HANSARD

 

NOVA SCOTIA HOUSE OF ASSEMBLY

 

 

 

 

STANDING COMMITTEE

 

ON

 

HEALTH

 

 

Tuesday, October 8, 2024

 

 

COMMITTEE ROOM

 

 

 

Protection of Health Data

 

 

 

 

 

 

Printed and Published by Nova Scotia Hansard Reporting Services

 

 

 

 

HEALTH COMMITTEE

 

John A. MacDonald (Chair)

Hon. Trevor Boudreau (Vice Chair)

Chris Palmer

John White

Nolan Young

Carman Kerr

Rafah DiCostanzo

Gary Burrill

Susan Leblanc

 

[Rafah DiCostanzo was replaced by Braedon Clark.]

 

 

In Attendance:

 

Judy Kavanagh

Legislative Committee Clerk

 

Gordon Hebb

Chief Legislative Counsel

 

 

WITNESSES

 

Department of Health and Wellness

Dana MacKenzie, Deputy Minister

 

Colin Stevenson, Chief of System Integration

 

Nova Scotia Health Authority

Karen Oldfield, Interim President and CEO

 

Scott McKenna, Chief Information Officer

 

Department of Cyber Security and Digital Solutions

Natasha Clarke, Deputy Minister

 

Tracy Fiander Trask, Associate Deputy Minister

 

College of Physicians and Surgeons of Nova Scotia

Dr. Gus Grant, Registrar and CEO

 

 

 

 

HALIFAX, TUESDAY, OCTOBER 8, 2024

 

STANDING COMMITTEE ON HEALTH

 

1:00 P.M.

 

CHAIR

John A. MacDonald

 

VICE CHAIR

Hon. Trevor Boudreau

 

 

THE CHAIR: Order. I call the meeting to order. This is the Standing Committee on Health. I’m John A. MacDonald, the MLA for Hants East and the Chair of the committee. Today we will hear from the Department of Health and Wellness, the Nova Scotia Health Authority, the Department of Cyber Security and Digital Solutions, and the College of Physicians and Surgeons of Nova Scotia regarding Protection of Health Data.

 

Just a reminder to put your phones on silent. I’d also like the committee to welcome our newest member, Carman Kerr. Now I’ll ask the committee to introduce themselves, stating their name and constituency, starting with the newest member, MLA Kerr.

 

[The committee members introduced themselves.]

 

THE CHAIR: For the purposes of Hansard, I’ll also recognize the presence of Chief Legislative Counsel Gordon Hebb to my left and Legislative Committee Clerk Judy Kavanagh on my right.

 

I’d like to welcome all the witnesses. What we’ll start with first is your name and your position, and then I’ll go to opening remarks. I’ll start with Mr. McKenna.

 

[The witnesses introduced themselves.]

 

THE CHAIR: Going forward, I’ll recognize you and the microphone will go on. We have some opening remarks. I believe Ms. Oldfield, Ms. MacKenzie, Ms. Clarke, anybody else? Dr. Grant. I will start on my left with Ms. Oldfield.

 

KAREN OLDFIELD: Thank you for the opportunity to address the committee. As the Nova Scotia Health Authority continues to expand access to digital health platforms, protecting health data remains a top priority. In a world where technology offers incredible opportunities for patient care, we are committed to ensuring that the information entrusted to us is kept safe and secure.

 

We do operate within a controlled network designed to control access. We have processes and policies that dictate how data is requested, how it is accessed, and how it is used, depending on its category. Working with our government partners, our goal is to protect health data. We comply with both provincial and federal legislation and adhere to all regulations concerning data storage and privacy, working with internationally certified privacy professionals who help ensure that every requirement is met. Terms are also built into our contracts with vendors to ensure data security is upheld across all partnerships.

 

The journey of health data often starts on paper, but we ensure that paper records are stored either at an NSHA or secure facilities and digitized before being securely destroyed based on current NSHA retention policies. As we expand digital access, platforms like OPOR, which is the acronym for One Person One Record, and YourHealthNS are revolutionizing patient care. We’ve seen great, positive feedback. Through centralizing health data, patients and health care providers alike experience the benefits of easier access, more coordinated care, and a seamless user experience.

 

As of today, over 400,000 Nova Scotians have downloaded YourHealthNS. While a small number opted out initially, many have since chosen to opt back in, demonstrating the value that they see in these systems.

 

The Nova Scotia Health Authority is committed not only to providing the best care but also to maintaining the highest standards of data protection as we innovate. We want to give individuals the confidence that their health information is safe and secure in modern environments with the highest security standards, and data is not accessible to vendors or even to health care professionals unless they are strictly authorized.

 

THE CHAIR: Deputy Minister MacKenzie.

 

DANA MACKENZIE: Thank you to the committee for the opportunity to be here today.

 

During my last appearance, I spoke about how our health care system is interconnected; how we must be innovative and solution focused and capitalize on opportunities that improve health care; and most importantly, how our decisions must be patient centered. These are fitting themes for today’s discussion.

 

To continue improving the future of health care, we will begin to rely on more investments and partnerships that will advance digital health in the province. Access to data and information is how we plan, manage, and allocate resources in health care. It’s how we give patients and providers more control over the care they receive and deliver.

 

Projects like One Person One Record, a province-wide clinical information system, will further connect and unify our health care system. We created YourHealthNS, a one-stop shop for health care information, resources, and services that has grown to give Nova Scotians electronic access to immunization and medical records. In fact, Nova Scotians want to access more records than we’re able to provide at this moment. This shows that people are taking more ownership of their health care - something the app was intended to achieve.

 

Partnership with tech leaders like Google Cloud will create efficiencies for health care professionals. Health care professionals must search through handwritten or scanned pages of medical records to prepare to see a patient - in some cases, hundreds of pages - an impossible task. Soon they will have better tools to help them. Integrating solutions into systems already in use in the province will allow them to search records faster. It will help inform decision making and ultimately improve patient outcomes.

 

Technology has become a big part of how business and other sectors are providing better, faster, and more convenient services to consumers. Health care is no different. Health care has gone high-tech. We must keep pace, but that does not mean we should move blindly.

 

The protection of health data is a priority as we expand access to digital platforms and integrate new solutions. We have strict measures and policies in place to protect health data from being misused, like the Personal Health Information Act, which helps us strike a balance between the collection and use of health data.

 

There are provincial and federal regulations that must be met in terms of where data can be stored. For example, if data cannot be stored in Nova Scotia, it must be stored in Canada. This is built into any contract with a vendor before we will work with them.

 

The future of health care isn’t down the road. It’s here. It is now. We’re embracing that future in Nova Scotia and taking steps today to prepare for tomorrow.

 

Thank you, and I look forward to your questions.

 

THE CHAIR: Deputy Minister Clarke.

 

NATASHA CLARKE: I’m pleased to be here today to talk about the Department of Cyber Security and Digital Solutions’ role in the protection of health data, and the role CSDS plays in enabling and supporting digital access to health information.

 

We live in a digital world. Globally, people are conducting business and arranging their lives online. Nova Scotians need to be able to interact with their government, and their health care system, in the same way.

 

Through our work with our valued partners, CSDS is supporting digital transformation in the health care system and doing everything we can to maintain the trust Nova Scotians place in our health care partners with their most personal information: their health information.

 

We want to make it easier for Nova Scotians to access their personal health information and feel empowered in the health care system to take ownership and control of their health, and it’s up to us to meet Nova Scotians’ needs in a way that’s safe and secure. That’s why the Department of Cyber Security and Digital Solutions was created in 2023.

 

We are only one of three provinces with a department dedicated to these important issues, and we’re helping to lead the way on how government shapes Nova Scotia’s digital future. There are risks, as there are in everything we do every day, and we work to manage those, but there are also so many rewards.

 

We’ve seen what’s out there beyond our borders and what we want to deliver for Nova Scotians. Recently, I had the opportunity to visit Estonia, and there, for example, citizens can access their health care records online, file their taxes in under five minutes, and start a business online, really in minutes, with both security and convenience. Estonia has transformed its entire economy by becoming a fully digital society. We aren’t there yet, but why shouldn’t we be next? There is a huge opportunity for us to deliver secure, reliable services that engage Nova Scotians and help them build trust with their provider and our health care system.

 

I look forward to answering your questions today.

 

THE CHAIR: Dr. Grant, if you have any opening?

 

DR. GUS GRANT: Again, my name is Gus Grant. I work at the College of Physicians and Surgeons of Nova Scotia. The college is a creature of statute; it was created by the Medical Act, and the Medical Act defines the objects of the college to be to regulate medicine in the public interest. When we’re speaking about the protection of health data, there are many angles which connect with a broad notion of the public interest, so I think I’m here to say that the voice of patients needs to be heard when speaking of the public interest - patients who have expectations of privacy and patients who also have expectations of service from the system that they fund through their taxes.

