UNLEASHING INNOVATION: Excellent Healthcare for Canada Report of the Advisory Panel on Healthcare Innovation Également disponible en français sous le titre : Libre cours à l’innovation : Soins de santé excellents pour le Canada To obtain additional information, please contact: Health Canada Address Locator 0900C2 Ottawa, ON K1A 0K9 Tel.: 613-957-2991 Toll free: 1-866-225-0709 Fax: 613-941-5366 TTY: 1-800-465-7735 E-mail: [email protected] This publication can be made available in alternative formats upon request. © Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2015 Publication date: July 2015 This publication may be reproduced for personal or internal use only without permission provided the source is fully acknowledged. Pub.: 150048 Cat.: H22-4/9-2015E-PDF ISBN: 978-0-660-02680-0 REPORT OF THE ADVISORY PANEL ON HEALTHCARE INNOVATION July 2015 The Honourable Rona Ambrose Minister of Health Ottawa ON Dear Minister, Please find attached the final report of the Advisory Panel on Healthcare Innovation. This report is the product of our consultations with Canadians, supplemented by literature reviews, commissioned research, and our own discussions and deliberations. We were humbled to be asked for advice on a set of issues that affect all our fellow citizens. We have also appreciated both your support throughout our mandate and your respect for our independence. We hope this report will be useful to you and your Cabinet colleagues, and that our recommendations will galvanize federal strategies and investments that strengthen Canada’s healthcare systems. David Naylor (Chair) Neil Fraser Francine Girard (Deputy Chair) Toby Jenkins Jack Mintz Christine Power i | Dedication This report is dedicated to the memory of our fellow panelist, Dr. Cyril B. Frank (1949-2015), healthcare leader and innovator extraordinaire. Chief Executive Officer of Alberta Innovates - Health Solutions, Cy Frank also found time to be Chief Medical Advisor to the Alberta Bone and Joint Health Institute, the McCaig Professor of Joint Injury and Arthritis Research at the University of Calgary, and a practising orthopedic surgeon. Just days before his sudden death, Cy had been in top form on a visit by several panelists and team members to Yellowknife and Whitehorse. The next stop was a full Panel meeting in Edmonton, where Cy elevated our discussions with his unique combination of vision, common sense, and irrepressible optimism about an excellent future for Canadian healthcare. As fate would have it, Cy’s parting words to us were that Canada should aim to build healthcare systems that were living laboratories, drawing patients and clinicians together in partnership with researchers, entrepreneurs, and innovators from all sectors and disciplines. We have sorely missed Cy in these last few months of deliberations and writing. However, we remain deeply grateful that the Panel had the opportunity to benefit from Cy Frank’s wisdom and unique perspectives as a relentless healthcare innovator, pioneering clinician-researcher, outstanding teacher, generous colleague, and great friend. REPORT OF THE ADVISORY PANEL ON HEALTHCARE INNOVATION Table of Contents Dedication . ii Acknowledgments . v Foreword . vii Chapter .1 .- .Healthcare .Innovation .in .Canada: .A Prologue . 1 Chapter .2 .- .Trending .Down .or .Scaling .Up: .Canada’s .Healthcare .Choice . 9 Chapter .3 .- .The .Evolving .Federal .Role .in .Canadian .Healthcare . 23 Chapter .4- .Breaking .the .Gridlock . 35 Chapter .5 .- .Patient .Partnership, .Public .Empowerment . 47 Chapter .6 .- .Integration .and .Innovation: .The .Virtuous .Cycle . of .Seamless .Care . 57 Chapter .7 .- .Channeling .the .Data .Deluge, .Mapping . the .Knowledge .Frontier . 69 Chapter .8 .- .Improving .Value .in .Healthcare . 83 Chapter .9 .- .Healthcare .and .Economic .Prosperity . 97 Chapter .10 .- .Tax .Policy .in .Support .of .Healthcare .System .Change . 109 Chapter .11 .- .Concluding .Summary . 119 Appendix .1: . .List .of .Recommendations . 127 Appendix .2: . .Full .List .of .Acknowledgments . 135 Appendix .3: .List .of .Commissioned .Research .and .Analysis . 142 References . 