“We’re not putting the patient first. We’re putting the citizen first,” says Scott McKenna, chief information officer for Nova Scotia Health and CanadianCIO Public Sector CIO of the Year. “Because the citizen isn’t always the patient. We’re consumers of services, and we make choices as consumers.”
That idea has become the foundation of Nova Scotia’s health transformation, an effort to rebuild the province’s digital infrastructure around the people who use it, rather than the institutions that run it.
The work began three years ago, when McKenna returned to his home province after a three-decade career in the federal public service, including as CIO for Health Canada and the Public Health Agency of Canada.
“I came back to Nova Scotia because we have leadership here that wants to transform,” he says. “We have a premier, a minister, and a CEO who are 100% behind it. They’ve removed barriers and let us run.”
For anyone running a complex system or leading a digital transformation, Nova Scotia’s approach has a lot to teach. They started by thinking about people, not processes, and then built the tech, the rules, and the data around that.
The result is a system that actually works for citizens, connects different players seamlessly, and gives leaders the insight they need to make smarter decisions. The hardest part of transformation is making all the pieces line up so the technology actually gets used.
Putting the citizen first
For McKenna, the starting point was trust.
“Digital isn’t about technology,” he says. “It’s about data and people.”
He wanted Nova Scotians to feel the same level of confidence in their health system as they do in online banking or other digital services.
“For decades, the financial industry has set an expectation that we can access our financial information anytime, anywhere, any place. In health, we can’t get some of our health information. That’s unacceptable.”
To make that shift, his team mapped the health experience from the citizen’s point of view.
“It’s an incredibly complex system,” McKenna says. “People want to know where they can get care, what’s available in their community, and that their information is secure and trusted. Clinicians want the same thing. They don’t want to spend time searching for information.”
That principle of meeting citizens where they are became the lens through which every technical and policy decision was made.
Building a foundation for access
In early 2023, the province finalized a digital strategy to improve citizen access and connect information spread across hundreds of hospitals, clinics, pharmacies, and virtual care systems.
The team adopted the international Fast Healthcare Interoperability Resources (FHIR) Release 4 data standard, ensuring Nova Scotia’s systems could connect with global best practices.
“Nova Scotia isn’t a big enough jurisdiction to drive the market. Canada isn’t either,” McKenna says. “So we landed on an international standard, because that’s what industry will align to”.
The province then invested in integrating and transforming data across providers, creating what McKenna calls “a comprehensive health record for every Nova Scotian.”
That record underpins the province’s ability to deliver secure, citizen-facing digital services and supports what he describes as “real transformation, not modernization with technology.”
Making interoperability a legal requirement
Technical alignment was only half the equation. In 2023, Nova Scotia introduced new regulations under the Personal Health Information Act that made health data sharing mandatory.
“Any health provider regulated in Nova Scotia must provide us the health record,” McKenna says. “That allowed us to bring it together for the Nova Scotian. It’s their data.”
The legislation required all regulated providers to share health records with the province. To avoid adding work for smaller clinics, the province took on the technical job of connecting systems and managing data.
“We asked no effort, no work from providers,” McKenna says. “We’ve done that work on the back end to build the data infrastructure and those pipelines.”
The change digitalized what McKenna calls the province’s “circle of care.” Information that once moved by fax or phone can now be shared securely among clinicians and patients.
“It’s approved now for that circle of care around the citizen,” he says. “What we’re doing now is digitizing that so it can be at people’s fingertips where it should be.”
Redefining engagement through convenience
In November 2023, the province launched YourHealthNS, a digital platform that provides citizens with a single access point to the province’s health system.
“We wanted to provide Nova Scotians a front door to the health system, not the hospital system,” McKenna says. “We wanted to put the power in the hands of citizens so they could figure out where to go for what and build that trust relationship”.
The platform has been widely adopted by Nova Scotians, with more than 800,000 downloads to date. Citizens can book appointments, find reliable information, and securely access records.
“If people want to share data from their phone or wearable, that could help prompt new ways of engaging — reminders, prescriptions, wellness tracking,” McKenna says. “The possibilities are endless.”
Feedback has been strong: 98% of users said they would continue using the app, and 97% said they understood their health information better.
Clinicians have also embraced it.
“Our clinicians are some of our biggest champions,” McKenna says. “They want to use this tool to help their patients navigate and manage their health.”
McKenna points to that collaboration as proof that transformation depends on engaging people early and across every layer of the system.
For leaders facing similar change, it shows that progress comes from bringing stakeholders into the process from the start, earning trust through participation, not persuasion.
Leading change in the public sector
McKenna believes transformation in public systems requires courage and persistence.
“One of the biggest differences between private and public sector isn’t bureaucracy. It’s the level of risk we need to take,” he says. “We can take great risk, but it must be calculated because these are Nova Scotians’ tax dollars.”
He often returns to the simple idea that if the work feels easy, the system isn’t changing fast enough.
“Transformation is not easy,” he said at the CIO Association awards. “But when you set the bar high, people can achieve incredible things.”
Nova Scotia’s effort is far from over, but its direction is clear. By focusing on citizens first and building everything else around that goal, the province is working to redefine what digital healthcare can mean in the public sector.
“Every Canadian deserves better,” McKenna says. “We’re setting the bar extremely high, and I want us to be held to account. Because that’s how we all learn, and that’s how we get better.”
Final Shots
- Nova Scotia’s health transformation shows how citizen-first design can realign complex systems around public value.
- Interoperability is achievable when data standards, legislation, and leadership move together.
- Early and broad stakeholder engagement builds the trust needed for sustained change.
- Convenience and transparency aren’t perks in public service delivery, they’re expectations.
- Transformation at scale is less about technology adoption than about maintaining focus, accountability, and shared purpose.
Digital Journal is the national media partner for the CIO Association of Canada.
