Supplementary Information Tables: 2016–17 Departmental Results Report
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
Name of recipient
Canada Health Infoway (Infoway)
Start date
March 31, 2001(a)
(a)Infoway's original allocation (2001) was governed by a Memorandum of Understanding. Infoway is presently accountable for the provisions of four active funding agreements, signed in: March 2003 (encompasses 2001 and 2003 allocations), March 2004, March 2007, and March 2010.
End date
March 31, 2015(b)
(b)As per the 2010 funding agreement, the duration of the agreement is until the later of: the date upon which all Up-Front Multi-Year Funding provided has been expended, or March 31, 2015. The duration of the 2007 funding agreement is until the later of: the date upon which all Grant Funding provided has been expended, or March 31, 2012.
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
Description
Infoway is an independent, not-for-profit Corporation established in 2001 to accelerate the development of electronic health technologies (collectively referred to as "digital health"), 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:
- $500M 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;
- $600M in the First Ministers' Health Accord of February 2003, to accelerate implementation of the EHR and Telehealth;
- $100M as part of Budget 2004 to support development of a pan-Canadian health surveillance system; and
- $400M 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 M 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.
Recently, Budget 2016 provided $50M over two years to Infoway to support short-term digital health activities in e-prescribing and telehomecare. Then in Budget 2017, Canada Health Infoway was allocated $300M over the next five years for expanding e-prescribing and virtual care initiatives, supporting the continued adoption and use of electronic medical records, helping patients to access their own health records electronically, and better linking electronic health record systems to improve access by all providers and institutions. 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 were no other audits scheduled or conducted during the year.
Significant evaluation findings by the recipient during the reporting year, and future plan
No performance evaluations were scheduled or conducted during the 2016-17 fiscal year. Infoway is scheduled to submit an independent evaluation report in March 2018 for funds allocated in 2010.
Summary of results achieved by the recipient
Investment Strategy: Infoway is a strategic investor, with a funding formula that typically covers up to 100% of territorial and 75% of provincial eligible project development and implementation costs. Infoway provides project oversight, advice and monitoring, while provincial/territorial partners are responsible for actual system development, implementation and funding of all other costs, including ongoing operational costs. In 2016-17, Infoway achieved project investment expenditures of $101.8M (78.3% of the $130M expenditure target). New investment project approvals totalled $67M, thanks in part to the success of the Investment Portfolio Optimization (IPO) initiative in recouping unspent funds (see below for further details).
Infoway estimates that investments in telehealth, drug information systems, diagnostic imaging, physician and ambulatory clinic EMRs have produced an estimated $19.2B in benefits (cost savings and efficiencies) for Canadians and the health care system since 2007, representing an increase of approximately $3B in the past year alone.
IPO Initiative: Building on the delayed projects review conducted in 2014-2015, Infoway management established a new business initiative known as IPO to conduct an in-depth assessment of all remaining EHR, EMR, telehealth and public health surveillance jurisdictional projects to accelerate the completion of these projects by June 2018. There were 68 active and on-hold projects included in IPO's initial scope, totalling approximately $179M in unspent funds. During 2016-17, 22 in-scope projects have closed and $43.5M has been recouped so far. All of these recouped funds have been reinvested in new projects.
Use of EHRs: There were an estimated 162,000 active EHR users across Canada in 2017, more than double the number from three years ago, and a 400% increase in the past five years. 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. Approximately 301,000 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, 2017, 94.6% of Canadians had EHR data available to authorized physicians.
Telehomecare: There was significant growth in the use of telehomecare (remote patient monitoring), where digital technology is used to monitor patients remotely (e.g., pulse, blood pressure, blood sugar, weight), improve patient/caregiver quality of life and reduce hospital visits. Nearly 24,000 Canadians have participated in telehomecare programs since 2010 and an estimated 7,000 patients were enrolled in provincial/territorial programs in 2016, an increase of almost 2,000 over the previous year.
Clinical Interoperability: The Digital Health Alliance (DHA), initiated in 2015-2016 to maximize national collaboration about topics related to standards and interoperability, continued to grow this year under the direction of the DHA Steering Committee. The DHA collaboration platform, InfoCentral, is a hub for communities of interest as well as dialogue across the country. The platform experienced tremendous growth in 2016-17 with 49 active virtual communities of interest across the digital health spectrum involving clinicians, vendors, developers and other e-health professionals. There were more than 46,100 visits to InfoCentral, up 62% from the previous year (2015-2016).
Certification: Since 2009, Infoway's national certification program has been promoting the use of trusted, interoperable, standards-based digital health tools. The program provides an independent, third-party service against which solution vendors can certify that their products meet pan-Canadian privacy and security standards. In turn, users know that their choice of software has met the highest standards for the private and secure control of personal health information. To date, more than 30 digital health software tools that are sold in Canada have been certified through this program by Infoway. These solutions support tens of millions of electronic patient records and are used by more than 30,000 physicians and many other clinicians and consumers across Canada.
