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AN iNdepeNdeNt sectioN by mediAplANet to the vANcouver suN
THe FUTURe OF HeALTH CARe
The need for partnerships between public sectors, private industry and academia to help drive health care innovation
BALANCING AFFORDABILITY AND SUSTAINABILITY
no.2/March 2012
pAGe 2
“Nurses are in despair every day in terms of their ability to care for their patients.”
Education & trainingthe need for academia to fi ll the career void.
mediaplanet’s business is to create new customers for our advertisers by providing readers with high quality editorial content that motivates them to act.
Future oF heAlthcAresecoNd editioN, mArch 2012Publisher: Maggie [email protected]: Ariela [email protected] [email protected] [email protected]: Jean Blake, Ken Donohue, Don Enns, Pamela Fralick, Nasir Jetha, Gordon McCauley, Andrew SealeManaging Director: Joshua [email protected] Developer: Mark N. [email protected] Credit: All images are from iStock.com unless otherwise accredited.
Distributed within: Vancouver Sun, March 2012This section was created by Mediaplanetand did not involve The Vancouver Sun orits Editorial Departments.
The future of healthcare
Canada will spend roughly $200 billion on health care this year. British Columbia’s expenditures are projected to be approximately $17 billion, or about 45 percent of the provincial budget.
The primary challenge asso-ciated with the delivery of health care revolves around ensuring a sustainable mo-del that continues to impro-ve patient outcomes, which
can only be achieved through a high degree of collaboration, research and innovation. There are several trends to pay attention to that that will continue to infl uence the fu-ture of health care:
Personalized medicine—This fi eld is moving from concept to reality as clini-cians apply it to diagnoses and individual treatment. T his model proposes that treatment decisions be predicated on each person’s unique genomic information.
Convergence of technologies—wire-less, nanotechnology and digital media are being integrated with therapeutics in the delivery of health care. For example, devices are being developed that will assist in diagnosis, surgery, rehabilitation and remote health monitoring that incor-porate minute sensors and real-time wire-less reporting systems.
Regenerative medicine—this is the pro-cess of replacing or regenerating human cells, tissues or organs to restore or estab-
lish normal function. Stem cell technolo-gies are evolving and the ability to create tissue and organs is moving from the lab-oratory to the clinic. Regenerative medi-cine has the potential to solve the problem associated with the limited availability of donor organs, as well as organ transplant rejection issues.
Strategic part- nerships—it is critical that all levels of govern- m e n t , academia and a w i d e v a r i e t y of tech- nology-driven life sciences companies e x p l o r e collabo- ra-
tions and joint ventures. Government can provide direction and funding, BC’s universities produce world-class research and highly talented graduate students and the province’s dynamic life sciences com-munity can synergize these elements and commercialize a host of new health care products and services.
Geographical shift—some emerging economies are positioning themselves as “new” science powerhouses that will make signifi cant contributions to the fi eld and ensure solutions are global in nature. Asia and Latin America are developing strong biotech clusters that will rival San Fran-cisco and Boston. And, health care tour-ism will play more of a role. Thousands of patients travel internationally every year for medical procedures that are more read-ily available outside of their home country.
Virtual development—bricks and mortar are being replaced by computer models and centralization which will lead to diff erent outsourcing models. For example, virtual health care companies are already provid-ing fully integrated services to retirement and adult communities as well individual homes of seniors and people with long-term illnesses.
Socialized medicine within Canada, which eff ectively results in a single payer system, has generated enormous amounts of data that if accessed appropriately, and could be invaluable in guiding future health policy. It is a resource that has his-torically gone untapped for a variety of reasons; however, it may serve as the foun-dation for how we assess and deploy health technology going forward.
It is important to note that BC has been a leader in the health care fi eld and well positioned to meet future challenges. Our public health institutions, interna-tionally- ranked research universities and approximately 300 life science com-panies possess a wealth of knowledge and have demonstrated a remarkable capacity to collaborate. This spirit of col-laboration has resulted in BC being rec-ognized as a world leader in such areas as genomics and oncology. It is clear that BC will be a leader in shaping the future of our health care.
dOn M. EnnS
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THe FUTURe OF HeALTH CAReFACTs
THE IMPORTANCE OF INNOVATION
WHAT YOU NEED TO KNOW
As global pioneers in biotech-nology, scientists, drug deve-lopers and business people in our backyard have established British Columbia as a leader in healthcare innovation.
