listening learning cihi and · 4 cihi annual report 2014–2015 listening and learning as we began...

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

4

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


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.

8


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


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.


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


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


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


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

https://www.cihi.ca/en/land/eating-disorders

16


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.


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.


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.


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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.


Not implemented.


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.


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.



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.


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


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— — — — — — — — — — — — —— — — — — — — — — — — —

4

4

4

4

4

4

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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

https://www.cihi.ca/land/using-data

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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.


HHH

Where is most of the money being spent?

$63.5billion

growth2.1%

growth0.8%

growth4.5%

30%of health spending

Drugs

$33.9billion


Physicians

$33.3billion


Growth has outpaced that for hospitals or drugs since 2007.

Hospitals

SourceCanadian Institute for Health Information, National Health Expenditure Trends, 1975 to 2014.

22


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.


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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


http://www.cihi.ca/land/cancersurgeries

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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.

27

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.


28


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.


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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.



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.


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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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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.


37

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.

38


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

40


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


http://www.cihi.ca/land/pediatric-surgery

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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


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.

46


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

48


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

50


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


http://www.cihi.ca/land/long-wait-times

53

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.

54


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.


56


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


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.


58


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

59

Capital investments

Capital investments ($ millions)

2011–2012 2012–2013 2013–2014 2014–2015 2015–2016


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.


60


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.

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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.


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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


64


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


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.

68


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

70


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)


71


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


72


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


73


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.

74


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.

75


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.

76


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.

77


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

78


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.

79


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

$


$

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

80


b. Pension benefit obligation

Changes in the accrued benefit obligation are as follows:

2015 2014Registered

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

$


$


$


$

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 —

81


The Plan’s assets consist of:

2015 2014Registered

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

$


$


$


$

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.

82


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

%


%


%


%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


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

84


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


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


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

Talk to usCIHI Ottawa 495 Richmond Road, Suite 600 Ottawa, Ontario K2A 4H6 Phone: 613-241-7860

CIHI Toronto 4110 Yonge Street, Suite 300 Toronto, Ontario M2P 2B7 Phone: 416-481-2002

CIHI Victoria 880 Douglas Street, Suite 600 Victoria, British Columbia V8W 2B7 Phone: 250-220-4100

CIHI Montréal 1010 Sherbrooke Street West, Suite 300 Montréal, Quebec H3A 2R7 Phone: 514-842-2226

CIHI St. John’s 140 Water Street, Suite 701 St. John’s, Newfoundland and Labrador A1C 6H6 Phone: 709-576-7006

www.cihi.ca

Better data. Better decisions.Healthier Canadians.

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