Administrative health data in Canada: lessons from history
Lucyk et al. BMC Medical Informatics and Decision Making
Administrative health data in Canada: lessons from history
Kelsey Lucyk 0
Mingshan Lu 2
Tolulope Sajobi 0
Hude Quan 0 1
0 Department of Community Health Sciences, Cumming School of Medicine, University of Calgary , 3280 Hospital Dr. NW, Calgary, Alberta, T2N 4Z6 , Canada
1 O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary , 3280 Hospital Dr. NW, Calgary, Alberta, T2N 4Z6 , Canada
2 Department of Economics, University of Calgary , 2500 University Dr. NW, Calgary, Alberta, T2N 1 N4 , Canada
Administrative data; Health services research; Health informatics; History
Many health researchers use administrative data (e.g.,
physician billing claims) to inform and enhance
decisionmaking and patient outcomes . In the health care
system, for example, administrative health data may be used
to regulate patient flow, determine resource-use, or
distribute funds to hospitals.
Canada has some of the most comprehensive and
high-quality administrative health data in the world, in
part due to its universal health insurance registries,
comprehensive coverage of inpatient and outpatient services,
and linkage of databases via unique personal identifiers
within provinces and territories . The largest
administrative health database in Canada is the Discharge
1) federal financial support in consolidating existing registers;
2) incorporating of modern data processing methods to analyze statistics;
3) standardize classification of diseases, and social and demographic
characteristics to facilitate comparability between regions; and,
4) encourage timely publication of statistics and reports; and finally,
From: Hall E. Royal Commission on Health Services. Ottawa: Queen's Printer,1964
that aim to improve health information and enhance
decision-making. We conclude our paper with
recommendations for present-day research in administrative
health data, which are drawn from the historical lessons
that emerged in our analysis. This paper will be of
interest to those who work with administrative health data
and also those in other countries that are looking to
build or improve upon their administrative health data.
We searched the academic and grey literature (e.g.,
PubMed, Google) for histories related to administrative
health data, by using key words such as “health
information,” “health statistics,” “administrative data,” and
“history.” As we gained familiarity with our sources, we
included more specific terms to identify additional
sources (e.g., “Manitoba Centre,” “hospital morbidity
database”). We used snowball sampling to further
identify relevant research centre histories, individual
biographies, and websites from provincial and national data
centres from documents referenced by our sources. For
brevity, we identified approximately 20 publicly available
key sources (from ca. 80) that encapsulated historical
trends in Canadian administrative health data. We
conducted a qualitative content analysis of these sources,
informed by historical methodology , following the
methods put forth by Krippendorf.  According to
Krippendorf, texts are considered artifacts of a given
social and cultural context that affects how they are
written, read, and interpreted. After a close reading of each
source, we extracted content related to the events,
individuals, challenges, and successes that emerged as
pertinent to the history of administrative health data in
Canada. We then compiled our findings to construct an
historical narrative, spanning from 1847 to the present
information regarding land holdings, dwellings, and
demographics [7, 8]. Initially, the census was a
responsibility of the provinces, but became a federal
responsibility when the country unified in 1867 . This initiated
the long-standing trend in Canadian health statistics of
provinces reporting data to federal sources for
compilation, analysis, and publication .
Two individuals are particularly important during this
early history of health statistics. First, former Deputy
Minister of Agriculture, Joseph Charles Taché (1820–
1894), standardized the collection of information by
census-takers, which allowed for comparable analysis
across provinces for the first time . Second, former
Minister of Finance, Arthur Harvey (1834–1905),
voluntarily collected and compiled various types of
administrative statistics from government departments (e.g.,
hospitals receiving government grants, coroners’
inquests), which he published and sold to Canadians as
the Year Book and Almanac of Canada . Harvey’s
Almanac was formally legislated and transferred to
Taché’s Department in 1879 and published as the
Statistical Abstract and Record. 
Throughout the 20th Century, statistical operations in
Canada became centralized. With cooperation from 8
provinces, a national system of vital statistics was
established,1 with all provinces and territories involved by
1949 . In 1948, former Dominion Statistician, Herbert
Marshall (1888–1977), amended the Statistics Act to give
the federal government authority to “collect, compile,
analy[z]e, abstract and publish statistics” to include
“hospitals, mental institutions, tuberculosis institutions, and
charitable and benevolent institutions.”  However, while this
was meant to provide timely and informative statistics, the
implementation of Marshall’s Act was far from efficient.
