An Agenda for Ontario s Health Innovation Leadership

Transcription

1 An Agenda for Ontario s Health Innovation Leadership Health research and innovation can make Ontario stronger. Stable and predictable investment is a smart choice in not only preserving but improving health services, and creating a new path to jobs and growth. JANUARY 2014 AN AGENDA FOR ONTARIO S HEALTH INNOVATION LEADERSHIP 1

2 In health care, innovation doesn t happen by chance. It begins with people asking questions. But innovation only takes hold when those people have the means to explore their questions, to test and retest solutions until answers are found and new questions are asked. Research creates innovation. Innovation drives progress. Progress makes us healthier, wealthier and smarter. Without yesterday s health research, we would not have today s standard of care. Without today s health research, innovations would remain undiscovered. Opportunities would be lost. Talent would go elsewhere. Decades of success have made Ontario a world leader in health research. And there is much more to be done. That is why health research is a major mission of Ontario s research hospitals. 2 THE COUNCIL OF ACADEMIC HOSPITALS OF ONTARIO

3 What Research Hospitals Bring to Ontario The Council of Academic Hospitals of Ontario (CAHO) represents Ontario s 24 research hospitals. Like all hospitals, CAHO hospitals are places of healing. What makes them unique is that they are also places of learning and discovery. CAHO hospitals educate the next generation of health care providers, and CAHO researchers translate knowledge into better patient care by taking research from the bench to the bedside. In partnership with Ontario s universities, we turn the patient care environment into a classroom and a laboratory. What benefits does that bring to Ontario? First, it makes Ontario healthier, by constantly improving patient care discovered here, tested here, and delivered here. Second, it makes Ontario wealthier, by creating new jobs and industries through the commercialization of new discoveries and the global marketing of these discoveries. And last, it makes Ontario smarter by driving a knowledgebased economy that attracts and engages the brightest minds from here and around the world. None of this happens spontaneously or in a vacuum. It happens because Ontario has made the deliberate choice to take the lead in supporting the unique mission of its research hospitals. And when Ontario leads, Ontarians benefit. IMPROVING QUALITY OF CARE AT REDUCED COST High-Intensity Focused Ultrasound (HIFU), developed at Sunnybrook Research Institute and Thunder Bay Regional Research Institute, is eliminating the need for invasive procedures for common conditions e.g. uterine fibroids. This has a potential savings of $35 million annually for Ontario s health care system on a one-time Ontario Research Fund (ORF) investment of $3.5 million. HIFU also has patient benefits: In addition to avoiding the discomfort and potential complications from surgery, recovery for patients is reduced from weeks to one or two days. Research led by Dr. James Kennedy from CAMH aims to identify genetic markers associated with poor medication response and/or adverse side effects after taking psychiatric medication. The overall goal of CAMH s IMPACT project is to improve health care to individuals on psychiatric drugs by proactively selecting the appropriate drug and the optimum starting dosage based on the patient s genetic information. IMPACT will focus on individuals receiving antipsychotics, antidepressants and mood stabilizers. One in five Ontarians will experience a mental illness in their lifetime. If medication is required, physicians may have to try several options, at different doses, until an effective medication with tolerable side effects is found. These differing responses to medication may be based on an individual s genetic profile. It is expected that pre-screening patients will save the Ontario government $88 million over 10 years in direct health care costs related to psychiatric treatment. AN AGENDA FOR ONTARIO S HEALTH INNOVATION LEADERSHIP 3

