Supplementary Information Tables 2017-2018 : Health Canada

Up-Front Multi Year Funding

Table of Contents

Conditional Grant to Canada Health Infoway

General information

Name of recipient

Canada Health Infoway (Infoway)

Start date

March 31, 2001Footnote a

End date

March 31, 2015Footnote b

Strategic Outcome

A health system responsive to the needs of Canadians

Link to department’s Program Alignment Architecture

  • Program 1.1: Canadian Health System Policy
  • 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;
  • $400M as part of Budget 2007 to support continued work on EHRs and wait times reductions;
  • Budget 2010, Canada's Economic Action Plan allocated an additional $500M 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.

In addition, Budget 2016 provided $50M over two years to Infoway to support short-term digital health activities in e-prescribing and telehomecare. Budget 2017 allocated Infoway $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. These agreements are reported on in the Up-Front Multi-Year funding and Details on Transfer Payment Programs of $5 Million or more.

Historically, Infoway has played the role of strategic investor in digital health projects executed in collaboration with a range of partners, in particular with Health Ministries of provincial and territorial governments and their related agencies, typically on a cost-shared basis. Project payments are typically made based on the completion of pre-determined milestones.

With the completion of its foundational EHR/EMR/Telehealth mandate, Infoway is transitioning to a direct service provider model through its Driving Access to Care strategy, funded through the allocations provided under Budgets 2016 and 2017. Driving Access to Care includes two national initiatives:

  • PrescribeITTM, a multi-jurisdiction electronic prescribing (e-prescribing) service being developed, implemented and maintained by Infoway in partnership with Health Canada, the provinces and territories, clinician regulatory and professional bodies, and other health sector stakeholders. PrescribeIT™ will improve medication management, help combat opioid misuse, and strengthen patient safety and health outcomes.
  • ACCESS Digital Health, a multi-jurisdiction initiative that will: provide integrated channels so that Canadians can view their health information; increase access to, and breadth of, digital health services available to Canadians; and improve digital communications between providers for more effective, efficient care.

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 health care 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

Infoway was required to undergo an independent evaluation of its performance in achieving the outcomes contained in its 2010 funding agreement with the federal government. That funding agreement granted $500M to Infoway to develop and implement electronic health records, electronic medical records, and systems or tools to support integrated points of service, including consumer health solutions. The evaluation report was very positive, with no recommendations for improvements.

The evaluation report was submitted to the federal Minister of Health and the Members of the corporation (the 14 federal, provincial and territorial Deputy Ministers of Health) by March 31, 2018 as required.

Summary of results achieved by the recipient

PrescribeIT™: PrescribeIT™ is a multi-jurisdiction e-prescribing service created, operated and maintained by Infoway. PrescribeITTM will provide safer access to medications and will eventually be financially self-sustaining. During 2017-18, limited production releases (LPRs) of PrescribeITTM went live in several Ontario sites, followed by Alberta. While the sample sizes are small so far, LPR participants surveyed are generally reporting satisfaction levels higher than the targets in the agreement between Infoway and Health Canada signed in February 2017. That agreement also included a target of three jurisdictions participating in PrescribeITTM by March 31, 2018. The actual result was double the target, with six provinces now signed up: Alberta, Ontario, Manitoba, Nova Scotia, New Brunswick, and Newfoundland and Labrador. These provinces represent 61% of the Canadian population, easily exceeding the contribution agreement target of 50%. Infoway has also engaged with 27 retail pharmacy companies (local, regional and national) that represent approximately 3,400 stores in those six provinces with whom Infoway has PrescribeITTM agreements. This represents more than 50% outlet share in these six jurisdictions (excluding independents). In addition, more than 1,400 prescribers, representing more than one million patients, have expressed an interest in the service.

PrescribeITTM is the foundation of Infoway’s commitments under the federal government’s action plan on opioid misuse. Infoway met all of those commitments, which included: establishing a national medication management stakeholder community to share knowledge and tools; an international e-prescribing environmental scan and lessons learned; development of e-prescribing interoperability standards; and the launch of the Canadian Clinical Drug Data Set in collaboration with Health Canada, to ensure the safe exchange of medication information across the health system. In the one-year progress report for Health Canada’s Action on Opioid Misuse in November 2017, Infoway was recognized for its work with PrescribeIT™ that is helping curb problematic opioid use through timely, concrete actions that deliver clear results.

ACCESS Digital Health: In 2017-18, Infoway launched ACCESS Digital Health (a working title). ACCESS Digital Health will include myHealth Gateway (also a working title), a multi-jurisdictional platform that will engage and empower Canadians to better manage their health through secure, integrated access to their health information such as diagnostic test results and immunizations. The Gateway will also offer Canadians virtual care solutions such as e-booking, e-visits, e-renewals and secure messaging that will enable new models of care by clinicians. In addition, ACCESS Digital Health will improve digital communications between providers for more effective, efficient care.

To scale and spread innovation, ACCESS Digital Health will prioritize large-scale, multi-jurisdictional or national initiatives. Three of these were launched in 2017-18:

  • The First Nations Closing the Circle of Care initiative will scale the successful investment with British Columbia’s Cowichan Tribes and deploy a community electronic medical record and personal health record (PHR) solution to 226 First Nations communities and over 174,000 people across ten provinces and territories. The national deployment of the Mustimuhw Citizen Portal will enable improved information sharing between points of care inside and outside of First Nations communities, and will act as a catalyst to improve health care delivery and health outcomes in Indigenous communities across Canada;
  • Infoway recently kicked off a multi-jurisdiction initiative in Atlantic Canada to create a digital health ecosystem that will amplify local initiatives and innovations to accelerate the achievement of their goals. All four Atlantic provinces have agreed to work with Infoway to create ACCESS Atlantic, with a target of better health outcomes through improved access to digital mental health services, and reduced wait times through evidence-based solutions like telehomecare and electronic referral services. ACCESS Atlantic will also generate local economic development opportunities; and
  • Infoway is developing myHealth Gateway as part of a digital health ecosystem concept that will empower Canadians to take greater control of their health care, health care interactions and health outcomes. During 2017-18, Infoway initiated work on the feasibility of such an ecosystem, focusing on: enabling access to patient/citizen data, digital tools to support virtual care, and provide support tools to enhance patient care delivery; enabling existing and new consumer solutions to develop, deploy and scale more rapidly; connecting data and services to provide a streamlined patient experience; coordinating a public-private initiative addressing the objectives above; and extending the PrescribeIT™ model to other initiatives.

Telehomecare: The $50M allocated to Infoway in Budget 2016 included $10M for telehomecare, which is the electronic monitoring of chronic disease patients in their own homes, significantly reducing the incidence of complications and rehospitalizations, and thereby increasing quality of life. The agreement between Health Canada and Infoway included a number of performance measurement targets for telehomecare, among which was a target of 5,000 new patient enrollments. From April 1, 2016 to March 31, 2018, Infoway achieved over 9,500 enrollments, which represents 190% of the target. Infoway also exceeded all of the targets for patient and health care provider satisfaction. Some examples from surveys of participating patients and providers:

  • 94.2% of patients and 85% of providers were satisfied with the telehomecare services, vs. targets of 80% and 70% respectively;
  • Patients reported that telehomecare reduced visits to emergency rooms (76.3% agreed) and to family physicians or walk-in clinics (67% agreed), vs. a target of 30%; and,
  • 91.1% of patients felt that telehomecare enabled them to better manage their health, vs. a target of 50%.

Increased Adoption of Digital Health: There were an estimated 191,000 active EHR users across Canada in 2017, an increase of more than 300% in the past five years. Active EHR 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 in a quarter.

There was also significant growth in the use of telehomecare: more than 31,500 Canadians have participated in telehomecare programs since 2010. Altogether, these patients avoided 45,000 emergency department visits and more than 26,000 hospitalizations, representing 188,000 hospital days. Every $1 invested in telehomecare programs generates more than $4 in health system value in the first year alone. This value is in addition to the high level of patient satisfaction and improved quality of life.

The use of electronic medical record (EMR) systems by primary care physicians in Canada continues to grow. According to the Canadian Medical Association (CMA) 2017 Workforce Survey, 85% of family doctors reported that they were using an EMR in 2017. That’s more than double the 41% noted in the 2010 National Physician Survey. The use of EMRs by specialist physicians has also more than doubled during that time. 79% of specialists reported using an EMR in the 2017 CMA survey, compared with 36% in the 2010 National Physician Survey.

Increased Benefits from Digital Health: Investments by Infoway and the jurisdictions in connected health information, physician and ambulatory (outpatient clinic) electronic medical records (EMRs), diagnostic imaging, drug information systems, telehealth and telehomecare have produced an estimated $26B in access, quality and productivity benefits for Canadians and the health care system since 2007. That represents an increase of more than $6.8B in the last year alone. This year, Infoway published a new pan-Canadian evaluation report entitled Connected Health Information in Canada: A Benefits Evaluation Study which finds that, each year, connected health information currently produces: an estimated $1B in health system value; time savings of 18 million hours for patients and 5.9 million hours for providers; and $189M in economic productivity gains.

