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 (CFHI)

Conditional Grant to Canada Health Infoway

General Information

Name of recipient

Canada Health Infoway (Infoway)

Start date

March 31, 2001^{Footnote a}

End date

March 31, 2015^{Footnote b}

Strategic Outcome

A Health System Responsive to the Needs of Canadians

Link to the organization’s programs

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

Description

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 for a total of $2.1B 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 EHR as a priority; $600 million in the First Ministers' Health Accord of February 2003, to accelerate implementation of the EHR and Telehealth; $100 million as part of Budget 2004 to support development of a pan-Canadian health surveillance system; $400 million as part of Budget 2007 to support continued work on EHRs and wait times reductions and in Budget 2010, Canada's Economic Action Plan allocated an additional $500 million to support continued implementation of EHRs, implementation of electronic medical records (EMRs) in physicians' offices, and integration of points of service with the EHR 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 2003 funding agreement was completed by March 2016 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 2016 independent performance evaluation report concluded that Infoway has met all of its obligations under the 2003 funding agreement and is continuing to achieve the expected outcomes. The report 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.

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/territorial partners are responsible for actual system development, implementation and funding of all other costs, including ongoing operational costs. In 2015-16, Infoway achieved 104% of the combined target, with project investment approvals totalling $36.2 million (a 74% increase over last year) and project investment expenditures reaching $134 million (exceeding thei $125 million expenditure target). Infoway estimates that investments in EMRs, diagnostic imaging, drug information systems and telehealth have produced an estimated $16 billion in benefits for Canadians and the health care system since 2007.

Delayed Project Review

Most of the investment approvals made in 2015-16 resulted from a review of delayed projects that was completed in September 2015. This review encompassed 38 projects in nine jurisdictions, representing $177.7 million in potentially stalled investment funds. The result: $50.1 million has been regained for reinvestment in other initiatives. As of March 31, 2016 $35.9 million has been reinvested in ten new initiatives, with more in development.

Electronic Health Records (EHRs)

There were over 139,000 active EHR users across Canada in 2016, up from 91,000 in 2015, an increase of nearly 53%. Active users are authorized health care professionals who have accessed two or more clinical domains, such as lab information systems, drug information systems or diagnostic imaging repositories, at least once a month or three times per quarter. A majority (more than 257,000) of health system professionals (doctors, nurses, pharmacists, other clinicians and administrators) are now using one or more EHR clinical domains. This represents more than half of all potential EHR users across Canada (estimated at 500,000). As of March 31, 2016, 93.8% of Canadians had EHR data available to authorized physicians.

Telehealth

Telehealth is the technology-enabled delivery of health care services when the clinician and patient are not in the same location. There were more than 600,000 total clinical telehealth events (clinician-patient consultations) in 2015, an increase of more than 200% since 2010. Telehealth is also used for educational and administrative purposes and for care delivery outside of conventional settings such as the home.

Telehomecare

There was significant growth in the use of telehomecare (remote patient monitoring), where digital technology is used to monitor patients remotely, improve patient/caregiver quality of life and reduce hospital visits. An estimated 5,000 patients were enrolled in provincial/territorial programs in 2015-16, double the estimated 2,500 patients who were enrolled in these programs in 2010.

Electronic Medical Records (EMRs)

An EMR 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 has supported the adoption of EMR systems by more than 38,000 participating clinicians in ambulatory clinics and community-based practices across Canada. According to the 2015 Commonwealth Fund International Survey of Primary Care Physicians in ten Nations, 73% of family physicians in Canada were using EMRs, triple the number from 2006.

In order to achieve the full potential benefits, clinicians’ EMRs have to be integrated in the jurisdictional EHR infostructures so that health information is available across the continuum of care settings. To date, more than 30,000 participating clinicians have achieved a clinical interoperability milestone that provides them with access to clinical content from the EHR.

Clinical Interoperability

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 2015-16, a number of activities were conducted as outlined in the Infoway’s Clinical Interoperability Strategy Action Plan:

• Infoway launched the Digital Health Alliance, with a focus on the sharing of health information between clinical organizations.
• A Partnership conference, devoted to standards and clinical interoperability, attracted 150 participants and a sold-out vendor showcase.
• The Clinical Interoperability Steering Committee continues to provide leadership from clinical, private sector, jurisdiction and health authority perspectives.
• The InfoCentral collaboration platform supports more than 20 online communities and provides a focal point for national dialogue on standards, interoperability, change management, architecture, and clinical adoption.
• Infoway hosted a number of international standards organizations and supports a multitude of activities to educate and promote the use of pan-Canadian standards.

Certification

Infoway’s certification program promotes the use of trusted, interoperable, standards-based digital health products, reducing the cost and risk to vendors and purchasers. In 2015-16, the program continued to focus on consumer health applications and EMR products with 15 products either certified or recertified (an increase of four products year over year).