Important innovative therapies in-vented here have navigated an ardu-ous development path, and are now being used to address serious health-care issues. As we begin to deal with the health care implication of an aging population, and grapple with meaningful budgetary challenges,
we must turn again to the leaders in BC’s life sciences community to ad-dress arguably the most significant threat to our healthcare system—neurodegenerative diseases like Alz-heimer’s (AD), Parkinson’s (PD), and other dementias.
Despite spending many billions of dollars, global pharmaceutical compa-nies have been unable to develop drugs that deliver anything more than mo-dest symptomatic benefi ts for AD. Tho-se drugs were fi rst approved about 20 years ago, the science is over 40 years old, and nothing new has come along for
10 years. Echoing the innovative spirit of our industry’s pioneers, here in BC we have the potential to develop a drug that appears to target the underlying patho-logy of a number of neurodegenerative diseases, not just the symptoms, and use a logical development pathway.
Our Vancouver company is in the fi -nal stages of developing a novel drug as a potential treatment for these devas-tating brain diseases. Allon’s lead drug candidate is based on using the human brain’s natural defence mechanisms to slow the process of neurodegeneration. The drug is in its fi nal stage of human
testing in a neurodegenerative brain di-sease called, Progressive Supranuclear Palsy (PSP), and pursuing a so-called orphan drug strategy to reach patients faster.
Our human clinical study in PSP is fully enrolled and we expect data at the end of the year. At that time we will learn if using the innovative spirit of BC biotech pioneers will lead to a treatment for PSP, and other serious dementias like AD and PD.
GOrdOn MCCaULEY
president and ceo, Allon therapeutics
Innovation drives the BC Life sciences industry
PH
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: FR
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Don M. Enns, President, LifeSciences BC
AN iNdepeNdeNt sectioN by mediAplANet to the vANcouver suN2 · mArch 2012
Future faces of healthcare in B.C.As the last leg of baby boomers prepare to settle down for retire-ment, a looming healthcare challenge sits on the horizon for Canadians. It’s no secret that Canada’s age-skewed demo-graphics point to an increased demand for healthcare profes-sionals and staff but anticipating and meeting that demand requires tenacity on both the education and policy fronts.
At the B.C. Nurses Union—whose contract is set to expire on March 31—annual nurses meeting, union president Debra MacPherson called on the provincial government to hire additional nurses to combat an im-pending “burnout.”
“Nurses are in despair every day in terms of their ability to care for pa-tients,” she said. “We’re looking at bringing in 2,000 more nurses.” Brit-ish Columbian taxpayers pay $17 bil-
lion a year for public healthcare. But the growing demand isn’t just based around nurses.
Kathy Kinloch, president of Van-couver Community College, says the demand is across the board. “There’s similar trends anticipated in other health professions, such as medic-al radiology, laboratory work, etc…,” says Kinloch. “All those critical diag-nostic areas equally have an import-ance in access because if those ser-vices are not available it becomes a bottleneck in the system with great-er wait times.” Kinloch points out that “there’s a particular stress on home and community care servi-ces—really 70 per cent of our cur-rent users are seniors.” Debbie Sar-gent, Dean of VCC’s School of Health Sciences, says the aging popula-tion is reflected by a shift in the way health care is administered. “There has been a move from institutional-ly-based care to home-based care,”
says Sargent—a registered nurse as well. “Meaning more and more skilled health care workers are need-ed in the community,” Darleen Ode-gard, Managing Consultant Recruit-ment Services , Fraser Health, says the new Critical Care Tower at Sur-rey Memorial Hospital opening in 2014 will also generate jobs for the sector. “More than 650 new staff and additional physicians will be re-quired once the building is complete and as a result there may be addi-tional demands created throughout Fraser Health with employees mov-ing to SMH and the subsequent back-filling throughout the region,” says Odegard.
The shape of healthcare to comeIn this digital age, healthcare innova-tion is also aff ecting the demands for staffi ng. “Technology changes how care is provided, and some techno-logical advances such as laparoscop-
ic surgery mean patients can be dis-charged home much earlier in their care,” says Sargent pointing out that shortened stays means a new ap-proach. “As more and more care moves out to the community, we see increas-ing demand for registered nurses, li-cenced practical nurses and health-care assistants as well as rehabilita-tion support personnel such as occu-pational/physiotherapy assistants,” she says. “Students are much more computer savvy than ever before, and they expect to be using computers, handheld devices and other techno-logical tools. Curriculum needs to be responsive to the needs and wishes of the students.” As the industry evolves to meet the growing demands, talk in the industry points to stronger re-cruitment eff orts. But Kinloch says the road ahead is bright. “We’re just in the beginning stages.”
andrEW SEaLE
CHALLenGes
Jean BlakeChief Executive Offi cer, Alzheimer Society of B.C
Question 1:From your perspective, what do you think is the most important factor when looking to health care for the future?