As would later be identified in the 1961–1964 Royal
Commission on Health Services (RCHS), the lack of
communication between the Dominion Bureau of
Statistics and other departments throughout the first half of
the 20th Century resulted in the timely and often
duplicated collection of statistics . Justice Emmett Hall
(1898–1995), Chair of the RCHS, identified in 1964 that
Canada’s “main need was for national statistics and for
data showing significant variations among provinces and
regions,” and recommended a national,
federallyfinanced clearinghouse be established to facilitate this
. The RCHS identified a number of solutions to
improve the state of health statistics in Canada, which are
listed in Table 2.
Results and discussion
A brief history of health statistics in Canada (1847–1964)
The collection of health-related statistics in Canada
formally began in 1847 when the Census and Statistics Act
of 1847 mandated the collection of vital statistics and
Recent developments in the history of administrative
health data: HMRI and CIHI
In 1963, the Hospital Medical Records Institute (HMRI)
was established to assist with the administration of
provincial and federal hospital insurance plans in 1963 . The
Table 2 Timeline of key events in the history of administrative health data in Canada
1847 Census and Statistic Act of 1847
Year Book and Almanac of Canada statistics transferred to Department of Agriculture
Bureau of Labour Statistics established
Ontario and Québec hospitals begin collecting hospital data
Dominion Bureau of Statistics established
Bureau establishes system of vital statistics for 8 provinces
Québec, the Yukon and Northwest Territories join the national system of vital statistics program
Statistics Act amended to give Bureau authority to collect hospital data
Newfoundland joins Canada, and its vital statistics program
Bureau establishes Hospital Morbidity Database
Royal Commission on Health Services commences
Hospital Medical Records Institute (HMRI) established
Royal Commission on Health Services ends
HMRI expands to 5 provinces
HMRI become not-for-profit, includes standardized classification
Rooses publish the first paper in Manitoba using administrative health data
HMRI develops Case Mix Groups
British Columbia Linked Health Data Project (BCLHDP) begins
Canadian Centre for Health Services and Policy Research (CHSPR) established
HMRI collects information for 75 % of discharges from Canadian hospitals
Institute for Clinical Evaluative Sciences established
Manitoba Centre for Health Policy established
National Task Force on Health Information recommends a coordinating council for health information
Canadian Institute for Health Information established
HMRI holdings transferred to CIHI
CHSPR permitted access to BCLHDP data
Population Data BC established
CHSPR transfers data holdings to Population Data BC
20th Anniversary of ICES and MCHP
Discharge Abstract Database covers 75 % of all inpatient discharges, for all provinces and territories (except QUE)
ICD-10-CA and Canadian Classification of Health Interventions implemented by CIHI
Legend: HMRI is Hospital Medical Records Institute; BCLHDP is British Columbia Linked Health data Project; CHSPR is Canadian Centre for Health Services and Policy
Research; MCHP is Manitoba Centre for Health Policy; CIHI is Canadian Institute for Health Information; DAD is Discharge Abstract Database; QUE is Québec; ICD-10-CA is
International Classification of Diseases, 10th revision, Canadian modification; ICES is Institute for Clinical and Evaluative Sciences; BC is British Columbia
Institute evaluated and compared the quality of medical
care of hospitals and assisted provincial/federal insurance
plans by compiling statistics from patient charts .
While initially intended only for Ontario, by 1970 the
HMRI included 77 general hospitals in 5 provinces .
By 1977, the HMRI received 1.5 million chart abstracts
per year, which grew to 4.1 million by 1991 .
The HMRI is important to the history of
administrative health data particularly due to the methodological
innovations it brought to this field. It encouraged the
standardized coding of diseases and operations in
accordance with the International Classification of
Diseases, Adapted for Indexing Hospital Records (ICDA)
among its participating institutions . In 1983, the
HMRI further increased comparability of health
information with their introduction of Case Mix Groups
(CMGs) . CMGs allowed for comparisons between
patient groups with similar resource-use or diagnoses,
and estimations of length of stay and expected cost of
care . Eventually, the HMRI was transferred to CIHI
to form a founding database of the DAD, in 1994.
The Bureau of Statistics also implemented a collection
program for health information beginning in 1960—the
Hospital Morbidity Database, which obtained data from
provincial ministries of health . However, the
provinces favoured the services of HMRI’s centralized data
processing system (compared to the Bureau’s edits for
comparability), which led to its success .
