
Episode 55: Standardizing Canada’s Health Data with CIHI’s Shannon O’Connor
September 16, 2026
In this episode of the Informonster Podcast, Charlie Harp sits down with Shannon O’Connor of the Canadian Institute for Health Information (CIHI) to explore Canada’s evolving approach to health data interoperability.
Shannon shares her journey into health data and standards, the unique challenges of Canada’s healthcare system, and the development of the Canadian Core Data for Interoperability (CACDI). The conversation explores how CACDI builds on lessons from initiatives like the U.S. Core Data for Interoperability (USCDI), why standardized and usable data matters for patient safety and care, and how Canada could unlock the potential of its vast health data resources.
Charlie and Shannon also discuss the future of CACDI, Canada’s proposed Connected Care for Canadians Act, and the role that data quality and standards will play in enabling better healthcare, research, and AI.
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Transcript
00:02.00
Charlie Harp
Hi, I’m Charlie Harp, and this is the Informonster Podcast. Today, On the Informonster podcast, I have the one, the only Shannon O ‘Connor from CIHI. Shannon. Welcome.
00:13.94
Shannon O’Connor
Thanks, Charlie. I am so excited to be here. I’ve been looking forward to this conversation for a long time.
00:19.12
Charlie Harp
Me too. So what we typically do in the Informonster podcast is when I bring on a guest. I asked them to talk a little bit about themselves and their journey and what brought them into the healthcare information technology space.
00:34.74
Charlie Harp
So, Shannon. How did you get here?
00:38.13
Shannon O’Connor
It’s a great question. And my journey into sort of health information was definitely not linear. So most of my life, or certainly most of my childhood into my adolescence, I actually wanted to be a lawyer.
00:49.52
Shannon O’Connor
So I thought I was going to go to law school. That was very much the plan. And then as we sort of got closer to making that a reality. I started to get cold feet a little bit. And I thought to myself, if you’re going to do this, you should really be.
01:03.35
Shannon O’Connor
100 % sure that that’s what you want to do. So I took a step back and I decided to go to grad school and pursue a master’s in criminology. I was always really interested in criminal justice so that was sort of like a soft way to test out whether that was the career path for me. So I did that. I finished grad school.
01:23.92
Shannon O’Connor
and I was actually working for Canada’s national prison system. I worked there really briefly when I finished grad school. And at the time, there’s a suite of assessment tools, I’m not sure if you’re familiar with them, the inter ride tools. So, they are a suite of sort of clinical assessment tools that are used in a wide range of settings um to assess folks for various things, but
01:47.30
Shannon O’Connor
The federal prison system where I was working was actually looking to implement these tools for mental health screening in the correctional facilities. And there was an organization that is sort of the steward of the assessment tools in Canada.
01:59.40
Shannon O’Connor
called CIHI. So I actually went there in person for a meeting. They were going to tell us a little bit about their journey with the tools and what they had learned. And I vividly remember getting off the elevator. We had our old office in Ottawa. It’s actually moved since, but it had this beautiful view of the Ottawa River.
02:17.42
Shannon O’Connor
And I thought to myself, you know this would be a really great place to work. I went home. I looked up CIHI. There was a job posting for an analyst in mental health and addictions, and I worked there within two weeks.
02:28.69
Charlie Harp
That’s awesome.
02:29.51
Shannon O’Connor
Yeah, so that was 14 years ago. But yeah, it was really one of those moments that was sort of like a tipping point and really made me feel like I landed sort of where I was supposed to be.
02:41.63
Shannon O’Connor
So then once I joined CIHI, I had a few different analytical positions, and then eventually sort of landed in this standard space. And I just absolutely fell in love with the world of data standards and standardized data, and helped sort of build CIHI’s first data standards team and that’s the team that I now manage.
03:02.08
Charlie Harp
So for a lot of the listeners are from your neighbor to the south.
03:07.38
Shannon O’Connor
Yes.
03:07.86
Charlie Harp
So could you share a little bit about the mission of your organization and what you guys do?
03:12.63
Shannon O’Connor
For sure. So CIHI, I think, serves a really unique role within Canada’s health care system. So we’re an independent, not-for-profit organization. We were formed just over 30 years ago. And really, the goal was for CIHI to be a trusted…
03:27.64
Shannon O’Connor
source of neutral, pan-Canadian health data. So we collect, analyze, report on, and increasingly sort of help Canadians make sense of Canada’s health data.