4 Health Research: An Investment That Attracts Investment Health research is not a cost. It is an investment, and the return on that investment is significant. Almost half of Canada s top research hospitals are in Ontario. Together, they invested $1.2 billion dollars in health research income in 2012 in Ontario. Sixteen percent of this total came directly from private industry. This is significant and worth considering further. The Task Force on Competitiveness, Productivity and Economic Progress annual report on the state of Ontario s economy highlights the continuing challenge of closing Ontario s productivity gap with competing economies in the United States. The Task Force identifies lower levels of business investment in productivity-enhancing tools such as machinery and equipment and information and communications technologies. It concludes that innovation, as reflected by spending on R&D and patent output, is low. 1 Today, a policy consensus is forming on resurrecting so-called dead money in business and corporate bank accounts in the form of investment in innovation and productivity. Health research in Ontario is a globally leading platform for attracting business investment. Ontario s health research enterprise attracts a disproportionate share of business investment in higher education research and development (HERD). At 16% of total R&D income collected, business and industry investment in Ontario s public health research enterprise is twice the average for Ontario, 2.5x the OECD average and more than the highest ranking national jurisdiction, Germany at 11%. Ontario is leading the capture of private investment in health research aimed at developing knowledge that can be commercialized globally in the form of new drugs, treatments and technologies. Ontario s research hospitals are attracting human capital to Ontario in the form of the brightest and best researchers. For example, Sudbury s Health Sciences North (HSN) has recruited a DNA expert from the esteemed Mayo Clinic to oversee the hospital s new Personalized Medicine Program: Dr. Rebecca McClure. She was drawn to the hospital s cutting-edge facility, the Advanced Medical Research Institute of Canada (AMRIC), and its brand new next-generation DNA sequencing machine, an ION Torrent Personal Genome Machine, to be used exclusively by McClure. This equipment puts HNS at the forefront of actual clinical testing using this new technology. Dr. Rebecca McClure, Health Sciences North Bringing McClure on board, with this new technology, will attract the next generation of researchers and health care providers to this research hospital. 1 Task Force on Competitiveness, Productivity and Economic Progress, Course Correction: Charting a new road map for Ontario, 12th Annual Report, November THE COUNCIL OF ACADEMIC HOSPITALS OF ONTARIO

5 Commercialization of health research is steadily progressing in Ontario. Over the last two years, 2011 and 2012, Ontario s research hospitals made approximately 574 intellectual property (IP) disclosures and commercialized 139 health research and innovation projects. The commercialization of health research and innovation creates new companies, new knowledge-intensive jobs and new opportunities for growth and economic diversification. ONTARIO S RESEARCH AND INNOVATION ENTERPRISE $1.2 billion 16, :1 36,000 Total investment in health research in Ontario Number of researchers and research staff in Ontario s 24 research hospitals Number of intellectual property (IP) disclosures made by Ontario s 24 research hospitals over two years Number of health research commercializations over last two years by Ontario s research hospitals Return on R&D investment in Ontario s research hospitals that accrues to the provincial economy Number of direct, indirect and induced jobs supported by total R&D investment in Ontario s research hospitals According to Research InfoSource, 18 of Canada s top 40 research hospitals are in Ontario. Indeed, some suggest that just as other provinces are uniquely endowed with natural resources to generate wealth, Ontario s health research enterprise is a unique, rich and fertile environment for knowledge accruing, extraction and translation/sharing, and wealth creation. The value proposition for investing in health research and innovation is higher quality patient care at reduced cost and a new source of economic growth. The return on investment is real and measurable. For every research dollar invested in Ontario s 24 research hospitals, 3 dollars of economic activity is generated, and approximately $2.50 of labour income is generated. Using the StatsCan Interprovincial Input-Output model, the $1.2 billion in research income collected and invested by Ontario s research hospitals is estimated to stimulate: $3.2 billion of economic output that benefits all of Ontario and its regions The return on investment is made more real by the evolving health innovation clusters in the communities across Ontario where research hospitals are located. Diagnostic technologies developed in Ontario s research hospitals are being commercialized for export and creating the jobs we want our youth to have across Ontario. Consider the example of RNA Diagnostics Inc. in Sudbury. This company expects to employ 60 people in Sudbury through the export of technology that can screen out chemotherapy for breast cancer patients and replace it with more effective treatments. Our partnerships with industry are accelerating the implementation and commercial potential of viable health research. For example, Hamilton Health Sciences hosts one of the most successful clinical trials institutes in the world. The Population Health Research Institute (PHRI), led by Dr. Salim Yusuf, began in 1999 with only a few staff members. Today, AN AGENDA FOR ONTARIO S HEALTH INNOVATION LEADERSHIP 5

