• Angus, M., Byczko, C., Grossman, G., Munro, R., Murthy, P., Parypa, B. (2021). Deployment of Health Care Facility Digital Infrastructure in Canada. A Framework for Standard-Based Solutions. Canadian Standards Association, Toronto, ON.

Executive Summary

Health care facility digital infrastructure plays a pivotal role in delivering today’s health care services. Digital infrastructure has evolved rapidly in recent years to meet business demands from many market sectors, while growth in connected devices, data-driven insights, integrated system automation and workflows in health care create greater demands and complexity. Today’s health care stakeholders are looking for scalable, secure, and future-proofed digital infrastructure to meet ongoing and future business needs. For the purposes of this report, health care facility digital infrastructure is defined as the hardware, software, networks, physical facilities, applications, and systems that are required to develop, deliver, monitor, control, or support digital services as well as the supporting skillsets and processes.

The objectives of this research report are to understand the current health care facility digital infrastructure landscape in Canada, identify gaps, and determine how standards-based solutions could better support the planning, implementation, intersystem communication, and life-cycle management of health care facility digital infrastructure. The research methodologies employed included a literature review, consultative interviews and a validation process. In total, over 550 records were identified from a large scope of sources, 14 interviews were conducted, and 20 subject matter experts were consulted to validate the proposed recommendations.

This report identifies several of the gaps between the health care facility’s needs and today’s available digital infrastructure standards, guidelines, and industry practices, and provides subsequent recommendations for standards-based solutions to help bridge these gaps.

Interview findings show that stakeholders are seeking to achieve maintainable, consistent, interconnected, networked/partnered, planned, and future-proofed health care facility digital infrastructure. While there is a large roster of standards available from several standards development organizations that can be referenced to assist with planning, designing, and implementing health care facility digital infrastructure, there are gaps between today’s health care facility digital infrastructure requirements and the in-use tools that are currently available and that support the industry. Despite this obstacle, health care facilities remain resilient by adapting their internal tools, resources, and processes as they creatively seek solutions to meet their business goals.

This case-by-case approach has led to a lack of standardization between organizations and across provinces and territories, resulting in a lack of transparency and a greater risk that smaller, less resourced and less experienced organizations will be vulnerable when implementing health care facility digital infrastructure that is not future-ready and may not have the capability to achieve the full functionality from the end-devices, software, and systems. Overall, this leads to inconsistent patient experiences from organization to organization and may also lead to less equitable and accessible care.

To address the gaps found through the research report, 12 recommendations have been identified for development of an overarching health care facility digital infrastructure standard or guidance document. The recommendations target three broad categories: people and processes; system integration and intersystem communication; and continuous improvements.

These recommendations include:

  1. Develop common definitions;
  2. Develop a digital health vision and strategy;
  3. Complete workflow mapping;
  4. Develop use cases and an integration matrix;
  5. Plan equipment in tandem with systems;
  6. Instil privacy and security by design;
  7. Complete risk identification – from new to existing;
  8. Develop a responsibility matrix;
  9. Design flexible and scalable digital infrastructure spaces;
  10. Develop commissioning documents;
  11. Institute a master system integrator; and
  12. Ensure ongoing training.

Through the consultative process, many interviewees expressed concern that standardization in the area of health care facility digital infrastructure may hamper the ability to achieve innovation, that recommendations may not be achievable by all, or that the standards may fail to stay up to date with changing needs in health care delivery. When developing a digital infrastructure standard, consideration needs to be given to the variances in funding, skillsets, and resourcing between health care facilities and provincial regulatory body processes.

Summary for Policymakers

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