Page 7: Health Canada – 2014–2015 – Supplementary Information Tables – Departmental Performance Report - Up Front Multi-Year Funding

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Up Front Multi-Year Funding

• Conditional Grant to Canada Health Infoway
• Conditional Grant to Canadian Foundation for Healthcare Improvement

Conditional Grant to Canada Health Infoway

General Information

Strategic Outcome

A Health System Responsive to the Needs of Canadians

Link to department's Program Alignment Architecture

Program 1.1: Canadian Health System
Sub-Program 1.1.1: Health System Priorities

Name of recipient

Canada Health Infoway (Infoway)

Start date

March 31, 2001^{Footnote a}

End date

March 31, 2015^{Footnote b}

Description

Canada Health Infoway Inc. (Infoway) is an independent, not-for-profit corporation established in 2001 to accelerate the development of electronic health technologies such as electronic health records (EHRs) and telehealth on a pan-Canadian basis. Its Corporate Members are the 14 federal, provincial and territorial Deputy Ministers of Health.

To date, the Government of Canada has committed the following funding allocations to Infoway: $500 million in 2001 in support of the September 2000 First Ministers' Action Plan for Health System Renewal to strengthen a Canada-wide health infostructure, with the EHRs as a priority; $600 million in the First Ministers' Health Accord of February 2003, to accelerate implementation of the EHRs and Telehealth; $100 million as part of Budget 2004 to support development of a pan-Canadian health surveillance system; and $400 million as part of Budget 2007 to support continued work on EHRs and wait times reductions. Also, as confirmed in Budget 2010, Canada's Economic Action Plan allocated an additional $500 million to Infoway, to support continued implementation of EHRs, implementation of electronic medical records (EMRs) in physicians' offices, and integration of points of service with the EHRs system. Infoway invests in electronic health projects in collaboration with a range of partners, in particular provincial and territorial governments, typically on a cost-shared basis. Project payments are made based on the completion of pre-determined milestones.

It is anticipated that Infoway's approach, where federal, provincial and territorial governments participate toward a goal of modernizing electronic health information systems, will reduce costs and improve the quality of healthcare and patient safety in Canada through coordination of effort, avoidance of duplication and errors, and improved access to patient data.

Comments on variances

N/A

Significant audit findings by the recipient during the reporting year, and future plan

The annual independent financial and compliance audits were conducted during the year, and both resulted in unqualified audit reports. There was no other audits conducted during the year and none were scheduled.

Significant evaluation findings by the recipient during the reporting year, and future plan

An independent performance evaluation on progress achieved under the 2007 funding agreement was completed by March 2015 and provided to the Minister of Health and the Corporate Members of Infoway. The independent performance evaluation report was also made available to Canadians on Infoway's web site.

The March 2015 independent performance evaluation report concluded that Infoway has met all of its obligations under the 2007 funding agreement and is continuing to achieve the expected outcomes. It also stated that Infoway is addressing an important need of Canadians and is providing national leadership in areas such as innovation, collaboration, interoperability, privacy and change management. The report did not make any recommendations as to anything Infoway should do better or differently.

An independent performance evaluation on progress achieved under the 2003 funding agreement will be commissioned for completion by March 2016.

Summary of results achieved by the recipient

Investment Strategy

Infoway is a strategic investor, with a funding formula covering up to 100% of territorial and 75% of provincial eligible project development and implementation costs. Infoway provides project oversight and monitoring, while provincial and territorial partners are responsible for actual system development, implementation and funding of all other costs, including ongoing operational costs. In 2014-15, Infoway approved $20.8 million in new projects, bringing its cumulative allocation of investments to $2.14 billion (406 projects since Infoway's inception). Infoway estimates that investments in EMRs, diagnostic imaging, drug information systems and telehealth have produced an estimated $13 billion in benefits for Canadians and the health care system since 2007.

Electronic Health Records (EHRs)

Infoway's goal, endorsed by all jurisdictions, is that by 2016, 100% of Canadians will have EHRs data available across six clinical domains (Client Registry, Provider Registry, Diagnostic Imaging, Lab, Drug and Hospital Clinical Reports/Immunizations). As of March 31, 2015, 91% of Canadians had EHRs data available to authorized physicians. Five of the six domains are at, or approaching, 100% availability. Continued progress on the sixth component, the Drug domain, remains a top priority. The province of Ontario will not have fully completed its drug information system by the end of 2016, which will have an impact of 5% on Infoway's goal. Infoway therefore expects to achieve availability of EHRs data for approximately 95% of Canadians by December 31, 2016.