In 1991, the National Health Information Council
(NHIC), Conference of Deputy Ministers of Health, and
Chief Statistician held a national inquiry into the state of
health information . At the time, four independent
groups were responsible for health information,
nationally: (1) the Canadian Centre for Health Information—a
division of Statistics Canada; (2) the HMRI; (3) the
Management Information Standards Group; and, (4) Health
and Welfare Canada . Thus, the NHIC
recommended the establishment of a national coordinating
council that represented non-government, government,
and private sector organizations . Eventually, this
resulted in the 1994 founding of CIHI, implemented under
the direction of the Health Infrastructure Consortium of
Canada. CIHI formed large national databases by
combining health information from the organizations listed
above. CIHI currently maintains 27 pan-Canadian
databases, and provides education, reporting tools, and
strategies for its users . It exists through partnerships with
the federal government, and partners with all provincial
and territorial Ministries of Health .
Provincial centres for administrative health data research
Three existing provincial health research centres have been
pivotal to the development and history of administrative
health data research in Canada. This section will briefly
review the histories of centres in Ontario, Manitoba, and
British Columbia (BC).
The Institute for Clinical Evaluative Sciences (ICES)
During the 1980s, the Ontario Medical Association
(OMA) and Ministry of Health became interested in
establishing a research centre that operated at arm’s length
of the government to promote evidence-based health care
. David Naylor and Jack Williams of the Clinical
Epidemiology Unit and Research program at Toronto
responded in 1991 with a proposal for ICES, which would
use administrative health data from the Ministry of Health
for population-level research . Their proposal was
strengthened by the Ontario Health Insurance Plan’s
recent issue of health cards to residents, which would allow
for patients to be tracked by unique identifiers (e.g., age,
medication) . The proposal was quickly funded with a
$20-million commitment from the Province .
As inaugural director, Naylor operated ICES as a
scaled-up version of the multidisciplinary model (i.e.,
epidemiology, health services research, and policy
formation). He implemented ICES at the Sunnybrook Hospital
in Toronto, with a broadened scope to include
academics, providers, administrators, and policy makers
. Initial goals of ICES were to investigate rates of
medical procedures, length of stay, and drug
administration . The Province, OMA, and independent
researchers and stakeholders each contributed one third to
the research endeavors of ICES . In its first year of
operation, ICES published approximately 30 research
papers, and developed a health atlas of system-related and
disease-specific information .
Today, ICES holds de-identified, linkable data on 13
million of Ontario’s residents, under the Personal Health
Information Protection Act, has 4 satellite sites in
medical schools across Ontario and established remote
access and analysis system for users [18–20]. ICES
continues to operate within arm’s length of the Ontario
Government and partners with numerous
national/provincial programs to produce work that informs policy
and expands the capacity for research in Canada .
The Manitoba Centre for Health Policy (MCHP)
In Manitoba, the history of administrative health data
research intertwines with the careers of Noralou and
Leslie Roos. In 1973, the Rooses came to the University
of Manitoba, where Noralou collaborated with David
Fish of Community Health Sciences to project provincial
healthcare needs using the administrative files of the
Manitoba Health Services Commission (MHSC) . The
MHSC collected data on registration, hospital, Personal
Care Home, and medical claims.  Initially, MHSC data
was provided to Noralou on the basis of good faith and
mutual trust, but eventually MHSC and Noralou devised a
system where multiple data sources were linked to individuals,
who could be followed through the services they sought.
Linkage overcame limitations of MHSC data, such as not
tracking births, deaths, or moves out of Manitoba .
With former Assistant Executive Director to the MHSC,
Paul Henteleff, the Rooses published the first paper using
linked administrative health data in Manitoba.2
In 1988, Fraser Mustard (former President of the
Canadian Institute for Advanced Research) recruited the
Rooses for his Population Health Program, and brought
them together with the Provincial Government and
Department of Medicine to form the MCHP. [21, 22]
Together an agreement was reached where the MCHP
would answer 6 research questions for the Province each
year in exchange for funding, and otherwise be granted
academic freedoms.  In 1990, the MCHP was given a
3-year contract for $3.2 million to encourage its
operation within arm’s reach of the Province .
Today, the Centre employs over 60 persons in the
fields of administration, communications, finance, data
analysis, information technology, repository access, data
acquisition, and research . The Centre operated
under the direction of Noralou until 2006, whose
contribution to healthcare has recognized nationally with an
Order of Canada [21, 22]. Today, the MCHP
collaborates with researchers and institutions across Canada,
and facilitates access to over 20 health databases, 5 social
databases, 5 education databases, 4 registries, and 9
special data files in Manitoba .
