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Leading Change for Ontario’s Med Tech Sector
Dr. Keller had long been interested in optimizing cardiac and vascular cells from embryonic stem cells for cardiovas-
cular repair. — Dr. Gordon Keller
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“This is where the imaging capabilities will be very helpful. We can record the electrocardiogram to see if the animal experiences arrhythmias, but we can even go further and we can actually map the electrical activity. We can challenge the heart to stimulate arrhythmias to see whether grafts formed with one type of cell are more vulnerable to those formed using our newer, more precise cells,” Dr. Laflamme said.
Should the imaging provide the answers they seek, Dr. Laflamme and his colleagues will be one step closer to a human clinical trial, which will also be launched in Toronto. tive Medicine. With a background in fine art, communications and journalism, Lisa continues to moonlight as a writer, photographer and editor, contributing to a range of Canadian and US-based publications. In 2014, she was alumni-in-residence for the acclaimed Science Communications program at the Banff Centre. She is also involved in several volunteer initiatives, including serving as a Board member for Science Borealis, a Canadian science blog aggregator. Follow her on Twitter and Medium @WillemseLA.
Lisa Willemse is a communications professional with 18 years’ experience working in the technology, child development and health research fields, and is currently a Senior Communications Advisor with the Ontario Institute for RegeneraTo see this story online visit http://biotechnologyfocus.ca/pace-progress-heartregeneration
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Leading change For ontario’s Med tech sector
Q&A WITH OnTARIO’S CHIEF HEALTH InnOVATIOn STRATEGIST WIllIaM CHaRnETSKI
In September, 2015 the Ontario government took a significant step towards bolstering Ontario’s health technology sector naming William charnetski as the province’s first-ever Chief Health Innovation Strategist.
In this special Q&A, Charnetski details his plans going forward in this role, his office’s priorities when it comes to the health technology sector and how he plans to continue to support healthcare innovation in the province.
William Charnetski Q: You’ve had an interesting career path, working at the highest levels of business, law and government, even working with one of the world’s largest pharmaceutical companies at AstraZeneca in UK. Tell us how you came into this role as Ontario’s chief health innovation strategist and why you took the job?
The subject matter of this work is very interesting to me. I’ve been looking at integrated health solutions for the past ten years and prior to that I was involved in work looking at how to use Canada’s investment in the healthcare system as an economic driver. Back then, it was difficult to move that idea forward as there was strong resistance from health officials to approach healthcare from that perspective.
When I returned from London, UK 18 months ago, I was looking to do two things in my next job. First, I’ve always been very interested in public policy, and I knew the time was right to try and “make a difference”. At the same time, I wanted to leverage the global experience and expertise I had acquired abroad. When the opportunity came up to lead the work to drive collaboration across Ontario’s health care system to accelerate the adoption and diffusion of new innovative health technologies with the purpose of not only improving patient outcomes, but also growing jobs in Ontario and building a health technology ecosystem, it pushed all the right buttons. I believe this work is important and that we can make a difference by both leveraging global expertise and bringing global best practices to bear here.
Q: What do you think motivated the Government of Ontario’s decision to name a Chief Health Innovation Strategist?
The government was visionary in looking at how it could use its $52 billion investment in the healthcare system as an economic driver. At its core, that was the motivation. It’s clear that if Ontario is going to win in the knowledge based economy, as opposed to some of the low costbased industries in which it has excelled in the past, it has to invest in innovation. There is an incredible opportunity to do so in Ontario’s health care industry. We will leverage that investment and grow a health technology ecosystem in which we create jobs and wealth in the province in one of the fastest growing job and wealth creators of the 21st century.
The other contextual point is the critical need to preserve the sustainability of the public healthcare system. To do that, it will be important to introduce innovation into the system more quickly and more broadly than has been done in the past. That also was a driving factor behind the decision to create this role.
Q: Can you briefly outline your mandate as chief health innovation strategist and take us through your daily routine in this role?
We’ve developed what we call a purpose statement and it is self-explanatory. The purpose of our work is to drive collaboration across Ontario’s healthcare system to accelerate the adoption and diffusion of new innovative health technologies and processes with three objectives: to improve patient outcomes, add value to the system, and grow jobs in the province.
In fact, it’s that third objective, growing jobs, that distinguishes us from many other public and private organizations in the province that are involved in health and innovation.
The uniqueness of this role is that we are focused on growing Ontario-based companies, including those who already export their health innovations globally, but cannot sell them in Ontario. The challenge for many health technology-based companies is that they often are unable to penetrate the market in their own backyard. Our purpose statement encapsulates what we’re trying to accomplish for them.
