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Annual Report, 2014–2015CIHI
Listening and Learning
Our visionBetter data. Better decisions. Healthier Canadians.
Our mandateTo lead the development and maintenance of comprehensive and integrated health information that enables sound policy and effective health system management that improve health and health care.
Our valuesRespect, Integrity, Collaboration, Excellence, Innovation
Table of contentsMessage from Board Chair and President 2
CIHI data in action: Our accomplishments 7
Our organization 37
Looking ahead 44
Management discussion and analysis 53
By the numbers: Financial statements 67
2
Message from Board Chair and
President
We’re listening. In fact, this past year, we’ve
focused on just that — listening to our funders,
to those working on the front lines, to system
decision-makers and to our employees.
3
Dr. Brian Postl Board Chair
David O’Toole President and CEO
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CIHI Annual Report, 2014–2015: Listening and Learning
As we began to work on renewing our strategic plan, we wanted to know 2 things: how are we meeting our customers’ current needs, and what are their emerging priorities?
In talking with our stakeholders from coast to coast — both internally with our
staff and with those working in the sector — a number of key themes emerged:
Data timeliness, the continuum of care and standards
While we’ve made progress on the timeliness of our data, there’s still room
for improvement. Increasingly, care is provided outside of acute care settings.
Our data holdings should reflect this. Just as important, with new sources
of data emerging, CIHI is in an excellent position to lead in the development
of standards, which are essential in order for information to be considered
relevant and comparable.
Engaging our stakeholders
Our stakeholders are very keen to work with us. They want to tap into our
expertise to get more meaning from our work. Over and over, we heard
that collaboration with a wide variety of players is critical to increasing the
impact of our data, as well as our products and services.
With time remaining on our current strategic plan (which runs from 2012 to 2017),
you may be wondering “Why renew it now?” The need for health information has
evolved significantly over the last 20 years and continues to change at a faster pace
than ever before. We need to keep up to remain relevant. The conversations with
our stakeholders provided a great deal of insight into their needs and our work, and
our future priorities will reflect what we’ve learned. You’ll be hearing more about
where we’re headed as we launch our new strategic plan in the coming year.
5
While strategic planning has been an important focus over the past few months,
we also accomplished a number of other things that are worth celebrating. In this
report, you can read about these and other successes:
• We’re supporting a number of federal initiatives related to prescription
drug abuse.
• We’ve expanded our data holdings to include information from the
patient’s perspective.
• We launched 2 major initiatives related to the Your Health System web tool.
• We were recognized internationally for our data security and privacy practices.
We’re very proud of the work we do and look forward to collaborating with our partners in the health care system to achieve our vision:
Better data. Better decisions. Healthier Canadians.
Message from Board Chair and President
Dr. Brian Postl Board Chair
David O’Toole President and CEO
6
7
CIHI data in action
Our accomplishments
At CIHI, we’re connecting. We’re collaborating with
our partners to gather the right data. We’re linking
with our clients to provide the data they need.
And ultimately, we’re connecting with Canadians,
providing better information to improve care.
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CIHI Annual Report, 2014–2015: Listening and Learning
Better data. Better decisions. Healthier Canadians.
As we enter the fourth year of our 2012 to
2017 strategic plan, we believe we’re on the
right track. This annual report provides many
examples of what has been accomplished
over the past year.
Our 3 strategic goals will continue to guide
us in the coming year as we transition to our
refreshed strategic goals and directions in 2016.
9
Our 3 strategic goals will continue to guide us
Improve the comprehensiveness, quality and availability of data
• We will provide timely and accessible data connected across health sectors.
• We will support new and emerging data sources, including electronic health records.
• We will provide more complete data in priority areas.
1
Support population health and health system decision-making
• We will produce relevant, appropriate and actionable analyses.
• We will offer leading-edge performance management products, services and tools.
• We will respond to emerging needs while considering local context.
Deliver organizational excellence
• We will promote continuous learning and development.
• We will champion a culture of innovation.
• We will strengthen transparency and accountability.
3
CIHI data in action: Our accomplishments
2
10
CIHI Annual Report, 2014–2015: Listening and Learning
Data driven
Goal 1: Improve the comprehensiveness,
quality and availability of data
Drilling down
Data quality
Data is at the heart of everything we do at CIHI. Every day, we build on our strong data quality culture, continually enhancing the data we provide.
Several data quality initiatives in the past
year illustrate this commitment:
• CIHI has been exploring data surveillance
techniques, taking cues from the finance
and insurance sectors. More sophisticated
data mining methods are being developed
to detect anomalies and outliers that we
don’t normally identify in regular analysis.
It’s this type of cutting-edge work that will
help provide more timely identification of
potential data quality issues.
• Each year, CIHI prepares provincial/territorial
data quality reports for deputy ministers of
health across Canada. The reports provide
a snapshot of the quality of data being
submitted to CIHI’s various data holdings.
This year, we added a new report on day
surgery, one of many improvements we
made to the reports.
• British Columbia recently started
reporting to the National Ambulatory
Care Reporting System (NACRS). As part of
its implementation, B.C. became the first
jurisdiction to have physicians and nurses
capture clinical data as part of the delivery
of care. CIHI took an in-depth look at the
quality of the emergency department data
B.C. reported to the database, including
the data captured by clinicians.
11
• We completed the first phase of an assessment of
the quantity and quality of financial and statistical
data submitted by long-term care facilities to the
Canadian MIS Database (CMDB). This initiative
supports the future reporting of this information.
• We launched a 2-year project working
with the Western Patient Flow
Collaborative to develop standards for
consistently defining alternate level of
care (ALC) in acute care hospitals and to
improve the ALC information reported to
the Discharge Abstract Database (DAD).
We have also made important progress in
understanding and validating long-term
care financial and statistical information
submitted to the CMDB from more than
1,500 facilities, totalling approximately
$18 billion. This work will serve as the
foundation for reporting on the provision
of long-term care in Canada, a growing
sector of our health care system.
CIHI data in action: Our accomplishments
In addition to these initiatives, CIHI achieved 100% electronic data submission across all data holdings. Less manual processing and faster and more efficient submissions will result in improved data quality.
12
CIHI Annual Report, 2014–2015: Listening and Learning
Making connections
Data Access and Integration strategies
CIHI’s Data Access Strategy does just that — improves access to data. This year, the strategy was augmented with new components:
• Post-secondary libraries across
Canada continue to house more
of CIHI’s inpatient data as part of
Statistics Canada’s Data Liberation
Initiative, available at no cost.
• CIHI is collaborating with the
Canadian Institutes of Health
Research to provide a data set on
high users of the health system in
order to support work on the Strategy
for Patient-Oriented Research (SPOR).
• Enhancements to CIHI’s Access Data web
page make it easier for health system
and policy stakeholders and the general
public to obtain data.
• CIHI provided data sets for use in
the federal government’s Canadian
Open Data Experience (CODE)
2015 hackathon.
In addition, CIHI continued to meet its
stated service standards for our ad hoc
data request service.
CIHI’s Data Integration Strategy takes a person-centred approach that will enable analysis of data along the health care continuum.
By investing in emerging technologies and
the evolution of our analytical environments,
CIHI is positioned to promote automation
and efficiencies in the delivery of our
busines objectives.
13
CIHI data in action: Our accomplishments
Monitoring abuse
Prescription drug abuse database
Health Canada recently announced that CIHI will receive $4.28 million in funding over the next 5 years to support federal initiatives related to prescription drug abuse (PDA).
CIHI will establish and run a new
program to improve pan-Canadian
PDA data and create agreed-upon
data standards and indicators.
CIHI will work with stakeholders
to understand what can be learned
from existing data sources and
where there are gaps. From there,
we can support stakeholder access
to and use of the PDA data and
provide leadership around standards,
analysis and reporting.
This is an opportunity for CIHI to create awareness, share knowledge and build capacity for better monitoring of abuse.
$4.28 million in funding over the next 5 years
14
CIHI Annual Report, 2014–2015: Listening and Learning
Patient-centred information
Patient experience survey/database and PROMs Forum
The first phase of the Canadian Patient Experiences Reporting System (CPERS) project was finalized in May 2014.
CIHI worked with representatives
from Canadian jurisdictions to
develop the Canadian Patient
Experiences Survey — Inpatient
Care, along with survey procedure
standards. The second phase of
the project, completed in March
2015, focused on developing a
pan-Canadian reporting system
as well as preliminary indicators
and measures. CPERS supports the
collection and reporting of patient
experiences in the acute inpatient
sector and is now ready to receive
data. CIHI is also assessing options
for measuring experiences in the
emergency department and long-
term care sectors.
CIHI’s Patient-Reported Outcome
Measures (PROMs) Forum was held in
February. The 60 participants included
senior policy-makers from federal/
provincial/territorial governments,
senior health system decision-makers,
international guests and selected
clinicians and senior researchers.
The event confirmed a high level of
interest in aligning PROMs initiatives
across Canada to better understand
the patient’s perspective on
health outcomes.
In response to the strong support from our stakeholders, CIHI has launched a new PROMs program of work.
Together, we are exploring
opportunities for advancing common
approaches to PROMs in Canada.
CIHI data in action
Eating disorders in women and girls
CIHI data supports standing
committee’s work on eating
disorders in women and girls
Read more on this story and other successes at www.cihi.ca/en/land
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CIHI Annual Report, 2014–2015: Listening and Learning
How Canada compares
The Commonwealth Fund survey
More than 5,000 Canadians age 55 and older were surveyed in 2014 as part of The Commonwealth Fund’s international survey.
The results highlight how experiences with health care vary across Canada and how they compare with those in other countries.
This past year, CIHI became a Canadian partner of this annual survey along with the Canadian Institutes of Health Research, taking
over from the former Health Council of Canada. We worked with provincial partners to increase sample sizes and to adjust and enhance questions to meet Canada’s information needs.
In January, we released How Canada Compares: Results From The Commonwealth Fund 2014 International Health Policy Survey of Older Adults. The report shows where Canadian and provincial results are significantly different from the international average.
SERVICES
Informal caregiving Results from The Commonwealth Fund 2014 International Health Policy Survey of Older Adults (age 55+) show that Canadians generally spend more time as informal caregivers than people in other countries and don’t always get the support they need.
1 in 5 older Canadians provided care to someone with an age-related problem at least once a week. That’s about the same as the international average of 11 countries.
4 in 5 older Canadian caregivers provided care for their family members.
Almost half (47%) of older caregivers provided care for at least 10 hours a week, which is higher than the international average of 40%.
Canadian caregivers were more likely to experience distress, anger or depressionif they provided 10 or more hours of informal care.
Almost one-quarter of Canadian caregivers needed help in the past year but didn’t receive it.
The main reasons caregivers didn’t get the help they needed were lack of services and not knowing where to go for help.
day aweek1
HELP
10hours a week10hours
a week
© 2015 Canadian Institute for Health Information
43%
Timely access to primary health careResults from The Commonwealth Fund 2014 International Health Policy Survey of Older Adults (age 55+) show that Canadians continue to experience challenges getting medical care when they need it.