Consumer Digital Health Solutions: One of Infoway's main objectives is to increase Canadians' access to digital tools that provide patients, family members and caregivers with "virtual care" services such as e-booking, e-visits, e-views and e-requests for prescription renewals. A 2016 Infoway survey of Canadians revealed that the availability of these consumer digital health tools has more than doubled in the past two years (from 6-7% in 2014 to 14-22 % in 2016) and Canadians' interest in using these tools remains high.
Investments in jurisdictional and large regional implementations across five jurisdictions are expanding the availability of consumer digital health tools across the country. The MyHealth Nova Scotia portal is currently being rolled out across the province of Nova Scotia. The Saskatchewan Citizen Health Information Portal is being rolled out to more than 100,000 citizens. A large regional patient portal in south-west Ontario will aim to provide service to 60,000 people. In British Columbia, the Mustimuhw Citizen Health Portal will be expanded to include all residents of the Cowichan Valley and the Chilliwack area. In Quebec, a provincial e-booking solution will provide citizens with improved access to primary care providers, and a provincial e-referral solution will give citizens priority access to specialized care, as well as to enable patient involvement in the referral process through an associated consumer-facing tool.
Digital Health Thought Leadership: To further the deployment of digital health innovations such as consumer digital health tools, EHRs and EMRs, Infoway's subject matter experts provide support to provincial and territorial partners in areas such as privacy and security, architecture, change management and knowledge sharing. The following are some examples of activities in 2016-17.
Continued sponsorship and hosting of the pan-Canadian Privacy Forum and the Health Information Privacy Group (HIPG), which bring together representatives from health ministries, e-health agencies and privacy commissioners to discuss information privacy issues for digital health innovations. In 2016-17, this work focused on the development of common approaches to information governance issues as related to privacy in digital health;
- Participation in the Conference on Problematic Opioid Use hosted by federal Health Minister Jane Philpott and Eric Hoskins, Ontario Minister of Health and Long-term Care, where Infoway committed to the Joint Statement of Action to Address the Opioid Crisis;
- Participation in forums and conferences, including: the Canada-United States Connected Health Workshop in Washington, District of Columbia; and, the Ninth International Conference on eHealth, Telemedicine, and Social Medicine (eTELEMED 2017) in Nice, France; and,
- Organization and sponsorship of the annual Infoway Partnership Conference and the annual national e-Health Conference.
Digital Health Deployment Knowledge Sharing: Infoway's Jurisdictional Implementers' Groups (JIGs) continued to provide support for EHR implementation and adoption in four investment programs: laboratory systems, diagnostic imaging, drug information systems and enterprise architecture. These groups inform jurisdictional strategies regarding topics relevant to their digital health deployment projects, such as data quality, identity management, clinical adoption, and integration. More than 160 people from across participating jurisdictions come together regularly at JIGs to discuss and collaborate on common implementation, deployment, operational and business issues, and to share experiences and lessons learned in their jurisdictional projects.
Change Management: Infoway sponsored and delivered a change management workshop in partnership with HealthCareCAN. Infoway also sponsors and sustains a Change Management Network, a Change Leaders Network and a LinkedIn Change Management working group, and works with change leaders across Canada using Infoway's Change Management Framework and Toolkit. Infoway and HealthCareCAN have also developed the course content for a Change Leadership Certificate program.
Health Data and Analytics: During 2016-17, Infoway authored Health Analytics Deployment Considerations and Approaches, a paper that provides practical considerations to help guide the successful design, deployment and use of health analytics tools in a complex digital health setting. The paper also proposes a capability maturity model for health analytics in the Canadian health care system, identifies emerging technologies and assesses opportunities for their use.
Infoway also convenes a discussion forum for those responsible for health analytics in provincial health ministries, e-health agencies, and the Canadian Institute for Health Information. This group shares experiences and successful approaches to analytics, and discusses common challenges to advancing the effective use of health analytics in Canada.
Clinician Engagement: During 2016-17, Infoway continued to foster and develop multiple approaches to clinician engagement and support of clinical communities and working groups, such as through the InfoCentral platform, which is seeing steady increases in the numbers of clinical users and repeat visits and interactions. Infoway also provides leadership and insight to the broader clinical community through white papers, research studies and commentary on meaningful, relevant content. Examples include: publication of annual pharmacist, physician and nursing surveys which are developed in partnership with national professional colleges and associations; working with the Registered Nurses' Association of Ontario to release a best practice guideline, Adopting eHealth Solutions: Implementation Strategies, to support nurses in the use of digital health; working with the College of Family Physicians of Canada to develop a Best Advice Guide about the use of EMRs; and co-sponsoring, with Accreditation Canada, a LEADing Practice Awards challenge to recognize leadership in improving the patient experience through the effective use of digital health technologies.
