HALIFAX, NS, June 15, 2026 – Canadian healthcare technology buyers are entering e-Health26 with a more demanding procurement agenda, according to new findings from Black Book Research. The firm’s 2026 Canada Digital Health Market Outlook shows that health systems are placing stronger emphasis on interoperability, Canadian data governance, AI controls, cybersecurity, workflow automation and measurable return on investment.
The report is based on a survey of 212 Canadian healthcare IT, digital health, privacy, clinical informatics, procurement, analytics and health-system leaders. Black Book says the findings point to a new phase in Canada’s digital health market, where buyers are no longer focused mainly on digitizing records.
Instead, they are asking vendors to prove that technology can connect systems, protect health information and deliver measurable value in daily clinical and operational work.
As Canada’s digital health community prepares to gather at e-Health26 in Halifax, the report finds that 18% of surveyed respondents are attending or planning to attend the event. Participating buyers said they will be evaluating vendors, exhibitors and sponsors based on the priorities now shaping Canadian health IT purchasing.
Interoperability Becomes a Core Buying Requirement
One of the clearest findings in the report is the growing importance of interoperability. Black Book found that 96% of Canadian healthcare IT buyers now say interoperability conformance is either mandatory or heavily weighted in their next major request for proposal or renewal.
The report suggests that broad integration promises are no longer enough. Buyers want evidence that solutions can support FHIR and API readiness, patient-summary exchange, data portability, transparent API economics and real Canadian integration references.
Black Book said the next Canadian buying cycle will not be defined only by who owns the health record. Instead, the key question is whether data can move across hospitals, primary care, community care, labs, imaging, pharmacy, long-term care, referral systems, patient-facing tools and provincial digital assets.
Data Sovereignty And AI Governance Move Into Contracts
The survey also shows that Canadian data sovereignty has become a major trust requirement. According to Black Book, 88% of respondents require or prefer Canadian data residency for sensitive digital health workloads.
The report notes that buyers are now looking beyond the location of the primary cloud region. They are also examining backup location, support access, subprocessors, cross-border controls, use of protected health information, termination rights and migration rights.
AI governance is also becoming a contract-level issue. Black Book found that 74% of respondents prohibit vendors from using Canadian protected health information for AI training unless explicitly authorized in writing.
This finding reflects a wider shift in how health systems evaluate artificial intelligence tools. Buyers are asking not only whether AI can improve workflow, but also how data is governed, how consent is handled and how patient information is protected from unauthorized secondary use.
Workflow ROI Becomes The Language Of Funding
Black Book’s report also highlights growing pressure to prove financial and operational value. The survey found that 82% of Canadian digital health investments now require measurable business or operational impact evidence before approval.
Buyers are prioritizing technologies that can reduce clinician documentation time, speed referral completion, lower manual work, reduce duplicate data entry, improve access and produce more predictable five-year total cost of ownership.
At the same time, funding new models remains a challenge. Black Book found that 70% of respondents say SaaS, AI, cloud or managed-service subscriptions are harder to fund than traditional capital projects. That creates a more complex sales environment for vendors trying to introduce subscription-based innovation into publicly funded health systems.
Canadian Vendors Gain Momentum Around Existing EHRs
The report does not describe the Canadian market as moving away from global enterprise health record platforms. Instead, Black Book says buyers are increasingly looking for Canadian and Canada-rooted vendors that can work around existing EHR environments.
In Black Book’s Canadian Vendor Buying-Cycle Fit Ranking, Smile Digital Health ranked first with a score of 89 out of 100, driven by its FHIR-native interoperability and standards-aligned health data infrastructure. TELUS Health ranked second with 87 out of 100, reflecting its Canadian digital health scale and platform breadth.
Novari Health / VitalHub ranked third with 85 out of 100 for referral management, central intake, waitlist management and access-to-care modernization. Petal ranked fourth with 82 out of 100 for care orchestration, scheduling, capacity optimization and workforce coordination. HEALWELL AI / WELLSTAR ranked fifth with 80 out of 100 for AI platform readiness, clinical data intelligence and AI-enabled workflow automation.
Other vendors identified in the ranking include AlayaCare, OceanMD, Verto Health, ThinkOn, Hypercare, CANImmunize and Tali AI.
Black Book emphasized that the ranking measures buyer-cycle fit, not market share, endorsement, sales volume or vendor influence. The firm said the strongest performers are those most closely aligned with interoperability, Canadian data sovereignty, AI governance, workflow ROI, cybersecurity, platform optionality and total cost transparency.
Global EHR Vendors Remain Central, But Supplemental Buying Is Changing
Global EHR vendors continue to play an important role in Canada’s acute care market, according to the report. These platforms remain central to enterprise record-keeping and large-scale clinical systems.
However, Black Book says the incremental buying cycle is shifting around the core EHR. Health systems are increasingly prepared to surround established platforms with supplemental solutions that address interoperability, referral management, access, workflow automation, AI governance and sovereign-data needs.
This shift suggests that Canadian buyers are not necessarily looking for full system replacement. Many are seeking targeted tools that can work with existing infrastructure while delivering faster proof of value.
e-Health26 Arrives At A Key Procurement Moment
With e-Health26 taking place in Halifax, Black Book says the event arrives at an important moment for Canadian digital health procurement. Buyers attending the conference are expected to look for vendors that can answer practical questions now appearing in Canadian RFPs.
Those questions include whether a solution can exchange structured data across care settings, meet Canadian data residency and support-access requirements, restrict protected health information use in AI training, reduce clinician workload, lower referral delays, control operating costs and provide realistic five-year affordability projections.
Black Book’s findings suggest the strongest vendors in the 2026 to 2028 cycle will be those that can prove value contractually, technically, operationally and financially. Claims about interoperability, AI readiness, sovereign data handling and workflow improvement will need to be backed by evidence.
Report Points To A More Disciplined Digital Health Market
Doug Brown, Founder of Black Book, said the survey points to a more disciplined stage of Canadian digital health transformation. He said providers are no longer treating interoperability, data sovereignty, AI governance, cybersecurity and workflow ROI as separate issues.
Instead, health systems are using them together as procurement tests. According to Brown, Canadian buyers are moving beyond whether technology can be deployed and asking whether it can be governed, connected, paid for and shown to improve work at the point of care.
The Canada Digital Health Market Outlook 2026 surveyed leaders across hospitals, health authorities, provincial and pan-Canadian digital health roles, primary care, community care, long-term care, diagnostics, mental health, payers and healthcare operating organizations.
The findings indicate that Canada’s next digital health buying cycle will reward vendors that can provide clear evidence, local trust, practical integration and measurable operational impact.
