Abstract
Peter Varga is the Chief Transformation Officer at HealthHub Solutions, Canada’s leading provider of bedside patient engagement technology. Leslie Motz is the Executive Vice President of Patient Services and Chief Nursing Executive at Joseph Brant Hospital in Burlington, Ontario. In this article, Peter and Leslie examine Canada’s ranking among OECD countries on the performance of its healthcare system and propose how optimizing processes around technology purchase and implementation can maximize the value that it can bring to improving health system performance.
Introduction
When it comes to spending on healthcare, Canada has deep pockets. Out of 38 OECD countries, Canada’s healthcare expenditure as a percentage of Gross Domestic Product (GDP) was 12.9% in 2020, second only to the United States at 18.8% of GDP 1 . Furthermore, Canada ranked fourth out of 38 OECD countries in 2020 on the amount spent on healthcare per person, with per capita spending at $7,507, well above the OECD average of $5,502 per person. 2
Unfortunately, this spending hasn’t always translated into exceptional performance, and the data reveal some interesting trends. In a 2021 Commonwealth Fund report
3
comparing the overall healthcare system performance of 11 high income countries, Canada came in 10th place, only ranking higher than the United States. To measure healthcare system performance, the study considered the following five indicators: • access to care; • care process; • administrative efficiency; • equity; and • healthcare outcomes.
The divergence between healthcare spending and healthcare system performance in Canada begs the question: What accounts for this gap? While there are a multitude of reasons, one particular challenge we face is how to better coordinate care both within individual care settings and across the care continuum. Technology can be an important enabler in achieving these goals, but the value that technology can bring is maximized when the processes around the technology are also optimized.
Lessons learned and proposals for the future
The COVID-19 pandemic had a disruptive effect on healthcare systems, shining a light on the limitations of healthcare models in Canada and around the world. Most of these challenges were known to us, but addressing deficiencies in the system, such as processes and infrastructure, is very challenging when demand for healthcare exceeds capacity on a consistent basis. At the same time, the pandemic has been a catalyst for positive changes as many health systems rose to the occasion and demonstrated their ability to innovate rapidly. This has served to re-invigorate their ability to innovate, with many expressing a desire to resist a return to more conservative approaches to transformation.
What are some strategies that healthcare leaders can employ to maintain momentum in this direction? Referring back to the key measures for health system performance from the Commonwealth Fund report, the following are some suggestions that could be beneficial.
Care process
While the majority of clinicians have timely access to patient information from within their care setting, the process to contribute to the clinical record or the process to access the complete longitudinal record can be a barrier to unlocking the potential benefit. In a fast moving, complex environment, workflow matters, and the focus on the clinician or patient experience when using technology is frequently underserved. This is particularly important as the adoption of digital solutions is increasing, according to a survey conducted by the American Medical Association, which found that physician use of technology to provide virtual care has doubled since 2016, and nearly 90% of doctors see at least some advantage in digital health tools. 4 With this in mind, as hospitals and healthcare organizations seek to support the stakeholders with technological innovations, understanding the workflow of the clinicians and patients is critical to unlocking their potential. This in turn will lead to higher efficiency and utilization, better outcomes, and enhance the user experience for clinicians and patients alike.
Administrative efficiency
Most public sector healthcare organizations are comprised of an operational and capital budget funding model. As technology investments have been historically capital investments, and because capital dollars are scarce and are frequently allocated to point of care investments vs. “back-office IT,” we have accumulated a significant amount of technological debt in our health system. Some of the consequences of carrying a high level of technological debt can include the following: • Increased downtime and system failures, leading to lost productivity; • Inability to integrate new technologies and systems, resulting in missed opportunities for innovation; • Difficulty in attracting and retaining talent, as employees may prefer to work for organizations with more modern technology; and • Increased security risks, as outdated systems may be vulnerable to cyberattacks and data breaches.
