A Health Platform for all Canadians: National Agenda, Local Enablement

We are all well familiar with the impact of Canada’s fragmented healthcare systems on maintaining parity of services and access to care across provincial jurisdictions. The variances in funding, in governance and coordination of care (or lack thereof), in procurement practices, and among healthcare priorities create an environment that makes innovation a challenge and scaling successful digital health initiatives nearly impossible.

Yet, despite this challenging history, today I am highly optimistic about Canada’s healthcare path forward. In some respects, it’s a net-new path. Advancements in technology, digital health, early adoption and citizen demand have created a new way forward. In other respects, it’s a well-trodden path for those willing to look slightly outside of the box. Consider Participaction.

Does anyone remember Canada without Participaction?
Yes, Participaction. Whether you are old enough to remember the launch of this iconic program in 1971 or not, chances are you’re familiar with the now dated, but famous 15-second public service announcement, “the 60-year-old Swede.” In it, an elder Swede jogs effortlessly beside a puffing 30 year-old Canadian. While the PSA ran only six times during the Canadian Football League games in 1973, it made its mark, sparking debate in Parliament and shaming Canadians into admitting they needed to ‘do more than just think about it – do it!’

I believe there is a lot we can learn from this long-standing national non-profit whose simple mission remains to help Canadians sit less and move more.

First, the program’s approach is focused on a single goal for Canada: become less sedentary and more active.

Second, it is regionally flexible: its “think national, act local” approach to get Canada moving provides a framework that individuals and their communities can adopt and make their own. It’s not one-size fits all. It’s one mission fits all, with guidelines and basic tools to allow communities to drive it forward their way.

In a similar vein, why couldn’t we adopt a national approach to health IT infrastructure for Canada that is defined and delivered on a provincial level? This is where the net-new path comes in.

Canada’s national digital health infrastructure is alive and well
In May of this year Canada Health Infoway announced PrescribeIT, a single, national ePrescribing system for which TELUS Health is the technical solution provider. This ePrescribing service is a national first for Canadian healthcare, exemplifying the notionof a national mission – a service for all Canadians – with regional delivery. The process from contracting to execution has been extremely rapid (just a few months) and employs an agile approach that is in itself net-new, especially at a nation-wide level. The service launched in Huntsville Ontario at the end of August and will be rolling out in other provinces in coming months.

Digital healthcare in Canada is the cornerstone to resolving many of the challenges common from province to province. With a national platform now established, it can be extended to enable other digital health priorities that matter to all Canadians, such as providing more efficient access to care, making it easy and convenient for citizens to take a more active role in their own care or monitor their own health.

But don’t just take my word for it.

The health of our population is in need of a digital booster shot According to the 2017 TELUS Health Digital Life Survey, 58 percent of older Canadians agree that digital technology would help them better connect with their healthcare provider but only 20 percent currently use it. Similarly, a new study funded by Canada Health Infoway found that 24 percent of Canadians use smart connected devices to track health conditions or well- being, but are typically younger adults between the ages of 18 and 30.

The issue seems to be more about actually using digital health technology; not questions as to its efficacy. These same studies report that 87 percent of Canadians agree that accessible, secure information-sharing between individuals and healthcare professionals would have a positive impact on the health of Canadians. Yet, while 32 percent of Canadian adults consult health apps on their mobile devices, only 28 percent of those in poor health do so.

What’s needed is a digital booster shot that can address this issue. Its effectiveness lies in linking apps to clinical data, so that individuals are able to engage with highly personalized and complete health information. This is the consumer value that has been missing thus far and that will drive stronger, consistent
use of health technologies.

An open, national health platform for Canada can serve this purpose by providing an avenue upon which to unleash creative, entrepreneurial talent, focus it on health and give citizens access to a variety of solutions.

Game-changing opportunities enabled by an open, national platform
As an open, not proprietary platform, innovations can be curated at a provincial level and offered to citizens. Configurable for each province,the platform can draw on the data repositories and other unique systems that are already in place. This can open a host of game-changing opportunities for the health of citizens, for the health system itself, and for innovators. For example:

  • Canadians will have a single source from which to access applications, designed by numerous innovators and curated by each province, that deliver modern-day conveniences like online bookings, electronic consultations and messaging with healthcare providers.
  • At a national level, Canada can be assured of infrastructure that can be leveraged to revitalize healthcare, successfully scale innovations and enable unprecedented opportunities for pan-Canadian collaboration and the creation of new marketplaces.
  • Provinces will have a health-focused economic innovation engine that can support local innovation, start- ups and industry development.
  • Innovators will have a sustainable platform with gold standard security, identity management and other pre-built essentials on which to build applications that can be expanded to multiple
    jurisdictions across the country.

Why is being patient-centred so hard?
There is a lot of focus placed on creating a patient centred health system, and rightly so. I believe that it will become a lot easier when we give citizens the tools they are demanding, ensure they deliver simple, but comprehensive health value and enable connected care. To get there, we need to collectively find our way around three primary sticking points:

  1. Funding inertia. We need to re- think how we fund digital health. This is not a single-payer proposition. In other words, placing the full cost burden on governments is not appropriate nor is it likely to generate a new path forward. Perhaps there are hybrid models to consider, including a combination of public funding, operational funding and user fees. Perhaps there is a role for employers and insurers as well.
  2. Health platform = infrastructure≠ apps . A health platform should be thought of like infrastructure that others can leverage, develop apps for, and use for the benefit of all Canadians. In this way it can be national, open and adaptable to meet the unique requirements of jurisdictions across the country.
  3. Deliver consumer value. We need to warrant that high personal value is delivered by health apps to ensure people continue to use them. Linking to clinical data is essential. When we can link apps to clinical data the patient experience becomes rich and developers can then build solutions that are customized to individual’s managing specific conditions, such as diabetes. And, we must also link to care providers who provide context and a trusted touchpoint to patients in interpreting information and collaborating on care plans.

As I mentioned at the outset of this article, I am highly optimistic about Canada’s healthcare path forward. We have national “platforms”, including the Federal health ministry, Canada Health
Infoway, and now PrescribeIT. We have no lack of innovation and innovators. And we have a start with one “app”, ePrescribing, to bring a national mission to life via regional implementation. Perhaps we are starting to take a note from our friends at Participaction and ‘do more than just think about it – do it!’