03:40.12
Shannon O’Connor
So we have, I think, just over 28, 28-ish databases, and over 10 billion health records. So a huge, huge source of health data. And Canadians really use this data for a number of things. So it helps inform policy. It helps inform care decisions. so
04:00.41
Shannon O’Connor
We have long-term care data. You know, some of my neighbors have actually told me that I use CIHI’s data to sort of do a comparison between long-term care homes to see if that’s a place that I would like to place a family member. And then also for things like management and research. So it’s a really, really interesting organization and we do a lot of really cool work.
04:19.57
Charlie Harp
So with respect to, at a high level. You know. I have a pretty good understanding of how the U.S. health system works. When it comes to Canada. How does…How does the health system work in Canada? I know it’s provincial. There’s a lot of provincial activity.
04:41.16
Charlie Harp
but kind of at a high level, how does the health system work in Canada?
04:44.63
Shannon O’Connor
Yeah, it’s quite different from the way that things work in the U.S. So in Canada, healthcare care is largely publicly funded. So the federal government funds the provinces and territories to essentially manage their own health systems.
04:58.25
Shannon O’Connor
So you sometimes hear, and I sometimes say, we talked about the Canadian health care system, but there’s really 13-plus different health care systems. So one for each province and territory, and then we do have some federally managed services as well. So things like Veterans Affairs or correctional.
05:14.78
Shannon O’Connor
populations are managed by the federal government. So because of that sort of federated, decentralized model, you can imagine there’s a complete lack of standardization. So, each province and territory tends to do things a little bit differently. They have their own processes. They have their own standards. And currently today, there is no Canadian federal
05:37.88
Shannon O’Connor
interoperability legislation. So we are working hard to change that. But that really does lead to just sort of this lack of standardization across the country.
05:46.59
Charlie Harp
So in some ways, it’s analogous to… the state,s and the state Medicaid, Medicare systems we have here.
05:52.87
Shannon O’Connor
Yeah. Absolutely. I would say the key difference there is the publicly funded nature of the system. But I think that, the really cool thing about that is that I think it also represents a huge opportunity in terms of data. So CIHI’s CEO, Dr. Anderson Chuck, often talks about our data as one of Canada’s natural resources.
06:10.74
Shannon O’Connor
Because truly, because of the sort of single-payer nature of our health care system and the diversity of our population, when you put that data together, it is really a wealth of information and something that could be used, or better used for things like research and analysis, and even artificial intelligence.
06:29.58
Charlie Harp
Very cool. So one of the things that we’re going to talk about today was the CACDI.
06:36.75
Shannon O’Connor
Near and dear to my heart. It’s one of my favorite things to talk about.
06:41.46
Charlie Harp
Well let’s do it.
06:43.42
Shannon O’Connor
Yeah, so I can tell you a little bit of about the journey of the CACDI because I think that’s another interesting story. So a few years back, the federal government took action to sort of address this disconnected healthcare system. So they funded CIHI
06:59.09
Shannon O’Connor
to start to sort of build out some data standards to help address this problem. One of the other hats that I wear is that I’m a member of the HL7 Canada Council. I’m sure your listeners are familiar with HL7A.
07:10.70
Shannon O’Connor
You’ve had some previous episodes on it.
07:13.06
Charlie Harp
Yep.
07:13.37
Shannon O’Connor
So I went to, actually, my very first HL7 working group meeting in New Orleans. It was in 2023, I believe. And I was keen and excited and we were just kicking off our connected care work. And I remember talking to someone at one of the receptions and I wish I could remember who it was, but I can’t. And I was telling him about all of the work that we were doing, and you know how disconnected our health data was, and how we wanted to fix it. And he looked at me and he’s like Why don’t you just…
07:41.61
Shannon O’Connor
Copy what the U.S. did with the USCDI. And I didn’t have a good answer. I kind of looked at it and I’m like, I’m not sure. So, after that, I became a little bit obsessed with the idea. I researched the USCDI, lots of parallels, despite the differences between our healthcare systems.
