Dr. Jennifer Zelmer is President and CEO of the Canadian Foundation for Healthcare Improvement. She is also President of Azimuth Health Group. In this capacity, she provides a range of advisory services to local, national, and international clients who seek to advance health and health care. She is also the Editor-in-Chief of Healthcare Policy, an Adjunct Faculty Member at the University of Victoria, Faculty/Advisor to the Canadian Foundation for Healthcare Improvement, and serves on a range of health-related advisory committees and boards.

Prior to founding Azimuth Health Group, Dr. Zelmer held a series of progressively responsible leadership positions in Canada and abroad, most recently as Executive Vice President at Canada Health Infoway, where she was executive lead for the organization’s national clinical adoption, innovation, consumer health, and communications programs, as well its Ontario investment portfolio. Dr. Zelmer
received her PhD and MA in economics from McMaster University and her B.Sc. in health information science from the University of Victoria. She can be contacted here.

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How would you describe the state of digital health in Canada? What do you think are main challenges facing this industry and what untapped opportunities remain to be seized by Canadian innovators?

Digital health is in a state of evolution in Canada and around the world. Across the country, many of the core building blocks are now in place. Most nurses, pharmacists, and physicians who provide direct care to patients are using digital tools, with most users saying that the quality of care they provide is better than before electronic records were implemented.

At the same time, there is much still to do. For instance, while most Canadians would like to be able to book appointments, request prescription renewals, view test results, and communicate with care providers online, only 14%–22% can do so. Likewise, there is potential to deepen use of assets that we have already invested in. For example, while most primary care physicians now use electronic medical records, fewer use the information in them to proactively reach out to patients who are due for preventive or follow-up care. In addition, there are opportunities to leverage emerging technologies, such as leading-edge artificial intelligence, robotics, and blockchain solutions, to improve health and healthcare.

All this makes for exciting times for Canadian innovators. Individuals, companies, and networks have set their sights on advances in these areas and many others. There is a plethora of opportunities to contribute to better health, better care, and better value in the health sector.

When it comes to innovation, how successful are Canadian bio-tech and health-tech companies? How do we rank internationally? Do you see them primarily focused on Canada, or are they equally interested in expanding into global markets?

Canada has a vibrant and growing biotech and health-tech ecosystem. Many companies are start-ups or small/medium in scale, with a few larger domestic and multi-national players. Companies of all sizes also work with a broad range of partners such as academic institutions that represent an essential part of the ecosystem.

I think most companies in the sector have their eyes on global markets. For instance, a 2015 study by the Information and Communications Technology Council found that more than half (54%) of Canada’s health ICT companies are exporters, with just over a third of total revenue generated from international markets. Many are focused on exporting to the United States. It was the source of about two-thirds of international revenues. Likewise, medical device exports grew by more than 70% between 2011 and 2016, according to Industry Canada. Here too our largest trading partner is the United States.

What is a value-based healthcare and how can it accelerate the adoption of innovation?

A value-based healthcare system is focused on optimizing outcomes that matter to patients per dollar spent. It holds promise in overcoming a variety of barriers to scaling and spreading innovation in the health sector.

For instance, health care silos can be a barrier to adoption of innovation. This is particularly true if one organization would need to make an investment in innovation that would result in benefits accruing to another – perhaps an innovative community-based solution that would reduce hospital readmissions. Value-based funding models can help bridge these divides and direct resources to the points in a patient’s journey, where they make the most difference. Bundled payments that include pre-hospital, in-hospital, and post-hospital surgical care are one such approach.

Another challenge that value-based healthcare is well-positioned to address involves limitations of traditional procurement models. Often, a request for proposal (RFP) includes detailed specifications for a desired product or service. This can shut out innovators who have developed different ways to achieve the desired results more quickly, to a larger extent, at lower cost, and/or in a way that improves patient or provider experiences. Value-based procurement, in contrast, seeks the best way of achieving a given outcome, with flexibility on exactly how those results will be obtained.

From a global perspective, value-based healthcare is relatively new. International benchmarking by organizations such as the Economist Intelligence Unit suggests that Canada is well-positioned to move ahead, and some programs are emerging. Examples include federal initiatives such as Impact Canada and provincial initiatives such as Ontario’s Value-Based Innovation Program.

Do you believe government grant programs adequately support the health and bio-tech sector? Do you feel companies have a good handle on what programs are available to them? Are there any specific programs that companies overlook?

The range and size of government grants and other programs to support health innovators varies by type of firm, type of technology, and stage of development. While some opportunities – such as the Scientific Research and Experimental Development (SR&ED) tax incentives – are relatively well known, others have a much lower profile. This seems to be particularly true for time-limited funding programs and initiatives.

Large firms often have staff dedicated to scanning for new opportunities, but smaller innovators may not. As a result, small but innovative companies may miss support to accelerate their work. For instance, last June we launched a trial of 3iOntario, a free weekly digest of opportunities to support health innovation in Ontario, from travel grants and hackathons to province-wide RFPs. An evaluation found that almost all subscribers had learned of at least 5 new opportunities through the service in its first few weeks, which suggests that many potential sources of support could otherwise have been overlooked.

Taking products to the market remains a key challenge for many startups, including those that are well-funded. In what ways, in your opinion, can Canadian bio-tech and health-tech startups engage with different players such as Local Health Integration Network (LHIN) to increase their chances of market success?

Both market entry and scale-up beyond an initial demonstration site remain key challenges for many innovators. Before going to the market, many innovators invest in testing their technology. However, the evidence needed for licensing or regulatory approvals is often not sufficient for broad-based adoption.

Early and deep engagement with potential clients and stakeholders can foster an understanding of how they operate, their priorities and goals, and decision paths. Regional innovation centres can be a great resource for connecting entrepreneurs with health sector partners.

Many have rich networks that involve regional authorities such as LHINs, health service organizations, and care providers. Likewise, for those seeking to serve hospitals’ needs, the Council of Academic Hospitals of Ontario’s broker program provides streamlined access to secure validation test sites in one or more of the 23 research hospitals across Ontario.

This interview was conducted by Reza Akhlaghi, a digital content and social media strategist with RDP Associates.