Population Data British Columbia (PopDataBC)
In BC, administrative health data research began with the
establishment of the University of British Columbia’s
(UBC) Health Sciences Centre. When the Centre first
opened in the 1960s, the Health Services Research and
Development unit was established and made partnerships
with the BC Ministry of Health Services to maintain and
provide access to health data throughout the 1970s .
Morris Barer and Robert Evans were two individuals
pivotal to BC’s development of administrative health
data research. In 1988, Barer, with colleagues from UBC,
BC Cancer Agency, and BC Ministry of Health—began
the BC Linked Health Data Project (BCLHDP), which
“was designed to capture the power of linkable and
longitudinal data, and avoid the inefficiencies associated
with project-by-project data linkage.”  BCLHD
included data from vital events and health care services
utilized by nearly all BC residents from 1985, and today
includes data from other agencies such as WorkSafeBC
. With Evans, who in 1990 was a member of the
Royal Commission on Health Care and Costs in BC,
Barer founded the UBC Centre for Health Services and
Policy Research (CHSPR) within the UBC College of
Health Disciplines . CHSPR developed from the idea
that UBC should influence health care policy and
planning for BC . Following an agreement with the BC
Minister of Health and Privacy Commissioner in 1996,
CHSPR was permitted to use BCLHD for applied health
services and policy research [24, 25].
CHSPR obtained national funding to expand its
breadth in data research in the 2000s, which allowed
them to partner with UBC and other researchers from
across the province to create PopDataBC: a
“multi-university, data and education resource facilitating
interdisciplinary research on the determinants of human health,
well-being and development.”  Today, PopDataBC
provides researchers with remote access to
individuallevel linked data on BC’s residents across the sectors of
early childhood, workplace, environment, and more .
The success of the increasingly expansive, standardized,
and collaborative history of administrative health data in
Canada reflects the recommendations made by the RCHS
over 50 years ago. We echo these recommendations for
the present field of administrative health data research,
with lessons drawn from this history.
Recommendation 1: Federal financial support in
consolidating existing registers
At the federal level, financial support has been
imperative to identifying national needs for health research.
The founding of CIHI and NHIC was made possible
through federal investments that improved the capacity
for evidence-based decision-making. Likewise, support
from provincial governments has also proven essential
to the long-term sustainability of data centres. As shown
for MCHP, for example, the support provided by the
Province of Manitoba has led to a long-term
collaborative working partnership.
Recommendation 2: Standardize classification of diseases
and social and demographic characteristics to facilitate
comparability between regions
As shown throughout the history of administrative
health data in Canada, the standardization of
classification methods has been no easy task. As historical
developments have shown (e.g., introduction of CMGs by the
HMRI), standardization allows for comparisons,
increases data quality, and reduces the need to adapt
multiple versions of reported data. Standardization also
facilitates the timely publication of reports, which are
especially important when considering the increasing
constraints to the resource capacity of data centres.
Recommendation 3: Establish a national clearinghouse
and coordinating agency for health statistics
CIHI and provincial data centres place Canada as a
global leader in the field of administrative health data
science. With government support, Canada’s
administrative health databases have developed into innovative,
high-quality, and informative resources for health
research. As we have shown throughout this paper, the
goals of establishing a national and standardized
database and clearinghouse were realized long before its
official founding in 1994. Provincial centres in Manitoba,
Ontario, and BC have shown how smaller-scale
developments can facilitate larger-scale project.
Evidence-based decision-making relies on high quality
health information. This paper has provided an overview
of the history of administrative health data in Canada,
and has provided lessons learned from the past for
present-day research. Specifically, we have highlighted
the following recommendations from the 1964 RCHS:
(1) standardization; (2) centralization of data resources;
and, (3) government financial support. The short
histories provided here illustrate the need for
longstanding financial commitments, and collaboration between
government and research centres in overcoming barriers
to standardization and centralization (e.g., top-down
HQ conceptualized this paper and participated in its design. ML and TS
assisted in the design and interpretation of this data and provided critical
feedback. KL conducted the primary research for this paper and drafted the
manuscript. All authors read and approved the final manuscript.
At the time of writing KL was supported by a University of Calgary Achievers
in Medical Science scholarship and is currently supported by an Alberta
Innovates – Health Solutions graduate student scholarship. TTS is supported
by an MSI Foundation New Investigator Grant and a University of Calgary
Seed Grant. HQ is supported by Alberta Innovates – Health Solutions.
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