Canada’s healthcare system employs about two million people, and its $228-billion budget accounts for roughly 11% of GDP. When I look at big numbers like these, I see big opportunities. So why are so many of us stuck in a negative feedback loop when it comes to discussing the future of healthcare? Why do we so often lack the ability to take innovations and deliver them at a national scale?
I think size has something to do with it. It can be overwhelming to contemplate change on such a massive scale. Instead of trying to fix everything at once, let’s take a page from the approach that IHI took with the Triple Aim. By that I mean, let’s ensure specific IT initiatives drive change in healthcare by achieving each of three key objectives: foster innovation, grow the economy and create jobs.
Healthcare systems can spur innovation, economic growth and job creation
This isn’t just empty rhetoric. This approach has already paid off in other parts of the world. New Zealand’s Orion Health employs more than 1,200 people in 24 offices across 15 countries. Its healthcare information technology solutions are implemented in more than 30 countries and used to facilitate healthcare for more than 100 million patients.
One of Orion Health’s early international wins was delivering a major electronic health record project in Alberta in 2000, which is still in operation today. Alberta is a long way from the Auckland District Health Board, where Orion Health got its start computerizing and connecting all Auckland hospitals in 1993 before the internet had really arrived.
Government officials in New Zealand had the vision to see that Orion Health’s approach would foster innovation, grow the economy and create jobs by focusing on a big disruptive idea — connecting hospitals in a network. The government also became a model user and went on the road with Orion Health to promote their technology.
Governments as champions and customers
In my 25 years in healthcare IT, I’ve built several businesses. Over this time, I’ve rarely seen governments embrace their role as a model user. Instead, I’ve seen narrow procurement requirements stifle creativity, along with an overemphasis on tax credits and grants at the expense of supporting market enablement. I’ve also seen homegrown IT companies sell their products and services around the world without being able to sign up a single Canadian customer.
Health IT innovators need to be able to work with governments as champions who should also become our first customers. There are some encouraging signs that this thinking is gaining ground. Bill Charnetski, Ontario’s Chief Health Innovation Strategist, and his team have a goal to grow businesses, create employment and build a health innovation ecosystem in Ontario. We need more of this kind of thinking across Canada.
Charnetski’s office was created to leverage investing in healthcare as an economic driver and job creator in Ontario. He correctly points out that money and talent shouldn’t be considered barriers to this goal. There is no shortage of investors interested in this space, no shortage of startups and talent, and no shortage of ideation — but what we don’t do is scale these companies up. We have an ecosystem of startups, technology and financing, but it’s not properly connected to healthcare providers.
Big business has a key role to play. In our case, TELUS is driving fundamental change by building an open ecosystem of digital health that includes electronic medical records, practice management software and consumer applications to drive efficiency, free up scarce healthcare resources and enable more patient-centered care. Championing an open ecosystem means we are serious about encouraging others to layer innovation on top of existing technology and systems.
To catalyze this vision, TELUS Ventures and many others have been active investment partners. At TELUS, current initiatives include using machine learning to detect patient deterioration early. A suite of smart point-of-care mobile solutions is delivering real-time patient data, care team collaboration, and clinical communications in a timely and intuitive way. We also have a wellness engagement platform that’s used by progressive companies to improve the health of their employees.
The point here is not to promote what TELUS is doing for its own sake, but to illustrate just one role of many that large corporations can play to support a health innovation economy.
An approach to innovation based on shared risk and reward How do we enable a thriving innovation economy? I do not believe the answer lies in grants or subsidies. Rather, I would like governments to regularly enable pay-for-success scenarios that allow companies to share risks and rewards based on well-defined health outcomes.
Social impact bonds are a compelling example of applying a collective risk approach to healthcare challenges. They use a pay-for-success model, where investors provide the upfront capital to run the project, and the government pays back the capital plus a reasonable return only if predetermined outcomes are achieved.
The Public Health Agency of Canada and partners, including the Heart and Stroke Foundation of Canada, are working with investors funding a social impact bond called the Community Hypertension Prevention Initiative. The bond will support the Public Health Agency of Canada’s work with residents of Ontario and British Columbia, who are 60 years or older, by giving them access to health coaches, online tracking tools and referrals to community resources such as walking clubs and community cooking classes.
This kind of approach can keep costs down and ensure that health outcome goals remain front and centre. It’s also a good fit in terms of how tech companies big and small operate. Taking on risk is part of our DNA. For example, large companies like TELUS take on risk every day when we invest upfront in things that need to produce a return on investment in the future like bringing fibre to the home and next generation 5G wireless.
Economic policies focused on growth that put patients first
Government can also play a key role as a market enabler through policies and funding that is tied to outcomes. For example, in the U.S. the concept of meaningful use initially offered financial incentives for healthcare providers to use e-tools. At the same time it includes penalties after a few years for late adopters. In many cases, this approach has supported significant uptake of technology.
If we make the right investments — for example in mechanisms that connect the health ecosystem — we will foster a future that delivers patient-centered care across different settings. I’m also convinced we will see the growth we need in innovation, the economy and employment.
In this future, Canadians will have more coordinated care. Your primary care physician will have instant access to all of your records, including your prescriptions and test results. You will also be able to interact with your health team virtually. No more repeating tests or chasing lab reports. Your data will be easy to understand and useful for making decisions because app developers will be working with patients and physicians to develop intuitive, user-friendly tools.
The cracks we see in community care will no longer exist. And if you are managing a chronic condition, you will be surrounded 24/7 by virtual care teams. For routine consultations, you won’t have to take time off work to talk to your physician. Instead, you will be able to use secure digital communications or video chats.
A three-step action plan to deliver on the promise of healthcare IT
To get to this future, we must take on collective risks in the search for shared benefits. I see three important steps that we must take.
First, Canadian healthcare organizations must embrace their role as model users. Second, procurement should be based on desired outcomes, not detailed specifications. And third, we need to embrace funding models that are based on shared risks and rewards.
The quality of our healthcare and the strength of our economy are set to become only more tightly connected as the pace of innovation accelerates. Countries all over the world are championing and investing in innovation to solve healthcare challenges and deliver wider economic benefits. There is no reason why Canada can’t be at the forefront of this generational shift.