Nearly 1 in 3 waited 6 or more days to see a doctor or nurse the last time they needed care.
All 10 provinces reported significantly longer wait times than the international average.
More than half of older adults reported difficulties getting medical care on evenings or weekends without going to the emergency department.
More than 1 in 3 (37%) older Canadians visited the emergency department for a condition that could have been treated by their regular doctor.
clocks
EMERGENCY
6+days
2+days
53% of older Canadians waited 2 or more days to see a doctor or nurse the last time they needed medical attention.
© 2015 Canadian Institute for Health Information
This was the same percentage as in 2007.
53%
43%
36%17%
18%
United States
UnitedKingdom
Canada
Germany
France
Australia
32% 2014
2007and 53%
17
Timely access to primary health careResults from The Commonwealth Fund 2014 International Health Policy Survey of Older Adults (age 55+) show that Canadians continue to experience challenges getting medical care when they need it.
Nearly 1 in 3 waited 6 or more days to see a doctor or nurse the last time they needed care.
All 10 provinces reported significantly longer wait times than the international average.
More than half of older adults reported difficulties getting medical care on evenings or weekends without going to the emergency department.
More than 1 in 3 (37%) older Canadians visited the emergency department for a condition that could have been treated by their regular doctor.
clocks
EMERGENCY
6+days
2+days
53% of older Canadians waited 2 or more days to see a doctor or nurse the last time they needed medical attention.
© 2015 Canadian Institute for Health Information
This was the same percentage as in 2007.
53%
43%
36%17%
18%
United States
UnitedKingdom
Canada
Germany
France
Australia
32% 2014
2007and 53%
One finding is that older Canadians have longer wait times and more difficulty seeing a doctor or nurse when they need medical attention than older people in 10 comparator countries.
However, the survey results were generally positive for many aspects of care received by older Canadians when they do see their doctor.
The 2015 survey will focus on primary health care physicians and their views on the health care system. We will continue to apply our data quality methodologies to the survey data and make it more accessible to researchers.
CIHI data in action: Our accomplishments
18
CIHI Annual Report, 2014–2015: Listening and Learning
We’re collecting more data than ever
CIHI data holdings
Out of our 30 data holdings,
10have 100%
participation
22have 80+%
participation
The table on the next page provides a snapshot of CIHI’s national data holdings.
As can be seen, in 2014–2015, progress was made in the participation of jurisdictions in CIHI’s data holdings.
Plus, we added a new one: The Commonwealth Fund Survey.
CIHI’s 30 data holdings as of March 31, 2015
Health care category Data on . . . B.
C.
Alt
a.
Sask
.
Man
.
Ont
.
Que
.
N.B
.
N.S
.
P.E.
I.
N.L
.
Y.T.
N.W
.T.
Nun
.
Acute and ambulatory care
Inpatient hospitalizations Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection.
Complete data collection. Quebec submits MED-ÉCHO data on an annual basis. This data is processed and appended to the Discharge Abstract Database (DAD) to create the Hospital Morbidity Database (HMDB).
Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection.
Day surgeries Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection.
Complete data collection. Quebec day surgery data is included in merged DAD/HMDB production data sets; the appropriate reference for this data is the HMDB.
Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection.
Emergency departments Partial data collection. Complete data collection.Partial data collection. Denotes progress in data collection efforts as compared with previous fiscal year.
Partial data collection. Complete data collection.In discussion. Denotes progress in data collection efforts as compared with previous fiscal year.
In discussion. Partial data collection. Partial data collection.In discussion. Denotes progress in data collection efforts as compared with previous fiscal year.
Partial data collection. Not implemented. Not implemented.
Ambulatory clinics Not implemented. Complete data collection. Not implemented. Not implemented.Partial data collection. Denotes progress in data collection efforts as compared with previous fiscal year.
Not implemented. Not implemented.Partial data collection. Day procedures using MIS Functional Centre Accounts that are currently grouped to clinics.
Not implemented. Not implemented. Not implemented. Not implemented. Not implemented.
Continuing and specialized care
Hospital mental health Complete data collection. Complete data collection. Complete data collection.Complete data collection. Denotes progress in data collection efforts as compared with previous fiscal year.
Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection.Complete data collection. Denotes progress in data collection efforts as compared with previous fiscal year.
Complete data collection.Complete data collection. Denotes progress in data collection efforts as compared with previous fiscal year.
Complete data collection.
Ontario mental health Not implemented. Not implemented. Not implemented. Partial data collection. Complete data collection. Not implemented. Not implemented. Not implemented. Not implemented. Partial data collection. Not implemented. In discussion. Not implemented.
Rehabilitation Partial data collection. Partial data collection. Partial data collection. Partial data collection. Complete data collection. Not implemented. Partial data collection. Partial data collection. Complete data collection. Partial data collection.
Not applicable. Not applicable. Not applicable.
Continuing care Complete data collection.Complete data collection. Denotes progress in data collection efforts as compared with previous fiscal year.
Complete data collection. Partial data collection. Complete data collection. Not implemented.Partial data collection. Denotes progress in data collection efforts as compared with previous fiscal year.
Complete data collection. Not implemented.Partial data collection. Denotes progress in data collection efforts as compared with previous fiscal year.
Complete data collection.In discussion. Denotes progress in data collection efforts as compared with previous fiscal year.
Not implemented.
Home care Partial data collection.Data submission plans being developed. Denotes progress in data collection efforts as compared with previous fiscal year.
Data submission plans being developed. Denotes progress in data collection efforts as compared with previous fiscal year.
Partial data collection. Complete data collection. Not implemented. Not implemented. Complete data collection. Data submission plans being developed. Data submission plans being developed. Complete data collection.In discussion. Denotes progress in data collection efforts as compared with previous fiscal year.
Not implemented.
Organ replacement Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection.Partial data collection. Denotes progress in data collection efforts as compared with previous fiscal year.
Partial data collection. Renal dialysis — fully implemented; organ transplant — not applicable.
Complete data collection.
Complete data collection. Denotes progress in data collection efforts as compared with previous fiscal year. Renal dialysis — fully implemented; organ transplant — not applicable.
Complete data collection. Denotes progress in data collection efforts as compared with previous fiscal year. Renal dialysis — fully implemented; organ transplant — not applicable.
Not implemented.
Complete data collection. Denotes progress in data collection efforts as compared with previous fiscal year. Renal dialysis — fully implemented; organ transplant — not applicable.
Not implemented.
Trauma (minimum data set)* Not applicable. Not applicable. Not applicable. Not applicable. Not applicable. Not applicable. Not applicable. Not applicable. Not applicable. Not applicable. Not applicable. Not applicable. Not applicable.
Trauma (comprehensive data set)* Not applicable. Not applicable. Not applicable. Not applicable.Complete data collection.
Not applicable. Not applicable. Not applicable. Not applicable. Not applicable.
Not applicable. Not applicable. Not applicable.
Joint replacements Complete data collection. Partial data collection. Participation is voluntary and thus not complete.
Partial data collection. Denotes progress in data collection efforts as compared with previous fiscal year.
Complete data collection. Complete data collection. Partial data collection. Participation is voluntary and thus not complete.
Partial data collection. Participation is voluntary and thus not complete.
Partial data collection. Participation is voluntary and thus not complete. Not implemented. Partial data collection. Participation is
voluntary and thus not complete.Partial data collection. Participation is voluntary and thus not complete.
Partial data collection. Participation is voluntary and thus not complete.
Not applicable.
Multiple sclerosis Not implemented.Partial data collection. Denotes progress in data collection efforts as compared with previous fiscal year.
Partial data collection. Denotes progress in data collection efforts as compared with previous fiscal year.
Data submission plans being developed. Denotes progress in data collection efforts as compared with previous fiscal year.
In discussion. Denotes progress in data collection efforts as compared with previous fiscal year.
Not implemented. Not implemented. Not implemented. Not implemented. Not implemented. Not implemented. Not implemented. Not implemented.
Pharmaceuticals Prescription drugs Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Not implemented. Complete data collection. Complete data collection. Complete data collection.Partial data collection. Denotes progress in data collection efforts as compared with previous fiscal year.
In discussion. Denotes progress in data collection efforts as compared with previous fiscal year.
Not applicable. Not applicable.
Incidents Data submission plans being developed. Data submission plans being developed. Partial data collection. Partial data collection. Partial data collection. Not implemented. Data submission plans being developed. Partial data collection.In discussion. Denotes progress in data collection efforts as compared with previous fiscal year.
Data submission plans being developed. Data submission plans being developed. Data submission plans being developed. Partial data collection.
Workforce Physicians Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Partial data collection. In discussion. In discussion.
Registered nurses Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection.
Practical nurses Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection.Partial data collection. Denotes progress in data collection efforts as compared with previous fiscal year.
Psychiatric nurses Complete data collection. Complete data collection. Complete data collection. Complete data collection.
Not applicable. Not applicable. Not applicable. Not applicable. Not applicable. Not applicable.
Partial data collection. Denotes progress in data collection efforts as compared with previous fiscal year.
Not applicable. Not applicable.
Nurse practitioners Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection.
Not applicable.
Complete data collection. Complete data collection.
Occupational therapists Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection.
Pharmacists Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Not implemented. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Not implemented.
Physiotherapists Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection.
Not applicable. Not applicable.
Radiation technologists Partial data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Partial data collection. Partial data collection. Partial data collection. Partial data collection.
Laboratory technologists Partial data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Partial data collection. Partial data collection. Complete data collection. Partial data collection. Partial data collection.
Health spending Health expenditures Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection.
MIS Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection.
Not applicable.
Patient costs Complete data collection. Patient costing is implemented in a subset of health care organizations. Data collection is complete in this subset.
Complete data collection. Patient costing is implemented in a subset of health care organizations. Data collection is complete in this subset.
Not implemented. Not implemented.
Complete data collection. Patient costing is implemented in a subset of health care organizations. Data collection is complete in this subset.
Not implemented. Not implemented. In discussion. Not implemented. Not implemented. Not implemented. Not implemented. Not implemented.
Commonwealth Fund Survey (Canada) Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Complete data collection. Not implemented. Not implemented. Not implemented.
Notes* Fiscal year 2013–2014 was the last year for National Trauma Registry (NTR) data collection; historical data will be maintained.
The Ontario Trauma Registry (OTR) continues to collect and report on injuries in Ontario.1. Quebec submits MED-ÉCHO data on an annual basis. This data is processed and appended to the Discharge Abstract Database (DAD)
to create the Hospital Morbidity Database (HMDB). 2. Quebec day surgery data is included in merged DAD/HMDB production data sets; the appropriate reference for this data is the HMDB. 3. Renal dialysis — fully implemented; organ transplant — not applicable.4. Participation is voluntary and thus not complete.5. Patient costing is implemented in a subset of health care organizations. Data collection is complete in this subset.6. Day procedures using MIS Functional Centre Accounts that are currently grouped to clinics.
Legend Denotes progress in data collection efforts as compared with previous fiscal year.