 

I think it’s also in the public interest to represent the voice of physicians, who have oaths that they have sworn and who also deserve clear instructions from the regulator and from the Province as to what their responsibilities are toward the private, confidential nature of the information they steward. It’s also in the public interest to speak of what can be expected of the system at large. The public interest is served by a system that is efficient, by a system that is armed with data that allows it to learn from itself. It would not be in the public interest to have a singular system as we do in Nova Scotia that had disparately housed data that couldn’t communicate with each other.

 

I’m not really sure why I’m here except to say that all of these angles, all of these perspectives align with the public interest as it pertains to medicine, which aligns with the mandate of the college. I think we’re all collectively here to find that sweet spot that balances these competing expectations that are not totally intentioned but somewhat overlapping right now.

 

I wish you luck in your work. I’m happy to answer any questions as they may pertain to the work of physicians.

 

THE CHAIR: As normal, we’ll have 20 minutes, 20 minutes, 20 minutes. At the end of 20 minutes, I’ll have to say order - not being rude. We’ll start with MLA Kerr for the Liberals.

 

CARMAN KERR: Thank you to everyone for being here. Dr. Grant, I’m glad you’re here as well. I’ve got some questions for you at the end.

 

With OPOR - One Person One Record - there was a vendor funding announcement a year ago or thereabouts. I’m curious about the clinical information system and the launch for go-live. There was reference, I think, on the website and on a press release for February 2025. Are we on track to hit that target?

 

THE CHAIR: Mr. McKenna.

 

SCOTT MCKENNA: One Person One Record is the Oracle Health solution that we’re putting in our hospital acute care systems across all of our hospitals across Nova Scotia. The biggest return out of that isn’t about digital: It’s about clinical standardization. We’re having the same processes deliver patient care from end to end across this province no matter which hospital you actually end up in, and then digitizing that - getting rid of paper.

 

[1:15 p.m.]

 

That is the biggest return out of that: to improve health care and patient safety for Nova Scotians. Where we are with the process of that? This is a large, multi-year initiative. The current plan right now, just walking through, is the IWK Health Centre will be the first site to go live, which is different from the original plan that was developed pre-contract. In August 2025, it will be the first site to go live. That is because the IWK is more of a singular health authority, and actually we can put that in place first without having - because we’re doing a provincial build. Any other hospitals, we want to make sure it’s done and it applies to the rest.

 

CARMAN KERR: Am I right to say the initial announcement was a two-year rollout? I believe it was Dartmouth General Hospital, Cobequid Community Health Centre, I think it was Bayers Lake Community Outpatient Centre as well. Has that now shifted to only the IWK site, or are those other sites also part of that initial rollout?

 

SCOTT MCKENNA: It has not shifted. The sites going first and second in order have shifted. Instead of going to Dartmouth General Hospital first, which was the original plan, IWK will go in August 2025. We’ll follow after that with two rollouts in the Central Zone, Halifax area, more around the Halifax Infirmary and respective hospitals and Dartmouth General and Cobequid. Subsequent to that we’ll do the rest of the zones. Although timeline from the original go-live seems to be pushed out, it’s delayed, it’s to make sure we do it properly. The end rollout is actually within the same window, about a few weeks’ difference at the end. The whole project is still on schedule, it just shifted on the implementation.

 

CARMAN KERR: Thank you for that clarification. I think the website of physicians.nshealth.ca still talks about those initial sites. I don’t know. I’ve had a couple questions about that. I’m curious what training process or supports are there for employees as we roll that out over the two years. Has that training for employees to shift to that new system already started? Has it started at the IWK, and does it already start for the other locations that are following suit after that one?

 

SCOTT MCKENNA: We’re standardizing our clinical processes. All clinicians in the province are represented in establishing those new processes and those norms that we’ll have in Nova Scotia. That in itself is the huge change management of this when we talk about the training. That is in itself the training, because clinicians themselves are physicians, are designing the workflow to be put in place.

 

The digital implementation is taking those workflows and just digitizing that and configuring the system to that. Part of that training actually is that change management, is the work that’s ongoing now by having all of our departments changing the way we do it. We're standardizing it and it has buy-in in it. It’s built by the clinicians, by the physicians. We’re just going to digitize that and put it in place.

 

There will also be training for people when we go live, absolutely. As we’ve learned from other sites across the country that have done this, we will have people at the elbow right in the hospitals with our clinicians to support them for all of those go-lives when we do that: the learning, the development, the standardization now, and then the actual implementation and the support for the training for that during go-lives.

 

CARMAN KERR: My understanding is the OPOR team has been travelling through the province and there have been virtual town halls, I believe. I think there was a survey conducted between February and mid-March this year. Could anyone comment on the feedback that emerged from those town halls and surveys and specifically how we’ve taken that information, if we have done so, and implemented it in our OPOR?

 

THE CHAIR: Ms. Oldfield.

 

KAREN OLDFIELD: I don’t think that either Scott or I would be able to give the specifics around that, but if it’s mission critical, we can certainly tally the feedback and share it. There’s nothing to be hidden; we just don’t know it ourselves.

 

THE CHAIR: MLA Kerr, is it fine that we’ll get it later? MLA Kerr.

 

CARMAN KERR: That’s great. It was more about how we’re using that information more than specifics, but I will take any offer for specifics as well.

 

I want to switch topics to the privacy breach at St. Martha’s Regional Hospital earlier this year. I think 2,000 people’s information was accessed. I’d like to know, despite - I assume there were safeguards in place. How did that breach occur? I don’t know who is best here to explain that.

 

KAREN OLDFIELD: Yes. What I can share with you - let’s start at the end and then work our way forward. I think we are aware of the fact that the individual, at the end of the day, was charged under PHIA. The matter is currently before the courts. I periodically see a little notice in the paper referring to it, so I’m going to be careful what I say so as not to jeopardize any proceeding before a court.

 

I can tell you that the particular matter actually surfaced through a fellow employee and was reported accordingly, which is exactly what we want to have happen in our policies. It was fully investigated. The matter took quite a while to investigate. As the deputy minister mentioned at the outset of her comments, there’s a lot of paper, and there were a lot of records, and it took a long time to make sure that everything was properly accounted for.

 

At the end, the individual was terminated, and the individual and the matter were referred to the appropriate law enforcement agencies under the Act, and subsequently, charges were laid. That is what I can share.

 

CARMAN KERR: Thank you for that response. I guess the next question would be, from what we’ve learned from that - understanding the sensitivity to the issue - what specific steps have been taken since that incident to ensure that it doesn’t happen again, or it doesn’t happen again for a long, long time?

 

KAREN OLDFIELD: First and foremost, I think the very day this all occurred, I personally delivered a message to our employees reminding individuals of our commitment to the protection of privacy under our code of conduct and under the law. That was followed up by a very intensive educational process. Every employee who begins at the Nova Scotia Health Authority is required to take a privacy course. That was refreshed for those who wanted a refresher, and we’re strongly encouraged to have a refresher.

 

As we know, from time to time, laws change and are updated, and it’s important for people to be aware not just of the law but also of the code of conduct and our expectations as an employer and our expectations as members of the public - our patients.

 

That was on the one hand, and then I think we also took some technical steps, which I’ll defer to my colleague Mr. McKenna.

 

SCOTT MCKENNA: When you think about some of the steps, as the CEO has mentioned - Ms. Oldfield - education awareness is paramount. We continue to email immediately and continue to weave that education awareness to all employees about their responsibilities and the privilege that they have with access and controls to do their jobs, which means access to health data.

 

The second piece is a review to make sure that we do have the appropriate access and controls on the systems and our employees, and that each employee has access to what they should have access to but do not have access to what they should not - what they’re not authorized to have access to.

 

Then the third piece - reviews - and these were already in place and were reviewed as well - is it doesn’t stop the event from happening, but how do we actually react to it? Do we have the right audit capabilities in place so that when it does happen, unfortunately - when we do have a bad actor and it happens - how does that get triggered? How do we get notified? How is that tracked so we can actually respond to that quickly, efficiently, and appropriately - in this case, bringing in the authorities?

 

CARMAN KERR: Switching topics, just to highlight Section 110 of the Personal Health Information Act and some questions around that. My understanding is the Premier and Doctors Nova Scotia committed to establishing a data governance framework, providing a formal commitment outlining parameters for collection, use, disclosure, and disposal, I believe, of personal health information. My question is: Has this framework been created?

 

THE CHAIR: Deputy Minister MacKenzie.

 

DANA MACKENZIE: Yes, I’m just pulling up the section of the Act, Section 110. It’s a regulation-making power under the statute of the Personal Health Information Act. The regulations, known as the EHR regulations, the Electronic Health Records Regulations, were passed in June of 2024. Those regulations govern the use of the EMR data that comes into the system, and there is a very well-functioning working group, a standing committee between the college, Doctors Nova Scotia, NSHA, and the department to discuss these issues. I believe the group meets bi-weekly, and we’re working through it. It’s that key work that allowed the launch of the YourHealthNS app. There’s a lot of coordination, a lot of collaboration, and some really great conversations happening now between those entities.

 

CARMAN KERR: My understanding is that the Information and Privacy Commissioner for Nova Scotia wasn’t consulted on that piece of legislation despite its impact on privacy and access for Nova Scotians. My question is: Why?

