Request for Applications for Primary Research Projects
Innovation in The Health System: eHealth - RFA 022
FUNDING AND GENERAL INFORMATION
- Deadline for applications: May 4, 2005 (must be date-stamped
by courier no later than May 3, 2005).
- Up to $1 million has been set aside in this competition for
the support of up to six research projects. Maximum funds per
project: $300,000. Contribution funding will not exceed 24 months.
- Applicants should consult the Ineligible Activities section
of the HPRP Guide
to research project funding.
- Applications for pilot, demonstration, implementation or evaluation
projects will not be accepted. Applications whose primary audience
is clinical managers, or whose focus is a single setting or organization
will not be accepted.
Definition and Scope
eHealth refers to the application of information
and communications technologies (ICTs)
within the health system across a wide range of functions – administrative;
management; diagnostic; treatment; public health; and medical
education. Its applications include, among others, electronic
health records, telehealth, e-prescribing, and health information
for the public, and have implications for all segments of the
health system, across the continuum of care. Within the scope
of this competition, successful proposals will:
- produce results that could be generalized across health care
(for example, acute care, primary care, home care, long-term
care) or public health (for example, prevention and surveillance);
- produce results that could be generalized across jurisdictions,
geographic settings or population groups; and
- examine the experiences of jurisdictions (federal, provincial/territorial
or regional) and organizations within the Canadian health system
that have mandates to make policy-related decisions concerning
the adoption, implementation and sustainability of eHealth applications.
Objective
The HPRP is
seeking to enhance the evidence base available to support the adoption
and implementation1 of eHealth technologies
that will result in better health outcomes and create efficiencies
within the Canadian health system.
The specific objectives are to determine critical factors which
affect:
- adoption, implementation, and sustainability of eHealth;
- outcomes of eHealth implementation; and
- governance challenges associated with eHealth applications.
Results from this research will assist federal, provincial and
territorial decision-makers as well as other stakeholders in their
ongoing policy work2 to promote a shared
vision3 for the adoption, implementation,
and sustainability of eHealth in the health sector.
Background
eHealth will result in new care, management, and administration
processes. The mainstreaming of eHealth will require changes to
established relationships within the health system, and between
the system itself and its clients/patients. It is important to
understand the results and implications of eHealth for providers,
system managers, services, and for patients/clients in terms of
delivery, access and health outcomes, and governance processes.
There is a broad national consensus on the need to move quickly
with the development of health information systems4,5.
This is apparent in numerous provincial reports on Canada's health
care system6. For example, the electronic
health record is viewed as having the potential to greatly improve
quality and timeliness in health care delivery, enhance health
system management, efficiency and accountability, and provide information
for surveillance and health research.
The First Ministers' 2000 Action Plan and the February 2003 First
Ministers' Accord identify eHealth as a key contributor to health
system modernization. The implementation of electronic health records
and the development of telehealth applications are specifically
identified as priorities. The First Ministers' Meeting of September
2004 further highlights the importance of developing and implementing
electronic health records and e-prescribing.
In support of these commitments, the federal government is making
significant investments to encourage the adoption of ICTs in
the health sector, including the funding of $1.2 billion to Canada
Health Infoway Inc.7 Health Canada
research investments to date include $10 million for the Health
Infostructure Support Program (HISP),
$80 million for the Canada Health Infostructure Partnerships Program
(CHIPP)
and $1 million for the Knowledge Development and Exchange (KDE)
Applied Research Initiative8. Other
jurisdictions have also made significant investments. Currently,
the basic infostructure capacity is being built: major standardized
components for electronic health records will be in place in three
to five years; there will be an increase in telehealth and web-based
applications; and the information base for reporting on health
system performance will be expanding.
The expected return on these investments is high, both in terms
of improved health outcomes and renewal and reform of the Canadian
health system. However, gaps remain relating to the challenges
around its adoption, successful strategies to overcome barriers,
the impacts of eHealth implementation, and the options for governance/roles
and responsibilities. Decision-makers need a stronger evidence
base to identify which avenues of investment hold the greatest
promise.