Consumer Health

Over the course of the year, use of e-booking and other consumer-related tools grew through investments in ten jurisdictions. More than 11,000 patients, family members and caregivers are currently enrolled to use consumer health innovations in seven demonstration projects. These projects enable patients, family members and caregivers to do a number of things online: view their health information such as lab results, schedule appointments, and consult with health care providers using secure messaging. The e-Booking Initiative concluded with the participation of over 1,200 primary and ambulatory care physicians and nurse practitioners. From those clinicians who implemented an e-booking system, a potential of 520,000 Canadians now have the capability to e-book. To date, more than 111,000 of their patients have registered. Nationally, this initiative helped to increase the proportion of family physicians offering this technology by 1.2%.

In March 2016 Infoway’s ImagineNation Challenges celebrated five years of success in sparking innovation across Canada. Since March 2011, ten Challenges have been held, with more than 380 teams of patients, clinicians, administrators and researchers, who have made more than 435 submissions and whose innovations have resulted in more than 74 million uses of digital health.

Digital Health Thought Leadership

To further the deployment of digital health innovations 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 activities in 2015-16.

• 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 innovations.

  Continued sponsorship of the Health Information Privacy Group, which in 2015-16 developed common understandings related to governance of the secondary use of digital health information.

  Presentations to forums and conferences, such as the Health System Use Summit, e-Health 2015, and Partnership 2015, focused on emerging strategies and trends to anticipate future privacy requirements and guidelines.

• Architecture

  In March 2016, Infoway published an updated Digital Health Blueprint: Enabling Coordinated and Collaborative Health Care. The Blueprint provides a framework for architecting and deploying digital health innovations, along with considerations for design choices and strategic planning. It goes well beyond the core interoperable EHR focus of the previous Blueprint and covers the broader digital health landscape.

• Change Management

  In 2015-16, the Infoway Clinical Adoption team provided an updated Change Management Online Toolkit, held a webinar series and hosted numerous learning sessions. The team continued to monitor and share new evidence-based leading practices through the Digital Health Infowatch, Virtual Library Portal and Infoway’s other knowledge transfer mechanisms.

• Health Data and Analytics

  In 2015-16, two Data Impact Challenges were conducted to leverage existing health and health care information to delve into unanswered questions such as the frequency of duplicate tests and baselines for “choosing wisely” recommendations on appropriate care. Thirty-four teams used their authorized access to data to provide answers to pressing policy questions.

Infoway also created a presentation entitled Health Analytics Blueprint - An Architecture and Deployment Model Framework which provides a framework for deploying health analytic capabilities, along with considerations for design choices and strategic planning.

In February 2016, Infoway and CIHI co-hosted a successful summit about health system use of data, attended by more than 130 delegates from across Canada. The summit discussed how analytics can change the way we make decisions in health care, whether at the point-of-care, in a facility, or in health systems.

Clinician Engagement

Infoway’s clinician engagement activities play a vital role in making digital health innovations an increasingly integral part of health care delivery. In 2015-16, these activities included the following:

• A working group comprised of regulators, pharmacists and the National Association of Pharmacy Regulators developed a best practice reference model for e-prescribing authentication across Canada.
• An e-Integrated Care Plan Working Group was established in collaboration with Infoway’s Reference Groups, resulting in the development of a common understanding for e-integrated care plans in Canada.
• A partnership between Infoway and the Registered Nurses' Association of Ontario was established to produce an evidence-based guideline on health care in the digital age.
• The Faculty Peer Leader Networks have seen nearly 30 faculty peer leaders leveraging resources developed in the earlier Clinicians in Training projects to connect with nearly 7,700 medical, nursing and pharmacy educator colleagues and students.
• In 2015-16, there were clinical peer leader networks active in 7 jurisdictions, with over 200 peer leaders engaging over 2,000 colleagues. Since the peer network program began, there have been a total of nearly 750 peer leaders who have engaged over 36,000 of their colleagues in the adoption, use and optimization of digital health innovations in clinical practice. Furthermore, Infoway’s “Knowing is Better for Clinicians” education campaign, which includes 94 clinical champions and 38 partner organizations, has reached more than 650,000 clinicians and health care leaders since 2012.
• A Student Interprofessional e-Health award was established to promote interprofessional practice in digital health.
• Infoway recognized five 2016 LEADing Practice Award recipients for their leadership in strengthening clinical practice and improving the patient experience through the advanced use of digital health innovations.
• Infoway led a very successful 2016 Peer Leader Symposium, entitled Building Peer Leader Bridges to Advance Clinical Practice with over 120 participants from across Canada.