It’s difficult to estimate the exact amount of efficiency loss due to technological debt, as it can vary greatly depending on the organization’s specific circumstances. However, it’s widely recognized that carrying a high level of technological debt can have a significant impact on an organization’s overall performance and efficiency, and it’s often recommended that organizations regularly assess and address their technological debt to minimize its impact. As digital health advances as a critical component of health delivery, health systems need to seek technology strategies that ensure sustainability of their investments, mitigate the risk of technological debt, and avoid diluting the value of their initial investment over time.
Access to care, healthcare outcomes, and equity
Many patients want virtual support during their hospital stay and when they arrive home after discharge. Healthcare in Canada has been traditionally based on an episodic care approach in which patients are treated on a case-by-case basis, rather than a population health-based approach. A population health approach emphasizes prevention, wellness, early detection, self-management, mitigation, and treatment across a wide spectrum of the population, rather than treating an individual’s disease state during the acute phase. Adopting digital solutions is essential to enabling population-based healthcare, helping to break down siloes between different hospitals, health institutions, and community-based care that have often fragmented patient care and hindered clinical decision-making. Transitioning to a population-based healthcare model will require replacing current models of care with new digital paradigms that are supported across the continuum of care. There are tremendous opportunities in this area, such as the following: 1. Improved accuracy and completeness of patient information: digital health solutions allow for the centralized storage of patient information, including medical history, medication history, and test results, reducing the risk of errors or missing information. 2. Better patient engagement and education: digital health solutions can provide patients with access to their health information and educational resources, improving their understanding of their health conditions and treatment options, and reduced length of stay in a hospital setting. 3. Improved communication and coordination among healthcare providers: digital health solutions facilitate communication and collaboration between healthcare providers, improving the continuity of care and reducing the risk of medical errors. 4. Improved disease management: digital health solutions can support disease management programs by providing access to patient data and population health analytics, allowing healthcare providers to identify and target high-risk patient populations for intervention. 5. Improved clinical decision-making: digital health solutions can provide clinicians with immediate access to up-to-date patient information, including test results and previous treatments, allowing for more informed clinical decision-making.
As our health systems seek to make care more accessible in the community through innovations in care delivery such as the “Patient Medical Home” enabled by primary care networks or health teams, the need for better coordination and communication becomes paramount. Canada’s health system is challenged to coordinate care across settings because primary care (where 90% of patient interactions with our health system occurs) is not well integrated from an information standpoint, with ambulatory and acute care settings. This “white space” between care settings makes it very challenging for care coordination to be effective and confusing for patients and their families to navigate. This inhibits our healthcare services from behaving like a “system,” resulting in silos of care where errors can occur, and patients can fall between the cracks in the system. Digital health can assist with closing the gaps, but it requires a coordinated effort from healthcare providers from across the continuum. Aligning incentives is a key challenge as the pursuit of systemic benefit often results in localized expense (i.e. the Ministries of Health are responsible for the “health system,” and stakeholders in the system receive disparate incentives to implement or adopt tools that deliver systemic benefit). It should also be noted that these solutions need to be equitable, addressing the populations who do not have a high aptitude for utilizing technology, as well as those who do not have access to the Internet or other devices that would enable these benefits.
Going forward
As demonstrated during the pandemic, when governments and the public sector sent out a call to action, the private sector came together to rapidly add capacity and capability to our healthcare system. 5 This required the public sector to deviate from the standard procurement approaches and bring industry closer to the organization to focus on solutions in a dynamic way and rapidly deploy solutions. In contrast, typical procurements would have sought to be prescriptive about solution requirements, implying that all facets of the solution be understood and included in an RFP before a purchase can be made. While the pandemic was hardly business as usual for all involved in terms of the procurement policies, many organizations chose strategic partners to build capability with broad outcomes identified and less rigour in terms of prescriptive requirements. The results were that innovations were deployed in record time, they were iterated in real time as the situation continuously changed, or they didn’t work, and there was a real sense of shared ownership in the outcome vs. a transactional relationship.
The question is how can our system derive the benefits of this approach while balancing the rigour required to manage public funds in a responsible manner? One option would be to pursue value-based procurement, where buyers consider strategic objectives and multi-faceted solutions that are best suited to meet clinical needs, focusing on the value generated from a particular solution. An example of this is the CAN Health Network, a national partnership made up of leading health organizations across Canada. The Network’s vision is to create an integrated marketplace for Canadian health technology companies to test and enhance their solutions with end users, and ultimately scale through innovative procurement processes.
