Stroke is the cause of over 50,000 hospitalizations each year in Canada. ^{Reference Holodinsky, Lindsay, Yu, Ganesh, Joundi and Hill1} To guarantee quality care consistent with best practices and identify health inequities based on geographic and sociodemographic factors, the retrospective evaluation of practices using data registries constitutes a key strategy. ^{Reference Yu, Bravata, Norrving, Reeves, Liu and Kilkenny2} The study recently published in the Canadian Journal of Neurological Sciences by Yu et al. (2025) highlights the importance of clinical-administrative data registries to evaluate and improve stroke management. For over 20 years, the Ontario Stroke Registry (OSR), originally known as the Registry of the Canadian Stroke Network, has managed to monitor trends in care, identify gaps in practice and guide interventions to improve quality of care and services, particularly regarding the hyperacute phase of ischemic stroke. ^{Reference Yu, Silver, Fang, Hill, Lindsay and Kapral3} The OSR has supplied essential data to clinicians, researchers, administrators and knowledge users in terms of influencing policies for the development and implementation of stroke care and services, notably the optimization of intravenous thrombolysis administration and the expansion of stroke care units. ^{Reference Yu, Silver, Fang, Hill, Lindsay and Kapral3} Additionally, the longitudinal analysis of this registry in the abovementioned study offers a global perspective on the limitations and strengths of implementing such infrastructures and how they contribute to the continuous improvement of practices in the neurovascular domain. ^{Reference Yu, Silver, Fang, Hill, Lindsay and Kapral3} A key strength of the OSR, moreover, is its capacity to include data representative of all stroke patients in Ontario, including those treated in rural areas or admitted to non-university or non-research centers, thereby favoring a more inclusive evaluation of quality of care. ^{Reference Yu, Silver, Fang, Hill, Lindsay and Kapral3} Furthermore, the possibility of linking OSR clinical data with Ontario’s administrative data has made it possible to enrich practice assessment while considering additional information such as deaths, readmissions for stroke recurrence and other health-related results, thus providing a more complete picture of stroke. ^{Reference Yu, Silver, Fang, Hill, Lindsay and Kapral3} However, this registry, initially designed for Canadian deployment, could not be maintained over time for all of Canada, because data collection was limited to the provinces of Ontario and Nova Scotia for feasibility reasons. ^{Reference Yu, Silver, Fang, Hill, Lindsay and Kapral3}

Now, the situation proves very different in Canada’s other provinces, particularly Quebec. Health data in this province are generally fragmented and often unavailable for systematic and comparative analyses. ⁴ This raises major issues concerning, in particular, the evaluation of clinical and organizational practices related to stroke. What’s more, in the absence of a database containing valid, relevant and measurable quality indicators in Quebec’s different types of healthcare centers, ^{Reference Bélanger, Beaudet, Lapointe and Houle5} it becomes difficult to identify regional disparities, optimize interventions and ensure equity in the management of ischemic stroke patients. While Canada does much to improve the quality of health data and their use for research and societal purposes, Quebec to date has been excluded from most pan-Canadian research, including studies on strokes. ^{Reference Holodinsky, Lindsay, Yu, Ganesh, Joundi and Hill1}

The example of the OSR clearly illustrates how a structured registry and systematized and digital data collection can positively impact the improvement of clinical and organizational practices over time. ^{Reference Yu, Silver, Fang, Hill, Lindsay and Kapral3} However, this registry is mainly based on time-dependent indicators related to the pre-hospital and hyperacute phases of ischemic stroke. ^{Reference Yu, Silver, Fang, Hill, Lindsay and Kapral3} In Quebec, for example, some of these practices are evaluated by the Institut national d’excellence en santé et services sociaux (INESSS) using data collected and available in the province’s five thrombectomy centers. ⁶ As a result, few retrospective studies evaluate the quality of interdisciplinary practices regarding ischemic acute stroke in differently designated centers in Canada or Quebec.

Solutions must be implemented specifically in each province in order to ensure the quality, accessibility and comparability of health data. For example, although Quebec has certain registries such as CARTaGÈNE ^{Reference Awadalla, Boileau and Payette7} and the Quebec Integrated Chronic Disease Surveillance System (QICDSS), ^{Reference Blais, Jean and Sirois8} these registries mainly focus on epidemiological data pertaining to chronic or genetic diseases. Moreover, few health establishments in Quebec have digital health record (DHR) search engines and searchable data. The few centers using such infrastructures currently tend to have digital records where data extraction is manual, complex and consuming of time and resources due to accessibility and availability challenges. These include the Purkinje Electronic Health Record (EHR Purkinje) and the Open Architecture Clinical Information System. However, the DHR with EPIC Systems Corporation’s platform, a priority project supported by the Government of Quebec, aims to create a single registry gathering under one roof the clinical-administrative health data of patients in the province. Although the DHR is fundamental to collecting and organizing health data, it is essential to specify the interdisciplinary information to enter and to identify strategies favoring the implementation and continuity of effective registries in various clinical contexts such as stroke.

By learning from the OSR ^{Reference Yu, Silver, Fang, Hill, Lindsay and Kapral3} and considering the realities specific to each province including Quebec, a solid and lasting data infrastructure can be built for patients in the acute ischemic stroke phase and for the continuum of care as a whole. The implementation of registries, combined with the integration of DHR search engines, will allow clinical-administrative data to be optimally used for clinical, research and management purposes. This effort is essential in order to evaluate and improve practices for interdisciplinary stroke management in Quebec and other provinces in Canada.