Results achieved in 2014-15 include:

• EHRs Systems - Clinicians across Canada are increasingly using EHRs systems to support the care of their patients. In 2006, there were approximately 7,600 EHRs users (based on access to two or more integrated jurisdictional data assets). By January 2015, there were more than 91,000 active EHRs users. This represents a nearly 12-fold increase since 2006 and a 46% increase over the figure of 62,000 EHRs users reported in 2014.
• Diagnostic Imaging Systems - As of March 2015, over 56,000 health care professionals are using diagnostic imaging system technology. Furthermore, over 88,000 health care professionals have access to diagnostic imaging reports electronically. Virtually 100% of exams performed in public hospitals in all 13 provinces and territories are filmless, stored digitally and available to physicians.
• Drug Information Systems - Nearly 65,000 health care professionals in 11 jurisdictions are estimated to be using drug information systems. Furthermore, over 71,000 clinicians in 10 jurisdictions can view electronic medication profiles for their patients.
• Registries - Registries needed to identify patients and health care providers have been established in every province and two of the territories. Some work is still required to complete the registries in Yukon.
• Laboratory Test Results - Systems to electronically capture and share laboratory tests are now fully or partially complete in all jurisdictions. It is estimated that there are currently over 90,000 users of lab information systems in Canada.

Telehealth

Telehealth is the technology-enabled delivery of health care services when the clinician and patient are not in the same location. It is estimated that 98% of hospitals in Canada are now telehealth-enabled. There were more than 500,000 total clinical telehealth events (clinician-patient consultations) in 2014, an increase of more than 180% since 2010. Telehealth is also used for educational and administrative purposes, and for care delivery outside of conventional settings such as the home.

Electronic Medical Records (EMRs)

An EMRs is an office-based system that enables a health care professional, such as a family physician, to record the information gathered during a patient's visit. Infoway's EMRs investment program has been highly successful: the program's original enrolment target of 12,000 community-based clinicians has been greatly exceeded, with over 19,800 clinicians enrolled across the country as of March 31, 2015. Use of EMRs by primary care physicians in Canada has grown from 37% in 2009, when Infoway began investing, to 77% in 2014. More specialists were also using EMRs in 2014 - 73%, compared with 28% in 2007.

Progress has also been made on a national scale in the implementation of EMRs in ambulatory care clinics. As of March 31, 2015, Infoway had launched 21 ambulatory EMRs projects covering over 60 hospitals with 11 different hospital information systems across nine jurisdictions, targeting approximately 25,000 clinical users. Ninety-two per cent of these ambulatory EMRs systems have been implemented so far.

To achieve the full potential benefits, clinicians' EMRs have to be integrated to the jurisdictional EHRs infostructures so that health information is available across the continuum of care settings. Infoway aimed in 2014-2015 to improve data exchange between EMRs and other clinical systems so that 75% of participating clinicians would be able to report increased clinical value from enhanced EMRs interoperability. According to the 2014 National Physician Survey, 80% of physicians now report that they have access to lab and diagnostic results electronically, meaning they are deriving enhanced clinical value from their EMRs.

New Clinical Interoperability Strategy and Platform

Despite the progress mentioned above, there is still a significant amount of work to be done in the area of interoperability. In 2014-15, after extensive consultations with stakeholders, Infoway developed a strategy called Accelerating Clinical Interoperability in Canada: The Path Forward. The strategy identifies opportunities to improve patient care by addressing key interoperability areas, and will be used over the next year to support the goal of connecting more clinical settings to improve patient care. In January 2015, Infoway launched InfoCentral, an online community platform to encourage collaboration on interoperability and to serve as a "one-stop shop" on health information standards.

Consumer Health and Clinical Innovation/Adoption

In 2014-15, Infoway invested in two streams of consumer health solutions, with a focus on improving the patient experience: five remote patient monitoring projects in four jurisdictions that have, to date, benefited more than 2,000 patients, as well as six new consumer health demonstration projects. In addition, based on the evidence from an earlier consumer health demonstration project, Infoway launched an e-Booking Initiative for physicians and nurse practitioners. Hundreds of clinicians from nine provinces have signed up to participate over a 12-month period.

Infoway also continued its successful program of ImageNation Innovation Challenges. In 2014-15, 46 teams (more than double the goal of 20 teams) from across the country participated in the 15-month e-Connect Impact Challenge. Participants were encouraged to connect digitally with their patients or their colleagues. There were 71,300,000 combined uses of their digital health solutions during the Challenge period. In addition, a Public Health Social Media Challenge was held to encourage participants to use social media to connect with their communities.

Digital Health Thought Leadership

To further the deployment of digital health solutions such as EHRs and EMRs, Infoway's subject matter experts provide support to provincial and territorial partners in areas such as privacy and security, architecture and change management. The following are some of Infoway's thought leadership activities in 2014-15.