A value-based procurement model uses diverse criteria for purchasing decisions, ensuring any products or services purchased align with the needs of clinicians and patients. More broadly, a value-based procurement model fosters true partnership, which will move health innovation in the country forward.
Implementing a more agile, flexible procurement model that prizes innovation and value-based outcomes while welcoming competition is especially critical in a post-pandemic world. Now is the time to revamp procurement processes and re-design procurement models that no longer serve our healthcare system. Because hospitals have an obligation to adhere to procurement guidelines, procurement reform is needed to secure innovative products and services that further the evolution of healthcare ecosystems, improving patient outcomes and care delivery.
As hospitals and health systems initiate or accelerate their digital health transformation, forming long-term strategic partnerships with organizations that have relevant expertise and experience is becoming increasingly important. The role of partnerships in healthcare innovation will only continue to expand. To improve their clinical services, quality of care, and patient outcomes, healthcare organizations must develop value-based, mutually beneficial partnerships.
Value-based procurement is also influenced by the changing technology landscape. Unlike legacy products where you buy a software licence and computers to run it on, industry offerings are evolving into “platforms” where customers pay for access to the platform vs. owning it. This is disrupting the IT industry and, by extension, is disrupting the procurement process. The following are examples of platform solutions: 1. Cloud computing: Cloud computing platforms such as Amazon Web Services, Microsoft Azure, and Google Cloud Platform are providing public sector customers with flexible, scalable, and cost-effective solutions for storing, managing, and processing data. 2. Software as a Service (SaaS): SaaS solutions such as Salesforce, Workday, and Office 365 are providing public sector customers with subscription-based access to software applications, reducing the need for costly, on-premise software installations and maintenance. 3. Internet of Things (IoT): IoT platforms such as AWS IoT, Microsoft Azure IoT, and Google Cloud IoT are providing public sector customers with scalable and secure solutions for collecting, analyzing, and acting on data generated by connected devices. 4. Artificial Intelligence (AI): AI platforms such as IBM Watson, Google Cloud AI, and Microsoft Azure AI are providing public sector customers with tools for automating tasks, analyzing data, and making predictions based on patterns and trends.
Public sector customers can benefit from technology platforms in several ways, including the following: 1. Increased flexibility: Technology platforms provide public sector customers with flexible solutions that can be easily scaled up or down to meet changing needs and demands. 2. Cost savings: Technology platforms can reduce costs for public sector customers by providing subscription-based access to software applications and reducing the need for costly hardware and maintenance. 3. Improved user experience: Technology platforms are designed with user experience in mind, providing intuitive and user-friendly interfaces that make it easy for public sector employees to access and use IT solutions. 4. Enhanced security: Technology platforms often provide advanced security features and protocols to help protect public sector data and systems from cyber threats.
Overall, technology platforms are disrupting legacy IT solutions by providing more flexible, scalable, and user-friendly solutions that can help public sector customers to improve efficiency, reduce costs, and provide better services to citizens. Unlocking this potential requires organizations to consider alternative procurement models such as value-based procurement, to align with industry’s trajectory.
The final word
Technology companies can be a valuable resource and make the process easier by developing long-term, value-based partnerships with public sector organizations. Partnering with organizations that have already undergone their own digital transformation will be especially valuable for healthcare organizations as they can benefit from their learnings.
Through these partnerships and visionary leaders who are willing to embrace risk and invest in digital health innovation today, healthcare organizations will achieve the digital transformation that is necessary for them to thrive and evolve into the future.
About HealthHub Solutions
HealthHub Solutions partners with Canadian hospitals and health systems from coast to coast, enabling their digital transformations as they move forward with their own digital strategies. HealthHub Solutions has gone through its own evolution, transitioning from a bedside entertainment solution to identifying and aggregating applications at the point of care, optimizing patient and staff experiences, health outcomes, and cost savings.
To learn more about our platform and how to advance digital transformation, contact: