Canada has done an AI in action environmental scan. Can you talk to us a little bit about those two topics and how they relate to what we're conversing about today?

00:12:16:01 - 00:12:38:02

Yeah. Thanks, Larry, for giving me the opportunity to say that. So it was published in May of this year. We went out to about how eight leading health care organizations across Canada hospitals, health authorities, whole provinces. And these are the folks who are sort of a little at the leading edge in terms of using AI in in clinical settings and in health care.

00:12:38:04 - 00:12:56:22

And, and we interviewed them and sort of asked them not about what they're doing, but we asked them what were the winning conditions and what did you need to have in place. So we talked about things like risk management. We talked about governance. We talked about, you know, safety and security. And so there was a not everybody approached it the same way.

00:12:57:00 - 00:13:17:23

But a couple of key things came through. And, you know, the strategy was, you know, you have to address a real world problem. It has to be a big problem. Don't use AI for the sake of using AI. Use it to address something that you're significantly involved in. And then your risk management, your risk tolerance is different.

00:13:17:23 - 00:13:35:06

Some of the big, larger hospitals have more risk tolerance and have more, frankly, expertise in doing this. So it was it was really it's an interesting read. It's available on the Digital Health Canada website free of charge, maybe 12 pages. So it's a it's an easy read as well. So I'd really encourage listeners to take take a look at that document.

00:13:35:08 - 00:13:57:23

And then just in, gosh, just a few months ago, we released this AI Environmental scan. So we went across the country and asked people to and did an of review of, AI in clinical settings only. And what projects were there and that we were available and that we could see publicly. And there were about 152 projects.

00:13:57:23 - 00:14:14:15

And since then, I should say a number of people have seen this report and said, you know, I'll add this one at this one. So we're up to about 170 or so. So we did that across Canada AI in clinical settings. And it was really interesting that one of the sort of I won't bore you with all of the details.

00:14:14:15 - 00:14:44:05

And again, this information is available on the website. But one of the thing that was most interesting to me that, about 59 or 69% of the projects were in pilot state. And so that's, you know, and that's not going to surprise anybody in health care in Canada with our pilot ideas. But, you know, that's so is it a reflection of we're just beginning in this field or is a reflection of our failure potentially to, to scale as a nation?

00:14:44:07 - 00:15:05:23

Yeah, it's a conundrum, isn't it? It's, cautiously optimistic and slightly risk averse is kind of how I would measure the temperature of Canadians right now is with respect to AI. You hear about the incredible potential, but you also hear some of the scary stories that go along with it as well. But I think you use the word very astutely, and it's the word trust.

00:15:06:04 - 00:15:43:23

As we move forward, we all have to really think about how to garner trust and ensure that the systems that are, being advocated for, really deliver on that promise, because I has incredible potential to make health care more equitable and efficient and human centered. But realizing that potential will all come down and depend on collaboration to move the data, transparency about how the black boxes work and shared trust again, it's exciting to see how Digital Health Canada and partners across the ecosystem, including Oracle Health, are laying the groundwork for responsible, data driven innovation that benefits every Canadian.

00:15:44:01 - 00:16:06:17

Shelagh, thank you so much for sharing your valuable insights and for your leadership at Digital Health Canada. Absolutely delighted to be a participant of that organization for many years. And so, thankful that you were in a leadership position there after your many years of great service from across the health care system. Before we close, would you like to leave our listeners with one takeaway?

00:16:06:17 - 00:16:29:16

What should we, as an industry and as Canadians, focus on to make this vision of connected, equitable and AI enabled health care real? Well, so first of all, thank you, Larry, for inviting me to participate. And then I really enjoyed the conversation, and I really appreciate the leadership that Oracle is showing. Not only, you know, in putting this podcast forward, but really, in the industry.

00:16:29:16 - 00:16:54:13

And so certainly, a firm that we are very happy to have included in our membership at Digital Health Canada. And, you know, I think, it's organizations like Oracle and associations like Digital Health Canada, we have I think, a responsibility as leaders in this space to really promote that one Canada approach and really lead the way in changing.

00:16:54:18 - 00:17:24:14

I think it's a culture shift. You know, health can be an economic driver. And this is a data that we have was a real natural resource. And so changing the mindset, I think would be really important for us to do. And I maybe I'll leave that challenge with our listeners and of their. Yeah, absolutely. And I think the messaging out of our federal agencies aligns very much with what you had just stated.

00:17:24:16 - 00:17:53:15

But there's an opportunity for Canada. It's one that can be both enabling for all of our health care journeys and potentially one that can help us fuel innovation and, perhaps potentially even fuel some domestic agency and industry to go alongside it. So in closing, I just want to say that at Oracle Health, we believe interoperability isn't just about connecting systems, it's about connecting people, provinces, and possibilities.

00:17:53:17 - 00:18:22:03

As AI and digital innovation continue to reshape health care, collaboration across technology, policy, and care delivery will be key to ensuring every Canadian benefits from a connected, data driven, and equitable health system. Thank you again, Shelagh, for all of your contributions today and over the course of your fantastic career. That's all for this episode of Perspectives on Health and Tech Podcast.

00:18:22:05 - 00:18:52:03

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00:18:52:05 - 00:19:04:00

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