6 Health Research: An Investment That Increases Quality it boasts a team of 240 employees and is the city s main driver of research. Yusuf s and the Institute s work draws scientists and doctors from around the world to Hamilton. The PHRI is a powerful example of how health research can establish Ontario as a global centre of excellence and create jobs in new industries in regions that faced economic challenges due to their dependency on declining industries. In the face of global economic volatility, investment in health research and innovation is a significant part of putting Ontario on the path to jobs and growth. In an evidence-informed health care system, we need to construct a seamless pathway for the wide-spread implementation of evidence-informed innovation. Ontario has yet to realize the full potential of sharing best practices and systematizing efforts to move research evidence into practice. Too often, we have found pathways to improve care and drive quality improvement in the health care system, but that knowledge never leaves the organization into which it was created. In 2010, CAHO resolved to address this challenge. Committed to fostering better collaboration and establishing a systematic approach to moving research evidence from the bench to the bedside, CAHO launched the Adopting Research to Improve Care (ARTIC) Program. The aim of the program is to move research evidence into practice from one hospital into other hospitals in order to drive quality improvement and benefit the health care system as a whole. The goal is to help build a systematic and sustainable implementation pathway for evidence adoption across the province. Dr. Salim Yusuf Population Health Research Institute Hamilton Health Sciences Through this program CAHO hospitals are working together to make sure that when research leaders in one institution discover a new way to provide better care for our patients, we all use that knowledge. In this way, we are taking the latest evidence from health care research and accelerating the spread and use of that knowledge where it counts: on the front lines of the health care system. For example, we are working together to use what we learned from research to enable better transitions in care for our surgical patients in the hospital; to bridge gaps between the hospital and community for people with long-term mental health issues; to tackle antibiotic resistance; and to challenge the popular perception that rest is best and instead raise the 6 THE COUNCIL OF ACADEMIC HOSPITALS OF ONTARIO

7 level of mobility of elderly seniors in hospital to improve their recovery. Conventional wisdom suggests that evidence from research can take up to 17 years to implement and spread across a health care system at pace and scale to make a difference to patients. Ontario s patients deserve better than this and should not need to wait a generation for quality to improve. ARTIC Program projects are demonstrating that evidence from research can be implemented and make a difference within two years. CAHO is committed to continuing our journey of learning through the ARTIC Program. CAHO believes the development of this knowledge should not be experienced by our community alone. Working with the Ministry of Health and Long-Term Care (MOHLTC), Health Quality Ontario (HQO) and world-renowned experts in knowledge translation, we aspire to build a sustainable pathway for implementing evidence that can improve care and Ontario s health care system. MOBILIZATION OF VULNERABLE ELDERLY IN ONTARIO (MOVE ON) KEEPS ELDERLY PATIENTS ACTIVE Research from hospitals in Toronto shows that rates of mobilization in patients in hospital are unacceptably low: less than 30% of patients were mobilized regularly in hospital. But without mobilization specifically, getting up, standing, moving and walking around the ward elderly patients in hospital will lose 1 to 5% of muscle strength every day. Compounding this, one-third of older adults develop a new disability during hospitalisation, and half of these patients are unable to recover function. The Mobilization of Vulnerable Elderly in Ontario (MOVE ON) project aims to change this by implementing an evidence-based strategy that promotes early and consistent mobilization of older patients and prevents functional decline in these patients admit-ted to acute care hospitals. Drs. Barbara Liu and Sharon Straus are leading the implementation of the MOVE ON Project across 14 Ontario hospitals. AN AGENDA FOR ONTARIO S HEALTH INNOVATION LEADERSHIP 7

8 Choosing to Sustain and Advance Ontario s Health Innovation Leadership Research is an investment in the future that sees a real and measurable return. It is as much about generating new business as it is about enabling productivity in our health care system. The facts are clear: Investment in health care research delivers results that matter to the people of Ontario, and beyond. Continued success depends on all of us. We need to work together to deliver an end-to-end health research and innovation strategy from molecule to medicine to market. The February 2013 Ontario Throne Speech speaks to the goal of building the strongest and most innovative health care system in the world. Achieving this goal is possible if we fire up our shared ambition to make it happen. So is a shared commitment to grow Ontario s economy. Our world has changed. Ontario s economy is now a services economy. Our competitiveness is a function of leveraging and exploiting knowledge in everything we produce. To be competitive, we need to be more productive. To be more productive, we need to increase our capacity for innovation. The federal Science, Technology and Innovation Council recently acknowledged that, with their significant investments in research and higher education, other countries are catching up and overtaking Canada. 2 So how do we get the economic and health outcomes we need? It starts with acknowledging Ontario s efforts to stimulate innovation in health care. This starts with increasing R&D investment in both the private and public sectors. And translating the innovation we produce into viable solutions to improve quality of life and meet market demand. Tackling Ontario s innovation challenge is not the responsibility of any one entity or sector. We re all in this together. Consider this: In 2011, Canada ranked 11th out of 41 OECD economies in R&D investment in higher education down from 4th in 2008 and 3rd in The MaRS EXCITE program at MaRS Innovation is making progress on a model to enables better health technologies to get to market faster leading to improved health outcomes. To be of value, research needs to be implemented. On November 19, 2013 Ontario announced the launch of the Ontario Health Innovation Council (OHIC) and tasked it with the job of recommending a strategy to enable the wide-spread adoption of innovation in our 2 Science, Technology and Innovation Council, 2012 State of the Nation: Canada s Science, Technology and Innovation System: Aspiring to Global Leadership, THE COUNCIL OF ACADEMIC HOSPITALS OF ONTARIO

9 health care system, thereby giving Ontario s health and life sciences industry a boost. Additionally, through the MOHLTC, Ontario is an investment partner in the CAHO ARTIC Program. This investment has helped expand the number of research evidence implementation projects in hospitals across Ontario. CAHO strongly supports and commends Ontario for these initiatives. We also believe that now is the opportunity to think big about health innovation in Ontario and to craft an end-to-end innovation strategy that leverages every asset and opportunity available. The value proposition for health research and innovation in Ontario is large and compelling. The business case exists to sustain the innovation platform that is the health research enterprise. We also believe that, more than ever, an overarching strategy is required to leverage and direct inputs (R&D, researchers and research teams) towards the outputs that we want to achieve namely, higher quality care, more productivity, jobs and growth, and investment attraction. In short, we need an agenda to become healthier, wealthier and smarter. Now is the time for health innovation leadership. The Value Proposition for Ontario s Health Research and Innovation Enterprise From Industry 16% > ATTRACTING BUSINESS INVESTMENT > 2.5 X OECD average 16,000 Researchers & Research Staff BETTER CARE AT LESS COST > Scalpel-free surgery could save $35 million per year on one procedure (fibroid tumours) HEALTH INNOVATION PLATFORM > Genetic prescreening, to predict which psychiatric meds work best, expected to save Ontario $88 over 10 years STRONGER, MORE DYNAMIC ECONOMY > Total GDP Impact: $3.2 billion $1.2 billion invested in health R&D in Ontario in 2012 > 36,000 total jobs supported > 139 health tech commercializations in last 2 years HIGHER QUALITY CARE FOR PATIENTS > CAHO ARTIC Program moves research evidence into practice > Average time to implement evidence: 17 years > ARTIC s goal: 2 years AN AGENDA FOR ONTARIO S HEALTH INNOVATION LEADERSHIP 9

10 A Health Innovation Leadership Agenda for Ontario A health innovation leadership agenda for Ontario requires a comprehensive end-to-end strategy. The pieces and partners need to be brought together to leverage the full potential of the health innovation system in Ontario from research, to adoption, to widespread practice and to health care markets broadly. The design of Ontario s hospital funding model can also have a positive impact on the strength and sustainability of the health research enterprise. (A discussion on that will follow.) 10 THE COUNCIL OF ACADEMIC HOSPITALS OF ONTARIO