Benefits Evaluation

Measuring, evaluating and reporting on the benefits being realized from Infoway’s digital health investments is an ongoing area of focus. 2015-16 was a productive year in benefits evaluation with more than 25 studies completed on topics such as patient access to lab results, ambulatory EMRs and telehomecare. Infoway also continues to provide support to evaluators across the country, including a refreshed Benefits Evaluation Toolkit.

Outreach to Canadians

2015-16 marked the third 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 220 million times, a 24% increase over the previous year, and reached the campaign’s target audience (Canadians aged 35-65) 14 times on average. This success was delivered at the lowest cost ever, $0.01 per impression, which is half the cost of last year and one-third the cost of the campaign’s first year.

Digital Health Week, first introduced in 2014-15 to provide a focus for celebrating the benefits of digital health, was much expanded this fiscal year, resulting in a total audience reach of 23 million, triple the reach of the previous year.The campaign has increased Canadians’ awareness of digital health (from 62% in 2015 to 75% in 2016), as well as their positive perceptions of its impact (from 63% in 2015 to 74% in 2016).

Stimulation of Canada’s Economy

With its partners, Infoway continued to stimulate the Canadian economy through investment expenditures. An economic impact model developed by the Conference Board of Canada estimates that digital health investments made by Infoway and its jurisdictional partners through the $500 million granted by the Government of Canada in 2010 will create 10,700 person-years of employment and add about $1.48 to overall Gross Domestic Product (GDP) for every $1 invested. The model also estimates that about $319 million will be recouped by federal, provincial and territorial governments through increased tax revenues. During 2015-16, these investments generated an estimated 890 person-years of employment, had a positive impact on GDP estimated at $92 million, and allowed the federal and provincial/territorial governments to recoup approximately $18 million and $8 million respectively. From the time the funding was granted in March 2010 through to March 31, 2016, there has been an estimated cumulative impact of 10,110 additional person-years of employment and a $1.05 billion increase in GDP.

Performance Information (dollars)

Conditional Grant to Canadian Foundation for Healthcare Improvement (CFHI)

General Information

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

Strategic Outcome

A Health System Responsive to the Needs of Canadians

Link to the organization’s programs

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

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 ten-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: 1) proactively identifying innovations and bringing together coalitions of the willing to spread front-line service improvements; 2) building leadership and skill capacity to help organizations champion and lead improvements; 3) enhancing health care innovations by involving patients, families and communities as experts in improvement and co-design; and, 4) using improvement tools to drive measureable results towards better patient care, better health and better value.

Comments on variances

N/A

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 2015 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

CFHI’s latest independent five-year evaluation was conducted in 2014 and reported on in the 2014-15 DPR.

CFHI pursues ongoing internal evaluative and measurement work of its activities and reports its results through its website and annual reports.

Summary of results achieved by the recipient

The Government of Canada’s objective in funding CFHI is to foster innovations in health care to help advance the delivery of high quality care and to increase efficiency in the health system.

In 2015-16, CFHI worked closely with healthcare providers, governments, policy-makers and other leaders towards its objectives:

• Delivering demonstrable results for Canadians by improving patient and family experience and care, population health and value-for-money;
• Being recognized as the leader in supporting the implementation, spread and scale of healthcare improvement across Canada; and,
• Remaining adaptable in a changing environment.

Results noted in CFHI’s 2015-16 annual report include: Support for numerous collaborations, for example:

• Improved quality of care for residents living with dementia in 56 long term care homes across seven provinces and one territory through the Reducing Antipsychotic Medication Use in Long Term Care Collaborative. Over half (54%) of the 416 participants had their antipsychotic medication discontinued or significantly reduced without any increase in falls or aggressive behaviour.
• CFHI, through partnership with Boehringer Ingelheim (Canada) Ltd., supported 19 teams across ten provinces to adopt best practices (e.g., coordinating care from hospital to home) for the management of patients with chronic obstructive pulmonary disease.
• A partnership with the Canadian Patient Safety Institute and the Canadian Home Care Association to form the Home Care Safety Falls Prevention Virtual Improvement Collaborative that includes five teams from leading home care organizations across Canada.
• A partnership with the Canadian Frailty Network and Mount Sinai to launch a 12-month improvement initiative to support 18 healthcare delivery organizations as they adapt and implement elder-friendly models of care and practice.
• Continued support for the Canadian 'Better Together Campaign: Partnering with Families' to change the concept of families as "visitors" and instead recognize them as partners in patient care.  Twenty-one organizations - including hospitals, health regions and others - have taken the 'Better Together' pledge to review their visiting hour policies and create formal policies for family presence.
• CFHI offered 26 On-Call webinars on diverse topics such as acute care for elders and best practices for data management, involving 2,400 individuals and teams in all provinces and territories. Based on 16 surveys, 82% of respondents said they will apply what they learned from the webinars in their workplace.

Performance Information (dollars)

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