Complete data collection Partial data collection Data submission plans being developed... In discussion Not implemented — Not applicable
CIHI data in action: Our accomplishments
19
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CIHI data in action
Using data to plan care
A new project is helping health
regions better understand —
and plan for — the burden of
disease in their region
RRead more on this story ead more on this story and other successes and other successes atat www.cihi.ca/en/land
21
Follow the money
NHEX turns 40
If you need to know about health spending in Canada, look to CIHI’s National Health Expenditure Database (NHEX).
The annual NHEX report outlines how
much money is spent, in what areas
and on whom, and where the money
comes from.
Since 1975, the NHEX report has
compared expenditure data at both
provincial/territorial and international
levels. The information supports
policy planning, decision-making
and research.
The 18th edition — National Health
Expenditure Trends, 1975 to 2014 —
was released in October in a more
contemporary online format.
Findings show that health expenditures in 2014 reached $215 billion, while growth, at 2.1%, hit its slowest rate since 1997.
How do the provinces and territories compare?
Per person (public and private), projected for 2014
N.W.T.$12,160
20% of budget
Nun.$13,160
31% of budget
B.C.$5,865
43% of budget
Y.T.$10,044
20% of budget
Alta.$6,783
38% of budget
Sask.$6,472
37% of budget
Man.$6,689
44% of budget
Ont.$5,894
41% of budget
Que.$5,616
30% of budget
N.L.$6,953
37% of budget
N.S. $6,761
46% of budget
P.E.I.$6,477
38% of budget
N.B. $6,340
40% of budget
Canada$6,045
38% of budget
Provincial/territorial government health spending as percentage of budget, projected for 2013
% of budget
SourceCanadian Institute for Health Information, National Health Expenditure Trends, 1975 to 2014.
CIHI data in action: Our accomplishments
HHH
Where is most of the money being spent?
$63.5billion
growth2.1%
growth0.8%
growth4.5%
30%of health spending
Drugs
$33.9billion
16%of health spending
Physicians
$33.3billion
15%of health spending
Growth has outpaced that for hospitals or drugs since 2007.
Hospitals
SourceCanadian Institute for Health Information, National Health Expenditure Trends, 1975 to 2014.
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CIHI Annual Report, 2014–2015: Listening and Learning
NACRS Clinic Lite
CIHI’s National Ambulatory Care Reporting System (NACRS) now has a “Clinic Lite” submission option, which provides a low-cost, rapid implementation method to collect patient-level information from outpatient clinics.
NACRS Clinic Lite is suitable for
capturing information on community
mental health, ambulatory care
treatment for chronic heart failure/
cardiac disease, chronic obstructive
pulmonary disease/respiratory conditions,
multiple sclerosis, stroke, renal failure/
dialysis, cancer care and other priority
services. The new submission option is
generic enough to support multiple clinic
types, both hospital- and community-
based, and provides the capacity for
customized data collection of interest
to specific clinics.
Mental health
The Mental Health and Addictions Data and Information Guide was released in March 2014 as a one-stop guide for individuals and health care organizations accessing mental health and addictions information through CIHI’s data holdings and publicly available products.
CIHI continues to actively participate in the Mental Health and Addictions Information Collaborative, with partners from the Mental Health Commission of Canada, the Public Health Agency of Canada and Statistics Canada. CIHI data was included in the Mental Health Commission of Canada’s new dashboard of mental health indicators, and work continues to enhance this resource.
23
Community care
Home and continuing care
CIHI collects information about community care services in Canada, including long-term care and home care, and sets Canadian data and information standards to ensure that information is comparable across the country.
Work in this area has been advanced on several fronts, including the following:
• We’ve significantly expanded the community data received from Alberta, Saskatchewan, New Brunswick and Newfoundland and Labrador.
• CIHI receives pilot community care data from several First Nations communities in Alberta. The home care pilot project is now being expanded to include all communities in Alberta over the next 3 to 5 years.
• CIHI is working with jurisdictions to prepare for implementation of the new suite of interRAI instruments, which includes the newest community care data standards. Training was offered on the new home care instrument in Ontario and is planned for the new long-term care instrument in New Brunswick.
• We are providing leadership in identifying client experience surveys (or data standards) for use in long-term care facilities in Canada.
CIHI data in action: Our accomplishments
24
CIHI Annual Report, 2014–2015: Listening and Learning
Understanding high users
Case mix tools: Population grouping methodology
In April 2013, CIHI launched a project to develop a population grouping methodology unique to Canada.
The population grouping method
helps us understand, among other
things, how to risk adjust and compare
performance and outcomes across
populations. It can also be used to
help with disease tracking, population
segmentation and funding allocation
decisions. Ministries of health,
regional health authorities and health
researchers are interested in these
methodologies for many reasons,
including the study of “high users”
of health care.
CIHI data in action
Reducing wait times for breast cancer surgeries helps maximize the chance of survival
See how 1 province is improving
outcomes for patients
Read more on this story and other successes at www.cihi.ca/en/land
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CIHI Annual Report, 2014–2015: Listening and Learning
Decision-making support
Goal 2: Support population health and
health system decision-making
Raising the bar
Health system performance: In Depth and Insight
CIHI’s 3-year plan to strengthen health system performance (HSP) reporting is aggressive, and it’s being noticed.
Initiatives such as our enhanced reporting tools are receiving international recognition. CIHI was among a group of health care organizations recognized for their outstanding websites and digital communications during the 18th Annual Healthcare Internet Conference. CIHI’s Your Health System web tool placed in the Best Interactive Site category. In addition, a recent impact evaluation shows that our key stakeholders rated the relevance of our
HSP work to their organization’s priorities as 4 out of 5. As well, 70% reported that CIHI’s products directly informed initiatives in their organization.
The In Depth section of Your Health System was launched in September 2014. It provides easy access to an expanded set of aligned indicators and contextual measures that reflect health system results at both the population and facility levels. Key features include peer group comparisons, benchmarking and top results, trend information, enhanced mapping functionality and exporting capability.
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In March 2015, Your Health System: Insight — a secure, web-based analytical tool — was released to designated users. It allows them to “slice and dice” their information in customized ways to look at which patient populations are driving their results. They can also look at open-year data to understand how their current performance relates to their past performance. And they can see comparative information for hospitals across Canada. In the first phase, a small number of indicators related to emergency and acute care were included.
CIHI data in action: Our accomplishments
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CIHI Annual Report, 2014–2015: Listening and Learning
The big picture
Corporate Analytical Plan
One of CIHI’s key goals is to answer the most critical health care system questions that our stakeholders are asking.
To meet this goal, we travelled the
country to hear from them. We want
to ensure that our priorities are
aligned with their needs and that
this is reflected in our corporate
Analytical Plan.
The plan provides a consolidated
overview of what we are working
on. It is a rolling picture that helps
to ensure that our reports, products
and indicators are aligned with our
strategic directions, and that they
are relevant to our stakeholders and
transparent to our partners.
The plan also identifies
opportunities for collaboration.
CIHI works with many partners
across the country and
internationally to develop our new
reports and indicators. This year,
we collaborated with our key
partner, Statistics Canada, on
projects in priority areas such
as mental health, cancer, health
inequalities and high users of
health services. We continue to
encourage and seek partnerships
for new analytical work.
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Back to school
Capacity-building, HSP schools, CMF school
Capacity-building is a buzzword these days, but at CIHI, it’s really about ideas and experiences.
We want stakeholders to be able to
use CIHI’s health data and information
to support their decision-making. So
we engage them through a series of
learning opportunities. Here are a few
examples from the past year:
• For the first time in Canada, a
Case Mix Funding School was
held in Toronto — hosted by CIHI.
Canadian and international experts
came together to discuss health
care funding and how to do more
with fewer resources. The concept
was based on an international
school run by Patient Classification
Systems International. There were
2 key components: funding system
design and implementation, and
funding analytics. One delegate
wrote, “Kudos to CIHI and the
team responsible for organizing this
forward-thinking event! I sincerely
hope CIHI has plans to repeat this
event at least annually to support
continued skills and knowledge
development across all regions
and levels of the Canadian health
care system.”
• Health Data Users Day was held in
November in Halifax. 100 participants
shared their experiences and
successes in using data effectively for
better decision-making in the health
system.
• We also held Health System
Performance (HSP) schools in Ontario
and in Manitoba. These sessions
are designed to build capacity for
teams working in health system
performance roles by helping them
build data and evidence into their
everyday work. The 3-day curriculum
incorporates presentations and
experiences from experts and
peers, panel discussions and hands-
on activities to address regional
issues and apply HSP concepts.
Woven throughout the session is a
comprehensive case study based
on key priority health issues.
Participants tell us that the program
hits the mark.
CIHI data in action: Our accomplishments
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CIHI Annual Report, 2014–2015: Listening and Learning
Excellence in all
Goal 3: Deliver organizational excellence
Privacy and security
ISO certification and prescribed entity status
CIHI is committed to protecting the privacy of Canadians and ensuring the security of their personal health information.
In September, for the first time, we received International Organization for Standardization (ISO) 27001: 2005 certification of our Information Security Management System. This achievement is an important milestone in the continual improvement of our privacy and security practices.
The implementation project leading to certification took more than 2 years as we developed a new governance model and risk management methodology for information security. We also enhanced processes and tightened controls and monitoring systems.
CIHI’s designation as a prescribed entity under Ontario’s Personal Health Information Protection Act, 2004 (PHIPA) has also been renewed. This means that health information custodians in Ontario, such as hospitals and long-term care facilities, may disclose personal health information to CIHI without the consent of the individuals concerned. CIHI can then use this information for analysis or to produce statistics that will contribute to the planning and management of the health system.
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This achievement is important in Ontario, but also across Canada, as ministries of health and other data providers can have confidence in CIHI’s sound privacy and security program.
We treat data protection seriously.
CIHI data in action: Our accomplishments
CIHI Annual Report, 2014–2015: Listening and Learning
Empowering our employees
Promoting continuous learning and development
CIHI empowers its employees to take charge of their careers through a series of continuous learning and development initiatives. This year, advanced LEADS training, elearning resources and a new Career Planning Program are having an impact.
T HEOWN
HPTA
LEADS is a leadership capabilities
framework that includes a review of
skills and strengths as well as personal
reflection. CIHI managers, and many
employees, have benefited from the
frequently offered courses. Now, that
theory is being put into practice with
the new Harvard ManageMentor®
program. This online learning resource
includes 25 modules that support
the LEADS framework, which has
5 components: Lead Self, Engage
Others, Achieve Results, Develop
Coalitions and Systems Transformation.