 

DANA MACKENZIE: A privacy impact assessment would have been done with respect to all of this work, and there’s no statutory requirement, I believe, to discuss that with the review officer, but the great collaboration between Doctors Nova Scotia, the college, ourselves, the review with the privacy impact assessment piece was considered sufficient to ensure that the various privacy interests and system interests were represented.

 

CARMAN KERR: The Act was passed, giving government access to patients’ health information, as we all know. I think in quotes it said: “Planning and management of the health system resource allocation” - I’m reading, pardon me - “and creating or maintaining electronic health record programs and services.”

 

My question: Did the department consider different or alternative methods to access this information, i.e., through hospitals or care clinics, just to maintain that aggregate anonymous data, or was this the clear path forward?

 

DANA MACKENZIE: With respect to the creation of the regulations, the other consideration of other sources with respect to the sources of the data, the goal of the YourHealthNS app is to actually give the records to the patients with respect to their primary care records. The source for those is the EMR data. That’s why those regulations passed under PHIA are focused on EMR data.

 

The actual app itself draws information and data from hospital systems, clinical information systems, inside the hospital. I’m going to look at my technical experts here quite frequently and my voice will drop off. We’re always looking for the least intrusive method of data collection, but also, because we have the joint goal in this particular case of getting Nova Scotians’ records into their hands, the EMR data was the target in terms of trying to make that legislative change in the regulations in order to advance that goal.

 

CARMAN KERR: I think when these amendments were first introduced - again, Section 110 - Doctors Nova Scotia and the college, I believe, raised concerns about the potential risk of granting the Minister of Health unrestricted access to personal health information. I did read, Dr. Grant, your correspondence for Law Amendments Committee a couple of times through. I do believe they secured a commitment from the Premier that ensured that the minister’s access to data was appropriately restricted, whatever that may look like, and the Act has since passed.

 

[1:30 p.m.]

 

My question would be: What regulations have been developed in collaboration with the government since then, and/or what regulations have been introduced to ensure that the minister’s access is regulated?

 

DANA MACKENZIE: I can begin and then have Dr. Grant actually weigh in to answer it fully.

 

The EHR regulations, through the collaboration with Doctors Nova Scotia and the college, provide that when electronic medical record information comes in to the minister - the minister’s our custodian of personal health information under the Act, as well, and has been since the passage of PHIA in 2010. When it comes in to the side of the system that the minister would have access to, it’s de-identified and aggregated so that it’s not identifiable to an individual person. That is actually expressed in the regulations, the EHR regulations that I referred to earlier. That was taken onboard, obviously, and was always a goal.

 

The minister’s comments in the House were to that effect, as well, and the regulations simply followed on after the passage of the amendment to the Financial Measures (2024) Act. That protection is there in the regulations, that it’s de-identified and aggregated in the hands of the minister for the purposes of system planning and resource allocation, and all those things.

 

I’ll hand the microphone to Dr. Grant.

 

THE CHAIR: Dr. Grant.

 

DR. GUS GRANT: I think the deputy minister has answered your question as to regulations. I can say there have been good faith, earnest discussions with government, the college, Doctors Nova Scotia, other interested parties about how to manage this. This is delicate stuff, but the first - one of the thrusts of my submissions to Law Amendments Committee was that we, wherever possible, de-identified aggregate data. That’s the data that will help the system learn from itself.

 

In the discussions we’ve had at the various meetings - and I didn’t realize it was bi-weekly, but it may be, and I may have missed a few - have been thoughtful discussions about what information is needed, what information is not needed, and how to manage information so it can be shared safely and appropriately.

 

Take the example of the app: I wouldn’t want a patient to go on the app and see a worrisome result of a biopsy without having it screened beforehand. Do you know what I mean? There’s medical input, and I think it’s Dr. Ashley Miller and is it Dr. Aaron Smith? There’s a thoughtful group of doctors trying to say, Okay, how do we sensitively manage this information? Whereas my submissions to Law Amendments Committee speak for themselves, I’ve been pleased with the engagement of government and everyone in the discussions since that time.

 

THE CHAIR: MLA Kerr, 10 seconds.

 

CARMAN KERR: Thank you for that response, and I hope I have more time in a second round.

 

THE CHAIR: Next will be MLA Leblanc.

 

SUSAN LEBLANC: Thank you very much for the discussion thus far. I have some thoughts on the app that, if we get to it, I’ll share later, but I was just trying to sign in again and it turns out I need to re-do my sign in. That’ll take me an hour.

 

First question is for the college - first couple. You may have referred to this a little bit, but since the changes were made to the Personal Health Information Act last year, has the department consulted with the college? You referred to the bi-weekly meetings - you may have missed some - but has the department consulted with the college or the members on the regulations and data governance as they pertain to access of the use of personal health information?

 

THE CHAIR: Dr. Grant.

 

DR. GUS GRANT: Yes.

 

SUSAN LEBLANC: Okay, great. Then, in April, the college released a statement noting that it would become a member of the committee. Can you elaborate a little bit on that, on your positive feeling about those meetings thus far? You referred to a couple of people - and I’m sorry I can’t remember the names. Why is it feeling positive, in particular?

 

DR. GUS GRANT: I think the content of the regulations that the deputy minister just described satisfied my immediate concern that wherever possible, we should have de-identified aggregate data. I don’t want to walk back what I said at Law Amendments Committee. I would prefer to see that in the Act, but I’m delighted it’s in the regulations. I think the discussions at these meetings - and I hope you’re not auditing my attendance - the discussion at the meetings were: Okay, how do we sensitively move the system forward without compromising the patient’s perspective? As I tried to outline in my opening remarks, there are principles that are intentioned here. Patients expect confidentiality, but they also expect a system that learns from itself. Doctors have an oath to confidentiality, but they don’t want that to be an impediment in a system that’s efficient.

 

I’ve been pleased with the discussions that were trying to find those sweet spots, and I think every voice has been heard. I think it’s been a positive step.

 

SUSAN LEBLANC: Just one more follow-up. Back in April, you talked about how you feared that this would alter the doctor-patient relationship. Are you satisfied that what you’ve seen thus far leaves that alone, or do you still think that it’s fundamentally going to change, given . . . ?

 

DR. GUS GRANT: I certainly haven’t had any complaints or concerns expressed to the college that would allow me to anchor an answer to your question with a specific. I think there are generational things to consider. I think older patients take a view of privacy differently than younger patients do, for instance. I think there will be equity-deserving groups that may be a little more suspicious than others. I think there’s change management, cultural work to do with this. But the law is what the law is, and the movement now is - the wheels are moving right now to build a system that better learns from itself. We will have to, in medicine, educate our patients accordingly.

 

SUSAN LEBLANC: This is for the Department of Cyber Security and Digital Solutions. We have been increasingly turning to private companies to deliver app-based health care, as we know, and as we’ve heard a lot about. Do we have safeguards in place to protect the personal health data of Nova Scotians if an app like Maple or the App - capital-A app - experiences a data breach? No, actually - forget the capital-A app, let’s just use Maple as an example - an external vendor, or whatever you call it. What are the safeguards that are protecting Nova Scotians if that company experiences a data breach?

 

THE CHAIR: Deputy Minister Clarke.

 

NATASHA CLARKE: I’m happy to address the question, and I would look to my colleagues to speak further if there’s anything in addition to the PHIA piece as that’s not in our area of responsibility. Government has standard terms and conditions and additional contracting pieces that we would include in those types of contracts that we would have with private sector companies around both privacy and cybersecurity. I think Deputy Minister MacKenzie addressed some of the pieces around data residency, for example, which is important to make sure that we have data residing in Canada and not elsewhere. Then, obviously, abiding by our privacy by design principles and security by design principles, but there are contractual obligations that companies would have to meet in order to be procured, used, and leveraged.

 

SUSAN LEBLANC: In your experience, does using a company that might have data from Nova Scotia but other places as well, could that cause unique or additional security risks if an organization or a company has data from a bunch of different jurisdictions? Or should that matter?

 

NATASHA CLARKE: I appreciate the question. That’s a very generic question, so I think it’s one that would require contextualizing and understanding the situation. Best practice would have us have segregated data - for example, having our own tenant. We use Microsoft 365, for example. We all use it, and we certainly know there are lots of other organizations globally that use Microsoft 365. Our data, for example, is our data. That data would not be shared across those boundaries, and it’s called a tenant, but in terms of answering, that’s the general answer to that question. I would not see on first blush that there would be any risk or concern, but again, that would have to be grounded in a specific abuse case.

 

SUSAN LEBLANC: This is a question for the Department of Health and Wellness or NSHA. On the topic of virtual care, a study from Canadian researchers released earlier this year found that some virtual care companies aren’t adequately protecting patients’ private health information from being used by drug companies and shared with third parties that want to market products and services, and that the for-profit virtual care industry valued patient data and appears to view data as a revenue stream.

 

Does Maple or any other government partner in virtual care or digital tools use data in this way? That’s my first question.

 

THE CHAIR: Mr. McKenna.

