This is an edited version of a speech given by Lydia Lee, Senior Vice President and Chief Information Officer, University Health Network, June 16, 2016 to the Information Technology Association of Canada (ITAC) in Toronto.
It’s a pleasure to speak to you all about a topic that is of great necessity to all of Canada — innovation.
Specifically, I want to focus on how public-private partnerships move the needle on innovation in this country. Given my background, I’m going to refer to innovation in digital healthcare, but I would suggest that my remarks apply to other industries as well.
Hospital funding has been flat
Because we are required to balance our budgets, this means a real cut in healthcare spending of three to five per cent year over year.
For academic hospitals, this is particularly pressing. It not only forces us to provide care in sometimes – I would argue – dangerously lean ways, but it also eats into our ability to drive research which is the engine for innovation in new drug discovery, new technological invention, new models of care that can prevent disease and improve outcomes. In other words, this is a problem with far reaching consequences.
At 11 per cent of GDP, healthcare will continue to eat up a disproportionate share, taking away from other sectors, like education and critical infrastructure, which is why we all say that healthcare is unsustainable without significant transformation. We have to “bend the cost curve.”
But what if we, particularly in the public sector, did not just think of healthcare as one giant cost centre? What if we thought about the $220B annual spend in hospitals, physicians and drugs as one of the biggest market economies Canada has to support economic growth and prosperity? What if we looked at the 60-70 per cent spend on healthcare labour as a source of human capital and know-how who contribute to new discoveries? Instead of “average length of stay” in hospital, how about “productive days saved” for those who re-enter society as productive participants? And what if we didn’t just use our data for records management but as a source of accumulated knowledge that could prevent disease and improve health and wellness?
Bringing in new revenues
Over the past decade, our province has made substantial and innovative e-health advancements, but not without our share of challenges.
Over the past 5 years, I had the privilege to lead a program called ConnectingGTA – a regional electronic healthcare system built to serve six Local Health Integration Networks (LHIN) for the seven million people who live in central Ontario. This program was co-funded by eHealth Ontario and Canada Health Infoway and underwritten by the Ontario Ministry of Health and Long Term Care. This system, live for over a year and now available for use by more than 40,000 providers across all sectors in the continuum of care, not just hospitals, is also serving as the backbone for our provincial EHR.
I can tell you from the scars on my back, how hard it is to deploy a large scale initiative involving hundreds of stakeholders where we had to agree on data sharing rules, technical standards, change management approach, privacy and security harmonization and clinical policy.
At the core of ConnectingGTA’s success, we always prioritized clinical value over technical delivery. We had over 150 clinicians and human factors engineers involved directly in the design of the solution to ensure that it would deliver clinical value.
While we worked to ensure alignment with the technical standards and provincial blueprint that served as our backdrop, we always prioritized clinical functionality over technical functionality to ensure we never lose sight of the system as an extension of the clinical teams that used it.
Through projects like Connecting GTA, we had to learn how to do project governance on a massive scale in a highly risk averse environment, we mastered “extreme project management”, and pushed the boundaries of our provincial privacy regulation, so much that it required updating in what is now Bill 119. Despite the challenges, there are huge gains from these programs.
Up until this project, public private partnerships had a bad wrap. UHN, Telus and eHO may have had different motivations for wanting the program to succeed – clinical need, market share, government success and reputation – but we all had aligned incentives that compelled us each to do what we needed to do to get the job done.
Most importantly, we are starting to see the patient experience slowly transform with the availability of real-time longitudinal patient information at the front-lines of care.
Patient centred eHealth strategy
Ontario’s evolving digital health strategy is placing a big emphasis on consumer e-health.
Building on ConnectingGTA, Ontario has a unique opportunity to accelerate innovation in the context of this new strategy. Since we had the foresight to build this system as a platform, the province can now serve up this infrastructure and data as a sandbox for innovation.
UHN and the MaRS Discovery District are partnering with the Province to support a new initiative for technology development called SPARK. SPARK will create a self-sustaining pathway – including process support, a dev/test sandbox environment and development and adoption toolkits. This sandbox environment will provide access to the data in the provincial repositories so that inventors, whether start-ups or large vendors, can create tools that will be certified for use in the provincial EHR.
Difficulty accessing data, navigating privacy and security rules, and dealing with complicated procurement processes are major issues driving vendors to pursue other, less difficult and more lucrative markets in other jurisdictions.
SPARK’s collaboration approach to invention, toolkits and access to expertise and, most importantly the data, will reduce the adaptation and adoption friction for new innovations by provider institutions.
Pull v. Push
SPARK allows government to come off the critical path for coming up with the roadmap of features and functions, in essence turning the former “push” approach for eHealth adoption into a market-driven “pull” model.
Private sector partners who already have proven solutions in areas like referral management, care planning, case management, clinical decision support and telehealth, will be able to sell their solutions in a regional app store that simplifies procurement, adoption and data access issues for vendors and providers alike.
We want to create an easy channel for patients and consumers to access their own data and credible health management tools. Unfortunately, there is a growing body of evidence that most of the wellness apps that currently exist do not have a significant impact on consumer health.
Sustaining Ontario’s eHealth investments
The business model behind SPARK will drive revenues back into the public purse that can be used to sustain the province’s EHR investment. We are examining past successes with other P3s such as Teranet and Green button that aligned incentives to create the right conditions for change.
We have successfully figured out P3s and other public-private partnership models for hospital builds. The public sector alone does not have the risk appetite, the capital, or the development capacity to meet the digital demand without private sector partnership.
We need to prove that by having public and private sectors working together, we can deliver on the promise of healthcare transformation.