Joshua Liu

Most people who have work in the Canadian healthcare system have undoubtedly shared the same ‘eureka’ moments on the impact digital health could have on improving patient care while reducing costs.

The transition from paper documents to Electronic Medical Records and Computerized Physician Order Entry (CPOE) were seen as significant milestones for many health care organizations, although even some of our “leading” organizations today still lag behind in this regard. Sometimes it feels as if our health care system is waiting for everyone to catch up before taking advantage of new digital health solutions.

All the while, three key trends in the past few years have created an unprecedented opportunity to radically improve healthcare delivery:

1. The explosion of mobile, wireless and wearable technologies
2. The transition from fee-for-service to value-based healthcare
3. The decreased barrier to entry for startup companies and increasing private investments in healthcare innovation

From improved patient-self management using mobile health (mHealth) applications to remote patient monitoring using wireless technologies, there are a growing number of digital health solutions that can support high quality care at scale for our growing population.

While the U.S. has unique healthcare problems of its own, they are certainly ahead of Canada in developing, testing and adopting digital health innovations. When you compare the Canadian digital health landscape to the American one, it’s almost as if Canada is in an entirely different universe.

So why is this concerning?

There is growing evidence that much of our costs and adverse outcomes are preventable. But the old way of requiring a healthcare professional to do everything is simply not scalable, and it’s a missed opportunity to not take advantage of digital health solutions to deliver safer, more efficient care at scale.

Upon reflection, there are several factors contributing to the limited adoption of digital health solutions in Canadian healthcare.

1. Fragmented system

In Canada, the way in which hospitals are governed ranges from a single health authority in Alberta to multiple health authorities in Ontario, although it can be confusing as to how much authority these organizations actually have. In contrast, most hospitals in the U.S. are part of a hospital system or network, often owned and operated by a central organization.

Fragmented system  = low diffusion of innovation. With most Canadian hospitals operating independently, even if an innovation is proven and adopted at one hospital, there is no inherent framework or incentive structure for such an innovation to spread to other hospitals.

Conversely, the successful adoption of an innovation at one hospital in a large U.S. hospital system (which can be as large as 100 hospitals) is often used as a case study for the rest of the hospitals in the system to also adopt the innovation. This is because such systems are owned by a central body which has the authority and incentive to scale successful innovations to its other hospitals.

2. Fragmented policies on personal health data

Related to Canada’s fragmented system are our fragmented policies on how we collect, store and disclose personal health information. Not only can these laws vary from province to province, hospitals within a single province often have varying policies of their own.

Both within and across provinces, we need a more unified set of guidelines and methods of approval. Healthcare organizations and companies both waste time and money every time an innovation’s privacy and security standards need to be re-approved at a new organization.

What’s acceptable in one hospital should be acceptable in every other hospital. And these requirements must be clear and publicly available.

3. Healthcare organizations’ tendency to build in-house

Because internally-developed technology takes longer to deploy and often stays within healthcare organizations, it is difficult for healthcare organizations to attract the most talented software developers and designers who want to build quickly and impact the global population. In contrast, health technology companies provide the most talented software developers the opportunity to build products that can impact patients and providers at a large scale.

In most cases, health care organizations should not be building digital health solutions in-house. They should focus on what they do best – delivering high quality medical care. What they should do is partner with technology companies who have greater technical talent and experience, and work together to solve these problems.

I am concerned when I see hospitals wasting resources to build their own digital health solutions that really good technology companies have already developed and tested in other environments. I don’t know why this happens more often in healthcare than other industries, but it does – instead, health care organizations should first look to the market and see what’s available. We reinvent the wheel way too much when it comes to digital health solutions.

The other problem is that even if a hospital develops a great solution, it often remains in-house and product improvements are limited. In contrast, health technology companies are more incentivized to achieve product excellence and scale their healthcare innovations to other organizations. Most siloed hospitals just don’t have the resources or incentives to build scalable digital health solutions.

4. Passive approach to value-based health care

No one changes unless they are forced, and we have created limited urgency in Canadian healthcare. Unfortunately, our current funding models are not quite conducive to digital health adoption. Although we are beginning to tie funding to quality, the vast majority of healthcare delivery is still funded based on volume, leaving little incentive for healthcare organizations to adopt digital health technologies that improve coordination of care and patient outcomes.

In contrast, the U.S. has been much more prolific in terms of investing in, testing and adopting new digital health solutions, mostly due to the more aggressive pay for performance guidelines in Obama’s Affordable Care Act  – for example, readmission penalties – thereby forcing providers to deliver higher quality care at a lower cost.

True, some parts of the Affordable Care Act are controversial and may ultimately be flawed, but you don’t know what policies will or won’t work unless you try. Personally, I’d rather be part of a system that’s a leader in trying to make value-based care work, instead of waiting and reacting to what works in other countries. Instead, our current funding model in Canada is out of date, and it’s killing our ability to innovate.

These barriers will come down with time, because ultimately we will be forced to. When we can’t pay for healthcare anymore, something will give. But we owe it to our providers and to our patients to get there faster.