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Career Paths
PLAN DEVELOPIncludes programs and tools to help employees understand their options for managing and planning their careers
Includes programs and tools to support employees in their development to help them attain their goals
MEASUREIncludes programs and tools that will help employees measure and assess their goals and progress
Maps of career streams within the organization—currently available for the Analytical and IT/Technical streams
Self-AssessmentStandOut, a strength-based assessment tool to help employees better understand their areas of strength when planning their careers
Career Plan A formal career plan that employees can complete and discuss with their manager and/or HR
Job Profile BankReference tool describing the job summary and the education and years of experience required for each position in the Analytical and IT/Technical streams
Existing options available through CIHI’s L&PD Program, including technical and soft-skills training, professional memberships and continuing education
Learning and Professional Development
A capability framework that defines the performance and behaviours of effective and successful employees—currently available for the Analytical and IT/Technical streams
Capabilities and Expectations
MentoringNew program to support engagement and retention of future leaders, and to strengthen leadership and people management capacity
Job ShadowingA new option where employees can get hands-on experience in a position they would be interested in eventually moving into
Informational InterviewsA new option to give employees additional insight into opportunities within the organization
SecondmentsA skills-exchange program between CIHI and other organizations that supports the acquisition and/or transfer of relevant expertise through a temporary assignment
CoachingExisting formal and informal coaching options, e.g., day-to-day job supervisory responsibilities, coaching as part of the Management Support Program, executive coaching for selected members of the management team
Performance ManagementCIHI’s existing Performance Management Program (PMP), designed to help employees plan their annual job and learning objectives
360° FeedbackA program to assess leadership capabilities—currently administered for team leads, managers and senior management on a rotating 3-year cycle
5 elearning analytical courses were
designed and developed internally
this year. The modules use CIHI data
and examples from our publications
to illustrate key concepts. The goal
is to introduce staff to quantitative
health research methods.
Another online addition to support
our healthy workplace is LifeSpeak.
This program provides expert-led
online streaming videos on a wide
variety of topics such as mental and
physical health, relationships and
families, and personal finances.
With the launch of the Career
Planning Program this year,
employees have greater
opportunities for career
development than ever before.
They are encouraged to plan,
develop and measure their
career path, taking the lead
with support from their manager
and the Human Resources
team. Opportunities range
from personal assessments and
technical and skills training to job
shadowing a colleague in another
part of the organization.
CIHI data in action: Our accomplishments
33
Career development is a win–win for employees and CIHI. We know that engaged, motivated employees are productive and committed to the organization.
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CIHI Annual Report, 2014–2015: Listening and Learning
Survey says…
Stakeholder and impact surveys
At CIHI, we want to know what our clients are thinking. So we ask them.
For several years, we have engaged
Nielsen Consumer Insights to conduct
a biennial stakeholder survey. The goal
is to evaluate satisfaction with CIHI’s
products and services, and general
performance. The results of the latest
survey were strong, with overall
satisfaction in the 90th percentile.
• Most stakeholders agreed that CIHI
is a credible source of data and
information and that it provides
a balanced perspective on health
data and analysis.
• A significantly higher proportion
of respondents (than in 2012)
said that CIHI meets or exceeds
their expectations.
We are continually making
improvements based on this feedback.
We also introduced an impact
evaluation survey to determine the
value of CIHI’s products and services.
We want to know how they are being
used to make decisions and to bring
about change in the health care
system. This survey was targeted to a
smaller and unique set of stakeholders
who are regular CIHI users.
• Overall, stakeholders rated the
usefulness of CIHI’s analytical
reports and tools fairly high and
indicated that these tools are
used in a number of ways that
are helpful to their organization.
• However, not all respondents
felt that their organization has
the expertise and/or capacity
to fully use these tools.
• In response, CIHI has launched
a capacity-building program to
assist stakeholders in developing
these skills.
• The majority of respondents
reported that CIHI’s analytical
reports or tools have directly
informed initiatives and efforts
in their organization.
These survey results will serve as good baseline information moving forward.
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Checks and balances
Performance audit
As part of its funding agreement with Health Canada, CIHI commissions a third-party performance audit.
The audit also assesses CIHI’s
relevance and performance.
The latest audit, which covers
April 2012 to August 2014, was
developed and conducted by KPMG.
The results are impressive, with the
identification of a number of positive
practices, including
• Active stakeholder engagement
• Consideration of stakeholders’
needs in investment decisions and
product and service development
• Leveraging of partnerships for
improved economy and effectiveness
• A strong information security policy
and related procedures to guide
the accuracy and safeguarding of
data holdings
• An organizational structure that
enables a high level of responsiveness
to jurisdictional stakeholders across
Canada by CIHI’s regional offices
The full results are used to continually
improve overall organizational performance.
We want to ensure that federal funds are used with due regard for economy, efficiency and effectiveness.
CIHI data in action: Our accomplishments
36
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Our organization
With more than 700 employees located in offices
across the country, CIHI’s work is governed by
a Board of Directors that links federal, provincial
and territorial governments with non-governmental
health groups. Board members represent all
health sectors and regions of Canada, and their
strategic guidance steers the work we do.
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CIHI Annual Report, 2014–2015: Listening and Learning
Board of Directors members and committees
(as of March 31, 2015)
Chair
Dr. Brian PostlDean of Medicine
University of Manitoba
(Chair)
(Winnipeg, Manitoba)
Canada at large
Dr. Verna YiuVice President, Quality, and
Chief Medical Officer
Alberta Health Services
(Edmonton, Alberta)
Dr. Marshall DahlConsultant Endocrinologist
Vancouver Hospital and Health
Sciences Centre
(Vancouver, British Columbia)
Region 1 (British Columbia and Yukon)
Dr. David Ostrow Former President and
Chief Executive Officer
Vancouver Coastal Health Authority
(Vancouver, British Columbia)
Dr. Heather DavidsonAssistant Deputy Minister,
Planning and Innovation
British Columbia Ministry of Health Services
(Victoria, British Columbia)
Region 2 (Prairies, Northwest Territories and Nunavut)
Dr. Marlene SmaduVice-President of Quality
and Transformation
Regina Qu’Appelle Health Region
(Saskatoon, Saskatchewan)
Ms. Janet Davidson Deputy Minister
Alberta Health
(Edmonton, Alberta)
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Region 3 (Ontario)
Ms. Janet BeedFormer President and CEO
Markham Stouffville Hospital
(Toronto, Ontario)
Ms. Susan FitzpatrickAssociate Deputy Minister
Ministry of Health and Long-Term Care
(Toronto, Ontario)
Region 4 (Quebec)
The non-government Region 4 (Quebec)
director position is currently vacant.
Mr. Luc CastonguayAssistant Deputy Minister, Planning,
Performance and Quality Assurance
Ministère de la Santé et des Services
sociaux du Québec
(Québec, Quebec)
Region 5 (Atlantic)
Mr. John McGarryPresident and Chief Executive Officer
Horizon Health Network
(Miramichi, New Brunswick)
Mr. Bruce CooperDeputy Minister, Department of Health
and Community Services
Government of Newfoundland
and Labrador
(St. John’s, Newfoundland and Labrador)
Statistics Canada
Mr. Peter MorrisonAssistant Chief Statistician
Social, Health and Labour Statistics
Statistics Canada
(Ottawa, Ontario)
Health Canada
Mr. Simon KennedyDeputy Minister of Health
Health Canada
(Ottawa, Ontario)
The Board met in June 2014, November 2014 and March 2015.
Our organization
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CIHI Annual Report, 2014–2015: Listening and Learning
We would like to recognize the contributions of several departing Board members:
• Ms. Helen Angus, Former Associate Deputy Minister,
Ontario Ministry of Health and Long-Term Care
• Dr. Luc Boileau, President and Director General,
Institut national de santé publique du Québec
• Mr. George Da Pont, Former Deputy Minister,
Health Canada
• Mr. David Hallett, Former Associate Deputy Minister,
Ontario Ministry of Health and Long-Term Care
Board committees
Human Resources Committee
The Human Resources Committee assists the Board in discharging its oversight
responsibilities relating to compensation policies, executive compensation,
senior management succession and other key human resources activities.
Governance and Privacy Committee
The Governance and Privacy Committee assists the Board in improving its functioning,
structure, composition and infrastructure. This committee exercises the powers and
duties of the nominating committee, in accordance with our bylaw. The Governance
and Privacy Committee also reviews and makes recommendations on the direction
of the privacy program, and on our privacy and data protection practices.
Finance and Audit Committee
The Finance and Audit Committee reviews and recommends approval of the broad
financial policies, including the yearly operational plans and budget, and reviews
the financial position of the organization and our pension plan. This committee also
formulates recommendations on the financial statements, the public accountant’s
report and the appointment of the forthcoming year’s public accountants, and it
provides direction and review of our internal audit program.
CIHI data in action
Improving surgical wait times in pediatric health centres with CIHI tools and data
Read more on this story and other successes at www.cihi.ca/en/land
42
CIHI Annual Report, 2014–2015: Listening and Learning
Membership (as of March 31, 2015)
Committee Member Met
Finance and Audit (FAC) John McGarry (Chair)
Bruce Cooper
Marshall Dahl
Susan Fitzpatrick
David Ostrow
Brian Postl
June 2014
October 2014
November 2014
January 2015
Human Resources (HR) Brian Postl (Chair)
Janet Beed
Janet Davidson
John McGarry
Peter Morrison
Marlene Smadu
June 2014
October 2014
November 2014
March 2015
Governance and Privacy (GPC) Janet Davidson (Chair)
Luc Castonguay
Heather Davidson
Simon Kennedy
Brian Postl
Verna Yui
May 2014
June 2014
October 2014
March 2015
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Senior management (as of March 31, 2015)
Name Title
Anne-Mari Phillips Chief Privacy Officer
Barbara McLean Director, Central Operations and Services
Brent Diverty Vice President, Programs
Cal Marcoux Chief Information Security Officer
Caroline Heick Executive Director, Ontario, Quebec and Primary Health Care Information
Chantal Poirier Director, Finance
David O’Toole President and CEO
Douglas Yeo Director, Methodologies and Specialized Care
Elizabeth Blunden Director, Human Resources and Administration
Francine Anne Roy Director, Strategy and Operations
Georgina MacDonald Vice President, Western Canada and Developmental Initiatives
Gregory Webster Director, Acute and Ambulatory Care Information Services
Jean Harvey Director, Canadian Population Health Initiative
Jeremy Veillard Vice President, Research and Analysis
Kathleen Morris Director, Health System Analysis and Emerging Issues
Kathryn Hendrick Director, Corporate Communications
Kimberly Harvey Director, Integration Services
Kira Leeb Director, Health System Performance
Louise Ogilvie Vice President, Corporate Services
Mark Fuller Director, Health Information Applications
Mea Renahan Director, Clinical Data Standards and Quality
Michael Gaucher Director, Pharmaceuticals and Health Workforce Information Services
Michael Hunt Director, Health Spending and Strategic Initiatives
Scott Murray Vice President and Chief Technology Officer
Stephen O’Reilly Executive Director, Atlantic Canada and Integrated eReporting
Our organization
44
`
Looking ahead
At CIHI, we’ve been listening. Extensive
consultation across the country has been a
priority over the past year. These connections
with our stakeholders will help guide us as we
finalize our next set of goals and priorities,
leading to a new strategic plan in 2016.
