[This article was originally published in Essays December 2011]

Infoway Board Chair Graham Scott gave an important speech last Friday to the Canadian Club.  He signalled a changing agenda for how Canada modernizes health information systems. 

Canada Health Infoway is ten years old and has had a successful first decade.  I have written previously about the challenges and opportunities facing Infoway in its second decade.  Several results from a normal maturation of this emerging industry and is predicted by academic models. Others are the result of exciting innovations happening across healthcare.  This essay is an attempt to track the progress and to highlight some remaining challenges. 

First, it is worth celebrating the successes that Infoway and the entire industry have had. Scott does this by talking about domain specific successes and how widespread adoption is in areas such as Diagnostic Imaging, Drug Information Systems, and Physician EMRs.  He holds up Alberta’s Netcare, Hamilton’s Clinical Connect, and Connecting GTA as examples of connecting among these systems.

Along with these “Old Infoway” examples, Scott also elaborates on the successes of Telehealth, particularly in Ontario.  He tells the story of a northern Ontario paediatric patient and her parents and notes that, “Ontario has one of the largest networks in the world.” He talks about how Telehealth, “…connects patients and health care providers who are not in the same place, from videoconferencing for mental health consultations to regularly monitoring vital signs at home for people who have chronic health problems.“  This signal that Infoway is embracing Telehealth continues on a report commissioned by Senior VP Jennifer Zelmer and others over the past year.  Telehealth and what Scott calls “virtual visits” are increasingly seen as the next generation of eHealth innovation.

Infoway has spent considerable time and effort trying listening to what consumers and patients actually want.  This is pretty impressive for a government enterprise.  They have organized focus groups across the country and “…asked Canadians about the types of e-innovations in health that they themselves would be most likely to use. Booking appointments online, renewing prescriptions, e-consults with care providers, and viewing their own health information, such as lab test results, topped the lists.”

To complete the transformation of health care, more technical work is required and Scott is clear that Infoway will be busy for many years implementing these foundational pieces.  But he is also clear that “…the biggest challenges are not technical.”  Throughout his speech he returns to the theme that the Infoway project is about much more than IT.  The human stories illustrate this point well.  We need to consciously change culture and clinical practice.  Infoway is ultimately about improving health care and clinical practice.  The regulatory, pricing, and practice changes required will be system-wide and Scott calls for this in his speech.

Scott’s speech is part of consulting with Canadians as Infoway develops its new strategic plan.  While no one speech can address every issue, there were half a dozen items that I would love to hear Graham Scott (and Infoway) address as it develops its plans:

1. The end point.  What is the view of how the role of Infoway shrinks over time? When do we finish? And what does a post-Infoway world look like?
2. Whose job is to reclaim the benefits for Canadians that the Infoway investments have created? I have written elsewhere about the example of out of control incomes for radiologists.  There are other examples.  Whose job is it to harvest “benefits”?
3. How do we shut down non-performing assets? Information technology projects fail all the time.  Private industry has a method for shuttering operations that fail or become obsolete over time.  In a mature industry this could be a good role for a national organization.
4. How do we regularize the provincial ehealth agencies and the regional ehealth providers?  In some provinces, it is an open secret that the provincial agency is underperforming.  Should Infoway exercise judgment and provide direction?  
5. What models for stable futures does Infoway see for the provincial agencies?  How will these relate to the eHealth providers?  What does a mature industry look like in terms of public/private partnerships and competition?  Infoway can certainly provide some insights on desirable industry structure.
6. How will we incorporate new technologies?  Scott mentions “…Ottawa Hospital where they are providing iPads to their 2100 clinicians.”  This is truly incredible adoption of a technology that is less than two years old.  Across our health system, guerrilla development and adoption of smartphones, tablets and other modern technologies are the new reality.  Infoway has made a big commitment by appointing CTO Dennis Giokas to focus on these challenges.

It is important to put these challenges into perspective and context.  Infoway is one of the most successful health IT policy implementations globally in my opinion.  Sure there are systems like Denmark that moved earlier and incorporated employed physicians.  But if you want Denmark’s Health IT then employ physicians. Given the constraints we faced in Canada, we have been successful and shown progress that merits further investment. 

Part of the reason for this success is due to visionary leaders like Graham Scott who have been willing to steer the good ship Infoway carefully through difficult waters.  Let’s continue to invest and innovate.

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