Privacy

• Continued sponsorship of the pan-Canadian Privacy Forum, which is the only national forum that brings together representatives from health ministries, e-health agencies and privacy commissioners to discuss information privacy issues for digital health solutions.
• Continued sponsorship of the Health Information Privacy Group, which received the 2014 Innovation Award for small organizations from the International Association of Privacy Professionals for work in developing common understandings that respect privacy while supporting the flow of health information across jurisdictions. The equivalent award for large organizations went to an Infoway investment, Ontario's "ConnectingGTA" project, which used the common understandings as the foundation for its work.
• Publication of a report entitled Privacy and Security Requirements and Considerations for Digital Health Solutions. This report identifies issues and factors for jurisdictions and organizations to consider as they adopt new digital health solutions.

Architecture

• Delivery of numerous workshops, presentations and webinars on the Digital Health Blueprint, an update of the EHRs Blueprint.
• Publication of white papers and delivery of presentations and webinars to stakeholders on health analytics architecture deployment model considerations, mobile health computing between clinicians and patients, and federated identity management in health care.
• Publication of benefits evaluation reports and backgrounders on four health system use demonstration projects that were successfully completed, showing promising results for the use of health analytics.

Change Management

Support for change management continued to be a focus in 2014-15, as part of co-investment projects and more broadly through the Pan-Canadian Change Management Network. In addition, a Change Management Reference Group was created to provide change management expertise and insights to assist and support Infoway's plans to accelerate value for Canadians and their health care providers through the use of digital health.

Clinician Engagement

Infoway's clinician engagement activities play a vital role in making digital health solutions an increasingly integral part of health care delivery. In 2014-15 these activities included the following:

• Infoway continued to support five active peer networks and continued to engage the other four completed peer network projects resulting in the engagement of more than 95 peer leaders who connected with over 2,300 colleagues this fiscal year. Since the peer network program began, there have been a total of 545 peer leaders who have engaged more than 34,000 of their colleagues in the adoption, use and optimization of digital health solutions in clinical practice.
• The Knowing is Better for Clinicians Education Campaign continued to grow, with 91 clinical champions and 38 partner organizations by the end of the fiscal year. Since inception, the campaign has reached more than 490,000 clinicians and health care leaders.
• Faculty Peer Leader Networks were established in partnership with the Association of Faculties of Pharmacy of Canada (AFPC) and the Canadian Association of Schools of Nursing (CASN) to support educators in preparing future clinicians to practise in a technology enabled environment.
• In partnership with the Canadian Medical Association and the Canadian Pharmacists Association, Infoway developed and implemented an "ePrescribing Think Tank" that brought together a select group of nursing, pharmacy and medical clinicians, professional associations and regulators to discuss advancing ePrescribing in professional practice. A working group is now developing a reference model of best practices for ePrescribing authentication across Canada.
• Infoway partnered with the Canadian Nurses Association on the first-ever survey of Canadian nurses exploring their access to and usage of digital health tools and the impact on practice. Findings reveal that 83% of Canadian nurses are comfortable using digital health tools in practice and approximately three-quarters feel digital health tools could improve continuity of care and patient safety.
• A new Faculty Interprofessional eHealth Award was created in partnership with the Association of Faculties of Medicine of Canada, the AFPC and CASN to promote the move toward interprofessional digital health competencies and team-based practices.

Benefits Evaluation

Measuring, evaluating and reporting on the benefits being realized from Infoway's digital health investments is an ongoing area of focus. 2014-15 was a very active year for benefits evaluations at Infoway, with 20 interim and 51 final benefits evaluation studies conducted, with a focus on Ambulatory EMRs, Clinical Innovation and Consumer Health projects.

Expanded Outreach to Canadians on the Value of Digital Health

2014-15 marked the second year of Infoway's Better Health Together public education campaign, which aims to raise the level of awareness and support for digital health among Canadians. The campaign was seen, read or heard 178 million times, a 43% increase over the previous year, and reached the campaign's target audience (Canadians aged 35-65) 12 times on average.

Stimulation of Canada's Economy

With its partners, Infoway continued to stimulate the Canadian economy through investment expenditures. Based on an economic impact model developed by the Conference Board of Canada, it is estimated that, in 2014-15, digital health solution investments made by Infoway and its jurisdictional partners through the $500 million granted by the Government of Canada in 2010 generated an estimated 1,820 person-years of employment, had a positive impact on gross domestic product (GDP) estimated at nearly $188 million, and allowed the federal, and provincial and territorial governments to recoup approximately $36 million and $16 million respectively. From the time the funding was granted in March 2010 through to March 31, 2015, there has been an estimated cumulative impact of 9,220 additional person-years of employment and an estimated $954 million increase in GDP.