RESEARCH THEMES
1. Barriers to the adoption, implementation, and sustainability
of ICTs in
the health system
Adoption and implementation of ICTs is
slower in health than in many other sectors. The substantial up-front
costs of implementing ICTs as
well as the challenges of automating the health system and even
the desktops of health professionals are all contributing factors.
It has generally been recognized that the path from early adoption
to full scale implementation requires a firm commitment by governments
and health professionals to a change management strategy. While
many theories exist on successful adoption, there are currently
no clear guidelines to lay the framework for the successful design,
development and implementation of ICTs in
healthcare9.
Research is needed on:
- the processes and strategies, including the roles of governments
and health professionals, that have led to the successful adoption
and implementation of eHealth;
- how barriers to adoption, implementation, and sustainability
of ICTs in the health system have been addressed;
- whether the barriers have been quantified and evaluated and,
if so, how;
- the key factors and strategies for success and their applicability
across the health system.
2. Outcomes of eHealth implementation
It is anticipated that wide-spread implementation of eHealth
applications will result in numerous benefits such as improved
health status, health system performance, and evidence for decision-making,
as well as the recruitment, retention, and training of health professionals.
It is also recognized that different eHealth investments yield
different returns and implementation may result in unexpected impacts.
Research is needed on:
- the outcomes (anticipated and unanticipated) of implementation
of eHealth applications;
- whether the outcomes support the federal government's vision
of integrating sustainable development into operations and how10;
- whether the outcomes have been quantified and evaluated and,
if so, how;
- changes in health status and health business processes when
adoption of ICTs is
successful.
3. Governance issues
Governance broadly refers to the interaction of processes, institutions
and traditions that determines how decisions are made (for example,
policies, guidelines, regulations, legislation). The growing use
of ICTs in
the health sector is translating into multiple challenges for health
regulators. These challenges include the provision of services
across jurisdictions, the development of electronic clinical guidelines,
and the need for multi-jurisdictional authorization for access
to information. The governance of eHealth will involve a highly
coordinated commitment from a large number of stakeholders and
decision-makers with different needs and priorities. As technology
evolves, leadership will be required on several different fronts
to address new questions, new issues and the changing roles of
stakeholders.
Research is needed on:
- the ongoing and anticipated governance issues;
- options for addressing governance issues;
- how the roles of those who collect, produce, and disseminate
the information are affected.
POLICY CONTACT
Applicants must get in touch with the policy contact at least
once during the development of their application. The policy contact
is responsible for ongoing interaction with researchers on the
policy issues and context. Inquiries should be directed to: Patricia
Scotcher, Senior Policy Advisor, Health and the Information Highway
Division / Applied Research and Analysis Directorate / Information,
Analysis and Connectivity Branch / Health Canada (tel.: (613) 941-9115,
email: patricia_scotcher@hc-sc.gc.ca).
ADMINISTRATIVE CONTACT
Inquiries regarding registration, eligibility/ineligibility, administrative
questions about time frames and budgets, application formatting
and content, the review process, and terms and conditions of the
HPRP should be directed to: Sherrill MacDonald, Senior Program
Officer, Research Management and Dissemination Division/Applied
Research and Analysis Directorate/ Information, Analysis and Connectivity
Branch / Health Canada (tel.: (613) 954-0830, email: sherrill_macdonald@hc-sc.gc.ca).
HOW TO APPLY
Applicants are required to register in order to obtain an application
form. Applications must be submitted by May 4, 2005 (must be date-stamped
by courier on May 3, 2005).
Applicants should consult the HPRP Guide
to research project funding before registering, which can
be found at: http://www.hc-sc.gc.ca/iacb-dgiac/arad-draa/english/rmdd/guide/eguide.html
BIBLIOGRAPHY
Advisory Council on Health Infostructure. (1999). Canada Health
Infoway: Paths to Better Health: Final Report (Cat. H21-145/1999E).
Ottawa: Government of Canada. Retrieved on December 2, 2004,
from: http://www.hc-sc.gc.ca/ohih-bsi/pubs/1999_pathsvoies/fin-rpt_e.pdf
Alvarez, Richard C. (2002). The promise of e-Health – a Canadian
perspective. eHealth International: The Journal of Applied Health
Technology: 1(4).