07:58.52
Shannon O’Connor
Lots of shared challenges, and was really envious of the work that you folks had done in the U.S. to help advance interoperability. So, that idea stuck with me. I brought it back. I pitched it to the team. It took a little while, but essentially that’s what we’ve done is we have built out Canada’s National Health Data Standard, the Canadian Core Data for Interoperability.
08:19.59
Shannon O’Connor
And it has a lot of similarities to not only the U.S., but also some of the work that they’ve done in Australia as well.
08:25.57
Charlie Harp
I think it also, in a number of ways, advances the idea of what we did with USCDI in terms of, you know, instead of being kind of broad and code system based, you guys have
08:37.94
Charlie Harp
specific value sets you target, which I think, really increases the quality and usability of the data. Because saying this thing should be in SNOMED, you know, can be pretty broad and people often misuse terminologies, or they’re not pointed at a particular set of concepts. So it’s very cool the work that you guys have done the last two years and it looks like, you roll that out,
09:04.24
Charlie Harp
and then you expanded it this year.
09:06.62
Shannon O’Connor
Yep.
09:07.00
Charlie Harp
Has anybody, how much have you actually done with it? Have people actually modeled it against the data they have to see if they can comply with it?
09:17.85
Shannon O’Connor
It’s a great question. And I think that’s really sort of the next phase for us is that implementation phase. So we intentionally started very small with Version 1 of the CACDI and then we expanded it out with Version 2.
09:30.33
Shannon O’Connor
Version 3 is coming soon and then expands even more on that. But yes, we are starting to see some of our provinces and territories sort of start to look at the data that they have in relation to the CACDI,
09:43.61
Shannon O’Connor
and start seeing, you know, how well does my data align, where are some of those gaps, or where can we start to sort of adopt some of these standards to really help advance our data, not only within our provinces and territories, but also to enable us to share that data with other provinces and territories. And we’ve done similar things with vendors as well. So another sort of really interesting comparison between Canada and the U.S. is that a lot of our vendors are the same.
10:09.21
Shannon O’Connor
Particularly in sort of the hospital information system space. So I remember in the early days of the CACDI having a conversation with a vendor and saying, you know how hard would it be for you to adopt something like this?
10:20.66
Shannon O’Connor
And he said to me, well, if it matches the USCDI, it’s super easy because we already do that. So that’s something that we’ve sort of kept in mind throughout as well. Of course, there are nuances with the Canadian health care system. and we do want the CACDI to be reflective of those. But, in cases where we can, we have aligned it with the USCDI as much as possible.
10:41.22
Charlie Harp
Excellent. So, when somebody asks you the why question, because I get, you know, as you know, Data quality is near and dear to my heart as well.
10:51.87
Charlie Harp
And occasionally people ask me the why. Why do I care about this? Why do I need to do this? When people ask you the why question for CACDI, what do you typically say?
11:02.65
Shannon O’Connor
Yeah, it’s a great question. And I think my why really goes back to the patient. So that is sort of the North Star through all of this is so patients don’t need to repeat their medical history, so they don’t have to be in situations where maybe important information is missed or overlooked. I think the CACDI,
11:24.15
Shannon O’Connor
once implemented, will really help ensure that, that core set of data is moving across the system with the patient. And we know that that can do things like help increase public safety or patient safety, and also lead to less errors. So that’s really the why to me.
11:40.40
Shannon O’Connor
I had my own sort of experience with the healthcare system when I was pregnant with my daughter. I traveled to Canmore, Alberta, for my sister-in-law’s wedding. And long story short, I ended up in the ER. I was fine. It was pneumonia.
11:53.58
Shannon O’Connor
But I was very, very sick. And I remember walking into the doors of that emergency room and realizing very quickly, and I mean, I had already worked within the healthcare system for over a decade at this point, but was really shocked to see that the people in that emergency room knew nothing about me.
12:11.99
Shannon O’Connor
So they didn’t know if I had any allergies. They didn’t know the status of my pregnancy. Like it was really on me to provide all of that information. And I often think about that and reflect on it. And I think.
12:23.74
Shannon O’Connor
Obviously I was fine. But had I been someone who, English wasn’t my first language, or I didn’t know the information that they needed to know to be able to properly convey that.
12:33.65
Shannon O’Connor
If i had been unconscious, I think that situation could have turned out very differently.
12:39.44
Shannon O’Connor
To me, that really is part of the why for me, is working towards a future where no other patient is put in that situation.