In addition, Infoway invited more than 100 clinical and faculty peer leaders, clinical reference group members and other clinical champions of digital health to participate in a Clinical Engagement Forum in February 2017. The agenda was designed to engage the clinical community to provide their insights into the federal government's priorities (e.g., patients' access to their own information, palliative care, mental health, First Nations health, homecare etc.). Infoway's clinical stakeholders have also been invited to join a new online community on Infoway's InfoCentral platform that enables collaboration and real-time engagement with Infoway's programs and priorities.
The faculty peer leaders will also complete their current projects in 2017, delivering on a multi-year program to develop health informatics content and e-resources that embed these competencies into the curriculum for nurses, pharmacists and physicians.
Benefits Evaluation: Measuring, evaluating and reporting on the benefits being realized from Infoway's digital health investments is an ongoing area of focus. Throughout 2016-17, nearly 30 project evaluations and surveys of clinicians and Canadians provided evidence of the progress in digital health. Early in the year, a successful launch of a pan-Canadian study about ambulatory EMRs revealed substantial value from these investments, as well as success factors for maximizing value. Evaluations from consumer health technology demonstration projects revealed improvements in patient satisfaction, value for the health system (e.g. fewer visits to physicians or emergency departments), clinic/clinician productivity and continuity of care (operational workflow, care coordination).
Outreach to Canadians: In March 2017, Infoway convened "Better Health Together", a citizen forum where 40 Canadians from across the country gathered to help develop a vision for the future of patient-centred, technology-enabled health. This work has informed Infoway's activities and will help to ensure that Canadians have the tools to be empowered and engaged in their health.
Infoway hosted the third annual Digital Health Week (November 14-20, 2016). The week brought together more than 40 national health care organizations and governments to celebrate the difference that digital health is making for Canadians.
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 by Infoway and its jurisdictional partners through the $500M 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 $319M will be recouped by federal, provincial and territorial governments through increased tax revenues. During 2016-17, these investments generated an estimated 679 person years of employment, had a positive impact on GDP estimated at $70M, and enabled the federal and provincial/territorial governments to recoup approximately $13M and $6M respectively. From the time the funding was granted in March 2010 through to March 31, 2017, there has been an estimated cumulative impact of 10,789 additional person-years of employment and a $1.1B increase in GDP.
| 2014-15 Actual spending | 2015-16 Actual spending | 2016-17 Planned spending | 2016-17 Total authorities available for use | 2016-17 Actual spending (authorities used) | Variance (2016-17 actual minus 2016-17 planned) |
|---|---|---|---|---|---|
| 87,956,664 | 82,700,467 | 37,877,924 | 37,877,924 | 37,877,924 | 0 |
Note: Infoway is also reported under Details on Transfer Payment Programs of $5 Million or more section of the Supplementary Information Tables.
Conditional Grant to Canadian Foundation for Healthcare Improvement
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
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
CFHI previously operated as the CHSRF, an arms-length, non-profit, charitable organization with a mandate to fund health services research and promote the use of research evidence to strengthen the delivery of health services. CHSRF received $151.5M in federal funding under separate up-front grants (1996-97 to 2003-04), as outlined below.
Up-front multi-year funding to CFHI has included:
- 1996-97: A $66.5 million endowment established the CHSRF.
Additional federal grants were provided to CHSRF for the following purposes:
- 1999: $25M to support a ten-year program to develop capacity for research on nursing recruitment, retention, management, leadership and the issues emerging from health system restructuring (Nursing Research Fund).
- 1999: $35M to support its participation in the Canadian Institutes of Health Research.
- 2003: $25M to develop a program to equip health system managers and their organizations with the skills to find, assess, interpret and use research to better manage the Canadian health care system (Executive Training for Research Application or EXTRA).
To reflect the evolution of its work, CHSRF was renamed as CFHI in 2012. The organization is now receiving contribution funding which supports the federal government's interest in achieving an accessible, high quality, sustainable and accountable health system adaptable to the needs of Canadians. Funding is designed to support CFHI's work to identify savings and efficiencies in the health system by: building leadership and skill capacity; enabling patient, family and community engagement; applying improvement methodology to drive measurable results; and, creating collaboratives to spread evidence-informed improvements.
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 2016 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 Departmental Performance Report.
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
As a result of a transition to the receipt of contribution funding in response to recent Budget funding commitments to CFHI, remaining up-front multi-year funding was held in reserve for costs related to its potential organizational wind-down (e.g. legal obligations related to its pension plan and contracts), should it be required in the future.
| 2014-15 Actual spending | 2015-16 Actual spending | 2016-17 Planned spending | 2016-17 Total authorities available for use | 2016-17 Actual spending (authorities used) | Variance (2016-17 actual minus 2016-17 planned) |
|---|---|---|---|---|---|
| N/A | N/A | N/A | N/A | N/A | N/A |
Note: CFHI is also reported under the Details on Transfer Payment Programs of $5 Million or More section of the Supplementary Information Tables.
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