Health Canada. eHealth InfoSource cybersanté. Ottawa:
Health Canada. Retrieved on December 2, 2004, from: http://www.hc-sc.gc.ca/ohih-bsi/pubs/bulletin/infosource_e.html
Health Canada. (2004). Backgrounder on Telehealth Activities
in First Nations and Inuit Communities. Ottawa: Health Canada.
Retrieved on December 2, 2004, from: http://www.crossingboundaries.ca/files.av/BackgrounderTelehealth.pdf
Information Technology Association of Canada. (2003). Toward
the Transformation of Health Care Delivery in Canada: Information
and Communications Technology in the Service of Health Care Innovation.
Canada: Information Technology Association of Canada. Retrieved
on December 2, 2004, from: http://www.itac.ca/Library/PolicyandAdvocacy/HealthcareandICT
/pdf/03FebTransformingHealthcarewhitepaper.pdf
Jennett P., et al. (2003). Socio-Economic Impact of Telehealth:
Evidence Now for Health Care in the Future, Vol. 1: State of
the Science Report & Vol. 2: Policy Report. Calgary:
University of Calgary. Retrieved December 2, 2004, from: http://www.fp.ucalgary.ca/telehealth/HTU_Recent_Publications.htm
National Advisory Committee on SARS and Public Health. (2003). Learning
from SARS - Renewal of Public Health in Canada (Cat. H21-220/2003E).
Ottawa: Government of Canada. Retrieved on December 2, 2004,
from: http://www.hc-sc.gc.ca/english/pdf
/sars/sars-e.pdf
REFERENCES
1. For a definition of ‘adoption' and ‘implementation',
see: Rogers, Everett M. (2003) Diffusion of Innovations (5th
ed.), (pp. 177, 179). New York: Free Press.
2. Health Canada. (2003). 2003-2004 Estimates.
Part III - Report on Plans and Priorities. Ottawa: Health
Canada. Retrieved November 23, 2004, from http://www.tbs-sct.gc.ca/est-pre/20032004/pdf/health-e.pdf
3. Advisory Council on Health Infostructure. (2001). Tactical
Plan for a pan-Canadian Health Infostructure: 2001 Update.
Ottawa: Health Canada. Retrieved October 19, 2004, from
http://www.hc-sc.gc.ca/ohih-bsi/pubs/2001_plan/plan_2001_e.pdf
(See also: http://www.hc-sc.gc.ca/ohih-bsi/pubs/2000_plan/plan_e.pdf)
4. Commission of the Future of Health Care in
Canada. (2002). Building on Values: The Future of Health Care
in Canada. Ottawa: The Commission (Romanow Report). Retrieved
on November 23, 2004, from http://www.hc-sc.gc.ca/english/care/romanow/index1.html
5. Standing Senate Committee on Social Affairs,
Science and Technology. (2002). Health Care Human Resources. In The
Health of Canadians - The Federal Role: Vol. 6. Recommendations
for Reform (Chapter 11). Ottawa: Government of Canada. (The
Kirby Report). Retrieved on November 23, 2004, from http://www.parl.gc.ca/37/2/parlbus/commbus/
senate/com-e/soci-e/rep-e/repoct02vol6.htm
6. For example, see:
7. Canada Health Infoway, 2003-2004 Annual Report
and Corporate Plan Summary 2004-2005, retrieved on December 2,
2004, from: http://www.infoway-inforoute.ca as
well as other documents on Infoway's Web site.
8. Information on these initiatives can be found
at http://www.hc-sc.gc.ca/ohih-bsi/about_apropos/finance_e.html.
9. Leonard, Kevin J. (2004). Critical Success
Factors Relating to Healthcare's Adoption of New Technology: A
Guide to Increasing the Likelihood of Successful Implementation. Electronic
Healthcare, 2(4), 72-81. Retrieved on December 2, 2004, from: http://www.electronichealthcare.net/EH24/EH24index.html
10. For additional information on the federal
government's Sustainable Development Strategies, see the website
for the Office of Sustainable Development, Health Canada: http://www.hc-sc.gc.ca/hecs-sesc/osd/index.htm.
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