Our first 20 years have provided a solid foundation. We are ready for the decade ahead and beyond.
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CIHI Annual Report, 2014–2015: Listening and Learning
Story Intro Header
Story IntroCIHI recently presented to Health Canada’s Advisory Panel
on Innovation, and our message was simple: information is
critical to enabling health care innovation. We need a strong
information base — and a strong information base is created
by adopting pan-Canadian data content standards.
Standardized data
Health system use
Every time someone has contact with the health care system, some type of data is created.
That information is used for clinical
purposes but also to support management
of the health system overall.
The data is valuable at several levels:
clinical practice; system review;
population and public health trending;
and research and surveillance. As
electronic medical records (EMRs)
and electronic health records (EHRs)
evolve, there will be even more data
to inform decisions.
47
We are moving forward with
2 priorities in this area:
• CIHI is setting the standard regarding
EMR data — what to collect and how
to collect it. We want to ensure
that critical health information can
be transferred between systems to
support care and be available for health
system use. Through collaboration with
Canada Health Infoway and partners
across the country, CIHI is working to
support a priority set of standardized
primary health care data by 2017. EMRs
and EHRs are more than just tools for
clinicians; they are tools for Canada,
to inform decision-making across the
health system.
• We also have work under way to reduce
the burden and cost of collecting and
sharing data.
We will continue to identify opportunities that support this goal, such as increased use of point-of-care data capture in hospitals.
Looking ahead
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CIHI Annual Report, 2014–2015: Listening and Learning
Coordinated reporting
Health system performance, eReporting
CIHI is building on more than 10 years of experience in strengthening pan-Canadian health system performance reporting.
Our new secure web tool — Your
Health System: Insight — is already
making a difference for decision-
support managers, analysts and
clinicians in emergency and acute
care settings.
To further broaden the view we
have of the health system, more
indicators and measures will be
added to integrate all hospital
reporting information in 1 place.
Expect more roll-outs shortly.
The strategy to integrate CIHI’s digital
reporting — known as electronic
reporting — started in concert with the
Health System Performance initiative.
As we move forward, we will adapt this
strategy to consolidate and streamline
the number of digital reporting products,
based on client input and feedback.
The intention is to create a truly integrated suite of information that is user-friendly, that can be updated quickly and often, and that presents a complete system view.
49
When I grow up
Mentorship program launch, employee survey
CIHI has grown significantly over the past 20 years, and CIHI staff tell us that they are changing too.
Every 2 years, we conduct an
employee survey — to listen and to
learn. What we’re hearing is that staff
want even more information on career
development. They want to take
charge of their futures.
To deliver organizational excellence,
we need to deliver to our employees.
In addition to our extensive Career
Planning Program, a new mentorship
program is planned to roll out over
the next year based on a pilot
over the past year. It provides
opportunities for one-on-one
linkages, pairing mentees with
mentors who match their interests
and goals. For example, an IT
consultant might be matched with
a vice president. The program
is supported by questionnaires,
discussion guidelines and personal
feedback mechanisms.
We want to foster a culture of support and engagement for future CIHI leaders. At the same time, current leaders can enhance their mentoring skills. It’s a win–win.
Looking ahead
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CIHI Annual Report, 2014–2015: Listening and Learning
Just 1 click away
Web audit and redevelopment project
Websites must continually evolve and change to respond to user need and new technology.
Our website is no different. We’ve
been listening to our stakeholders’
feedback — good and bad. And a
recent web audit has provided insight
into how best to redevelop the site.
We want it to be one of CIHI’s core assets, giving stakeholders the information they need at their fingertips.
CIHI CIHI CIHI
CIHI data in action
How does Canada compare?
Results for people age 55 and older
from 11 countries
Read more on this story and other successes at www.cihi.ca/en/land
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Management discussion and analysis
This section provides an overview of our
operations and an explanation of our financial
results. It should be read along with the
financial statements in this annual report.
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CIHI Annual Report, 2014–2015: Listening and Learning
Who does what• Management prepared the financial statements and is responsible for the
integrity and objectivity of the data in them. This is in accordance with
Canadian accounting standards for not-for-profit organizations.
• CIHI designed and maintains internal controls to provide reasonable assurance
that the financial information is reliable and timely, that the assets are
safeguarded and that the operations are carried out effectively.
• The Board of Directors carries out its financial oversight responsibilities
through the Finance and Audit Committee (FAC), which is made up of
directors who are not employees of the organization.
• Our external auditors, KPMG LLP, conduct an independent audit in
accordance with Canadian generally accepted auditing standards and express
an opinion on the financial statements. The auditors meet on a regular basis
with management and the FAC, and have full and open access to the FAC,
with or without the presence of management.
• The FAC reviews the financial statements and recommends their approval
by the Board of Directors. For 2014–2015 and previous years, the external
auditors have issued unqualified opinions.
DisclaimerThis section includes some forward-looking statements that are based on
current assumptions. These statements are subject to known and unknown
risks and uncertainties that may cause the organization’s actual results to
differ materially from those presented here.
55
FundingCIHI receives most of its funding from the provincial/territorial ministries of health
and the federal government.
• The proportion coming from these 2 levels of government has evolved over time
but has been stable over the last few years.
• Our total annual source of revenue averaged $105.6 million between 2011–2012
and 2014–2015. This pays for our ongoing program of work related to our core
functions and priority initiatives.
Annual sources of revenue
Revenue source ($ millions)*
2011–2012 2012–2013 2013–2014 2014–2015 2015–2016
Actual Actual Actual Planned Actual Planned
Federal government — Roadmap/Health Information Initiative $86.6 $83.0 $77.7 $77.7 $79.4 $78.5
Provincial/territorial governments — Core Plan $16.4 $16.7 $17.1 $17.4 $17.4 $17.4
Other† $8.0 $8.5 $4.9 $5.2 $6.7 $5.1
Total annual source of revenue $111.0 $108.2 $99.7 $100.3 $103.5 $101.0
Notes* Reflects annual revenue on a cash basis; therefore, excludes depreciation and CIHI Pension Plan
accounting expenses–related revenue.† Includes contributions from provincial/territorial governments for special-purpose programs/projects
as well as lease inducements received in 2012–2013 and planned for 2015–2016.
Management discussion and analysis
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CIHI Annual Report, 2014–2015: Listening and Learning
Funding agreementsSince 1999, Health Canada has significantly funded the building and maintenance
of a comprehensive and integrated national health information system. Funding
has come through a series of grants and contribution agreements referred to
as the Roadmap Initiative or Health Information Initiative (HII).
• The 3-year HII funding agreement was put in place with Health Canada
in 2012–2013.
• It included a phased-in 5% reduction over 3 years. As a result, the annual
base funding went from $81.7 million in 2012–2013 (same as 2011–2012) to
$77.7 million in 2014–2015.
• The HII agreement was recently renewed for 2015–2016 at the same level
as 2014–2015.
• It was amended to include a new 5-year program of work on prescription
drug abuse (PDA), for a total of $4.28 million.
• The first 2 years presented in the table include funding from the Roadmap
agreement for $5.0 and $1.3 million, respectively.
• The results presented for 2013–2014 and 2014–2015 reflect delays encountered
with a few key projects in 2013–2014; the projects were completed in 2014–2015.
Health Canada had approved the associated carry forward of $1.6 million from
2013–2014 to 2014–2015.
Through bilateral agreements, the provincial/territorial ministries of health
continued to fund our Core Plan (a set of products and services provided to
the ministries and identified health regions and facilities).
• These agreements provided $17.4 million in funding in 2014–2015.
• They have been renewed for 1 year, through 2015–2016, at the same
funding level.
57
Management’s explanation of results
Operating expenses
Operating expenses ($ millions)*
2011–2012 2012–2013 2013–2014 2014–2015 2015–2016
Actual Actual Actual Planned Actual Planned
Salaries, benefits and pension expense $71.3 $76.8 $75.6 $79.8 $78.7 $77.4
External professional services, travel and advisory committee expenses $14.9 $11.2 $8.8 $10.8 $11.0 $8.7
Occupancy, information technology and other $17.6 $17.3 $16.3 $16.1 $16.0 $16.3
Total operating expenses $103.8 $105.3 $100.7 $106.7 $105.7 $102.4
Note* Reflects operating expenses; therefore, includes amortization of capital assets and accounting pension
plan costs.
Management discussion and analysis
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CIHI Annual Report, 2014–2015: Listening and Learning
Total operating expenses, 2014–2015: $105.7 million
• These include compensation costs, external professional services, travel
expenses, occupancy and information technology costs required to deliver
on several key project initiatives undertaken in 2014–2015, including project
activities carried forward from 2013–2014.
Total remuneration, 2014–2015: $5.1 million
• This includes any fee allowance or other benefits to our senior management
team involved in the accomplishment of our 3 strategic directions.
Total expenses variance relative to planned 2014–2015 activities: $1 million
• This relates primarily to a reduction in salaries and benefits expense due
to the adoption of a new pension accounting standard.
• The annual pension plan expense for accounting purposes is based on the
underlying methodology and interest rates prescribed by the Chartered
Professional Accountants of Canada.
As a proportion of the total operating expenses, our actual investments in
our 3 core functions remained relatively in line with the planned expenses.
Actual operating expenses by core function, 2014–2015
$38.4 million — More and better data
$41.3 million — Improved understanding and use
$26.0 million — Relevant and actionable analysis
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Capital investments
Capital investments ($ millions)
2011–2012 2012–2013 2013–2014 2014–2015 2015–2016
Actual Actual Actual Planned Actual Planned
Furniture and office equipment $0.1 $0.1 — — — —
Computers and telecommunications equipment $2.4 $1.8 $2.3 $0.7 $1.2 $1.3
Leasehold improvements — $0.4 $0.1 — $0.1 $0.2
Total capital investments $2.5 $2.3 $2.4 $0.7 $1.3 $1.5
Acquisition of capital assets, 2014–2015: $1.3 million
• This is a decrease from prior years. Fewer investments in hardware, software and
telecommunications-related equipment were required.
• Capital investments for 2014–2015 were higher than planned due to acceleration
of capital investments from 2015–2016 resulting from resource availability.
Management discussion and analysis
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CIHI Annual Report, 2014–2015: Listening and Learning
Pension plans Current plan
• Our registered defined benefit plan offers our employees an annual retirement
income based on length of service and final average earnings. It is being funded
by both the employees and CIHI.
• As of March 31, 2015, the plan assets were $153 million for 951 members,
76% of whom are active participants.
• In addition, we supplement the benefits of employees participating in the
plan who are affected by the Income Tax Act’s maximum pension limit.
– This supplementary plan is not pre-funded and we make benefit payments
as they become due.
– These benefits are accrued and recognized in our financial statements
in accordance with applicable accounting rules.
Wind-up
• In November 2014, CIHI’s Board of Directors approved a decision to wind up
the CIHI Pension Plan effective December 31, 2015.
• Beginning January 1, 2016, CIHI employees will join the Healthcare of Ontario
Pension Plan (HOOPP), the British Columbia Municipal Pension Plan or the
Group RRSP.