Question 2:What is one of the biggest issues we will face in our health care in-dustry? How can we mitigate the severity of this concern?
Question 3:How can British Columbians contribute to furthering the quality of our health care system?
Canadians need a pan-Canadian response to the dementia epidemic that improves care at every stage of dementia. Actions of the highest priority must include steps to reduce risks for dementia, delay its onset, im-prove care and look after the needs of caregivers. The following fi ve components of a comprehensive National Dementia Strategy are essential for ensur-ing sustainable success: 1. An accelerated investmet-nt into dementia research. 2. A clear recognition of the important role played by informal caregivers, provid-ing them with Information, education, and support. 3. An increased recognition of the importance of risk re-duction and early intervention. 4. Greater integration of care and increased use of “best practices” in chron-ic disease management. 5 . A strengthening of Canada’s dementia workforce through education, training, self-management and investing in volunteers.
Government needs to act. Other nations and other provinces have taken proactive measures to mitigate the impact of dementia. We encourage the B.C. government to do the same by investing in a provincial dementia action plan that addresses the 5 components above is critical. But individual Brit-ish Columbians have an important role to play as well: Early diagnosis gives the best chance of qual-ity life with dementia. All of us need to be informed about the disease, prevention, caring for our brain health, and help to inform others.
Canada is facing a dementia epidemic and needs to take action now. Approximately 500,000 Canadians have Alzheimer’s disease or a related dementia today. It is the most signifi cant cause of disability among Can-adians (65+) and it already costs Canadian society many billions of dollars each year. For the past decade, demen-tia and its potential impacts on national economies have been the subject of growing interest around the globe. Forecasts show that within 20 years, worldwide prevalence will increase two-fold. There are more than 35 million people with dementia in the world at this time. It is estimated that by 2050, this number will in-crease to 115 million people1. Canada, too, can expect a several-fold increase in dementia in the coming dec-ades. The governments of Australia, Norway, the Neth-erlands, Scotland, England, France, and the European Parliament have all taken steps to study dementia and its consequences. Many have chosen to make dementia a national priority. Canada has yet to take these steps.
“Nurses are in despair every day in terms of their ability to care for patients.”
Sustainability. Health care is the largest public ex-penditure by BC’s provincial government at 40 per-cent of the total budget. We are concerned about the in-crease in chronic illness, the aging of all health profes-sionals, a shrinking tax base relative to the increasing number of people requiring health care, and what this combination might look like in the future. Our health care system must continue to evolve from a reactive one to a proactive one and that means system-wide changes must occur as well as individual British Col-umbians making healthier choices.
A key concern is ensuring we have an adequate number of trained health professionals to provide care to the population. Our physicians are aging—more than 40 percent of physicians are over the age of 55 and will be retiring in the next decade; younger physicians are adopting a better work/life balance than their pre-decessors; and more women are entering the profes-sion but generally spend less time at work as they al-so take on the lion’s share of child rearing. Physician workforce planning will need to be better coordinated provincially and nationally to ensure BC has the right number and mix of physicians.
Prevention is a key area that refers to the steps Brit-ish Columbians as well as society can take to reduce the impact of illness on the population. We need to en-courage patients as partners in their health care where they take some responsibility by living a healthy life-style and following their doctor’s recommendations. Prevention activities need to be in place to support the population in its health goals ranging from promo-ting exercise and a healthier diet to evidence-based clinical prevention services such as screenings and immunizations.
Nasir Jetha, MDPresident, BC Medical Association
Pamela FralickPresident, Canadian Healthcare Association
Integration. Canada has become quite adept at pro-viding excellent acute care; not so much around illness prevention and continuing care. We are not adept at connecting the dots among these three core elements of the continuum of care. If we truly believe in a person-centred approach to health service delivery, we must make integration of the various ‘pieces’ of the health system much more seamless. Shift our nine-to-fi ve system to address Canadians’ 24/7 needs. Embrace elec-tronic health records. Establish a pharmacare program. We know what to do—we need to do it.