There is no “usual day” in my role, which is part of what makes it so interesting and rewarding. I love my job and say so nearly every time I have a public speaking engagement of which I have many. What we do straddles the public sector (i.e., the Ministry of Health and Long-Term Care within which I sit on the Deputy Minister’s Executive Leadership Team) and the private sector and broader public sector. The latter group includes the various healthcare providers, universities, colleges, research institutions, incubations labs, innovation centres, entrepreneurs, innovators, multi-national companies, and health tech/device companies doing business in Ontario. A day in my job may involve internal meetings with Ministry colleagues where my role is to help ensure we are all considering how innovation can be introduced into healthcare delivery in the province. It is also important to build relationships with Health Ministry colleagues because, of course, whatever we set out to do must also be a priority for them. Otherwise, nothing will happen as they ultimately have the delivery accountability. Our office does not. So it is critical to our success to collaborate well with them.
A day in my job may also involve external meetings with any of those public or private institutions I’ve described. We’re either hearing from a company about their successes or frankly the challenges and the barriers that they face and how we can help them. We’re hearing from healthcare providers and listening to what their priorities are and sharing with them some ideas on how we could broker relationships between them and innovators.
Moreover, raising public awareness is another part of our function, and this includes giving speeches or participating in panels with a clear purpose to help achieve our priorities and objectives.
Our focus is on how to help make that happen by using enabling or virtual technologies like digital or mobile health. — Bill Charnetski
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Q: Can you tell us about these priorities and objectives?
From the very beginning, I’ve said to people that we will judge ourselves by the impact we have had, not by the activity we generate.
To have that impact, it’s very important to focus our efforts. There’s a saying that if everything is a priority, nothing is. If you’re actually going to make an impact, you have to focus on a few strong priorities. So we’ve decided to focus on five.
The first is to optimize pathways to adoption and diffusion for innovative Ontario health technologies. This focuses on having the healthcare system drive demand and using the pull of a single payer system.
Our second priority is to enable effective procurement of innovation by shifting the health care system to strategic, value-based procurement and removing barriers for small- and medium-sized enterprises to participate.
Procurement is meant to be a driver of innovation, but in Ontario, it hasn’t been seen that way. The environment is very constrictive, and the rules are very narrow and often interpreted conservatively, making it difficult for the procurement agent or healthcare provider to procure innovation.
It’s a very cost focused system where the focus is on driving down costs. Now the good news: A supply chain management review is now underway, including work of an expert panel that will be making recommendations for change to the procurement model.
Our third priority is a critical one for most healthcare systems globally, namely, home and community health. We call it “Better care closer to home” and our focus is how to make it happen by using virtual, mobile and digital health technologies. This is fertile ground for Ontario health tech companies and there are many that have been successful in marketing these products around the world. However, they struggle with adoption in Ontario and I hope to change that.
The fourth priority is empowering On-
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Our role in this is to help the people doing this type of work to collaborate closely with innovators that provide these types of innovative solutions. And finally, the last priority is to enhance aboriginal health outcomes. — Bill Charnetski
tarians through digital health by building a dynamic market of ehealth tools and supports to navigate and personalize their path to health and wellness, including for example the use of electronic health records. The principle is that we should have a patient-centric approach to the use of personal health information to allow patients and their circle of care to make better and faster care decisions. Our role is to help the people doing this type of work and to collaborate closely with innovators that provide these types of innovative solutions.
The fifth priority is to enhance Aboriginal health by advancing opportunities for innovation to address health challenges in their communities. This is a broad and important topic and there are huge opportunities before us to use new madein-Ontario health technologies and apply them to enhance health outcomes for First Nations people across the province.
Q: You’ve mentioned the challenges and barriers innovators in this space face. What are some examples?
We hear about procurement issues, both the rules as they are drafted and the behaviors associated with assessing and applying those rules in practice.
I think the biggest concern we hear expressed revolves around procurement practices that either make it very difficult for Ontario’s smaller- and medium-sized enterprises to qualify or participate in a tender, or the act of participating is just onerous.
The procurement system in Ontario is relationship based, it’s not necessarily evidence based. Larger companies are able to employ many people to build the necessary relationships in such a system while small- and medium- sized companies may have only one or two people and are not able to blanket the province in the same way.
Then, increasingly, hospitals are bundling the goods and services that they’re asking for in tender, making it impossible for small- and medium-sized enterprises to qualify.
Even when a small or medium sized enterprise can qualify for a tender, the procurement process often requires hundreds of pages in response to Requests for Proposals and a long time investment. Again, while larger companies are able to do because of their bigger workforces and portfolios, it is virtually impossible for smaller companies to participate.
There’s also a risk aversion in Ontario to go with a smaller and lesser known company. There are other challenges, such as bringing innovative devices or processes to the healthcare market and realizing that the doctors fee schedule that governs the reimbursement and payment of physicians for their services doesn’t even contemplate the particularly innovative approach or device being put forward.
Quite literally, a doctor will not get paid for adopting the innovative technology being offered. These are some of the barriers that we see over and over again.
Q: Staying on this topic of procurement, the Government of Ontario announced in May of last year its intention to launch a $20 million Health Technology Innovation Fund as a means to back the adoption of made-in-Ontario technologies. Fast forward to the present and you’ve just announced you will soon be accepting applications for this Fund. Tell us about it and who it’s geared towards?