 

SCOTT MCKENNA: Unequivocally no. To Deputy Minister Clarke’s point, when we bring in any type of technology or company, we do an assessment of the technology to make sure it meets the Canadian standard for protection of health information. In Canada that’s Protected B classification. We do a security assessment of that. It’s our data that becomes part of our Nova Scotia environment, whether it be a cloud environment with Microsoft or Google, or Oracle, or whether it be Maple in this case, that’s part of our environment. Companies do not have access to that data. Their technology does, and it’s our patient data that we protect. It’s not for the companies to share or to access.

 

THE CHAIR: MLA Leblanc, just a quick question: Were you reading from a report?

 

SUSAN LEBLANC: I was, yes. I can table that.

 

THE CHAIR: As long as you do it by the end, it’s all good. MLA Leblanc.

 

SUSAN LEBLANC: Those rules are expressly prohibited in contracts with those vendors or companies?
 

SCOTT MCKENNA: Yes, we have the security clause that goes into it, and I think Deputy Minister MacKenzie mentioned earlier, when we talked about YourHealthNS, there’s a privacy impact assessment and a risk assessment, as we do with all technologies, to put the data security and the privacy of our health information at the forefront of everything we’re doing.

 

SUSAN LEBLANC: Just a question about this. You know there have been data breaches. I got one of those letters as an employee of the Province or someone who gets paid by the Province that said, Your information was compromised, blah de blah, but just so you feel better about it, we’re going to give you a year of free credit checking or monitoring. That’s awesome, that’s great, but what happens when TransUnion of Canada sends me the thing that says, Actually, yes, you’ve been compromised? I’m just wondering, when you talk about how these companies have to adhere to all these strict rules, is that literally what it is? They have to provide a year of free credit checking, or is there much more to it? Please say yes.

 

SCOTT MCKENNA: I can start and Deputy Minister Clarke can - broader piece there. She may want to weigh in. Going back to protection of our data - and the privacy of our health information is paramount - there are three types of events that can happen. The first one is making sure that our information is secure, and that’s why we’ll stand here and say that we implement to the Canadian standard for health information. The technology is secure.

 

The second type of event that can happen is obviously what we talked about earlier. We have an individual who has access to data, and that’s bad acting. That cannot be prevented. You can put controls in place and you can react to it.

 

The third type of information event that can happen would be we can have the most secure technology that we have, but the company itself may have a vulnerability in the software. We see that every day with events. I’ll defer the next piece of that to Deputy Minister Clarke. How we react to that is as soon as that vulnerability by the company - which sometimes is global - becomes aware, it’s how we react to that to make sure that patch is put in place immediately and critically.

 

[1:45 p.m.]

 

Those are three types of events that can happen. Two of them you can mitigate, but you can’t prevent; one we can mitigate as best as we can, down to zero. That’s what we try to do.

 

SUSAN LEBLANC: To the college again: in 2022, the College of Family Physicians of Canada released a report that stated, “for-profit virtual care presents a problematic approach to health care delivery as these models are fundamentally designed to maximize profits.”

 

Would the College of Physicians and Surgeons of Nova Scotia agree with that? Is that a view you share? And could you speak more broadly to any concerns with virtual care as it relates to quality or continuity of care and patient data?

 

DR. GUS GRANT: Wow, that sounds like a whole year of a graduate-level course. I would say this: Virtual care is here to stay. I hope that we have the focus to evaluate it - to evaluate that it’s helping patients, that its outcomes are real, and that it’s cost effective.

 

I don’t subscribe to the views of the College of Family Physicians of Canada, which sounded from the quote you provided that they were vilifying all private platforms for virtual care. I think it serves no one any good to make that judgment right now. Private virtual care is here, and what we should be trying to do is make sure it’s delivered safely and effectively to the benefit of patients.

 

I think the issue with virtual care, from my perspective, is: Are we respecting the paramountcy of patient choice when they choose whether to see - I think it’s incumbent on physicians to offer both virtual and in-person care, and it’s incumbent on physicians to exercise professional judgment as to whether virtual care is appropriate for the presenting complaint.

 

There are standards of the actual care delivered that have to be enforced. There are rights of patients that have to be considered. Again, we have to measure and evaluate. We’re in the bit of this trough right now where it’s become completely normalized in medical practice, and we’re only now starting to accumulate the data to measure whether it’s been effective or not.

 

I tried to answer a number of the aspects of your question, but it was a big question.

 

SUSAN LEBLANC: Those are the tabling documents. My next question literally says: Virtual care is here to stay in some form.

 

This is actually a question for the deputy minister: Is the partnership with Maple also here to stay, would you say, or is the government looking into developing capacity to offer a fuller in-house virtual care system?

 

THE CHAIR: Deputy Minister MacKenzie.

 

DANA MACKENZIE: I’m going to ask my colleagues from the NSHA to speak to the virtual care piece, and then follow up, if that’s acceptable to you.

 

THE CHAIR: Ms. Oldfield.

 

KAREN OLDFIELD: Sure, I’ll start. As has just been mentioned, there are quite a few organizations now offering a form of virtual care. That would include TELUS Health. There are a number of different companies that have an offering. I think if we start with the premise that virtual care is here to stay, then I would see a day where we would actually put this out to see the offerings that the various companies can provide. It may not be the same for all companies. For example, you may have a company that specializes in mental health or in different aspects of the health system. I think it’s incumbent on us to actually see what the entire suite is and then go forward from that.

 

I’m going to start there. I have to say, Maple’s been a good partner. They definitely stepped up and had a product when required at the outset of COVID-19. Now it’s five years later and we have the opportunity to look across the board and to see other companies that have developed excellent products as well, to see if we are getting the outcomes at a cost which is affordable for the Nova Scotia taxpayer.

 

THE CHAIR: MLA Leblanc, do you need more?

 

SUSAN LEBLANC: I just have a clarifying question. That’s great, that’s very helpful. Do you ever see a day when we bring it in-house? That was the other part of the question.

 

KAREN OLDFIELD: One never says never. I look at our virtual emergency - good parts of it are actually - the technology was developed by Dr. Janet Sommers at the Colchester East Hants Health Centre; a Nova Scotian developing the technology using Nova Scotia tech with Nova Scotia providers in Nova Scotia institutions. I think that’s a great example, and I also believe where we can develop the capacity and do it, then we should be looking at that.

 

SUSAN LEBLANC: Dr. Grant, you referred to the importance of virtual care. Do you hear from physicians or members who want to increase their practice of virtual care? How could they be greater supported by the government to do that, if you’re hearing that from them?

 

DR. GUS GRANT: I think there’s broad support for virtual care throughout the physician ranks. I haven’t heard for calls from physicians about looking for greater support - most of the physicians are working as hard as they want, as fast as they want.

 

I think there are still some tensions and some wrinkles to be ironed out. There are patients who often want to be seen in person, and sometimes that doesn’t align with physician scheduling and vice versa, and there’s tension within the medical profession too, insofar as I’m hearing from consultant physicians that referrals aren’t as thoroughly worked up by primary care providers as they once might have been. These are, I would think, quite predictable growing pains.

 

Five years ago, virtual care didn’t exist and now it’s absolutely a staple in the delivery of care. I think we’re still learning how to best use this tool. Again, I would say if you surveyed all the physicians in the province, the percentage of them saying that virtual care is not here to stay would be inconsequentially low. Are there things, lessons still to be learned? Absolutely. Are we getting better at it? I hope so. Are we measuring it? I hope so.

 

THE CHAIR: MLA Leblanc, 45 seconds.

 

SUSAN LEBLANC: Is there a standard of how long someone should wait to see a physician in terms of primary care, or do those kinds of standards exist?

 

DR. GUS GRANT: That would be impossible to impose. There are primary care providers whose practice is almost exclusively chronic disease management such that - they can wait a long time to get an appointment. There are other primary care providers who incorporate a degree of episodic or acute care, and thus have same-day bookings available. It would be absolutely impossible to mandate a requirement like that.

 

THE CHAIR: Thank you, Dr. Grant, with two seconds.

 

We’ll go to MLA Palmer.

 

CHRIS PALMER: Thank you, everybody, for being here this afternoon. It’s a very important topic for us to be speaking about this afternoon. I take some of the comments that have been made this afternoon. I appreciate, Dr. Grant, your comment about finding the sweet spot between patient privacy and getting better management of the system with data. I think we’re getting there, and I think it’s important. Hopefully Nova Scotians are hearing the information that we’re hearing this afternoon and get a chance to learn more because it is about education, I think, the more we’re moving forward.

 

I’d like to ask my first question to Deputy Minister Clarke or ADM Fiander Trask. Last year, the government created the Department of Cyber Security and Digital Solutions, and you outlined in your opening remarks that we’re one of three provinces in Canada, so I think we’re on the leadership end of that point. Could you please outline the importance of having a dedicated focus on these areas and expand on what you’ve spoken about so far? Just talk about that.

 

THE CHAIR: Deputy Minister Clarke.

 

NATASHA CLARKE: How much time do we have?