Caring for informal caregivers. Some 2.1 million Can-adians contribute to this largely invisible part of the health system, many of whom have given up paid em-ployment to care for their loved one(s). And this is a con-stituency less organized to advocate for its needs than other groups. More eff ective support for Canada’s in-formal care givers is critical. The Family Caregiver Tax Credit was a good start, but this credit is only available to those who have the fi nancial ability to make use of the credit. A more equitable solution would be an ad-justment in CPP/QPP pension calculations and the pro-vision of an expanded compassionate care benefi t.
Advocate for innovation, and be an active partici-pant in the innovation process. Every person, every or-ganization, should have innovation as a cornerstone of its raison d’être. Creating a culture of innovation will lead to both healthier outcomes and the needed effi -ciencies everyone craves. It means understanding and employing formal concepts such as LEAN and 6 Sigma, along with such low-tech approaches as a workplace suggestion-box. It means seeking ideas from every em-ployee, every patient, every British Columbian...every Canadian! Integrating innovation into our health sys-tem will be the cornerstone to vault Canada to world-class health outcomes.
INNOVATION HELPS
DOCTORS BET-TER MANAGE
PATIENTS WHO LIVE WITH ONE
OR MORE CHRONIC DISEASE
INNOVATION HELPS
1FACT
PHOTO: FRASER HEALTH AUTHORITY
AN iNdepeNdeNt sectioN by mediAplANet to the vANcouver suN mArch 2012 · 3
www.alzheimerbc.org | 1-800-667-3742
Let’s Face It, B.C.
A diagnosis of dementia is hard to hear but there is help.
Connect with the Alzheimer Society of B.C.throughout the progression of the disease for:
• Information• Education
• Support Services
news
Last February, an IBM computer named Watson competed on “Jeopardy”! against two long-running champions.
In a thrilling two-game, combi-ned-point match broadcast over three episodes, Watson beat its opponents to win US$1 million in prize money.
Watson is a question-an-swering computing system that responds to questions in natural language and sorts through reams of informa-tion at a mind-blowing pace.
Philosophical musings aside (are machines really smarter than humans?), Wat-son’s technology comes in-to its own in the healthcare arena, where 2000 new med-ical papers are published every day (700,000 a year), and physicians are strug-gling to keep up, according to Jeffrey Betts, IBM busi-ness development manager, healthcare and life sciences division.
The power of large-scale computingIBM is developing a program to help doctors access the most re-levant, timely information on their smartphone or computer. The application will be ready in 24 months.
Watson’s children, meta-phorically speaking, will emerge as savvy physicians’ assistants on smartphone ap-plications or as a drop-down box in a physician’s clinical support system.
“Using the brute power of large scale computing, the program will sort through relevant articles to create a list of statistically probable hypothesis and diagnosis to support physicians’ decision-making,” says Betts.
It is unlikely that Wat-son’s progeny will bask in the glamour of television cam-eras, but there will probably be a lot of grateful patients and doctors.
Better decision-making for doctorsThe University of British Columbia’s Faculty of Medicine is also studying better decision making processes. “Together with the Ministry of Health and BC Medical Association, we have digitized 52 clinical practice gui-delines into an iPhone applica-tion for general practitioners,” says Dr. Kendall Ho, eHealth Strategy Office director.
Within five clicks and 10 seconds, clinicians can find the required information. Work on delivering the elec-tronic format of these guide-
lines began in 2006, even though the iPhone applica-tion was only completed last June.
UBC is also researching electronic communication strategies like social media to support patient-centred care. Ho’s team is investigating how health professionals can, through technology, coordin-ate their advice to benefit the patient, rather than having it doled out.
The patient as kingTreating the patient as king ma-kes compelling economic sense. “Quality and customizing healt-hcare and appropriate treat-ment options [at the outset] are cheaper than fixing mistakes,” argues Betts.
A strong patient focus, underpinned by cutting-edge technology, can markedly improve diagnosis and lead to better targeted treatment. Such an approach results in reduced patient suffering and cost to the state. Ultim-ately, patients are kept out of the hospital, he continues.
Surely, a goal worth aspiring to.
indrani nadarajah
Research trends in healthcare
AN iNdepeNdeNt sectioN by mediAplANet to the vANcouver suN4 · mArch 2012
Question: What innovations await patients in the BC healthcare system?Answer: A renewed focus on higher e� ciency brings care to the forefront.