143 | iii UNLEASHING INNOVATION: EXCELLENT HEALTHCARE FOR CANADA iv | REPORT OF THE ADVISORY PANEL ON HEALTHCARE INNOVATION Acknowledgments This report is the culmination of thousands of hours of The Panel wishes to especially acknowledge the generosity engagement, consultation, research, and deliberation, made of those who voluntarily gave their time to participate in possible only by the efforts of many. To these individuals the Panel’s endeavours. In particular, the Panel is indebted and organizations, the Panel would like to express its to many individuals who provided expert advice and critical gratitude. In doing so, the Panel members must emphasize assistance in the organization of roundtables, special that they alone bear final responsibility for what is presented sessions, and site visits, undertaking customized analyses, in their report. In particular, elected and appointed officials and otherwise moving the Panel’s agenda forward. A of the federal, provincial and territorial governments should special nod must go to: Phillip Bazel of the University of not be assumed to have endorsed or approved any of the Calgary’s School of Public Policy, Alan Bernstein of the views, interpretations or recommendations contained in Canadian Institute for Advanced Research, Meghan Baker this document. and Alison Bourgon of the Canadian Institutes of Health Research, Ryan Galloway of the Center for Medicare and First and foremost, the Panel wishes to thank the individuals Medicaid Innovation, Jean-Louis Denis of the École from the Healthcare Innovation Secretariat who provided nationale d’administration publique, Zayna Khayat of exceptional support to the Panel and its members. Marcel MaRS, Erik Landriault of the Royal Danish Consulate Saulnier, as Executive Secretary to the Panel, was both a General (Toronto), Andrew Macleod of the Change fount of knowledge and the key departmental liaison with Foundation, the Hon. John Manley and staff of the Canadian Health Canada. David Clements was the Executive Director Council of Chief Executives, Angela Morin, Sonia Isaac- for the Healthcare Innovation Secretariat, with overall Mann and Erin Tomkins of the Assembly of First Nations, responsibility for research, consultation and other activities. Pierre-Gerlier Forest of the Johns Hopkins Bloomberg His extensive knowledge of the health sphere and expertise School of Public Health and Jeremy Veillard of the Canadian in indicators and information systems were invaluable. The Institute for Health Information. Additionally the Panel Panel further wishes to highlight and acknowledge Peggy would like to express its deep appreciation to the hundreds Ainslie for her exceptional leadership, many insights, and of individuals who took the time to attend these events tireless effort over the course of the Panel’s mandate. ‘The and contributed valuable perspectives. For a comprehensive Trio’ as they came to be called, proved every day that three list of organizers and attendees, please see appendix 2. heads are better than two, let alone one. Panel members also had ample occasion to appreciate the talent and Mary Pat MacKinnon and staff at Ascentum Inc. helped dedication of the entire secretariat staff – Joanne Desormeaux, to coordinate and effectively facilitated regional stakeholder Andrea Lecomte, Salimah Maherali, Leslie Meerburg, consultation sessions across the country. As well, a number Karin Phillips, Kajan Ratneswaran, and Stephanie Soo – all of individuals and organizations conducted commissioned of whom made indispensable contributions in administrative research and facilitated engagement activities on the Panel’s and strategic coordination, research, writing, analysis, and behalf, including G. Ross Baker of the University of Toronto, communications. In sum, while Panel members are content J.C. Herbert Emery of the University of Calgary, David to be held accountable for anything in the report that makes Flaherty of David H. Flaherty Inc., Diane Gagnon of the anyone unhappy, they would ask that happy readers give University of Ottawa, Don Husereau of the Institute of due credit to the remarkable team listed above. Health Economics, Karine Guertin of the University of Montreal, Maria Judd of the Canadian Foundation of Many senior provincial and territorial health officials lent Healthcare Improvement, Sharif Mahdy of the Students their time and counsel to the Panel, including Ministers Commission, Anne Snowdon of the Ivey Centre on Health Glen Abernethy, Gaétan Barrette, Dustin Duncan, Eric Innovation at Western University, John Sproule of the Hoskins, Steve Kent, Mike Nixon, and Fred Horne; and Institute of Health Economics, Terrence Sullivan of Terrence Deputy Ministers Bob Bell, Stephen Brown, Bruce Cooper, Sullivan and Associates, and Jason Sutherland of the Janet Davidson, Debbie DeLancey, Max Hendricks, Karen University of British Columbia. The Panel appreciates the Herd, Tom Maston, Michael Mayne, Patricia Meade, Colleen excellent work of all the aforementioned individuals, Stockley, and Peter Vaughan; as well as their respective organizations, and enterprises. staff, who facilitated and participated in visits, regional meetings, and stakeholder consultation events. v | UNLEASHING INNOVATION: EXCELLENT HEALTHCARE FOR CANADA Finally, the Panel would like to thank the hundreds of stakeholder organizations and members of the public