The $20 million Fund is designed to support pre-market evaluations and early adoption of innovative Ontario health technologies. Through it, we will invest $5 million over each of the next four years to accelerate innovation across multiple health care settings.
In the spirit of the importance of prioritizing our work to have the greatest impact, instead of spreading the resources across all five priority areas, we’re going to focus on better care closer to home for the fund’s first round. It will support home and community care such as virtual, digital and mobile technologies and work towards delivering better coordinated and integrated care in the community.
Eligibility for funding will require strong collaboration in what we call a Health Innovation Team. Depending on the application stream, a Health Innovation Team may consist of an Ontario based health technology business, health procurement professionals in provincially funded health delivery organizations, researchers with expertise in research and evaluation design and implementation, and most importantly, whoever will be using the technology such as a clinician, doctor or patient.
A note on the Ontario based health technology businesses: these will include either small to medium sized enterprises or a large multi-national business, as long as more than half of their R&D and manufacturing occurs in Ontario.
The fund will have three streams. The first stream is called Prototype. Innovators should apply if they’re looking to test a new product or feature of their product. They will have the opportunity to work with a healthcare provider(s) to get valuable input on the design. Each team must have a strong business plan, including a feasibility study and problem validation, and the end result will be a new technology that is market ready with proof of its potential value in Ontario’s healthcare system.
The second stream is Premarket Evaluation. Innovators will work with healthcare providers in a health innovation team to test the feasibility of use of their product on a day-to-day basis including training and changes in workflows. The activities from this stream should result in the development of an evidence package that can support procurement of the product to the healthcare provider’s hospital, clinic, or a home care setting. The stream also includes an economic analysis that examines the efficiency of the technology and potential cost savings to the system, as well as a plan that outlines the systems and processes required for wide scale adoption.
The third stream is called Early Adoption. Innovators will work with their
health innovation team to refine the evidence package and develop a plan to help facilitate adoption of their product in multiple healthcare locations. That includes strategic or value based procurement. Here results will include successful adoption, multiple healthcare locations and a report on the change and knowledge transfer required to successfully adopt the new technology.
Health innovation teams can only apply to one stream at a time. For the purposes of the program, medicines, vaccines, drug efficacy research will not be supported. We’ll have an expert panel that reviews proposals, and panel membership will depend on the type of proposals we receive. Details on applications will be available on July 4.
Q: The other major component of your recent funding announcement was that you will soon be recruiting Innovation Brokers. How do they fit into what you’re hoping to accomplish?
The creation and hiring of “Innovation Brokers” was also one of the key recommendations made by the Ontario Health Innovation Council – in addition to the creation of my role. I’m very excited by this concept and the process of hiring our first two Innovation Brokers is well underway.
This office was created to be an outward facing organization, and as is the case with any high performing social enterprise, whether it is in the public, political or private sphere, the notion of very knowledgeable community representatives is critical and highly valuable.
We want people who are able to bring insight from a particular geography or sector into the strategic and tactical conversation. This is hugely valuable, and that is what these Innovation Brokers will be. They will apply that insight to work with innovators and health care providers to create an even greater culture of innovation across the province, principally by enhancing connections.
Moreover, their job or brokering function is to remove barriers to the scaling and adoption of innovation, and to link the health tech companies with potential opportunities from healthcare providers. They will be our eyes and ears in the community. They will also be the people on the proverbial ‘other end of the phone’ when an entrepreneur or innovator is trying to figure out their way through the Ministry of Health and Long-Term Care landscape. Similarly, they will be there to inform the healthcare providers what certain companies are doing.
Q: You have a big task ahead of you. What is the hoped for outcome and how will you know you’ve succeeded?
Our goal is to build a health technology ecosystem for Ontario and we will judge our success on metrics. Those metrics will be derived from questions such as: • Have we actually had technologies introduced into the system?; • Has that improved patient outcomes?; • Has it created new companies and jobs in Ontario?; • and Has as it led to additional investment in Ontario?
In addition, we will put patients first in our work. When I described my work to a friend who was a very smart professional but not in the health care industry, she asked a question of me that was so profound our team has put it on the wall in our office: “From a patient’s perspective, in two years, what will I see
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that is different as a result of your work?” Like everyone in the Ministry of Health and Long-Term Care, that governs our work.
The $20 million Health Technologies Fund is an important step, but it is only one tool to help us achieve those objectives. Ultimately, we will succeed or fail based on how we measure up to those questions. And I am convinced that, with all the resources we have across the province, which includes world class hospitals, research institutions and universities, full government support in a single payer system and hundreds of passionate hard working people already driving health innovation in the province, we will succeed.
In particular, I believe there will be a tipping point. We will not have to change everything. We just have to change a few things, and there will be a tipping point where a few changes will have significant benefits for the health care system, for patients and for the economy.
Ultimately, I believe we will see significant improvement in the ability of Ontario companies to grow and prosper because of Ontario’s health care system and not in spite of it. At the same time, we will see improved outcomes that will benefit all Ontario patients.
To see this story online visit http://biotechnologyfocus.ca/leading-change-forontarios-med-tech-sector
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