61
Contributions (current plan)
• Contributions to the CIHI Pension Plan are determined by actuarial calculations
and depend on employee demographics, turnover, mortality, investment returns
and other actuarial assumptions.
• CIHI’s and employees’ contributions are pooled, invested and professionally
managed by Standard Life Investments Inc.
– In light of the upcoming wind-up, the plan administrator instructed Standard
Life Insurance Company of Canada (the custodian of the funds), in late
November, to liquidate the investments and invest in a Canadian customized
bond fund.
– The new fund is based on the CIHI Pension Plan characteristics.
– The investment manager’s performance and the investment policy are
reviewed annually.
• In order to reach the employer–employee cost-sharing ratio of 55%–45%,
employees’ contribution rates were increased by 0.3% on January 1, 2014,
and by 0.45% on January 1, 2015.
Actuarial valuations (current plan)
• 2 actuarial valuations are prepared at different times and use different
methodologies and assumptions:
– For accounting purposes (see note 7 of the financial statements)
– For funding purposes (this is also used for regulatory purposes and
management of the plan)
• Per the January 1, 2014, actuarial valuation (for funding purposes), the
plan reported a $17.7 million funding excess to the regulatory authorities.
• The next actuarial valuation for funding purposes will be as of
December 31, 2015. The plan must be fully funded prior to the wind-up.
Management discussion and analysis
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CIHI Annual Report, 2014–2015: Listening and Learning
Internal audit programOur internal audit program
• Provides independent and objective assurance to add value to and improve
our operations
• Helps us accomplish our objectives by bringing a systematic, disciplined approach
that both evaluates and improves our control and governance processes
• Is prepared using a risk-based methodology that targets our audit resources
at areas of highest risk, significance and value for the organization
In 2014–2015, activities included
• An audit of procurement and payment compliance and controls
• Penetration testing and vulnerability assessments of the ITS network and server
infrastructure and selected applications
• An audit of access rights by staff and consultants to CIHI networks and databases
• An internal audit of ISO 27001 version 2005 and a certification audit of ISO 27001
version 2005
• A compliance audit of 1 third-party data recipient regarding CIHI’s Data Request
Form and Non-Disclosure/Confidentiality Agreement
Action plans were developed to address the areas for improvement recommended
by the consultants contracted by us to specifically perform these activities.
In 2015–2016, the focus of the internal audit program will continue to be on
information security and privacy.
Risk management activities The goal of CIHI’s risk management program is to foster reasonable risk-taking
based on risk tolerance. CIHI’s approach to risk management is to proactively
deal with future potential events through risk mitigation strategies. This risk
management program serves to ensure management excellence, to strengthen
accountability and to improve future performance. It supports planning and
priority setting, resource allocation and decision-making.
63
CIHI is committed to focusing on corporate risks that
• Cut across the organization
• Have clear links to achieving our strategic directions
• Are likely to remain relevant for the next 3 to 5 years
• Can be managed by the senior leadership of CIHI
CIHI’s Risk Management Framework consists of the following 4 cyclical processes
that help us achieve our strategic directions:
CIHI’s Risk Management Framework
Achievingour
strategic goals
Mon
itor a
nd co
mmunicate Establish framework
Risk response and treatment
Assess the
risk
s
Process, methods, tools
Governance framework
Policy framework
Risk
-man
agem
ent reporting
Man
ager
ial/bo
ard oversight
Revie
w framework
Key risk indicators
Strategy/action plans
Risk championsIdentify
strate
gic go
als
Risk iden
tifica
tion
Risk ass
essm
ent
Management discussion and analysis
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CIHI Annual Report, 2014–2015: Listening and Learning
Risk management activities for 2014–2015The executive management team assessed a number of key risks that could prevent
CIHI from achieving its strategic directions based on their likelihood of occurrence
and their potential impacts. 4 of these risks were identified as corporate risks
due to their high level of residual risk (risk level after considering existing
mitigation strategies).
Remaining relevant
The need for national/pan-Canadian data may become less relevant due to pressure
on individual provinces and territories to deliver system transformation. Also, the
increased availability of data from internal systems, including clinical registries,
might focus system managers’ efforts inward rather than outward on cross-country
comparable data. This could diminish CIHI’s importance as a source of data to
identify areas for quality improvement. CIHI addressed this concern by releasing the
Your Health System web tool, holding a national Consensus Conference to define
priorities for future indicator development and holding a national forum on patient
safety measurement (in partnership with the Canadian Patient Safety Institute).
In addition, CIHI held multiple HSP and case mix schools to help stakeholders
understand and use HSP data and information, and case mix products.
Electronic health records
Although the implementation of EMRs and EHRs presents CIHI with the potential
to acquire data more easily and from new sources, a lack of standards for data
captured electronically creates a challenge to generate comparable information.
To address this, CIHI has developed a multi-year data supply/EHR sourcing strategy
that involves sourcing information directly from EHR hospital information systems.
This will yield data that is richer, more efficient and more timely. As part of this
initiative, CIHI developed a low-cost, rapid implementation method to collect
patient-level information from outpatient clinics: NACRS Clinic Lite. 2 pilot
hospitals — 1 in Manitoba and the other in Ontario — will be collecting standardized
patient outcome data related to nursing care via EHRs and submitting this data to
CIHI in September 2015. Also that same month, a demonstration project in British
Columbia will see a subset of inpatient and emergency department data flow
to CIHI directly from the region’s EHR/eHealth Solution, reducing the collection
burden on clinicians.
65
To address the slow progress toward making primary health care (PHC) data
comparable across the country, CIHI delivered a new version (v3.0) of the EMR
content standard. The standard consists of 45 priority data elements, 20 PHC
Reference Sets and 8 Clinician-Friendly Pick-Lists (CFPLs). The focused scope
of this new version aligns with jurisdictional priorities, addresses key gaps in
PHC information and directly supports performance measurement for clinicians
and decision-makers. CIHI is currently looking to engage in some demonstration
projects to test the standard. In fall 2014, CIHI presented to the Conference of
Deputy Ministers of Health on health system use. The federal/provincial/territorial
deputy ministers agreed to adopt common content standards for primary health
care EMRs by 2017 and to use their authority to accelerate adoption within their
own jurisdictions.
Funding
CIHI continued to experience a progressive decline in funding over its 3-year
Health Canada funding agreement, which came to term in March 2015. To meet
financial pressures, CIHI maximized its use of available funding toward new priority
investments and successfully managed the employee pension plan. We were able
to secure 1-year extensions to funding agreements with provincial/territorial
jurisdictions and Health Canada. We began consultation with our stakeholders
regarding the renewal of our strategic directions, which will be supported by
our funding request for future agreements. We also received targeted funding
for a new 5-year program of work on prescription drug abuse.
Building relationships
CIHI led an inclusive consultation exercise to renew its strategic plan, asking
stakeholders in all jurisdictions to help inform CIHI’s strategy for the next 5 years.
The results of this consultation indicated broad support for CIHI and some concrete
ideas to shape its priorities. Through our exploration of additional opportunities
to engage federal/provincial/territorial sectors and key stakeholder groups, we
were able to identify and act upon region-specific needs to develop or enhance
our products and services. Examples include
• Holding a Health Data Users Day in Halifax and Toronto
• Operating Health System Funding schools in Ontario and Manitoba
• Supporting provincial and regional partners in submitting data to the Continuing
Care Reporting System and Home Care Reporting System
Management discussion and analysis
66
67
By the numbers
Financial statementsYear ended March 31, 2015
Independent auditors’ reportTo the Board of Directors of the Canadian Institute for Health InformationWe have audited the accompanying financial statements of the Canadian Institute
for Health Information, which comprise the statement of financial position as at
March 31, 2015, the statements of operations, changes in net assets and cash flows
for the year then ended, and notes, comprising a summary of significant accounting
policies and other explanatory information.
Management’s responsibility for the financial statements
Management is responsible for the preparation and fair presentation of these
financial statements in accordance with Canadian accounting standards for not-
for-profit organizations, and for such internal control as management determines
is necessary to enable the preparation of financial statements that are free from
material misstatement, whether due to fraud or error.
Auditors’ responsibility
Our responsibility is to express an opinion on these financial statements based
on our audit. We conducted our audit in accordance with Canadian generally
accepted auditing standards. Those standards require that we comply with ethical
requirements and plan and perform the audit to obtain reasonable assurance about
whether the financial statements are free from material misstatement.
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CIHI Annual Report, 2014–2015: Listening and Learning
An audit involves performing procedures to obtain audit evidence about the
amounts and disclosures in the financial statements. The procedures selected
depend on our judgment, including the assessment of the risks of material
misstatement of the financial statements, whether due to fraud or error.
In making those risk assessments, we consider internal control relevant to
the entity’s preparation and fair presentation of the financial statements in
order to design audit procedures that are appropriate in the circumstances,
but not for the purpose of expressing an opinion on the effectiveness of the
entity’s internal control. An audit also includes evaluating the appropriateness
of accounting policies used and the reasonableness of accounting estimates
made by management, as well as evaluating the overall presentation of the
financial statements.
We believe that the audit evidence we have obtained is sufficient and
appropriate to provide a basis for our audit opinion.
Opinion
In our opinion, the financial statements present fairly, in all material respects,
the financial position of the Canadian Institute for Health Information as at
March 31, 2015 and the results of its operations, changes in net assets and its
cash flows for the year then ended in accordance with Canadian accounting
standards for not-for-profit organizations.
Other matter
The financial statements of the Canadian Institute for Health Information as at
and for the year ended March 31, 2014 were audited by another auditor who
expressed an unmodified opinion on those statements on June 19, 2014.
Chartered Professional Accountants, Licensed Public Accountants
July 28, 2015
Ottawa, Canada
69
By the numbers: Financial statements
Statement of financial positionAs at March 31, 2015, with comparative information for 2014
2015 $
2014 $
AssetsCurrent assets
Cash and cash equivalents (note 3) 10,016,619 14,985,889Accounts receivable (note 4) 4,662,415 1,601,019Prepaid expenses 3,003,774 3,034,327
17,682,808 19,621,235
Capital assets (note 5) 9,153,368 11,265,372Other assets (note 6) 325,161 166,969Accrued pension benefit asset (note 7 d) 7,110,900 9,281,500
34,272,237 40,335,076
Liabilities and net assetsCurrent liabilities
Accounts payable and accrued liabilities (note 9) 5,059,844 5,985,004Unearned revenue 2,083,003 2,433,219Deferred contributions (note 10) 2,335,084 4,663,218
9,477,931 13,081,441
Accrued pension benefit liability (note 7 d) 610,100 741,200Deferred contributions (note 10)
Expenses of future periods 311,022 153,180Capital assets 6,747,055 8,595,366
Lease inducements (note 11) 2,178,410 2,755,8709,846,587 12,245,616
Net assetsInvested in capital assets 1,958,363 1,964,611Unrestricted 26,923,443 26,749,095Remeasurements — pension (note 7 e) (13,934,087) (13,705,687)
14,947,719 15,008,019
Commitments (note 15)34,272,237 40,335,076
See accompanying notes to financial statements.
