Peter W. Vaughan

Canada’s health systems are fragmented geographically and by sector. In the 2017 Commonwealth Fund report comparing health system performance in 11 countries, Canada ranked 9th. Only six per cent of Canadians viewed their personal health information online in the last two years. Yet valuable data reside in repositories in both the public and private sectors in Canada. A national digital health big data strategy is the foundation of a 21st century health care ecosystem. 

Digitization has changed almost every sector of the economy; yet health care, one of the largest goods and services industries in the world, hasn’t seen major disruption—yet.

The markets were taken by surprise with the recent announcement by Amazon, Brookshire Hathaway, and J.P. Morgan Chase that they would fund a new venture to provide cheaper and better health care for their employees. Why would these companies venture into the black hole of health care?  

Digital transformation is about to disrupt the health care status quo. Data, big data, advanced analytics and the companies poised to take advantage of them will facilitate that revolution across the entire spectrum of the health care industry.  It’s already happening. Babylon Health (UK) currently has more online patients in Rwanda than in Britain.

As Canadians, we need to quickly reimagine a digital Medicare 2.0, and soon, otherwise someone like an Amazon, Google, Apple or Babylon Health will be providing health care to Canadians for a fee. The Netflix of health care is coming and it’s floating on a sea of ever-increasing big data in health care. 

While there is no generally accepted definition of Big Data, for our purposes I mean large volumes of structured and unstructured information from a variety of sources, and accessible at great speed, or what has been referred to as the three V’s (volume, velocity and variety).

In Canada, most health data are locked away and difficult to access for meaningful use. Data are stored in multiple forms and locations: in tens of thousands of doctors’ offices as electronic or paper records (health care is still primarily a cottage industry in Canada); in private corporations, insurance company servers, universities and research agencies; in lab and diagnostic-imaging hard drives; as administrative information in hospitals or health ministries and federal agencies; and yes, on smartphones. All are disconnected from aggregate meaning and the new patterns and algorithms that someday might more accurately diagnose, treat faster, and yield better results. For payers, and in Canada that is everyone who pays taxes, health care big data holds the key to unlocking value in health care.

The rise of cloud-enabled solutions has yielded a wealth of ways to identify patterns and analyze treatments in real-time. We are witnessing an explosion of real-time data, data on wearable devices, what has been called the “quantified self.” 

The Internet of things (IoT) includes sensor enabled data shifting the community of care from the hospital (back) to the home. This is already the case in St. Louis, Missouri where Mercy Health’s Virtual Hospital—a hospital with no beds—has been leading the way with higher patient satisfaction, lower cost and better outcomes.

While the promise of personalized medicine has been slow, many observers believe we are reaching a tipping point as our understanding of genetics and epigenetics (how the environment and other external factors interact with our biology) evolves.

With more online health services available, the potential to improve access with mobile technologies requires the organization and governance structure to deliver it. 

Canada can be a global leader in the age of real-time, citizen-centric health care. Canada’s provincial and territorial single payer systems could become a first-mover advantage if harnessed in a collaborative, citizen-friendly way. 

Real-time data is the foundation of the future of health care, enhanced by artificial intelligence (AI), predictive analytics, and data-driven decision making at the heart of value-based health care. 

Today Canada’s health information systems are extremely fragmented geographically and by sector. 

Adoption of digital health in Canada has been slow and awareness by Canadians is low. In the 2017 Commonwealth Fund report comparing health system performance of 11 countries, Canada ranked ninth overall and last on access.

A Canada Health InfoWay survey in 2016 found only six per cent of Canadians had viewed online or downloaded their health information in the last two years. Only four per cent had emailed their regular primary provider with medical questions in the last two years. Yet, the vast majority of Canadians would like to be able to e-request a prescription renewal, access their medical records (view) online, book an appointment and consult with a health care provider online.

There are many valuable data repositories in Canada in both the public and private sector that can generate significant benefits and savings to Canadians, organizations and governments. However, a lack of a coordinated technology and regulatory ecosystem is preventing this value from being unlocked and there is a wide variance of standards, privacy controls and data governance.

The Netherlands, Croatia, the United Kingdon and India are using digital technologies to provide access to health records to citizens, health professionals and some biotech companies. 

There are corporations in Canada who have built significant data-driven ecosystems in other industries including Telus, RBC and eBay to name a few. These investments have resulted in ongoing benefits including new revenue- generating businesses, value creation, and higher use of data across multiple lines of business. 

Canada is the only Organisation of Economic Cooperation and Development (OECD) country without an electronic prescribing solution. Canada Health InfoWay and its contracted partner, Telus, launched e-prescribing in August 2017 (PrescribeIT). It offers a national solution that will integrate with provincial drug repositories and provincial registries. To date, six provinces and a range of pharmacy retailers have expressed a willingness to get on board. 

In the world of big data, Canada, with its 35 million people has the opportunity to build a pan-Canadian platform. This health care platform could be used to provide access to care via mobile devices or web-based tools for better access, and with evolving 5G at a far lower cost, expanding coverage into rural and remote areas.

Raw data stored in a secure trusted big data platform or series of connected platforms could be the foundation of an ecosystem with privacy enabled filters, cyber-shield controls and sound data governance. This could stimulate the proliferation of an application marketplace which in turn would drive economic development. Citizens would have access to their own data, insights, and customized analytics. 

Canada needs digital health legislation for the 21st century as part of a broader digital health strategy, one that fosters local, regional, pan-Canadian conversations around modernization of Medicare in the digital world, including agreement on ownership, access and physician remuneration for digital care; one that mandates electronic prescribing.

The European Union has put in place General Data Protection Regulations to modernize privacy and use of data controls.

The Netherlands has committed to 100 per cent patient access to electronic health records and to have 50 per cent of outcomes measured. Measuring outcomes is the foundation of value-based health care; a fundamental shift away from utilization cost-containment to value for service rendered. To do that, we have to measure outcomes not activities. 

Big Data in health care is a tool. The ability to integrate large health data sets creates both an economic opportunity and an essential first step in a value-based health care system. 

Governance is key to accountability. We can learn from other countries, including Denmark, the Netherlands, Croatia and Australia which have a central organization for data privacy and data governance. Working together, Canada already has organizations that could be assigned the role. Federal leadership is needed to mandate alignment on Big Data in health care.

Canada can be a global leader in a new age of real-time health care. 

Leveraging these shared assets will foster the next generation of research, product development, companies and creative leadership, which will establish Canada as an international incubator, attracting talent and exporting new health and bio technology to tackle the most complex health care challenges today and tomorrow.  

Peter W. Vaughan is former Deputy Minister of Health and Wellness in Nova Scotia. He is Board Chair, Canada Health InfoWay. 

peter@petervaughan.ca