12:46.91
Charlie Harp
I think that’s a fantastic goal. I think when people like us… who are pretty savvy when it comes to healthcare care information, and you find yourself in a situation where you’re struggling,
12:57.89
Shannon O’Connor
Mm-hmm.
12:58.11
Charlie Harp
I mean… as i As I’ve gotten older, unfortunately, I’ve spent more time in doctor’s offices than I’d like to. And you always have to fill out the forms. You always have to answer the same questions.
13:10.81
Charlie Harp
And because I’m fairly knowledgeable, I can do that with a certain degree of accuracy and completeness. I think. But I imagine people that, you know,
13:22.48
Charlie Harp
aren’t steeped in healthcare care, you know, aren’t steeped in the terminology and the things that we deal with, that it’s a struggle for them. And when I do things for, you know, my in-laws, my friends, and relatives when they find themselves in a situation.
13:37.68
Charlie Harp
It’s terrifying. And so, being able to not just have the data, but have the data be usable and right, I think is important.
13:49.65
Charlie Harp
I also think that, you know, patient outcomes and patient care is obviously a big driver, but the other thing that I find, that sometimes it astounds me that people don’t get, is that there’s all this other benefit, especially if you look at someplace like Canada.
14:10.28
Charlie Harp
or the NHS, where they have a national health care system, and they have, in Canada do you, forgive my ignorance, but do you guys have a national patient identifier?
14:22.00
Shannon O’Connor
We do not.
14:23.11
Charlie Harp
Okay.
14:23.22
Shannon O’Connor
yet.
14:23.26
Charlie Harp
Okay. So in that way you’re kind of like us, but from what I hear in the NHS, it doesn’t really solve their problem either. But I think being able to look at that data, especially if you’re the payer
14:36.16
Shannon O’Connor
Mm-hmm.
14:36.98
Charlie Harp
for the care, it’s got to give you insights that you wouldn’t get if the data wasn’t shared or wasn’t usable. Like when you look at CIHI and their data, and people kind of comparing the quality of care at a long-term care facility.
14:50.88
Charlie Harp
You would think that when you’re looking at, you know, what products are going to be paid for on formulary, what procedures are going to be
14:59.64
Charlie Harp
addressed, I would imagine having that data in a big normative, you know, high quality repository would be of huge value.
15:08.32
Shannon O’Connor
Absolutely, and I think standards are really the key to that. Like that is all fundamentally important but without, as you say, that sort of standardized data foundation, the data is really only as good as the standards that underlie it.
15:21.00
Shannon O’Connor
I mean, I’m obviously a data standards nerd, so it’s no surprise to hear me
15:23.40
Charlie Harp
No.
15:25.71
Shannon O’Connor
I truly believe that from the bottom of my heart.
15:26.29
Charlie Harp
Well.
15:28.86
Charlie Harp
I don’t know anything about no standards. I think that concept of the semantic normalization. In fact here’s kind of an interesting story. I was talking to somebody at the CDC recently
15:44.53
Charlie Harp
because we were doing something with PIQI. And I kind of went into it, and I felt bad afterwards, because I went to it thinking, well, you guys are going to want your own rubric.
15:53.78
Shannon O’Connor
yeah
15:54.12
Charlie Harp
for testing quality and which things you want to look at and everything else. And the person from the CDC, I won’t name names, but they said no. We want to use the USCDI 3.1 rubric because if that’s what everybody’s using,
16:07.91
Charlie Harp
why create another bar for people to have to achieve?
16:09.62
Shannon O’Connor
Absolutely.
16:12.12
Charlie Harp
And I just thought that that was incredibly, a very mature and smart way to think about it. Because very often in healthcare, people have their own niche of things they want.
16:23.21
Shannon O’Connor
Mhm.
16:23.46
Charlie Harp
And sometimes you’re like, no, no. That standard is not good enough. I think one of the amazing things about, whether it’s the USCDI or the CACDI, is that it creates kind of a qualitative threshold.
16:37.39
Shannon O’Connor
Yep.
16:38.20
Charlie Harp
that gives you at least the ability to look out at data and see how it measures up against that qualitative standard, and say, okay, I can use that data. And for the people that can’t, that haven’t met that bar,
16:52.11
Charlie Harp
you can go back to them and say, here’s what you need to do to meet that bar.
16:54.72
Shannon O’Connor
Exactly.
16:55.45
Charlie Harp
Here’s where you’re off base. So, the whole idea around it is amazing. And I think that it’s great that people are getting behind it.
17:05.31
Shannon O’Connor
For sure. And that it’s inspiring work in other countries as well is a pretty cool story too. And I know we have definitely benefited in Canada from the work that’s been done in the U.S., but as I said, also in Australia, and the collaboration between our countries has really been incredible.
17:21.96
Charlie Harp
I think that’s, I mean, that’s one of the great things about HL7. Is it can kind of convenes people, like-minded people together, and that way people aren’t reinventing the wheel from scratch.
17:32.27
Shannon O’Connor
Exactly.
17:32.75
Charlie Harp
learning from what other people have done. So…what’s the future look like for CACDI?
17:41.21
Shannon O’Connor
Great question. I think the future is very bright. So I say to people sometimes, and once again, I truly believe this, there really hasn’t been a more exciting time for digital health in Canada than I think right now. So we have had a bill introduced in our parliament. So it’s called Bill S-5, the Connected Care for Canadians Act.
18:00.75
Shannon O’Connor
That was introduced. last winter and I’m not sure how it works in the U.S., but in Canada our parliament sort of rises for the summer. So they are not sitting right now, but it had reached sort of its second reading right before Parliament
18:17.21
Shannon O’Connor
paused for the summer. So once that house comes back in the fall, we’re very, very hopeful that that bill will be passed. And once that happens, I think it sets off a chain reaction of things. The bill essentially will do two things. It will require digital health vendors
18:33.48
Shannon O’Connor
to comply to a specific set of standards. So we’re very hopeful that that will be the CACDI. And it also will prohibit information blocking. So very similar to the U.S. Cures Act. So once the bill is passed, I think sort of the,
18:48.13
Shannon O’Connor
I mean it’s all hard work, but the hard work begins on writing the regulations. So that’s where we’ll get to see what standard, and sort of what are those requirements for digital health vendors. I’m very hopeful that CACDI will make its way into that legislation and then we’ll be in a situation where provinces and territories will sort of have that legislative incentive to implement the standard.
19:10.42
Charlie Harp
That’d be wonderful. Maybe you come back and tell us about it when it happens.
19:13.24
Shannon O’Connor
Yeah, that would be great.
19:14.54
Charlie Harp
That’d be great. So. If you had a magic wand, and you could make anything magically happen with that wand. Let’s keep it scoped within healthcare.
19:25.54
Charlie Harp
What would you make happen?
19:29.59
Shannon O’Connor
That’s a great question. Truly, I think the easy answer is getting the CACDI into those regulations. Like that has been my magic wand laser focus for the past few years.
19:41.47
Shannon O’Connor
But I think also. I’d say that’s answer number one A. Number one B would be for Canada to find a way to really unlock the power of that health data. So once again, we’re sitting on just this wealth of information.
19:58.98
Shannon O’Connor
We’re sort of in a situation where our healthcare system is under a lot of stress. So wait times are increasing, we have a primary health care staffing crisis, so many Canadians don’t have a family doctor.
20:12.20
Shannon O’Connor
Can we use sort of the power of that data and information to help find efficiencies across the system, to help sort of build more intelligent healthcare system? I don’t know if that’s something that could even be solved with a magic wand, but that would be sort of my other wish. Would be
20:28.57
Shannon O’Connor
for Canada to unlock the power of its health data in a way that benefits the system and benefits Canadians.
20:34.24
Charlie Harp
I think that’d be a good wish for the U.S. too.
20:36.21
Shannon O’Connor
Yeah.
20:36.15
Charlie Harp
I think we have a lot of the same type of problems, and I know a lot of people are looking to AI to help maybe solve some of that, and as somebody who’s been working in this industry for
20:49.76
Charlie Harp
a very long time. My big fear is that we’re going to unleash some of the amazing capabilities of generative AI against the data that we have.
21:01.23
Charlie Harp
And the result is not going to be ideal just because of the nature of the data that we have.
21:06.45
Shannon O’Connor
Yeah.