Performance Information (dollars)

Conditional Grant to Canadian Foundation for Healthcare Improvement

General Information

Strategic Outcome

A Health System Responsive to the Needs of Canadians.

Link to department's Program Alignment Architecture

Program 1.1: Canadian Health System
Sub-Program 1.1.1: Health System Priorities

Name of recipient

Canadian Foundation for Healthcare Improvement (CFHI), formerly known as the Canadian Health Services Research Foundation (CHSRF)

Start date

1996-97

End date

N/A

Description

Between 1996 and 2003, CFHI received a total of $151.5 million in federal funding, including $66.5 million at the time of its establishment to set up an endowed fund and federal grants for the following purposes:

• 1999: $35 million to support its participation in the Canadian Institutes of Health Research (CIHR) and $25 million to establish a 10-year program to develop capacity for research on nursing recruitment, retention, leadership and health system restructuring (Nursing Research Fund).
• 2003: $25 million to establish a program for the enhancement of skills of health system managers in health services research (Executive Training for Research Application or EXTRA program).

By 2009, the CFHI had reoriented its work within its established mandate and changed its name in 2012 to the Canadian Foundation for Healthcare Improvement to reflect the evolution of its work. CFHI remains an independent organization, dedicated to accelerating healthcare improvement and transformation for Canadians within four strategic areas: 1) building leadership and skill capacity of health leaders; 2) enabling patient, family and community engagement in healthcare improvements; 3) applying improvement science to healthcare; and 4) creating collaboration with healthcare organizations to spread evidence-informed improvement.

Significant audit findings by the recipient during the reporting year, and future plan

CFHI's financial records are reviewed and audited annually by independent external auditors. The 2014 external financial and pension audits showed no major concerns, with the auditors reporting an unmodified audit opinion.

Significant evaluation findings by the recipient during the reporting year, and future plan

In 2014, a five-year independent evaluation was conducted to assess CFHI's relevance, performance (effectiveness) and value in accelerating healthcare improvement across Canada. This included an assessment of its current programming achievements and performance against its strategic priorities and goals. Key observations included:

• CFHI has made itself very relevant to its key stakeholders, and there is support for the organization to continue with its drive and focus on healthcare quality improvement initiatives.  Further, CFHI has made concerted efforts to continuously improve the effectiveness and efficiency of its processes and operating structure to support its mission and areas of priority.
• CFHI has made progress towards the achievement of its 2009-13 strategic priorities and there is evidence that CFHI has been able to support significant and positive impacts on the Canadian healthcare system.  A partial-benefit cost analysis, conducted through the evaluation, identified that CFHI programming generated significantly more benefits to Canada than the funding invested in CFHI over the time period studied.
• CFHI has the potential to enhance its effectiveness by: clearly delineating and focusing on its unique role in the healthcare system; increasing activities in relation to spreading best practice innovations; strengthening its processes to manage and monitor its partnership arrangements; and continuing to implement a defined performance measurement system.

CFHI has a formal management response and action plan to address these recommendations and is incorporating them into its ongoing work.

Summary of results achieved by the recipient

CFHI continued in 2014 to support new ways of spreading healthcare innovations across the country by working with healthcare providers, governments, policy-makers and other leaders to bring about real improvements in the quality and efficiency of patient care, and to support the spread of these improvements.

In undertaking this work, CFHI was guided by three strategic priorities: accelerating evidence-informed improvements in healthcare delivery; engaging patients and families; and, promoting policy analysis and facilitating dialogue for improvement.

In 2014, CFHI successfully:

• Supported numerous collaborations, for example:
  • Spreading the Appropriate Use of Antipsychotic Medication in Long Term Care to improve care for dementia patients through support for 15 teams across 7 provinces with 187 team members.
  • INSPIRED approaches to Chronic Obstructive Pulmonary Disease (COPD) to transform care for people living with COPD and their caregivers through support for 19 teams across 10 provinces with 214 healthcare professionals.
• Supported 22 teams (99 team members) from healthcare organizations across 6 provinces and 1 territory who are partnering with patients and families in designing, delivering and evaluating healthcare services with the goal of better patient care and outcomes.
• Supported 40 leaders through 11 improvement projects across Canada as part of the EXTRA program.  Examples of projects included:  redesign of geriatric inpatient services; improving mental health care inequalities in an inner city; using ePortfolios as a method of scaling up integrated quality assurance; and creating an integrated mental health and addiction assessment service.
• Acted as a program partner for the Institute for Patient- and Family-Centered Care (IPFCC)'s annual conference which showcased innovative collaborative programs among healthcare professionals, patients and families.

Performance Information (dollars)

N/A

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