It’s obvious that there’s massive potential for technology companies to improve Canada’s healthcare system, giving people access to the services they need when they need them. Yet there are many reasons why it’s been difficult to reach the critical mass necessary to change processes—and mindsets—around how Canada delivers healthcare.
“In order to chart a path for healthcare in Canada … we need to understand the somewhat obscure structure we’re working with.”
In BC’s tech industry, you don’t have to look far to find someone who has hit a barrier trying to innovate in our healthcare system. In my case, it was just down the hall: my colleague Cameron Burke has had to change his plans—or cancel his projects—on more than one occasion.
Prior to PwC, Cam worked for three different healthtech companies—and each time, he ran into the challenge of navigating regulation. In Cam’s words, at one company “we received an email letting us know that we were the successful bidder for a tech deployment contract. This notice was the culmination of eighteen months of work, from presentations and travel to Proof of Concept to RFP submission.” Of course, Cam and his team were thrilled—as an approved vendor, they could “land and expand” within the Canadian health sector.
But twelve months later, there was still no progress. “We were still waiting to go live due to political and procurement issues out of our control. I was paying new employees that I committed to hiring in our RFP submission, and the situation was untenable. This experience was one of many I had trying to navigate and understand the realities and complexities of health sector procurement.”
In order to chart a path for healthcare in Canada so that more companies like Cam’s can succeed, we need to understand the somewhat obscure structure we’re working with. Because public healthcare, while a commonly-touted benefit of the Canadian system, is far from simple. While government bodies publicly fund our services, many of these services are delivered by private entities that submit claims to provincial insurers.
It’s time to bring Canadian healthcare out of the 20th century
This single-payer system wasn’t designed to be flexible to changing consumer preferences, and as Canadian industries evolve alongside digital innovation, healthcare has been lagging behind. Part of the problem is a lack of interoperability and data sharing among the “Three Ps”—the three levels of stakeholders in the healthcare system.
- Payer: In Canada, approximately 70% of payments come from the government, which funds basic public healthcare for all citizens. While the federal government allocates some money to nation-wide programs, as well as the provinces and territories, most of the services we access are facilitated at the provincial or territorial level. The remaining 30% are covered by insurance companies. Normally the payer doesn’t retain user data.
- Provider: Health Service Providers include doctors, pharmacies, clinics, hospitals, long term care facilities and home care as a few examples. There are also a number of allied health services that aren’t insured by the government, including dentists, nutritionists and chiropractors.
Increasingly, we’re broadening our definition of health service providers to include more preventative health and betterment, including those practitioners who operate outside of traditional Western healthcare. We’ve also seen wellness and fitness become popular lifestyle trends. Generally, providers do retain records on their users, but these aren’t shared between organizations.
- Patient: The third stakeholder in the healthcare system is the patient (and their families) who shares information confidentially with care providers. However, oftentimes their own data is not readily accessible to them, or they are not clear on how to request it.
In the current landscape, a patient who breaks her arm may go to the hospital to get an X-Ray, but it might be a tedious process for her physical therapist to access that same record. Or the picture might be given to her on a CD-ROM, which is about as technologically sophisticated as it gets at times. In an era when immediate, personalized service and simplified, secure data sharing are becoming the norm, we need to empower the end-user to consent to sharing their own data across services.
In the Three P system, it’s the patients who stand to gain first and foremost from better data collection rules, but arming healthcare providers with the data they need to do their jobs will also streamline services and help increase efficiency at all points of the care journey.
Technology can’t solve regulatory issues
At first glance, healthcare looks like it’s ripe for disruption by tech startups, but there are a few factors getting in the way. Regulations around data sharing and privacy are an obvious obstacle, compounded by the fact that Canada’s regional and federal governments administer healthcare in different ways.
But legislative hurdles aside, there are more nuanced issues that have made the Canadian healthcare landscape a precarious place for innovation.
“For instance, when a startup devises a new digital health solution, it’s not always easy to identify the target market.”
For instance, when a startup devises a new digital health solution, it’s not always easy to identify the target market. Say a company launches an app that helps users manage their blood pressure. Who should buy it—the patients themselves, or the providers that could benefit from simplified procedures and lower costs? If it’s a product or service that supports the government’s role in the value chain, companies have to then be mindful of the sensitive protocols around transparency and accountability with taxpayer money.
Of course, all this is possible, but it requires that healthtech and government work together to arrive at solutions that both empower the end-user and work within regulatory limitations. Digital disruption is receiving plenty of support from innovation teams within the health sector, but procurement is highly regulated and has to conform to provincial legislation and directives. That makes it difficult for small tech companies to compete with their global multinationals rivals, who have billions in the bank and dedicated RFP teams. Federal and provincial healthcare leaders want innovative solutions, but there needs to be a concerted effort to redefine the rules and guidelines around public sector procurement. Part of that is providing access to data.
If you want innovation, you need information
When there’s a wealth of information available, technology companies have the raw material they need to build an open innovation model: startups and incumbents playing side-by-side in the proverbial sandbox, co-creating modern solutions. We see this with financial services, where Canada is currently looking at the merits of adopting open banking.
Just look at the Mint app, and what a difference it makes for users to understand and analyze how they budget their spending. Now picture something comparable in healthcare—an API-based model of your medical record that you could share with your providers, insurers, family members and your circle of care, at your discretion.
Imagine having these critical pieces of information at your disposal, providing a predictive view of your health that helps you determine the care you need. Imagine being able to see this data for your dependents. This is what could be available to patients in a more open system.
At present, there’s a lack of interoperability between health systems because they weren’t designed to talk to one another. Doctor’s offices and hospitals still often have on-prem IT infrastructure, creating isolated pockets of siloed data. It’s possible to derive some limited algorithmic intelligence with this, but big data practices are needed to take us into the 21st century.
The adoption of potential solutions is lagging due to the opaque value chain in the industry. While the general value chain is pretty straightforward in a financial services context, Canadians are less clear on the costs of healthcare; and with the public single-payer system, they’re much less likely to invest their personal savings in a medical app. It’s this lack of transparency that often puts our healthtech companies in a bind.
Changing the industry from the top down and bottom up
To tackle these challenges, we have to help the Three Ps see what they stand to gain. At the highest level, governments need to know that creating space for tech to succeed aligns with their larger healthcare agenda and digital transformation goals.
“All the pieces of the puzzle are just waiting to be assembled … we just need to bring them together in a way that works.”
This doesn’t mean that tech companies should try to influence government; it means that we need to have a more productive discussion about our current privacy and consent management policies, and how they’re getting in the way of providing modern, cloud-based health services that could better serve communities.
In this context, insurance providers and employers could also be thought of as “payers” as well—contributing the funds that allow patients to seek treatment from providers. Tech companies can partner with these stakeholders, as well as private care providers, to demonstrate the clear ROI of investing in digital health solutions.
But it’s the consumers who perhaps hold the greatest power in changing the conversation around sharing information, granting access and determining their own care. By demanding control over their medical data, they can make a major impact in moving Canada towards an open healthcare model.
All the pieces of the puzzle are just waiting to be assembled. We have the stakeholders, the investments in health and technology, the experienced entrepreneurs, and an active tech ecosystem. Now we just need to bring them together in a way that works so that we can create transformative change.
If you’d like to discuss Canada’s digital healthcare landscape and the role of tech companies within it, we’d love to talk. Reach out to us at tara.mccarville@pwc.com and cameron.p.burke@pwc.com.