On behalf of the CIHI Board:
Director Director
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CIHI Annual Report, 2014–2015: Listening and Learning
Statement of operationsYear ended March 31, 2015, with comparative information for 2014
2015 $
2014 $
RevenueCore plan (note 12) 17,390,658 17,050,273Sales 2,807,812 2,370,426Funding — other (note 13) 3,646,415 2,218,267Health information initiative (note 10) 81,777,582 78,735,392Other revenue 237,402 264,245
105,859,869 100,638,603
ExpensesCompensation 78,659,526 76,050,211External and professional services 7,913,370 6,196,672Travel and advisory committee 3,072,242 2,643,654Office supplies and services 717,618 854,977Computers and telecommunications 6,435,268 6,621,034Occupancy 8,893,745 8,802,952
105,691,769 101,169,500
Excess (deficiency) of revenue over expenses 168,100 (530,897)
See accompanying notes to financial statements.
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By the numbers: Financial statements
Statement of changes in net assetsYear ended March 31, 2015, with comparative information for 2014
Invested in capital assets
$
Remeasurements — pension
$
Unrestricted
$
Total 2015
$
Total 2014
$Balance, beginning
of year 1,964,611 (13,705,687) 26,749,095 15,008,019 (3,016,994)Excess (deficiency)
of revenue over expenses (696,066) — 864,166 168,100 (530,897)
Change in invested in capital assets 689,818 — (689,818) — —
Remeasurements and other items related to pension (note 7 e) — (228,400) — (228,400) 18,555,910
Balance, end of year 1,958,363 (13,934,087) 26,923,443 14,947,719 15,008,019
See accompanying notes to financial statements.
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CIHI Annual Report, 2014–2015: Listening and Learning
Statement of cash flowsYear ended March 31, 2015, with comparative information for 2014
2015 $
2014 $
Cash provided by (used in)Operating activitiesExcess (deficiency) of revenue over expenses 168,100 (530,897)Items not involving cash
Amortization of capital assets 3,406,191 3,926,421Amortization of lease inducements (591,106) (588,377)Pension benefits 1,811,100 734,210Amortization of deferred contributions — capital assets (2,493,030) (3,076,605)Loss on disposal of capital assets 40,350 50,980
Change in non-cash operating working capital (note 14) (4,306,219) 796,745Net change in other assets (158,192) 235,821Net change in deferred contributions (1,525,573) 3,496,050
(3,648,379) 5,044,348
Investing activitiesAcquisition of capital assets (1,344,095) (2,356,941)Proceeds on disposal of capital assets 9,558 10,226
(1,334,537) (2,346,715)
Financing activitiesLease inducement received 13,646 —Increase (decrease) in cash and cash equivalents (4,969,270) 2,697,633Cash and cash equivalents, beginning of year 14,985,889 12,288,256Cash and cash equivalents, end of year 10,016,619 14,985,889
Represented byCash 1,816,619 1,285,889Short-term investments 8,200,000 13,700,000
10,016,619 14,985,889
Supplemental informationInterest received 185,514 197,539Interest paid 31 62
See accompanying notes to financial statements.
73
By the numbers: Financial statements
Notes to financial statementsYear ended March 31, 2015
1. OrganizationThe Canadian Institute for Health Information (“CIHI”) is a national not-for-profit organization
continued under Section 211 of the Canada Not‑for‑Profit Corporations Act.
CIHI’s mandate is to lead the development and maintenance of comprehensive and integrated
health information that enables sound policy and effective health system management that
improve health and health care.
CIHI is not subject to income taxes under paragraph 149(1)(I) of the Income Tax Act (Canada).
2. Significant accounting policies and change in accounting policy
Significant accounting policies
These financial statements have been prepared by management in accordance with Canadian
accounting standards for not-for-profit organizations in Part III of the CPA Canada Handbook —
Accounting and include the following significant accounting policies:
a. Revenue recognition
CIHI follows the deferral method of accounting for contributions for not-for-profit organizations.
Funding contributions are recognized as revenue in the same period as the related expenses are
incurred. Amounts approved but not received at the end of the period are recorded as accounts
receivable. Excess contributions which require repayment in accordance with the agreement are
recorded as accrued liabilities.
Contributions provided for a specific purpose and those restricted by a contractual arrangement
are recorded as deferred contributions, and subsequently recognized as revenue in the same
period as the related expenses are incurred.
Contributions provided for the purchase of capital assets are recorded as deferred
contributions — capital assets, and subsequently recognized as revenue over the same terms and
on the same basis as the amortization of the related capital assets.
Interest revenue is recorded as period income on the basis of the accrual method.
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CIHI Annual Report, 2014–2015: Listening and Learning
Restricted investment revenue and investment losses on restricted contributions are debited or
credited to the related deferred contributions account and recognized as revenue in the same
period as eligible expenses are incurred.
b. Capital assets
Capital assets are recorded at cost and are amortized on a straight-line basis over their estimated
useful lives, as follows:
Tangible capital assetsComputers 5 yearsFurniture and equipment 5–10 yearsTelecommunication equipment 5 yearsLeasehold improvements Term of lease
Intangible assetsComputer software 5 years
c. Lease inducements
Lease inducements, consisting of leasehold improvement allowances, free rent and other
inducements, are amortized on a straight-line basis over the term of the lease.
d. Pension benefits
CIHI maintains a defined benefit pension plan.
Pension benefits are accounted for using the immediate recognition approach. Under this
approach, the amount of the accrued benefit obligation net of the fair value of plan asset is
recognized on the statement of financial position. Current service and finance costs are expensed
during the year, while remeasurements and other items, representing the total difference between
actual and the expected return on plan assets, actuarial gains and losses, and past service costs,
are recognized as a direct increase or decrease in net assets.
The accrued benefit obligations are measured using an actuarial valuation prepared for accounting
purposes. The assets are measured at fair value at the date of the statement of financial position.
e. Foreign currency translation
Revenue and expenses are translated at the exchange rates prevailing on the transaction date.
Any resulting foreign exchange gains or losses are charged to miscellaneous income or expenses.
Foreign currency monetary assets and liabilities are translated at the prevailing rates of exchange
at year end.
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By the numbers: Financial statements
f. Use of estimates
The preparation of financial statements requires management to make estimates and assumptions
that affect the reported amounts of assets and liabilities and disclosure of contingent assets and
liabilities at the date of the financial statements and the reported amounts of revenue and expenses
during the year. Actual results could differ from management’s estimates. These estimates are
reviewed annually and as adjustments become necessary, they are recognized in the financial
statements in the period they become known.
Significant management estimates include assumptions used in determining the accrued pension
benefits asset and liability.
g. Financial instruments
Financial instruments are measured at fair value on initial recognition. Subsequent to initial
recognition, they are accounted for based on their classification. Cash and cash equivalents as
well as investments are measured at fair value. Accounts receivable net of allowance for doubtful
accounts and accounts payable and accrued liabilities are carried at amortized cost. Because of
the short-term nature of the accounts receivable as well as the accounts payable and accrued
liabilities, amortized cost approximates fair value.
It is management’s opinion that CIHI is not exposed to significant interest rate or credit risks
arising from the financial instruments.
Interest rate risk
Interest rate risk refers to the adverse consequences of interest rate changes on CIHI’s cash flows,
financial position and investment income.
Credit risk
Credit risk relates to the potential that one party to a financial instrument will fail to discharge
an obligation and cause the other party to incur financial loss.
Credit risk concentration exists where a significant portion of the portfolio is invested in securities
which have similar characteristics or similar variations relating to economic, political or other
conditions. CIHI monitors the financial health of its investments on an ongoing basis.
In addition, as disclosed in note 8, CIHI has an available line of credit that is used when sufficient
cash flow is not available from operations to cover operating and capital expenditures, including
contributions to the CIHI Pension Plan.
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CIHI Annual Report, 2014–2015: Listening and Learning
Changes in accounting policy
Effective April 1, 2014, CIHI retrospectively adopted the new CPA Canada Handbook Accounting
Part III, Section 3463, Reporting Employee Future Benefits by Not-for-Profit Organizations which
incorporates Section 3462, Employee Future Benefits issued.
Under the new standard, the actuarial gains and losses and past service costs are no longer
deferred and amortized over future periods. The accrued benefit obligation, net of plan
assets, and adjusted for any valuation allowance, is recorded in the statement of financial
position. The annual benefit cost is recorded in the statement of operations, and all changes
from remeasuring the accrued benefit obligation are recognized on the statement of changes
in net assets. In addition, interest cost and expected rate of return on plan assets are replaced
with a net interest amount that is calculated by applying the discount rate used to calculate
the net accrued benefit obligation.
For defined benefit plans for which an actuarial valuation for funding purposes exists, an
accounting policy choice between using the funding valuation or an accounting valuation
is available. CIHI has elected to use an accounting valuation as the basis to measure its
defined benefit plans.
Upon transitioning to Section 3463, an adjustment to the statement of financial position
was required. The unamortized losses of $13,705,687 as at April 1, 2014 were immediately
recognized as a transitional adjustment to net assets. In addition, the amount of deferred
contributions related to pension plan expenses of future years were immediately recognized
as a transitional adjustment to net assets, resulting in an increase in the net assets of
$22,755,116 as at April 1, 2014.
The following table provides a reconciliation of the net assets as at April 1, 2013, and the
excess of revenue over expenses for the year ended March 31, 2014 as previously reported,
with those computed after adopting Section 3463.
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By the numbers: Financial statements
Excess of revenue over expenses for the year ended March 31, 2014
$
Net assets as at April 1, 2013
$Excess of revenue over expenses for the year and
net assets, as previously reported 137,320 5,821,270Recognition of unamortized actuarial gains and losses 1,625,500 (31,796,497)Changes to interest cost on accrued benefit obligations 175,600 —Changes to interest income on plan assets (2,266,200) —Reversal of deferred contributions — expenses of future
periods related to defined benefit plan (203,117) 22,958,233Excess of expenses over revenue for the year and
net assets, restated (530,897) (3,016,994)
The impact on the statement of financial position and cash flows for the year ended
March 31, 2014 is as follows:
As previously reported
March 31, 2014
$
Amended Section
3463
$
Restated March 31, 2014
$Statement of financial positionAccrued pension benefit assets 22,985,852 (13,704,352) 9,281,500Accrued pension benefit liability 739,865 1,335 741,200Deferred contributions —
expenses of future periods 22,908,296 (22,755,116) 153,180Unrestricted net assets 3,993,979 22,755,116 26,749,095Remeasurements — pension — (13,705,687) (13,705,687)
As previously reported
March 31, 2014
$
Amended section 3463
$
Restated March 31, 2014
$Statement of cash flowsExcess (deficiency) of revenue
over expenses 137,320 (668,217) (530,897)Pension benefits 269,110 465,100 734,210Net change in deferred contributions 3,292,933 203,117 3,496,050
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CIHI Annual Report, 2014–2015: Listening and Learning
3. Cash and cash equivalents Cash and cash equivalents are comprised of cash and short-term investments with a variety
of interest rates and having original maturity dates of less than 90 days.
