Distribution of Electronic Access to Personal Health Information (PHI) across Sociodemographic and Socioeconomic Strata in Canada 

August 2024

Canada Health Infoway

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ABSTRACT

Using data from the 2023 Digital Health Equity Analysis conducted by Canada Health Infoway, we examine the current landscape of access to electronic personal health information across several population groups in Canada. We explore the concept of digital health equity and discuss its importance in facilitating improved health outcomes and experiences through increased access to electronic personal health information across the health system. Furthermore, we present examples of current initiatives and work taking place to support equitable access to personal health information online.

BACKGROUND AND CONTEXT

The spread of COVID-19 required expeditious and innovative solutions to facilitate continued access to health services and personal health information while supporting physical distancing measures (Health Canada 2021). These solutions took the form of virtual care platforms, patient portals, clinical decision support tools and more. Many of the solutions that were rapidly deployed at this time have remained in place and gone on to support improved access to personal health information across the Canadian healthcare system.

For instance, Canada Health Infoway (Infoway) has committed to improving connectivity among all care sectors, organizations, and providers through the Shared pan-Canadian Interoperability Roadmap (Canada Health Infoway 2023). Within the Roadmap, it is highlighted that a connected Canadian healthcare system relies on all persons in Canada being able to access, manage, and share their personal health records (Canada Health Infoway 2023). Electronic access to personal health information, a key component of personal health records, is an integral to enhance connectivity (Canada Health Infoway 2023). Additionally, the “Connected Care for Canadians Act” (Bill C-72), proposed by the federal government, reflects a significant step forward in strengthening Canada’s healthcare ecosystem by prioritizing data sharing and interoperability (Health Canada 2024).

Ideally, through these initiatives, all patients should be able to effectively use technology to access their personal health information regardless of their socioeconomic, sociodemographic, cultural, linguistic, racial, or ethnic group, enabling every person in Canada to remain informed and engaged in all aspects of their care (Health Canada 2021; Canada Health Infoway 2023). In turn, this equitable access should translate into more positive health outcomes and behaviours through increased patient involvement (Health Canada 2024).

However, this is currently not the case. Instead, it has been revealed that digital health solutions, implemented during the pandemic, may have unintentionally exacerbated pre-existing health inequities across several population groups, hindering action towards improved access to online personal health information and a more connected healthcare system (Public Health Ontario 2023; Crawford, A. & Serhal, E. 2020). This is concerning as delayed access to personal health information has been found to impact access to care and lead to negative health outcomes, particularly for those in marginalized and vulnerable populations (Health Canada 2024).

As a result, work to adequately interpret and evaluate dimensions of digital health equity has progressed significantly since the onset of the pandemic. Virtual care experts have consulted and defined digital health equity as “the provision of equitable health service using digital communication or information tools for the collection, exchange and use of health-related information for purposes of promoting quality care (Health Canada 2021).“ A digital health supplement to the Health Equity Impact Assessment has been developed as a tool to support equitable design considerations for digital health solutions prior to and during development and delivery (CAMH 2022). Additionally, frameworks, such as the Digital Health Equity Framework (DHEF), have been proposed to define the scope of digital health equity and the factors that impact it (Crawford, A. & Serhal, E. 2020). Resources for more information on the Health Equity Impact Assessment and Digital Health Equity Framework (DHEF) are provided in the Appendix sections [2] & [3].

In each case, the complexity of digital health equity is emphasized. There are numerous perspectives and factors to consider when assessing digital health equity due to the interactive and overlapping nature of individual identity (Crawford, A. & Serhal, E. 2020; Public Health Agency of Canada 2022). Nonetheless, it is necessary to develop a current state picture of access to electronic personal health information. This analysis hopes to identify how digital health solutions can be improved to adequately support initiatives related to health system connectivity and access to electronic personal health information for all population groups in Canada.

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