Story written by Qurrat Ul Ain.
A pandemic-born network of Canadian emergency physicians, hosted at the University of British Columbia, has become the world’s largest emergency medicine research infrastructure and is now ready to combat health emergencies in a fraction of the time.
When Dr. Corinne Hohl, an emergency physician and Department Head of Emergency Medicine at the University of British Columbia (UBC), walked into the emergency department during the COVID-19 pandemic, she was worried. Patients, families, and caretakers were worried. People had questions, and she remembers not having enough information to answer them.
“We were watching the news from China and northern Italy and Seattle and recognizing that we didn’t know really very much at all about this illness [COVID-19], and that we would be faced with looking after these patients and potentially getting infected and potentially infecting our patients, our families,” recalls Dr. Hohl.
In that time of uncertainty, Dr. Hohl co-founded the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN), a unified national infrastructure that collected harmonized, real-time clinical data, all connected by shared governance and data-sharing policies across Canada to better understand the unknowns of the health crisis and little did she imagine how this would transform our preparedness for future health emergencies.
Act I: One agreement to connect a country
CCEDRRN’s true breakthrough lies as much in clinical discovery as in its systemic innovation.
Traditionally, launching a multi-center patient registry across Canadian provinces is an administrative marathon. With more than 20 institutions involved, each with its own ethics board, privacy laws, and contractual requirements, the paperwork alone takes years. During a public health emergency, those delays kill people.
“Because it’s health data, institutions are very, very careful with transferring such data to others. Factors like privacy, research ethics, and consent from patients [weigh in], so it’s not something you’re just going to share without the proper paperwork in place”, notes Lisanne Boon, Senior Contracts Advisor on Innovation UBC’s Sponsored Research team.
However, the team achieved the seemingly impossible. Boon worked with the research team of CCEDRRN to design a single overarching agreement that allowed for seamless data sharing, using pre-cleared ethics framework templates, and a secure, remotely accessible data architecture.
“Because of the urgency... we were able, within a matter of just two weeks, to get an agreement signed by provincial leads across Canada”, said Boon. Over 20 major research institutions and health authorities eventually signed on, allowing clinical data to flow safely into a harmonized database from over 50 emergency departments. This was unprecedented.
The resulting platform delivered crucial clinical insights during the pandemic. During the Omicron surge in the holiday season, hospital admissions began to rise again; BC’s Deputy Provincial Minister of Health called Dr. Hohl. The question was urgent: “Is the new rise in admissions being caused by the newer, more contagious Omicron variant, or remnants of the last Delta wave?” The answer could inform whether or not the province would need to reimpose stricter lockdown restrictions, she recalled. CCEDRRN’s rapid data provided the answer that raw admission numbers could not: “roughly 50% of admitted SARS-CoV-2-positive patients were actually asymptomatic incidental cases, admitted for trauma”, allowing policymakers to make more calibrated decisions. “That finding helped inform the province’s decision not to lock down again.” She added.
This research-to-policy link traditionally takes years to develop but seconds to utilize, made possible by infrastructure. And for the first time in Canadian history, it is doing so at the scale and frequency needed to make the warning count.
Act II: CCEDRRN to CEDRN; real-time intelligence for health emergencies
During the catastrophic 2021 Pacific Northwest heat dome, emergency rooms were overwhelmed by sudden mortality, with deceased individuals being pulled from condos. The Climate Institute of Canada requested that the same infrastructure be repurposed to track heatstroke. And that moment, when this pandemic tool pivoted to climate disaster without missing a beat, became the proof of concept for the Canadian Emergency Department Research Network (CEDRN), the infrastructure born for COVID, but built to outlast it, for any health emergency.
CEDRN encompasses 88 emergency departments across seven provinces, making it the world’s largest emergency medicine research network. Innovation UBC’s sponsored research team provides contractual support to enable the network’s activities as efficiently as possible, while the Vancouver Coastal Health Research Institute (VCHRI) offers operational space.
Today, CEDRN supports real-time surveillance and risk prediction across three critical health domains: I: Opioid poisoning by developing a mortality prediction tool to address over 20 Canadian deaths daily; II: Chest pain and cardiac risk stratification to optimize emergency resource allocation; and III: Pandemic-preparedness and health emergencies surveillance for emerging respiratory threats. This multi-domain approach demonstrates how the network flexibly adapts its infrastructure to address evolving public health needs, according to Amber Cragg, Research Manager at CEDRN. “ In a fraction of the time taken during the pandemic [COVID-19].”
Act III: Equity, Sovereignty as Systemic Innovation
A core strength of CEDRN is its commitment to equity and inclusive governance.
The network’s governance ensures research is shaped by all the people it is designed for. Dr. Stirling Bryan, Interim Executive Director at VCHRI, describes this as “truly patient-oriented research.” “One of the things that CEDRN does incredibly well is to reflect on other interest holders who need to be at the table. It is a great example of doing truly patient-oriented research,” he said.
An Indigenous Advisory Committee (IAC) led by Dr. Chenoa Matthews, anishininewak (Sachigo Lake First Nation), population health epidemiologist with the VCHRI’s Indigenous Health Research Unit, and incoming Assistant professor at UBC’s School of Population and Public Health, reviews research proposals and analytic plans to ensure that when researchers have findings about Indigenous patients, they interpret them appropriately. The committee, which includes pan-Canadian representation from First Nations, Métis, and Inuit communities, is an attempt to, as Dr. Matthews, “to build something in a good way from the start.”
“The committee reviews proposals to ensure that their actual plan is headed in the right direction. They have the right partners engaged. They have the right framing, epidemiologically speaking, of the question at hand or how they plan to represent Indigenous people and other ethnicities in the context of their research question. As well, we’re hoping to have opportunities to be a part of the interpretation of findings even when nation-specific identifiers don’t exist,” said Dr. Matthews.
A formal Patient Engagement Committee (PEC) embeds citizens and patient partners into research design as collaborators, ensuring studies reflect real patient priorities. By integrating directly into electronic medical records (EMRs), CEDRN builds research capacity at small centers, enabling their participation in multi-site studies. This allows regional and rural emergency departments to access standardized research and mentorship, and contribute data, enhancing the applicability of findings to under-represented populations.
