This is very well expressed. Because I work in Canada, the outcome won't have direct impact for the Ontario Cancer Registry. However, while the political challenges differ and also the Registry itself is an in-house product, we do use two of the CDC "Plus" products as data feeds. A downside for us would be CDC having to produce more complex systems for the U.S. market that would be burdensome for Ontario Health to maintain (with little justification too, since the extra functionality would be unused here).