Oh Canada – A Good One!

This is almost too much. Two invaluable documents in two days!

The second is entitled 2015: Advancing Canada's Next Generation of Health Care.

The document can be downloaded from the following URL:

http://www.infoway-inforoute.ca/en/pdf/Vision_2015_Advancing_Canadas_next_generation_of_healthcare.pdf

On the main Infoway Web Site (http://www.infoway-inforoute.ca/en/home/home.aspx) it is described as follows:

“A Vision for Health Care in Canada

Consulting with leaders in all areas of the Canadian healthcare sector, Canada Health Infoway has developed a comprehensive strategy -- a vision -- for the next ten years of investment in healthcare information systems. The full report, 2015: Advancing Canada's Next Generation of Health Care, serves as a roadmap for modernizing Canada's healthcare system and forms the strategic framework to guide Infoway's investments and priorities for the years ahead.”

What points should be made about this refreshingly brief (36 pages) and well structured strategic document.

First it really should be read closely for all interested in e-health in Canada not only for its useful assessment of how Canada has gone forward but for the number of lessons and parallels it provides to the Australian situation.

Second the analysis of the issues facing Health Service Delivery in Canada really read like a “Guidebook to the Town of My Birth” in the clarity and accuracy they provided.

It is hard to argue with the following:

“In the future, the need to coordinate and manage information will become more crucial as:

• Patient consumerism continues to raise demand for transparency and timely delivery of health care, more self-care options, and alternative service delivery options (e.g., tailoredsolutions 24/7 at convenient locations, such as in the home).
• Canada’s aging population and Canadians’ health status drive an increased incidence of chronic diseases (e.g., diabetes) and an increased need for ongoing cancer care. By their nature, these types of conditions require managing a patient through many different care settings for extended periods of time, rather than just through “traditional” acute care interventions.
• The shortage of general practitioners creates a more sporadic pattern of care across multiple channels (e.g., walk-in clinics, acute care emergency settings, specialists) in which the system can no longer rely on the GP as a single point of integration to generate and manage a holistic view of the patient over time.
• Care settings continue to shift from acute to home care and other alternatives, particularly for more complex and information dependent treatment decisions such as chronic disease management. This will require further coordination across centres that traditionally lack information technology capabilities and the ability to request support as well as review the quality of care delivered.
• The rising costs of health care and continued funding and human resources constraints demand significantly higher levels of performance management by the system to drive improvement and to ensure its sustainability.”

It is also impossible to disagree with the barriers to better e-health identified.

“However, they have expressed concerns about a number of barriers that need to be overcome to

achieve the vision and realize the full value of the health infostructure. These barriers are:

• Inconsistent and sometimes insufficient commitments over time by federal and some provincial jurisdictions to fund the completion of the health infostructure

• The lack of a truly compelling “story” (for politicians, physicians, and the public) about the urgent and crucial need to build the health infostructure

• The inability to fully illustrate the impact (although all believe the benefits are there) and provide proven case studies

• The challenges of driving implementation and user uptake, including redesigning basic processes to unlock the full value of the system investment and providing the resources to ensure successful implementation and change management.”

It is quite clear from the body of the report that progress has not been quite as quick as may have been desired and that while real progress has been made there has been inconsistent levels of progress between different provinces (remind you of anywhere?)

Third the report is clearly, at least in part, a document to try and free up additional and very substantial funds to ‘finish the job’. The scale of additional funding beyond the $C1.2B already committed seems to be quite considerable.

“The total incremental cost of this integrated vision over the next 10 years is estimated to be between $10 billion and $12 billion in additional capital, and between $1.5 billion and $1.7 billion in annual operating costs (Figure 6). This does not include the additional ~$3.5 billion to $4 billion cost to provide integrated systems to allied health professionals and the broader community care environment (e.g., all long-term care facilities, home care, public health, and mental health).”

It is fair to say the only way this will happen is because there has been real and measurable progress thus far. We will have to wait and see what the Canadian budgetary process does with this request – given the proof of considerable progress to date.

It is interesting that this works out to approximately $C350 per capita. If applied to Australia and converted to Australian Dollars (1.00 CAD = 1.11914 AUD) would be of the order $A 8.23 Billion over 10 years. To attract that sort of funding we will really need a persuasive plan!

The benefits from implementation are estimated to provide a payback period of eight to ten years even allowing for ongoing operational costs and upgrades etc. Beyond this time frame the benefits will assist in ensuring the sustainability of the Canadian Health System into the future.

The last, and most obvious point it that it is clear Canada now has an implementable Health IT Vision and Strategy – and some real strategic runs on the board to date. We, on the other had, still seem to languish. Mr Abbott and Mr Eccles are you listening! This document is really worth a read as an example of what might help us here in Australia move forward!

David.