Executive Summary
INTRODUCTION
Canada 2020 brought together a diverse group of health practitioners and health policy experts to look at the future of innovation in health care and how it will help Canadians seeking care and support their families through the health care experience. All this was done against a sobering look at the cost of health care across Canada.
The discussion was not theoretical as it focused on the improvement of care through innovation and in the case of the Children’s Hospital of Eastern Ontario the roadblocks to innovation. The Canadian government is attempting through a new initiative to find ways to change the regulatory culture in order for it to be sufficiently agile to keep up with innovation in care so that Canadians are not deprived of new remedies stranded in regulatory limbo.
The Honourable Mary Ng spoke of the government’s initiative to foster innovation through the creation of the CAN Health Network.
There was an important discussion about values and innovation and finally a political gloss was put on the proceedings in the areas of pharmacare, pandemics and federal-provincial relations regarding health care.
VIRTUAL CARE, Dr. Sandy Buchman, President, Canadian Medical Association
He focused on the need to advance virtual care and its technology as it is of great assistance to those in remote communities as well as helping patients receive care where they live. The CMA’s Virtual Care Task Force mandated to “promote the delivery of publicly insured medical services through virtual means” has reported.
It recommended that national standards be developed for patient health information access, simplification of registration and licensing processes so that qualified physicians can provide virtual care across provincial and territorial boundaries and update virtual care competencies among medical students and as part of continuing education for doctors.
As well a pan-Canadian framework establishing excellence in virtual care must be developed.
Dr. Buchman’s presentation set out a theme that continued throughout the day; regulators and governments need to keep up with innovation and changes in health care delivery or just get out of the way. Medical advancements are too important to be derailed by regulatory inaction and red tape.
HEALTH CARE COSTS, DEMOGRAPHIC PRESSURES AND EMERGING CHALLENGES, Mostafa Askari, Chief Economist, IFSD, Uottawa
Askari presented a chilling report on rising health care costs. He used the metric of comparing rising health care costs to increases in GDP and the overall trend is that spending on health care has increased and it is growing faster than the economy. They are also rising faster than other government expenditures.
Costs are driven by increases in GDP, an ageing population and growth in excess costs. On ageing, costs jump considerably for the group between 85-90 years of age. And life expectancy is increasing adding to the pressures on the system.
While it seems counter intuitive, Askari explained that the use of advanced technology actually increases costs, adding more pressures. Every province has seen an increase in health expenditures as a share of GDP and they face the choice of dealing with these fiscal challenges by either raising taxes or reducing expenditures.
The present fiscal imbalance between the federal government and the provinces means the federal government will be asked to increase the health transfers. Given these challenges, Askari asked whether it is time to review the Canada Health Care Act to see what can be done to make health care sustainable.
On the subject of pharmacare he doesn’t see how, given the federal fiscal situation, the federal government can do more than fill provincial gaps.
PANEL DISCUSSION: GROWING THE HEALTH INNOVATION ECOSYSTEM, Matthew Collingridge, General Manager, Digital, GE Healthcare, Janet Daglish, National Director, Bayshore and Bill Charnetski, EVP, PointClickCare
Charnetski sees health care innovation as an economic driver and job and wealth creator fuelled by the adoption of new technology. It should lead to long term economic growth. But he stressed the need to improve productivity in the provision of health care as the system is not sustainable as presently constituted.
Daglish spoke about the development and use of a digital health platform where data is collected to provide better care. A digital experience is created for patients which they can access and share with family to help in providing support in hospital and afterwards. This leads to better patient and family cooperation along the care journey. The patient controls who has access as the patient is in charge of their health data. We need to create the right experience for the right patient.
Collingridge talked about GE seeing its role as looking for what we are missing and what can be done differently particularly using Artificial Intelligence. This should increase productivity in the health care system. He set out challenges: need to move more quickly in accessing data; technology developed must be “true and proven”; competition is needed as well as reinvestment and the delivery of health care needs to be accelerated. He has three suggestions: drivers’ licences could provide a note that on death medical records are to be donated; P3 collaboration should be used to solve specific problems and the system needs to be more agile in seeking funds, utilizing means such as crowd funding to address certain issues.
The goal is “the best of care at lowest cost” and this can be done by driving productivity while eliminating errors and inefficiencies.
STEPPING INTO THE FUTURE OF TREATMENT AND CARE IN CANADA, Elizabeth Toller, Ex. Director, Regulatory Innovation, Health Canada and David Lee, Chief Regulatory Officer, Health Canada
This session offered hope that, first, the federal government realizes that the present regulatory approach is not keeping up with innovation and probably impeding it and second, there is a commitment to provide more agility in the regulatory process to help further innovation.
Lee explained it is difficult for regulations to keep up with innovation given the complexity of new drugs and processes used to develop them as well as shifts in health treatment. Treasury Board has authorized expenditures on bringing innovation to the regulatory process.
Toller explained that the focus is now on making regulations more agile without lessening the commitment to safety. This is to be accomplished through: clinical trials which could include virtual trials; new products which don’t fit within traditional strictures can be tested in the “regulatory sandbox” tailored to individual products; agile licensing for new drugs keeping up with the pace of innovation and establishing better means of communicating with Canadians. This new approach will involve looking at and perhaps adopting international regulatory practices and application to specific drugs and elements.