21:06.51
Charlie Harp
I think cleaning up the data, because you’re right, at least in the U.S. We have a staffing crisis, in terms of the number of providers. We have
21:17.37
Charlie Harp
you know, people with more comorbidities. We’re also ratcheting up the amount of data in the U.S. I think it doubles every 73 days.
21:25.98
Shannon O’Connor
Wow.
21:26.51
Charlie Harp
When you start thinking about precision medicine and,
21:29.23
Shannon O’Connor
mm-hmm
21:30.21
Charlie Harp
data. You know, talk about a tsunami for a provider trying to reckon with everything for a patient. We really need data and technology to help us get through it all.
21:45.54
Charlie Harp
And the data quality. Part of the reason why with PIQI. Now was the time for PIQI for me to introduce this two years ago was,
21:55.94
Charlie Harp
we have to do something. We have to rely on the data. And so initiatives like USCDI, CACDI, AUCDI in Australia creating something where we can actually understand, say, here’s the requirement for usability.
22:09.84
Shannon O’Connor
Mm-hmm.
22:10.43
Charlie Harp
And then try to understand that. I think is an important part of our evolution as healthcare ecosystems.
22:16.12
Shannon O’Connor
Yeah.
22:19.16
Shannon O’Connor
I would agree
22:19.76
Charlie Harp
I’ll tell you what, you take the first wish, I’ll take the second wish. If we only get one wish between the two of us, we’ll have it covered.
22:26.47
Shannon O’Connor
Deal. I was going to say too, maybe it can be a global magic wand.
22:29.74
Charlie Harp
Yeah, yeah.
22:30.57
Shannon O’Connor
Just wave it all across the world.
22:30.45
Charlie Harp
There’s no reason why we can’t. It’s a wish. Why keep it local? Anything else that you want to share? Is there anything about you that nobody would suspect that you want to disclose at this point?
22:45.54
Charlie Harp
We already know you were an aspiring lawyer before you decided to put your amazing talent to work to benefit healthcare.
22:49.07
Shannon O’Connor
I don’t think people would suspect that.
22:54.27
Shannon O’Connor
Something about me that no one would suspect? I know something that sometimes surprises people.
23:00.68
Charlie Harp
Yeah.
23:01.11
Shannon O’Connor
Is that I, so my family is big into golf.
23:05.17
Charlie Harp
Yep.
23:04.95
Shannon O’Connor
So when I was in high school, I actually taught kids how to golf. That was my summer job. I don’t know why that surprises people, but I know when I tell people that they’re like, really? Maybe because I’m a terrible golfer now, but.
23:18.05
Charlie Harp
Well, I’ve always been a terrible golfer, so.
23:20.56
Shannon O’Connor
People do.
23:20.72
Charlie Harp
Maybe when we get together, you can give me a lesson.
23:20.91
Shannon O’Connor
At one phase of life people did somehow trust me to teach their children how to golf, so, yeah. I don’t know if that’s surprising, but.
23:28.91
Charlie Harp
Are there any famous golfers now that you will lay claim to as your protégés?
23:32.61
Shannon O’Connor
I wouldn’t like claim to them, but Brooke Henderson is doing some pretty cool stuff at Canadian.
23:37.64
Shannon O’Connor
I have no claim to her. Absolutely not. but Yeah.
23:42.66
Charlie Harp
all right Well, hey, thank you so much for being on the podcast today. I really appreciate it.
23:47.06
Shannon O’Connor
Thanks, Charlie. It was great to chat with you and very excited about all of this in the future and what’s to come. so
23:52.81
Charlie Harp
likewise we’re going to have you back on we’re going to talk about what happens with Bill S5 and maybe we can do kind of a recap. Are you going to be at the HL7 meeting in September?
24:01.87
Shannon O’Connor
I will be, I’m really looking forward to it.
24:03.79
Charlie Harp
I’ll see you there.
24:04.76
Shannon O’Connor
Yeah, we’ll finally meet in person.
24:05.36
Charlie Harp
All right.
24:06.06
Shannon O’Connor
I can’t wait.
24:06.68
Charlie Harp
Yeah. Thank you so much.
24:08.35
Shannon O’Connor
Thanks, Charlie. Great to talk to you.
24:10.19
Charlie Harp
Alright, I’m Charlie Harp, and this has been…
24:13.51
Charlie Harp
another exciting episode of the Informonster Podcast.