4. Accounts receivable2015
$
2014
$Operating 1,820,925 1,544,224Funding — other 2,841,490 56,795
4,662,415 1,601,019
Government refunds receivable at the end of the year are $187,870 (2014: $387,313).
5. Capital assets2015 2014
Cost
$
Accumulated amortization
$
Net book value
$
Net book value
$Tangible capital assetsComputers 9,288,262 6,025,896 3,262,366 3,346,454Furniture and equipment 6,190,568 5,006,392 1,184,176 1,634,498Telecommunications equipment 1,074,827 1,024,878 49,949 82,198Leasehold improvements 10,848,293 7,813,409 3,034,884 4,081,454Intangible assetsSoftware 12,341,329 10,719,336 1,621,993 2,120,768
39,743,279 30,589,911 9,153,368 11,265,372
The capital assets include $Nil assets (2014: $819,172) that are not in service at the end
of the year.
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By the numbers: Financial statements
6. Other assetsOther assets consist of rent deposits to landlords for office space as well as prepaid software,
equipment support and maintenance expenses.
7. Accrued pension benefitsCIHI has a contributory defined benefit plan (“Registered Retirement Plan”) which offers its
employees annual retirement income based on length of service and highest consecutive five-year
average earnings. In addition, CIHI supplements this benefit to plan members who are affected by
the application of the Income Tax Act’s maximum pension limit (“Supplementary Retirement Plan”).
In November 2014, a decision to wind-up the pension plans effective December 31, 2015 was
approved by the CIHI’s Board of Directors.
The most recent actuarial valuation for funding purposes of the Registered Retirement Plan
was prepared as of January 1, 2014. The next valuation will be as of December 31, 2015.
The fair value of the plans’ assets and accrued benefit obligations for accounting purposes
are determined as at March 31 of each year.
The following tables present the plans’ funded status and amounts recognized in CIHI’s
statement of financial position.
a. Pension expense
The pension plans’ expenses include the following components:
2015 2014Registered
Retirement Plan
$
Supplementary Retirement Plan
$
Registered Retirement Plan
$
Supplementary Retirement Plan
$
Current service cost, net of employee contributions 8,963,200 97,500 8,176,400 64,600
Interest cost on accrued benefit obligation 5,257,100 35,000 4,817,500 28,500
Investment income on plan assets (5,732,800) — (4,428,300) —
Pension expense 8,487,500 132,500 8,565,600 93,100
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CIHI Annual Report, 2014–2015: Listening and Learning
b. Pension benefit obligation
Changes in the accrued benefit obligation are as follows:
2015 2014Registered
Retirement Plan
$
Supplementary Retirement Plan
$
Registered Retirement Plan
$
Supplementary Retirement Plan
$
Defined benefit obligation, at end of prior year 112,693,300 741,200 107,056,200 632,800
Current service cost, net of employee contributions 8,963,200 97,500 8,176,400 64,600
Interest cost on accrued benefit obligation 5,257,100 35,000 4,817,500 28,500
Employee contributions 4,152,300 — 3,847,000 —Benefits paid (3,383,600) (27,800) (4,275,400) (11,600)Actuarial loss (gain) 9,560,100 (235,800) (6,928,400) 26,900
Accrued benefit obligation, end of year 137,242,400 610,100 112,693,300 741,200
c. Pension assets
Changes in the plan assets are as follows:
2015 2014Registered
Retirement Plan
$
Supplementary Retirement Plan
$
Registered Retirement Plan
$
Supplementary Retirement Plan
$
Fair value of assets, beginning of year 121,974,800 — 98,407,600 —
Interest income 5,732,800 — 4,428,300 —Employer contributions 6,781,100 27,800 7,896,100 11,600Employee contributions 4,152,300 — 3,847,000 —Benefits paid (3,383,600) (27,800) (4,275,400) (11,600)Remeasurements —
return on plan assets 17,377,300 — 11,671,200 —
Fair value of assets, end of year 152,634,700 — 121,974,800 —
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By the numbers: Financial statements
The Plan’s assets consist of:
2015 2014Registered
Retirement Plan
%
Supplementary Retirement Plan
%
Registered Retirement Plan
%
Supplementary Retirement Plan
%Asset categoryBonds (Canada) 100 — 34 —Equities (Canada) — — 25 —Equities (Global) — — 41 —
100 — 100 —
d. Accrued pension benefit asset (liability)
CIHI recorded the assets and liabilities as follows:
2015 2014Registered
Retirement Plan
$
Supplementary Retirement Plan
$
Registered Retirement Plan
$
Supplementary Retirement Plan
$
Accrued benefit obligation, end of year (137,242,400) (610,100) (112,693,300) (741,200)
Fair value of assets, end of year 152,634,700 — 121,974,800 —
Funded status — surplus (deficit), end of year 15,392,300 (610,100) 9,281,500 (741,200)
Valuation allowance — wind up (8,281,400) — — —
Accrued pension benefit asset (liability) 7,110,900 (610,100) 9,281,500 (741,200)
e. Remeasurements — pension
Remeasurements, which are recognized directly in net assets rather than in the statement of
operations, consist of the difference between actual and expected return on plan assets, actuarial
gains and losses, and changes in valuation allowance. For the year, the remeasurements for both
pension plans amounted to $228,400 [2014 - $(18,090,810)].
The amounts recognized in CIHI’s financial statements account for the decision to wind-up
the pension plans, and more specifically a curtailment gain of $20,051,900 is included in the
remeasurements amount reported as of March 31, 2015.
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CIHI Annual Report, 2014–2015: Listening and Learning
f. Actuarial assumptions
The actuarial assumptions, which represent management’s best estimate assumptions used
to determine costs and benefit obligations, were as follows:
2015 2014Registered
Retirement Plan
%
Supplementary Retirement Plan
%
Registered Retirement Plan
%
Supplementary Retirement Plan
%Service cost for years
ended March 31Discount rate 4.70 4.70 4.50 4.50Rate of compensation increase 4.00 4.00 4.00 4.00
Accrued benefit obligation, as at March 31
Discount rate 3.4 3.4 4.70 4.70Rate of compensation increase 4.00 4.00 4.00 4.00
8. Bank indebtednessCIHI has a line of credit of $5,000,000 with a financial institution bearing interest at prime rate.
This credit facility is secured by a general security agreement on all assets with the exception
of information systems. As at March 31, 2015, a letter of credit in the amount of $515,800
(2014: $204,200) for the purpose of the Supplementary Retirement Plan had been issued
against the line of credit.
9. Accounts payable and accrued liabilitiesAccounts payable and accrued liabilities are operational in nature and include $Nil (2014: $139,066)
representing the annual excess contribution received from Health Canada for the Health
Information Initiative.
The government remittances payable at the end of the year is $83,736 (2014: $85).
10. Deferred contributionsa. Expenses of future periods
Since 1999, Health Canada has been significantly funding the building of a comprehensive national
health information system and infrastructure to provide Canadians with the information they need
to maintain and improve Canada’s health system and the population’s health. Health Canada’s
funding contribution is received annually based on CIHI’s capital resources requirements.
83
By the numbers: Financial statements
Deferred contributions related to expenses of future years represent unspent restricted
contributions. The changes for the year in the deferred contributions — expenses of future
years are as follows:
2015
$
2014
$
Balance, beginning of year 4,816,398 3,055,150
Current year contribution received from Health Canada 77,758,979 79,293,900
Contribution payable to Health Canada (note 9) — (139,066)
Amount recognized as funding (79,284,552) (75,658,787)
Amount transferred to deferred contributions — capital assets (644,719) (1,734,799)
Balance, end of year 2,646,106 4,816,398
Less: current portion 2,335,084 4,663,218
311,022 153,180
b. Capital assets
Deferred contributions related to capital assets include the unamortized portions of restricted
contributions with which capital assets were purchased.
The changes for the year in the deferred contributions — capital assets balance are as follows:
2015
$
2014
$
Balance, beginning of year 8,595,366 9,937,172Amount received from Health Information Initiative 644,719 1,734,799
Amount recognized as funding (2,493,030) (3,076,605)
Balance, end of year 6,747,055 8,595,366
11. Lease inducementsThe lease inducements include the following amounts:
2015
$
2014
$Leasehold improvement allowances 447,950 705,395Free rent and other inducements 1,730,460 2,050,475
2,178,410 2,755,870
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CIHI Annual Report, 2014–2015: Listening and Learning
During the year, free rent and other inducements of $13,646 (2014: $Nil) were provided. The
amortization of leasehold improvement allowances and free rent and other inducements are
$257,445 and $333,661, respectively (2014: $257,445 and $330,932, respectively).
12. Core planThe Core Plan revenue relates to a set of health information products and services offered
to Canadian healthcare facilities, regional health authorities and provincial/territorial ministries
of health. Provincial/territorial governments have secured CIHI Core Plan on behalf of all facilities
in their jurisdiction.
13. Funding — other2015
$
2014
$Provincial/territorial governments 3,228,937 2,148,700Other 417,478 69,567
3,646,415 2,218,267
14. Change in non-cash working capital items2015
$
2014
$
Accounts receivable (3,061,396) 332,348Prepaid expenses 30,553 (568,468)Accounts payable and accrued liabilities (925,160) 1,363,739Unearned revenue (350,216) (330,874)
(4,306,219) 796,745
85
By the numbers: Financial statements
15. CommitmentsCIHI leases office space under different operating leases, which expire on various dates. In addition,
CIHI is committed under various agreements with respect to professional contracts and software
and equipment maintenance and support. The minimum amounts payable over the next five years
and thereafter are as follows:
$
2016 10,911,6442017 9,495,0902018 9,172,5792019 7,255,1532020 4,310,9812021 and thereafter 25,585,767
16. Comparative information Certain comparative information has been reclassified to conform with the financial statement
presentation adopted in the current year.
Production of this document is made possible by financial contributions from Health Canada and provincial and territorial governments. The views expressed herein do not necessarily represent the views of Health Canada or any provincial or territorial government.
All rights reserved.
The contents of this publication may not be reproduced, in whole or in part, without the prior express written permission of the Canadian Institute for Health Information.
For permission or information, please contact CIHI:
Canadian Institute for Health Information495 Richmond Road, Suite 600Ottawa, Ontario K2A 4H6
Phone: 613-241-7860Fax: [email protected]
ISBN 978-1-77109-394-1
© 2015 Canadian Institute for Health Information
How to cite this document:Canadian Institute for Health Information. CIHI Annual Report, 2014–2015: Listening and Learning. Ottawa, ON: CIHI; 2015.
Cette publication est aussi disponible en français sous le titre Rapport annuel 2014-2015 de l’ICIS : écouter et apprendre
ISBN 978-1-77109-395-8
10789-0715
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