HEALTH CARE INNOVATION, Hon. Mary Ng, Minister of Small Business, Export Promotion and International Trade
She spoke about her focus on innovation both by the private sector and by government and developing a fast track review process for game changing drugs.
She explained that the federal government’s CAN Health Network is an attempt to keep innovators in Canada and their products in Canada. It is to facilitate the adoption of Canadian health care solutions through offering innovators a single window through which they can access opportunities and investments. Companies can grow through Canadian health care purchasing and from there create global companies with jobs in Canada. These companies will also be able to take advantage of the trade agreements negotiated by the government.
The Network will encourage collaboration among scientists in public-private partnerships creating opportunities for innovation with real solutions which can be sold around the world; Canadian entrepreneurs growing and prospering “bringing solutions to the world” while providing better care for Canadians.
ADOPTING INNOVATION ON THE FRONT LINES, Alex Munter, President and CEO Children’s Hospital of Eastern Ontario and Jodi Butts, Independent Board Member
This session was as advertised, a real view from the front lines of care, the need for acceleration of innovation and clearing roadblocks.
It is Munter’s view that the biggest challenge in health care is NOT ageing but chronic disease in children’s health. Among many problems he highlighted childhood obesity.
He listed five issues that stand in the way of progress by organizations like CHEO. First, the system is undercapitalized, resulting in huge capital deficits. Second, micro-management of operations by the provincial government to the extent that every day is a compliance exercise, taking time and personnel away from delivering care. Third, privacy legislation which was written before the development of today’s technology has to be navigated daily. Patients should own their data. Fourth, there is excessive rigidity hampering the delivery of care. Fifth, hospital based research is extremely fragile as it competes with all other hospital needs for funding.
In discussion with Jodi Butts Munter explained he is establishing an “improvement culture” at CHEO by which employees are encouraged to bring forward ideas for improvement. This he believes will foster employee engagement. He looks on virtual care as a great opportunity so that people don’t have to come to the hospital but realizes there are still privacy issues. Their last discussion concerned shrinking human resources as he said “we’re running out of people.”
GLOBAL CONTEXT, GLOBAL RISKS, Dr. James Orbinski, Dahdeleh Centre for Global Health Research, York University
In this important discussion Orbinski focussed on technology in the context that we need to understand the socio-political implications of employing or adopting technology.
Values matter in the deployment of technology. It has to be looked at through the lens of equity, fairness and justice. Then there is the effectiveness and excellence of technology to be considered. And the fact that technology should be provided to those who need it most.
Technology, he explained, is not free of value implications. There are clear choices and values to consider when it is deployed. He used climate change/global warming as an example of an issue that we need to confront as it has grave implications for our future as the globe heats up.
The world is different now than it was ten years ago. There is now water scarcity and failing crop yields which has implications for migration throughout the world and possible conflict; conflict which is regional and borderless with global impact. There is a dynamic between climate change and fragile states and in this case how we use technology matters!
Values matter in the use of technology and innovation.
THE 3P’s OF HEALTH POLITICS IN 2020—PHARMACARE , PROVINCES AND PANDEMIC, Tim Powers, Summa Strategies, Anne McGrath, National Director, NDP and Peter Cleary, Santis Health
The role of this panel was to place a political overview on some of the topics discussed during the day. There was agreement between Powers and McGrath that the Liberals are governing as if they have a majority but that health care is not a priority. Powers pointed out that governing is more complex now than ever. McGrath’s view is that there will be an election when the Liberals want one. Cleary’s view is that the government is governing well and is functioning as a minority.
On health care McGrath noted the looming pandemic and provinces want more money for health care, not for pharmacare. Powers believes that provinces want to get health deals done and should include mental health. Cleary offered that instead of pharmacare, provinces have their own priorities.
Is there a political risk for the government in not getting pharmacacre done? McGrath believes that not getting it done could be a risk but the government may put the blame on the provinces. However when not doing pharmacare is combined with no action on electoral reform then there could be an accumulated risk to the government. Powers added that it could be framed as another broken promise.
McGrath believes Canadians want health care improved but doubts that the Liberals will do it. Powers believes it could be part of reconciliation. Regardless, as the panel seemed to agree, the spring budget will pass as the Bloc will support it.
On pandemic preparation McGrath noted that the Liberals have not successfully dealt with big issues but dealing with a possible pandemic, communication with the public is key. Also the government should be looking to the Medical Officer of Health for advice and leadership.
CONCLUSIONS
- Innovation is vital to optimal health care delivery in Canada.
- With regard to virtual care, regulators and governments must keep up with innovation in health care delivery or get out of the way. The healthcare system needs to be agile.
- Costs of health care delivery are rising but could be addressed by eliminating the fiscal imbalance which presently exists between the provinces and federal government.
- If pharmacare is delivered, it will come in the form of filling existing gaps.
- Innovation can be an economic driver and a wealth creator.
- Innovation can allow patients to have their own digital health platform, which can be shared with family.
- Productivity in the delivery of health care must be improved.
- The development of regulations must keep pace with innovation so that regulations do not become a roadblock.
- Alex Munter, CEO of CHEO offered that the biggest challenge in health care is not aging, but children’s chronic diseases.
- Values matter in the development of innovative technology