Investment Portfolio Optimization Initiative: In the summer of 2016, Infoway began an Investment Portfolio Optimization (IPO) initiative to accelerate the completion of all active jurisdictional projects within the EHR, Telehealth, Public Health Surveillance, and EMR and Integration programs such that, wherever possible, the projects are completed and/or closed by June 30, 2018. Where appropriate, the initiative will recommend the cancellation of remaining work on stalled projects and return unspent funds for reinvestment. The original scope of this initiative included 68 jurisdictional projects with approximately $179M in remaining unspent funds. As at March 31, 2018, 43 of these projects have closed and $61M has so far been recouped for reinvestment.

Pan-Canadian Leadership in Digital Health Knowledge and Collaboration: Infoway is the recognized national leader in digital health knowledge and collaboration. It will continue to play that leadership role to enable the delivery of its two strategic initiatives, PrescribeITTM and ACCESS Digital Health. As with its foundational investments, these two new strategic directions need leadership and insights in critical areas such as privacy, security, solution architecture and standards, interoperability, change management, and the effective use of emerging technologies. In 2017-18, Infoway demonstrated pan-Canadian digital health leadership in multiple ways, including the following examples:

  • Infoway continued to sponsor national collaborative bodies such as the Pan-Canadian Privacy Forum, the Health Information Privacy Group, the CIO Forum, and the Jurisdictional Implementers’ Groups. Infoway also established the Telehomecare Collaboration Forum, where representatives from eight jurisdictions held collaborative discussions about plans, priorities and strategies to tackle common challenges.
  • Infoway also expanded its collaboration with the Canadian Institute for Health Information (CIHI) to advance the appropriate use of data and analytics to enable a high-performing health care system. Infoway and CIHI have signed a memorandum of understanding for closer collaboration on topics such as: data collection, methodologies, indicators and analysis (e.g., health indicator development, establishment of data collection tools, data analysis); strategic planning and governance (e.g., data governance, health analytics); and communication, events and stakeholder engagement.
  • The Infoway-hosted InfoCentral ecosystem, which is home to 45 virtual communities of interest for clinicians, technology service providers, developers, standards, jurisdictions and other e-health professionals from across the country who are contributing to thought leadership, interoperability and technical solution architecture. In 2017-18, 22,000 visitors interacted on InfoCentral, an increase of nearly 15% from the previous year.
  • Infoway’s Clinical and Change Leadership team facilitated a number of stakeholder workshops providing leadership, best practices and insights in change management to support successful implementations and effective use of digital health solutions. The Clinical and Change Leadership team also supported seven peer leader projects during the fiscal year, whose goals included advancing the use of EMRs, scaling of innovative solutions and services such as e-prescribing, enhancing existing digital health competency for clinicians entering practice, and facilitating patient access to personal health information.
Performance Information (dollars)
2015-16 Actual
spending
2016-17 Actual
spending
2017-18 Planned
spending
2017-18
Total
authorities available for use
2017-18 Actual
spending (authorities used)
Variance (2017-18 actual minus 2017-18 planned)
82,700,467 37,877,924 25,847,647 25,847,647 25,847,647 0

Note: 2017-18 Departmental Results Report, Supplementary Tables for Infoway are reported under Up-Front Multi-Year Funding and Details on Transfer Payment Programs of $5 Million or more.

Conditional Grant to Canadian Foundation for Healthcare Improvement

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 Policy
  • Sub-Program 1.1.1: Health System Priorities

Description

The Canadian Foundation for Healthcare Improvement (CFHI) previously operated as the Canadian Health Services Research Foundation (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.

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 collaborative to spread evidence-informed improvements.

Up-front multi-year funding to CFHI has included:

  • 1996-97: A $66.5M 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).

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 2017-18 external financial and pension audits showed no major concerns.

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

No new results associated with the conditional grant to report for 2017-18. CFHI held the remaining up-front multi-year funding (approximately $10M) 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.

Performance Information (dollars)
2015-16 Actual
spending
2016-17 Actual
spending
2017-18 Planned
spending
2017-18
Total
authorities available for use
2017-18 Actual
spending (authorities used)
Variance (2017-18 actual minus 2017-18 planned)
N/A N/A N/A N/A N/A N/A

Note: 2017-18 Departmental Results Report, Supplementary Tables for CFHI are reported under Up-Front Multi-Year Funding and Details on Transfer Payment Programs of $5 Million or more.

Footnotes

Footnote 1

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.

Return to footnote a referrer

Footnote 2

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.

Return to footnote b referrer

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