ACHIEVING GREATER VALUE AND BETTER PATIENT EXPERIENCES THROUGH INNOVATIONImagine being able to order and choose a meal from your hos-pital bed. That’s one of the ini-tiatives that Vancouver Coastal Health Authority (VCH) is piloting at Lions Gate Hospital to redu-ce food wastage, and provide a better patient experience. With health care now consuming al-most half the provincial budget, health authorities across the province are increasingly under pressure to do more with less. Vancouver Coastal alone is en-gaged in more than 50 different projects aimed at creating effi-
ciencies.“We started getting serious about fi n-ding effi ciencies about fi ve years ago, because we were running a defi cit and needed to fi nd ways to get leaner,” says Duncan Campbell, VCH’s chief fi nan-cial offi cer. And the health authori-ty was committed to reaching its bud-get reduction targets without reducing service.
Waste and ineffi ciencies are inevita-ble in a highly complex environment, such as health care, and so Vancouver Coastal, along with other health autho-rities in BC, has sought innovations by engaging frontline health care provi- ders to make processes more effi cient.
“We’ve seen some positive results,” says Campbell. “Since 2008, our cost per ca-se has risen only 1 percent, compared to the normal growth rate of about 6 per-cent.”
One other area where health authori-ties have seen some effi ciencies and cost savings has been in the contracting of non-clinical services such as food servi-ces, housekeeping, protection services, information technology, and linen ser-
vices. “We are particularly good at pro-viding good health care, but it’s tough to provide all services well,” says Mary Ackenhusen, Vancouver Coastal’s chief operating offi cer. “We found that when we were providing some of these servi-ces we became complacent, and didn’t hold ourselves to account the same way we are holding these contracted provi-ders.”
Sodexo Canada, which fi rst provided services to Riverview Hospital in 1989, now has a large presence in BC’s health system, as the number of contracted services has increased. While Campbell acknowledges that the fi nancial savings have been modest, because Sodexo’s staff are unionized, the big benefi t has been cost certainty, because of the fi xed contracts that are in place, and levera-ging Sodexo’s vast international expe-rience. “They have large buying power, and are sharing their knowledge in such things as environmental sustainability practices,” he says.
“We provide immense value to the health system, because we can focus on
our core strengths, which is being the very best at the nine services we provi-de,” says Barry Tellford, senior vice-pre-sident healthcare operations, Sodexo Canada. “Our clients challenge us at eve-ry opportunity to improve overall quali-ty and to continuously improve our ef-fi ciencies.” Contracted providers such as Sodexo are subject to audits and ac-countability measures that were never in place when the health system itself was providing the service directly.
“If we don’t innovate and become more effi cient, we won’t have the kind of health care system that we’ve come to expect,” says Ackenhusen. And that work is being acknowledged, evidenced by a statement the Minister of Finan-ce made in his recent budget speech in which he singled out the health system for innovations that have had some re-markable outcomes.
InsPIRATIOn
1 3
2
ENGINEERING HOPE1-3. Neovasc is in the pre-clinical stage of devel-oping the Tiara, a novel transcatheter device that will enable the treatment of mitral regurgitation, a condition that is often se-vere and can lead to heart failure and death. PHOTOS: KRISTA NEALE,
NEOVASC INC
“if we don’t in-novate and be-come more ef-fi cient, we won’t have the kind of health care sys-tem that we’ve come to expect.”
Access
EfficiencyPatientSatisfaction
EffectivenessSafety
TotalQuality
Approach
A Total Quality Approach for Health CareFor more than 40 years, Sodexo has been working in partnership with Canadian hospitals and health care institutions to design, manage and deliver Quality of Daily Life Solutions that help improve overall performance and patient satisfaction. Sodexo’s On-Site Service Solutions – which include building operations and maintenance, patient and retail food services, housekeeping and janitorial services, environmental services and Clinical Technology Management – help our clients meet and exceed their overall performance objectives.
For more information on how your healthcare organization can benefi t from Sodexo’s On-Site Service Solutions, please contact Barry Telford, Senior Vice President Healthcare Operations at 866-632-8592 ext. 33328 or by email at [email protected].
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Book your appointment today
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KEn dOnOhUE
INNOVATION RESULTS IN
COST SAVINGS TO THE HEALTH CARE SYSTEM SURPASSING $100 MILLION FROM FEWER HOSPITAL AND EMERGENCY
VISITS.
INNOVATION
2FACT
