Dr. Darren Larsen is Chief Medical Information Officer (CMIO) at OntarioMD. As CMIO, Darren provides clinical advice to many provincial and national steering committees and clinician advisory groups and has been instrumental in forging system-level partnerships in many sectors. Darren is a tireless champion of optimization of EMRs and health informatics in empowering Ontario’s physicians, with a focus on quality patient care and practice efficiency. He provides a clinician perspective and guides all aspects of OntarioMD’s work to evolve and advance EMRs and digital health for primary care and community specialist clinics. This includes clinical practice change, quality improvement, data quality and analytics, and EMR maturity measurement. He recently shared his insights with RDP Associates on the state of innovation in Canada’s digital health sector.
Canada’s biotech and health-tech industries are among the most dynamic and innovative sub-sectors of the tech industry. But despite its dynamism, scaling up and go-to-market remain pressing challenges. Why is that?
Indeed, Canadian minds are anteing up some amazing ideas in the digital health space. We have such a strong well to draw upon for creativity and innovation. There is an endless need for new products, services and thinking in health care, for patients, providers and the health system, yet despite the demand, it is incredibly hard to bring innovation to market. I frequently say that real change requires resolution not revolution, and it is hard to maintain excitement and enthusiasm when the system falls short of the needs of innovators beyond the ideation phase. The reasons for this are complex, but some key issues that we could collectively work on to try to improve the situation quickly bubble up.
a) There is very low tolerance for failure in health care. Some of this is predictable, based on clinicians’ training in evidence. Some fall at the health system level, where even small failures lead to blame rather than learning, and it often becomes a story on the front pages of a newspaper. Some of this is even cultural. As Canadians, we do not trust our own innovators until they have been proven in another market or immediately hit the news.
b) Our classic public-sector procurement rules are complicated and hard to navigate. This leads to a bias toward established companies which have greater capability to persist and respond.
c) There is a basic distrust of business in our socialized health care system. The private sector is viewed with suspicion, and the introduction of profit motives makes those of us who believe and have invested in socialized medicine, somewhat wary. We must find a middle ground.
d) Regulatory issues abound in health-tech, from Health Canada medical device status rules, to technical standards often being vague, to privacy legislation being used as an excuse to stop innovation even when it is designed to permit it.
e) The investment/venture capital landscape is different and less permissive in Canada than it is in the US. It is frankly easier to find investors and backers south of the border than it is within our own country.
f) The desire to take a chance on promoting and partnering with new companies is low in Canada. We are guilty of “death by a thousand pilot projects” and accept this as the norm. Most pilots are created to test a very narrow product or service window of safety rather than facilitate scale and spread of the same. Unlike in the start-up space, in healthcare, we lack the “fail fast and fail forward mentality”, which is essential to the innovative process.
Many government grants are generic, but some are industry-specific such as those for clean-tech and agri-tech. Do we need specific grants that target biotech and health-tech sectors to ease some of the challenges they’re facing?
This might well be an option to try. The use of grant money could be tied to co-design or creative procurement that does not predict the final end-point for a product, but rather allows it to evolve organically until it reaches a desired state or value. Design thinking methodology could, and likely should be placed into the grant awarding process. Technology engineers, designers, and providers must align to ensure that they have created a product or service that is actually needed. Then, a shift to value-based funding and support might ensure ongoing success. Currently, many innovation grants do not consider scale and spread of an idea or product. There are incubators that provide in-kind expertise rather than cash. And there are investors who want to see successful companies move forward. The sweet spot is combining these in partnerships.
How would you describe the relationship between the government and Canada’s tech sector including its startup community? Where do health-tech and health care fit into their dynamics?
I possess a cautious optimism in this space. There is certainly an increase in the promotion of start-ups and a growing community of innovators who network and learn from each other. Also, we are seeing some fantastic government-supported or -partnered innovation hubs like MaRS, McMaster Innovation Park, the BMZ and DMZ at Ryerson University, and Velocity at the University of Waterloo, which are great as examples in Ontario alone (and more nationally: Ontario even has a Chief Health Innovation Strategist in the Ministry of Health and Long-Term Care, William Charnetski. These are great starts, but these are early days and this is still nascent work. It will take a long time to change a culture.
Are there sub-sectors of Canadian healthcare that conduct a significant amount of R&D?
I see a lot of progress in Canada now with the creation of health care “living labs“. These are unique spaces where partnerships are used to test products in working environments like hospital units (Mackenzie Health, Southlake Hospital) or human-centred design spaces (UHN Centre for Global eHealth Innovation, JLabs by Johnson and Johnson, Bridgepoint Active Healthcare) or digital health evaluation spaces (MEDIC at Mohawk College, WIHV at Women`s College Hospital). These serve as platforms for integrated thinking about solving clinical problems using integrated technology, not as siloed projects that are procured individually. I believe these may be our future.
What is your definition of a ‘value-based healthcare system’ and what are its key defining parameters?
Value takes many forms and changes according to who is looking for it and what their goal is. Certainly, from the government’s perspective, the value can be calculated in the ratio of quality (or outcomes) over cost. This is very important when setting budgets and ensuring that they are getting what they pay for. This is often the default value proposition in a publicly-funded health system, and it is indeed important.
Value, as measured by a patient, is a whole other proposition. They may value being listened to, having a concern demystified, or simply being told they will be fine.
The clinician perspective exists in the intersection of the health system and patient lived experience. We face the multifaceted challenges of unprecedented demographic change, medical system evolution, and continual demands to innovate every day. But on the positive side, this can challenge physicians in creating solutions.
Ultimately, the value can be only generated in trusted relationships. All three players in healthcare (funder, provider, patient) must work on mutual trust to achieve common goals. This is more than value; it is being valuable.
Do you think the newly revamped tax laws in the U.S could be incentivizing Canadian health-tech companies to move south?
Certainly, permissive tax rules may have an influence, but I believe that tech companies venture south before developing a strong presence in Canada for some far more basic reasons. The US market is much larger. An entrepreneurial spirit is deeply ingrained in American culture. There is greater degree of tolerance for failure. There is much more capital to draw upon from investors who are willing to take a chance on health-tech, knowing that they will win some and they will lose some. Still, there are challenges in the US too. It is a dog-eat-dog world in health care south of our border. Sometimes the stories of speed in success or failure are a distraction from a business purpose that enables longevity. Real change requires resolution rather than revolution.
This interview was conducted by Reza Akhlaghi, a digital content and social media strategist at RDP Associates.