 

THE CHAIR: Eighteen minutes, 51 seconds. He’s done it before.

 

NATASHA CLARKE: Not to be cheeky about it, I’m actually incredibly proud of being the province’s first deputy minister of a department like this. We know, for example, that cyber security attack, cyber risk is the single largest business risk facing the globe today. I think it really demonstrates the Province’s commitment to emphasizing a focus in this area. What I also don’t want us to lose sight of is the digital solutions part of the name as well. Why I think that’s really important is that the focus and the approach we take in our department is putting the needs of users first.

 

When you think about the technology that you interact with today, which you probably don’t think about, it’s on your phone, it’s easy; my son loves Uber Eats. That’s what we want to offer up to Nova Scotians: building services with them, designing them with them, understanding their needs. Not just focused on government’s needs, but how do we meet their needs so that we’re designing policies and services that work for them.

 

I think that also translates into the cyber security world as well. We very much put cyber security, by design, as our approach to thinking about how we deliver things. Yes, both of these things can be in tension with each other, but we can’t have one outweigh the other, meaning I can have the most secure house, but that would mean every door in my house would be locked and I couldn’t flow around and access things. We have to balance those things, all focused on the needs of users.

 

I’m really proud that Nova Scotia has taken that leadership. I’m pretty certain we were actually Province No. 2, just behind Quebec. The impact that has had - it has meant that we’ve been able to have focused attention on these important priorities, working with partners like the Department of Health and Wellness and the Nova Scotia Health Authority in helping us advance and work in ways that people just expect us to today.

 

CHRIS PALMER: Part of what we do as MLAs is inform and educate people and try to promote what we’re doing. I find a lot of times there are so many things happening, it’s hard to keep up with all of the things that are happening in our health care system. We’re not only trying to fix the health care system that’s been there; we’re actually building a brand-new health care system for the future. We know that, and that’s what collecting data is all about.

 

I wanted to ask a question about the app. I don’t know who to direct this to, but we’ve heard that over 400,000 downloads have been made here in Nova Scotia about this, averaging about 2,500 interactions per day with the app. Could you please talk about some of the features that are there now? Nova Scotians need to know what is available through that app, what potentially is coming in the future applications for that as well.

 

THE CHAIR: Ms. Oldfield.

 

KAREN OLDFIELD: We’re going to share the answer to this question. I’d like to start by talking about a lecture that I attended last Thursday night at the Faculty of Medicine at Dalhousie University. It was the Kinley Lecture series, and they had last week speaking Dr. Jane Philpott. She was asked a question after her lecture, which was on primary health care. She was asked about digital - similar questions. Dr. Philpott referred to a study of 10,000 Canadians. It was a national study and we did participate in Nova Scotia. I’m sorry, I just can’t recall - I think it was OurCare Initiative or something. It focused in large part on digital. It talked about the fact that overwhelmingly, Canadians want to have access to their health records. They want access to these health records in their hands.

 

I was happy to hear this. I knew of the study, but she reiterated it because this is exactly what YourHealthNS has attempted to do. We talk about One Person One Record, and yes, it’s going to be a very good thing, very good for clinicians, helpful for Nova Scotians. YourHealthNS actually is One Person One Record in a person’s hand. Scott will never say this, but I will say that Scott and his team, and there are others here, actually created this app in record time compared to other provinces, and it is a very good product. There’s lots of work yet to do, and we’re going to keep doing it, but I just want to commend Scott and his team for the work that they did do in getting this to come to fruition. I would invite Scott to share some of the newest features that the app offers Nova Scotians.

 

[2:00 p.m.]

 

THE CHAIR: Mr. McKenna.

 

SCOTT MCKENNA: Thank you for the comments, CEO Oldfield. I will say we have an incredible team that has done incredible things across the system. It’s almost a year now since we publicly launched the app. It was made in November. I was just reflecting right now on that. The story hasn’t changed. This is about empowering Nova Scotians, putting information into Nova Scotians’ hands, because individuals made decisions. If you remember, when we launched this last November, it had no health records in it. This wasn’t about health records. This was about giving people information so they could actually find where to gain access to care in their communities, what health information is valid coming not from the internet; coming from Nova Scotia sources to empower people, to put people behind the cars they could drive and get those answers, because individuals made decisions.

 

We’ve now progressed. We all know that the first, from Day 1, everyone says, I want my health information. We heard Dr. Grant talk about how there’s a journey to that. We have to continue that change management and the journey. We then move to February. We then pilot to include some health information. It’s not everything, it’s some. We went to the launch of records at the end of June, which empowered all Nova Scotians to have a certain set of their health records, and that will continue to evolve. We’ve seen this Summer, we’ve now rolled out going forward your X-ray reports and your ultrasound reports. We all know that’s a natural evolution we will continue to do, because Nova Scotians currently can get access to their health records, but it’s very hard.

 

I use the example: I think I’m fairly informed, and it takes me 10 minutes to figure out how to book a COVID-19 vaccine in Nova Scotia. That’s the whole point of the app, to empower people and help people press the easy button. Is it perfect? Absolutely not. We have a journey to go, we’re on a journey, but we’re making incredible progress.

 

Another piece I did want to talk about as we enhance and improve the health system, as Deputy Minister MacKenzie talked about the Act and the regulations and how we’re bringing the primary health care data onboard, I will reiterate that what is only being used and provided back to individuals is their information. We do not even provide that information to our hospital clinicians. That’s not within the Act. Personally, as a Nova Scotian, I want to, because I expect everyone who’s in my circle of care to have access to my information, including my first responder. That’s a change management and we’ll get there. Nova Scotia will get there. We’re protecting the information in there.

 

What else is coming in the app? We talk about expanding health records, we know that will come. We already went public, had a conversation at the end of August about bringing on partners with Google to help the citizen experience, to not just have questions where they’re searching for information and they’re (inaudible) and they’re clicking, they’re actually - now you get Nova Scotians, when we launch that piece, will be able to talk in real language to the app to find out information about a disease, information on where I can get care based on what I’m presenting. It’s interactive, and how to get access. That will continue to evolve, but the core of what we’re doing has never shifted. It is about putting the power of the information in the hands of the Nova Scotian so they can make informed decisions.

 

The last thing I will say, because I’m sure everyone has stories about this with their friends, their families, their colleagues: I’ll share one of mine, because we can’t talk about other people’s health information. I recently went to see my primary care provider. I had the information in my hands that she didn’t have access to. There is no source for health records that’s comprehensive in Nova Scotia. Hospitals have the information, primary care has information, first responders have information, but we’re trying to bring it down together in one spot. She asked me, Where did you get that? You must have gone into a walk-in clinic. I had it there and I could share it with her.

 

At the end of the day, I don’t think it was a patient safety issue for me, but ultimately those can be patient safety issues and patient outcome issues. We’re empowering Nova Scotians to help them manage their health through a health-management tool. It will continue to evolve, and we’ll get better at it, and we’ll manage the risk - as Dr. Grant said - of what information when, because there’s a change-management issue as well.

 

CHRIS PALMER: Just quickly, Chair, am I allowed to read a text from someone?

 

THE CHAIR: As long as it’s tabled. You must table it - not your phone, but the text will have to be tabled. You will also have to have been given permission.

 

CHRIS PALMER: Fair enough. I’ll pass. But I have a good recommendation from someone in Ontario who is interested in this app, a doctor would like to come to Nova Scotia because (inaudible).

 

THE CHAIR: Sorry, what were you saying? (Interruption) You just wanted to count down your eight minutes? (Laughter)

 

MLA Palmer.

 

CHRIS PALMER: I’d like to pass it on to my colleague MLA Boudreau.

 

THE CHAIR: See, he’s a hog. MLA Boudreau.

 

HON. TREVOR BOUDREAU: This is just my second meeting as a returning member of the committee. The last time I didn’t get to ask a question. I talked it out. I enjoyed that a lot. (Interruption) There are a few of us here.

 

You think of data - I think it’s really hard for us to understand how much data we’re talking about and how impactful this is, whether it’s on the health care level or whether it’s with the Department of Public Works or whether it’s whatever. I would say - I think Deputy Minister Clarke kind of stole what I was going to say. This government has made this a priority. There is no reason outside of making it a priority than creating a department of Cyber Security and Digital Solutions. I would say I’m very proud of our government, just as the deputy minister would say that we’ve taken this seriously, and we continue to do that.

 

Then I was thinking about what else I was going to say, and Ms. Oldfield kind of stole a little bit of what I wanted to talk about. My wife and I are both health care practitioners, and when we heard about the idea of One Person One Record and how it would impact our ability to treat and care for patients in Nova Scotia - this is revolutionary. This is huge, and we’re doing it the right way. I’m really looking forward to that perspective and that way.

 

Then I think of the app and how it allows patients - people - to take responsibility for their own health. As a health care provider, I get to spend 15, 20, or 30 minutes with somebody, but the rest of the day, they’re on their own. It’s about giving those people and empowering people to make decisions that better their health, and what better way than having that data right in front of you?

 

I say this - we’re moving the needle. It’s an iceberg. You don’t get to see what’s going on at the bottom, but all that work is going to come to fruition. I would say I’m very excited about it, if you can’t tell.

 

I do have a couple of questions to ask. The first one is a little bit about the One Person One Record, and I’ll direct it to either the department or the Nova Scotia Health Authority. We’ve talked a little bit about the app, and I know we’re continuing to work on One Person One Record, but can you talk to us about the impact of an integrated medical records and data-sharing system and what that means to Nova Scotians and what it will do to patient care?

 

THE CHAIR: Deputy Minister MacKenzie.

 

DANA MACKENZIE: I’m going to deputize Chief Stevenson to speak to this, along with, perhaps, to then give part of the answer to Mr. McKenna as well, if that’s okay.

 

THE CHAIR: Mr. Stevenson.

 

COLIN STEVENSON: I’m happy to start. I think this builds on a lot of the conversation about EMRs. I think what’s really important for people to understand within Nova Scota is that there are EMRs in primary care, but every clinical information system that exists within the acute care setting has an EMR. Right now within Nova Scotia, within the environment, if you kind of think about it from zones and the geography, the Central Zone has a clinical information system that is comprised of multiple applications based on service, and the rest of the province has a different clinical information system. The IWK Health Centre has a different clinical information system.

 

When those systems were implemented, even though some of them are MEDITECH Expanse environment, they were implemented in different ways or different sort of instances across the province. So we have huge variation associated with what those clinical information systems are and how they’re used or how they function.

 

Mr. McKenna kind of talked about - we can talk about a clinical information system project, but really it’s about changing how people work. It’s about changing care and care delivery. One of the big values associated with moving the entire province through the OPOR process and what that project is really is actually getting us to some consistency and commonality around how we’re supporting and delivering care to Nova Scotians across the province. It’s actually creating an environment in which that information that follows me - as an individual who may be trying to access care in different parts of the province, I know that information is actually going to follow and be there with me regardless of where I go, and that the clinicians who have the authority to support me in my care actually have the ability to access that information. One of the biggest pieces really is around that care consistency associated with the access of the information and the availability.

 

There are other things that are part of what a typical clinical-information system would be that Nova Scotia is taking advantage of. Those are things such as there are built-in clinical decision supports. They actually provide you with a provider based on the information that’s entered with some information to help support you in what that care delivery is. It allows us to take certain things that are currently paper based and digitize them or pull them into the entry system so that they’re actually there and part of the record. Right now we have some information that isn’t part of that clinical-information system as a digitized record. It’s still paper based.

 

It provides information and training for clinicians as well as information that actually follows the patient. It increases efficiencies within care, and it can create more cost-effective care. Most importantly, it actually has the ability to improve the quality and safety of the care that we’re delivering to patients.

 

THE CHAIR: Mr. McKenna, do you have something to add?

 

SCOTT MCKENNA: The only thing I will add to that, and it’s germane to the whole conversation today, is that in Nova Scotia, we’re making the impossible possible. We will be the first province in Canada - and I say that not to be first, but it shows the collaboration, doing it the right way, starting with the legislation, the regulations that are put in place to enable us to actually move forward in creating that patient record, that one-patient summary.

 

There’s no place else in Canada that will have that. They have it at hospitals. In Nova Scotia, we’re bringing primary care data and hospital care data together, so we’ll have a comprehensive patient summary, first of all for the Nova Scotian. As we’re able to exchange that in legislation and regulations - that’s what every physician in this province wants. We’ll be able to get there. As we continue to implement standardization and other systems, the data will become better and we will have more data, but it doesn’t prevent us from using what we have today and getting it out there. Every Nova Scotian and every clinician wants to have that so they can give great quality care and safe care and produce great outcomes.

 

We’re doing that now, and that’s what we’re on track for. I’m extremely proud and humbled to be part of this province and the incredible teams that collectively across the system are enabling that.

 

THE CHAIR: MLA Boudreau with 49 seconds.

 

TREVOR BOUDREAU: I’m probably not going to get to a question, but I think somebody had said this to me before. It might have been the minister. Previously you’d be in the emergency room, you’d be being transferred from Strait Richmond Hospital to Halifax, and they’d take your file and stick it under your leg and say, See you on the other side, and hope that data gets there, and hope that information gets there.

 

I would say there are risks in not doing this. We talk about the risk of doing, but what about the risk of not doing this and not moving forward in a way that’s going to not only provide clinicians with the ability to make more informed decision-making, but also it comes back to that app, where we talk about people being able to take responsibility and . . .

 

THE CHAIR: Order. The next round, we’ll be doing 10 minutes each. It’s to the Liberal Party. MLA Clark.

 

BRAEDON CLARK: We’ve been talking a bit about the importance of records and management. Mr. McKenna, you mentioned your situation there. It just made me think of something myself. I have a condition that is totally fine. It’s called situs inversus. All of my internal organs are reversed in position. My heart is on the right side, liver, whatever. It’s all backwards, mirrored. My mom thinks I’m a medical marvel. (Laughter)

 

Basically, there are no complications with that, but the point is that I switched family doctors a few years back. I get EKGs periodically just to make sure everything is going fine. My family doctor called me and said, Come in, I’ve got to see you and talk to you about something. Okay, I guess. She says, Do you know you have this condition? I said, Yes, I’ve known this for 30 years, ever since I was a little boy. But that data just never crosses over when I switch family doctors. Now, in my case, it’s fine, but if it’s just your heart, for example, that can cause big issues. It just made me think about that and how important it is to have that coordination. I think it’s really important, and I’m glad we’re moving in that direction.

 

[2:15 p.m.]

 

I did want to ask about the app as well. I think one piece of it that we hear about a lot is the number of downloads - 400,000, I think Ms. Oldfield said at the beginning. That’s good. That seems good. That’s necessary, but not sufficient, I guess, to show that it’s working. I have a few dozen apps on my phone; I might use 10 per cent of them in any serious way.

 

What other metrics do we look at beyond the number of downloads to know that the app is working to move us in the direction we want to go in as a system?

 

THE CHAIR: Mr. McKenna. Is it you or someone else?

 

SCOTT MCKENNA: I’ll start with, first of all, going back to privacy of individuals. It’s front and centre in the way we’ve designed this. We’re not tracking individuals and what they’re doing. That would be a breach of privacy. That’s a start.

 

What we do know is how many downloads there are. We do know how many times - how many aggregated people have logged in to - MLA Leblanc mentioned earlier she was having struggles logging in - so how many unique log-ins we have. We do know how many times a certain record was accessed, like maybe looking at your lab data, but not by individual.

 

We have those types of metrics. We get feedback, as well, within the app from people who are willing to give us feedback. I will say that those people, if they have behaviours like me, when it’s working well, we don’t give feedback. We give feedback when things don’t work well. But the feedback we get, we listen to that. People want more records. People want to change this. We take that back to say, “How can we improve the app - when the road map of what strategically - what we’re trying to achieve?”

 

The final piece I will say on that as well: We know how many people go through the current virtual assistant to get access to care. Not everyone uses that to get access to care or find out where they can get access to care, but we do understand how many people ended up where the end points are. Those are metrics that are aggregate that we do track and we can pull while protecting the individuals’ usage.

 

The last thing on the app would be around how we actually continue to evolve and listen while we’re meeting there. Most digital applications by government - Singapore is the most digital-literate society in the world, and if you can hit penetration - 15 per cent of your population - that’s extremely high for government. Not for Apple or Google or someone’s TikTok app, but for government. If we extrapolate - it is about 450,000 downloads, I do believe - a download could be a family of five who might use the same iPad.

 

We say 35 to 40 per cent of Nova Scotia’s population have the app. That’s extremely high success, and I know we’ll do better. We’ll exceed that. We’ll continue to do better, but the opportunity is what drives us. It means we have a way to reach out and communicate information and access to that much of the population. It’s not the only channel. It’s a digital channel, but I think that’s where the opportunity lies. We have that much penetration. How do we use the tool to maximize that to reach Nova Scotians?

 

THE CHAIR: Ms. Oldfield.

 

KAREN OLDFIELD: I’d like to just add to that. In addition to what Mr. McKenna said, based on surveys, we also have demographics, which is very interesting in terms of who is using it. I want to clarify, as well, that we’ve used the term “download” here today, but that would also include an individual who is using their desktop computer. It’s not 450,000 people walking around with an app on their phone.

 

The demographics are very instructive. All of this information is able to be used to help us better manage the entire system end to end.

 

THE CHAIR: MLA Clark, four minutes left.

 

BRAEDON CLARK: I’ll try to be as quick as I can on this one. Mr. McKenna, just so I understand correctly, I realize that there’s no individualized data, and that’s totally fine, but do you know for example what percentage of Nova Scotians who have the app, how many of those 450,000 have never used it versus have used it X period of time per month? Do you have that kind of information?

 

SCOTT MCKENNA: No, that would be tracking individuals, and that would be a privacy infringement.

 

BRAEDON CLARK: Deputy Minister Clarke, I just wanted to ask you a question here. My memory might be a bit off on this, but I seem to recall that the department was announced, and then maybe within a week there was the MOVEit cyber breach. That was unfortunate timing. My sympathies for that. I think that was how the sequence of events played out.

 

Right into the deep end there - from that experience, what particular steps has the government taken to make sure that we don’t have that kind of situation again, which I know affected lots of institutions and governments around the world, not just here in Nova Scotia?

 

THE CHAIR: Deputy Minister Clarke.

 

NATASHA CLARKE: Thanks for that memory. It did certainly emphasize the need for a department such as this, and I think it was, yes, seven to 10 days to the point where when we had to issue letters. We actually had to create letterhead.

 

A couple of things I’ll just comment on: First of all, I’m still incredibly proud of the team’s response. We have a major incident process and an incident response process, so the cyber event itself was actually very short-lived. Then obviously we were into communicating with Nova Scotians about the effect of what then turned into a privacy breach as a result of the nefarious actors having access to our systems for a very short period of time.

 

Subsequently, we’ve published a “lessons learned” publicly around the MOVEit breach. We are working with our colleagues across government to improve things like data management practices. This isn’t always just about technology, but it is about how we are using data, making sure that the data that we are sharing around using technologies like this is what’s needed in that moment and not anything more than that.

 

We’ve been an analog government here in Nova Scotia since the 18th century, so we’ve got some work to do in terms of modernizing those processes to work the way that we do. We’ve rolled out cybersecurity training across government as well. We’re the first line of defence as the individuals in the organization, so raising our awareness and literacy around cybersecurity is really important. Everything we click on, whether that’s a link or an email, might be a way that a bad actor can gain access to our system, so I think we all work together.

 

Then of course there are a number of other steps that we’ve taken that I would love to be in a position to share with this committee. Unfortunately, bad actors like to pay attention to the things that we’re doing and can use that information against us. This is, as we’ve talked about, in terms of a journey with an app and continuously improving. That is the work that this department is focused on, and that will be a combination of people, process, and technology to make improvements, to do our best, to be as resilient as possible, to mitigate as many issues or risks as we can. The reality is this is big business now. As government, we need to work not just within our own organizations, but also with organizations like the Canadian Centre for Cyber Security, all of our federal, provincial, and territorial committees.

 

THE CHAIR: Order. MLA Burrill.

 

GARY BURRILL: I think my question would be, Ms. MacKenzie or Ms. Oldfield, for you. I want to ask about patients’ access to records in a different context, the context where, at least in my constituency office, we probably most often hear from patients has to do with when their physician has retired. They’re discovering that it’s going to cost a considerable amount of money for them to access their records from the retired physician, a lot of times more than they’re able at that moment to afford, particularly if we’re talking about more than one member of a household. I’d like to know: Are there protocols around this, particularly as to the charges and the fees, or is it in fact a matter of what the market will bear? How does this work?

 

THE CHAIR: Deputy Minister MacKenzie.

 

DANA MACKENZIE: This answer is more appropriately dealt with by Dr. Grant.

 

THE CHAIR: Dr. Grant.

 

DR. GUS GRANT: The physician owns the chart. The patient has an enduring right of access to the chart. The situation you described is quite common, particularly now that many physicians upon retirement or death have no successor in their practice. The common practice now is - and I’ve phoned widows, I’ve rented a truck to get records from garages. It’s a weakness in our system now because of the shortage of physicians. The college has a professional standard that requires that the fee charged to a patient is reasonable and reflective of the time involved. This shouldn’t be exorbitant.

 

The most common practice right now for physicians upon planned retirement or planned leaving of practice is to have their records after they tell the patients, I’m retiring in four months, or whatever. Many of them get a copy at that point in time, but upon retirement with no successor, they simply upload the charts to one of the data storage sites - DOCUdavit or Iron Mountain, or I can’t remember the name - then the patient can go there. That’s a situation where the patient is charged what the market will bear. It’s an unfortunate thing.

 

The most common perception is that the patient owns the chart and they are offended by any charge. Meanwhile, the physician has been paying lease costs for the space, administrative costs for the staff, and then it takes an hour or two to copy a chart. It costs money.

 

GARY BURRILL: Thank you for explaining that, but just as you explain it, it sounds as though it might be helpful - wouldn’t it be helpful if there were some guidelines or protocols? For example, we hear from people who say, My cousin paid X, I’m being asked to pay Y. This doesn’t enhance confidence. Wouldn’t that be a good direction for us to be moving?

 

DR. GUS GRANT: There are guidelines and standards on our website.

 

GARY BURRILL: I’m thinking further about where possibly the department or the Nova Scotia Health Authority might be able to be helpful. One of the situations where we hear from people are in instances where there’s been a sudden change, sometimes because the physician has passed away. There are all manner of complications you hear about, kind of these belong in the same category as taking the truck to the garage. For example, people negotiating with executors and so on - all kinds of things that seem kind of anachronistic.

 

If it’s fitting to ask Mr. MacKenzie and Ms. Oldfield about this - if not, we could ask Dr. Grant too: Would it not be helpful to have a public means by which, in those situations, data came under the stewardship of the department or NSHA - some systematic way it could be dealt with so that you didn’t have these kinds of anachronisms?

 

DANA MACKENZIE: Yes, I’m happy to begin a response and then invite Dr. Grant to take over. The issue, actually, draws into sharp relief the imperative of digitizing records as best and as quickly as we can. The problem actually is something that’s squarely within our windshield, if you will, because of the urgency of these exact types of situations. I’ll make that statement.

 

[2:30 p.m.]

 

With respect to the actual standard, that regulation is within the purview of the college. We’re always discussing items like this. That transition piece, where we are trying to strengthen and support physicians with respect to the operation of their clinics, that is work that NSHA has undertaken in a very accelerated and focused way so that pending retirements and pending transitions are supported and monitored, and physicians are given attention and support in those periods of time, so that we can exactly avoid that type of situation.

 

I will hand the microphone now to Dr. Grant on that piece, but it is something that is a concern for us and is a topic of discussion.

 

DR. GUS GRANT: A few quick points. If I’m not mistaken, I believe that PHIA prevents a physician from charging for the transfer of a record to another physician. I think that’s likely honoured somewhat in the breach more than the observance, but that’s a safeguard in place for your constituents.

 

A second thing that’s relevant is that last year, for the first time, physicians, when they renewed their licences, were asked: In the event of the sudden closure of your practice, who will be the successor or custodian of your records? We advised them at that time that there would be a duty in the subsequent year to identify a custodian.

 

But I’d echo the meta comment of the deputy minister - this is exactly the type of circumstance why we need to be digitized. I remember in the buildup to this legislation in April or whatever, I said to - it might have been Ms. Oldfield or the Premier - if you want an early win on this, assure physicians across the province of successor custodianship. It’s a hassle for everybody, and it’s particularly in - it’s small numbers, but physicians pass away suddenly or leave practice suddenly or something happens, and very few have taken the time to plan for those successor rights.

 

I feel for your constituents. We get lots and lots of calls. We have a full-time presence at our college who’s helping with practice-closure issues like that. But this is exactly why a digital record will be so much benefit - better benefit - than the paper-based records that are still - what is our percentage now? Is it 20 or 30 per cent are still paper based in primary care?

 

THE CHAIR: MLA Burrill with 90 seconds.

 

GARY BURRILL: I think it’s very clear, what you’ve explained. I still want to ask, though, from a policy point of view - I’m thinking about that fee, whatever it is within the guidelines that the patient is confronting. Would it not be consistent with the principles on the basis of which we finance access to health care in the province, if the Province, MSI, somehow assumed responsibility for that fee, rather than the patient privately?

 

DANA MACKENZIE: It certainly is a reasonable proposition, but in the actual calculation of the fee, given the protections available with respect to the requirement to the college standard - keep it low and reasonable - combined with the supports that are given by the college itself on the transition, I think that there are protections there to mitigate against extremely high charges in those cases.

 

GARY BURRILL: Thank you very much for explaining this and laying it out. It’s very helpful.

 

THE CHAIR: MLA Boudreau.

 

HON. TREVOR BOUDREAU: No real preamble this time. I’m going to direct this one to Dr. Grant.

 

I would say everybody has a different comfort level with technology. Whether it’s a patient or a physician, their comfort level with digitizing health information and their ability to use technology is different. We’re all human. We’re all different.

 

I guess what I’m asking is: What advice could the college provide on how government could work with physicians during a period of transition like this, when it comes to the technology? Are there things that physicians would like government to do to help?

 

THE CHAIR: Dr. Grant.

 

DR. GUS GRANT: There are. But I’d like to echo the earlier positive sentiment I uttered: I think the college is being now. I can think of a couple of examples - and Scott, jump in. At one of the data-governance meetings or whatever, as you were trying to populate the app with data and resources, there were links to certain websites.

 

I scurried down the rabbit hole of one of those links. It was on opioid prescribing. It had been industry sponsored, and the science in it was bad. We had to take steps to say, Okay, how do we vet the links we have? We were heard and the adjustment was made.

 

Similarly, on what information and when information should be shared with patients, there’s an expertise to that, and physicians are being heard on that. I think the custodianship and succession of charts is a really relevant thing, where government can hear from physicians - maybe best through Doctors Nova Scotia - of the realities of that. I can tell you, I used to be a family doctor in the late Cenozoic Era (laughter), and that was a real cost. It was a hassle when somebody was - we need to find solutions there.

 

I think physicians are being engaged and are being heard, and there’s growth to be done. I don’t have any unction about our involvement today.

 

TREVOR BOUDREAU: Thank you for that. I think I’ll pass it over to my colleague MLA White.

 

THE CHAIR: MLA White.

 

JOHN WHITE: We talked today about the importance of health care data from the patient and practitioner perspectives, and we started to talk about long-term planning and resources - long-term planning for the Department of Health and Wellness. I’m wondering if you can elaborate on that a little bit, on having the data and how it comes to planning the workforce and stuff like that.

 

THE CHAIR: Deputy Minister MacKenzie.

 

DANA MACKENZIE: I’ll begin, and then perhaps hand the microphone to CEO Oldfield.

 

The data allows the management of the system in a very deep and impactful way, in terms of getting access to rolled-up, de-identified data to allow us to see what’s happening in primary care so that those resources in our health human resource planning - our resource allocation - can be appropriately deployed. It’s a finite resource. The data helps us actually plan and allocate incredibly intelligently. That’s always the goal with respect to that system-wide data.

 

I’ll ask Ms. Oldfield. She’s far more articulate on this point than me.

 

THE CHAIR: Ms. Oldfield.

 

KAREN OLDFIELD: Without information, it is very difficult to manage. It’s difficult to organize, it’s difficult to manage, it’s difficult to plan, it’s difficult to allocate resources, and it’s difficult to figure out how much money a person needs to pay for things. Various people today have talked about how information is power, and truthfully, the data is the most important piece of information we can possibly mine.

 

I’m just going to give a very small example. I mentioned demographics a few moments ago. We know from the demographics that, contrary to what one might think, it is not the very young who actually use YourHealthNS. It’s a different demographic: a very high percentage of persons 70 and above. Okay. Now, we also know that sometimes the younger can teach the older. I know I certainly learn every day from the younger showing me how to use my phone and this, that, and the other thing.

 

Here’s what we did based on the data. This Summer we had six students who went around the province - they were called health ambassadors - to work specifically in community and with particular emphasis on a senior demographic to help them download the app or put it on their computer and explain what it did, how to use it, how to access, how to get your data, et cetera.

 

Those students went to as many possible public events, like the Blue Nose Marathon, for example, a booth there. They went to seniors’ homes, they went to farmers’ markets. The data helps us to know what people need. How could people use that app more effectively? Very small example, but it was meaningful in community. I’d just share that. The more kinds of information, and particularly, very sophisticated information that we have, then we can better use that to manage the system from end to end.

 

JOHN WHITE: All day long, we’ve talked about the importance of digitized information with the health data and medical records. Obviously, our side of the floor - we’re talking about both sides here - we’re dealing with the residents at home, our constituents, who want to know how the health records are being kept protected and what’s going on. We talked about desensitizing the information - or depersonalized, it was called? De-identifying. We talked about that. We talked about standards in place with the companies you’re dealing with.

 

I would like to give you a few minutes to put all that information in one place so that you can tell us so we can clip it and we can share it so we know how we can tell our residents that their information is safe.

 

THE CHAIR: Who wants that?

 

DANA MACKENZIE: I will begin, but I’m probably not going to be able to produce any clips about my level of technical knowledge on it. I think my colleague Mr. MacKenna can speak to some of the security protections that are at a more technical level, and my colleague Deputy Minister Clarke as well.

 

In terms of the overarching piece, I think the governing principle for health data is always that the minister as a custodian has a strong and very clear obligation under the Personal Health Information Act to ensure that data is only collected, used, and disclosed for the purposes for which it’s collected and in minimally intrusive ways. The minister takes that - obviously as any minister would - incredibly seriously. That colours all of the protections that get built with respect to apps, OPOR, clinical information systems, vendor contracts, all of those things.

 

That principle animates all of the work that we do in this space, and that finds articulation in the regulations, for example, that this government passed with respect to making sure that whenever that data comes onto the minister’s side of the fire cloud, they call it, it’s de-identified and not actually traced back to an individual. There’s nobody looking at anything in terms of a data lake or anything that comes in inappropriately, and that’s a commitment that is very clearly set out in the regulations.

 

We also want to hear from the college and Doctors Nova Scotia, so we partnered with them in those regulations and have an obligation to consult whenever we’re moving forward with any type of innovation inside the app itself in what we call the electronic health record. The commitment is there.

 

In terms of the technical aspects, I’m going to hand the microphone over to Mr. McKenna first and then to Deputy Minister Clarke to perhaps provide some more of the technical protections that can help inform the record.

 

THE CHAIR: Mr. McKenna, 33 seconds. (Laughter)

 

SCOTT MCKENNA: I can answer the question. The new investments that’ve been made over the past few years with the current government have built health transformation. Digitization, we had a good conversation on that today. We needed to get there. What we can say is implementation of those investments is done with modern technology that is secure, and privacy and data security is at the forefront of what we do. We can say that standards for health information in Canada is Protected B classification.

 

THE CHAIR: Order. Good try. I’m going to allow closing comments. I’m going to start right to left, and I’m not going to miss anybody this time.

 

Dr. Grant, do you have any closing comments?

 

DR. GUS GRANT: No, I appreciate the opportunity to appear. Thank you.

 

THE CHAIR: Ms. Fiander Trask, do you have any closing comments since they didn’t grill you much.

 

TRACY FIANDER TRASK: No, I got off lucky. No, and thank you very much.

 

THE CHAIR: Deputy Minister Clarke.

 

NATASHA CLARKE: I just wanted to say an extended thanks to the committee today to have the opportunity to come and share a little bit about our new department and to participate in this very important conversation.

 

THE CHAIR: Deputy Minister MacKenzie.

 

DANA MACKENZIE: I have no comments, thank you.

 

THE CHAIR: Mr. Stevenson.

 

COLIN STEVENSON: No comments, thank you.

 

THE CHAIR: Ms. Oldfield.

 

[2:45 p.m.]

 

KAREN OLDFIELD: This is scary, but I’m going to make one. It’s something we haven’t talked about today at all - so not to open a conversation, but to share, which is that some of the tools we’ve talked about - we’ve talked about apps, we’ve talked about OPOR - but we have to remember how important they are in the context of recruitment and retention of clinicians and health care workers across the board.

 

We are talking about students who come from medical school or schools of nursing or pharmacy or OT or PT. They are coming out of school very versed in digital applications and how scary it is when they come to work on Day 1 and all of a sudden they’ve gone back in the past to a time before they were born. We have to remember how important it is to encourage, to retain, and to recruit our health care clinicians.

 

I just want to put that in your minds as we conclude today. Thank you for your time.

 

THE CHAIR: Mr. McKenna.

 

SCOTT MCKENNA: No additional comments. Thank you for the opportunity - an incredibly important topic.

 

THE CHAIR: I’d like to thank everybody for coming.

 

We don’t have a lot of business, so I’m going to take a three-minute recess. We are in recess.

 

[2:46 p.m. The committee recessed.]

 

[2:50 p.m. The committee reconvened.]

 

THE CHAIR: Order. I call the meeting back to order. I’m going to go to the agenda, once I get to it.

 

Under committee business, the first issue is, we had a request for Diabetes Canada to be virtual at the November 12th meeting. Is there any objection to that? Concern? All the other witnesses will be in person.

 

Hearing none, I’m assuming we’re okay with that. Perfect.

 

We received correspondence October 3, 2024. It’s on the agenda, so that’s the only reason I’m going to keep reading this. It’s a letter to the committee and to the Minister of Health and Wellness from Oliver Aygun, regarding “Request for Independent Investigation into Systemic Issues in Nova Scotia Health’s Patient Transfer System.”

 

This item is actually before the courts, so I would like this to stay confidential until it changes. We’re not going to be discussing it while it’s in front of the courts. Everybody okay?

 

We received another letter, but I’m just going to refer to it as the letter you received from the clerk this morning. There’s been no notice for anybody to see it. It’s kind of late. I would prefer this to be looked at at next month’s meeting because there are some concerns on whether we can discuss it or not. Is there any objection to that? You guys are great.

 

Because both of those documents were not publicly discussed - they’re both confidential, so the contents of the emails are not to be discussed outside. Thank you, Mr. Hebb.

 

I think the next thing is me saying we’re going to meet again. (Interruption)

 

Is there any other business? Seeing none, the next meeting is Tuesday, November 12th, 1:00 p.m. to 3:00 p.m., Advancing Diabetes Care. The witnesses will be the Department of Health and Wellness, Nova Scotia Health Authority, IWK Health Centre, and Diabetes Canada.

 

No other discussion? The meeting is adjourned. Thank you, everyone.

 

[The committee adjourned at 2:52 p.m.]