11 Ontario Health Innovation Leadership Agenda at a Glance CAHO believes that the following are the key elements for an Ontario health innovation leadership agenda: We need to align research strengths and capabilities in our hospitals with health system priorities. We need to arrive at a framework for stabilizing investment in these priorities in a predictable and sustainable fashion. We need to streamline the path for rapidly moving evidence-informed innovation clinical and technology into practice across the healthcare system and into new markets. ALIGN RESEARCH CAPABILITIES WITH HEALTH SYSTEM PRIORITIES Design a health research and innovation strategy for Ontario that defines the measures of success for health innovation from research to implementation to commercialization from bench to bedside, to business. Design a governance framework to implement the strategy and investment framework and to take accountability for enabling targeted outcomes. STABILIZE INVESTMENT IN HEALTH RESEARCH AND INNOVATION Ontario s decision to reinvest in the Ontario Research Fund is worthy of recognition and praise. The ORF invests in the best science in the province, and acts as a magnet to attract matching dollars from donors, industry and other partners and other levels of government. Ontario has made a smart decision in challenging times to invest in a knowledge-based economy and in our future. CAHO urges all parties in the Legislature to support this commitment in current and future provincial Budgets. With new ORF investment in place, CAHO is proposing a dialogue with government and stakeholders about future investment strategies that will: a) sustain Ontario s health research enterprise over the long-term; and that will b) meet the health research engine s needs of certainty and predictability. RAPIDLY MOVE HEALTH INNOVATION INTO PRACTICE AND NEW MARKETS Ontario requires an evidence implementation pathway. The CAHO ARTIC Program is a model that can be leveraged to facilitate the change for technology adoption in health care. The proposal is to renew the investment partnership with Ontario, including HQO, to continue building Ontario s research evidence implementation pathway. CAHO encourages OHIC to think as big and broadly as possible about Ontario s health innovation system and to make recommendations about how to sustain, grow and leverage Ontario s significant and dynamic health research and innovation enterprise to enable better health care at less cost; and as an engine for investment and economic renewal. In the last two years, Ontario s research hospitals have made 574 intellectual property disclosures and commercialized 139 research projects. We have the opportunity to support the broader commercialization of innovation in our research hospitals. Several CAHO members and their respective foundations are working with Ontario and industry partners to create a meaningful risk capital initiative to help bring promising health research in our hospitals with commercial potential to market. CAHO strongly supports and encourages these efforts. AN AGENDA FOR ONTARIO S HEALTH INNOVATION LEADERSHIP 11

12 Refine the Hospital Funding Formula to Reflect the Unique Value Delivered by Ontario Research Hospitals Ontario s funding formula needs to be consistent with the agreed upon role and accountabilities of Ontario s research hospitals. In a recent report on hospital funding formulas in Canada, the CD Howe Institute asked, How do we align the way we pay for our hospitals with what we expect from them? Ontarians expect research hospitals to play many roles: They provide the skills and capital for specialized care and the coordination of care for patients with complex chronic conditions. ACCOUNTABILITIES OF ONTARIO S RESEARCH HOSPITALS Our research hospitals provide Ontario residents with timely access to advanced patient care services; train the next generation of health care professionals; conduct leading-edge research; and act as a connector and partner with others in the system, thereby building capacity for all. There are four accountabilities of our research hospitals: (1) excellence and innovation in patient care, (2) excellence and innovation in education, (3) research and innovation, and (4) system role. They teach and train Ontario s next generation of health professionals. They undertake leadership in education of current and future health professionals, and facilitate and lead continuous quality improvement in education of health professionals. EXCELLENCE AND INNOVATION IN PATIENT CARE EXCELLENCE AND INNOVATION IN EDUCATION They drive research and innovation to address the most pressing health care challenges. SYSTEM ROLE RESEARCH AND INNOVATION They facilitate and lead knowledge creation and discovery. Just as critically for the benefit of the system, research hospitals lead knowledge transfer and work with industry, government and other system partners to ensure rapid technology development and transfer. There are several considerations for addressing the accountabilities of research hospitals. As a general principle, CAHO proposes that: Research and hospital funding models reflect the full costs of the integrated research hospital business model and the accountabilities of the research hospital to the Ontario health care system. 12 THE COUNCIL OF ACADEMIC HOSPITALS OF ONTARIO

13 Conclusion Ontario has had to make tough choices to contain the adverse impact of economic downturn on our communities, our families and the services we use. CAHO is presenting Ontario with the opportunity to make informed and intelligent choices about strengthening health care and creating a path to jobs and growth. It makes sense to invest in health research and innovation. It improves the quality of care while reducing health care costs and driving jobs and growth across Ontario. It provides a sustainable platform for continued growth by attracting, retaining and developing skills and talent the primary input to production in a global economy that is transforming to value-added services. In short, investment in health research and innovation makes Ontario healthier, wealthier and smarter. We have so much to build on. In hospitals and community across Ontario, over benches and at the bedside, world-leading innovation is happening right now. In the race to win tomorrow, that s our starting point today. But we need leaders across Ontario s business, industry, finance and all sectors of the economy to be part of the solution. We all need to embrace the new bottom line for health care research and innovation, and make the case for sustainable investment, in a time of tough choices. It is our common cause for renewing and stabilizing investment in Ontario s health research and innovation enterprise. CAHO invites all to be a part of the dialogue and discussion. About CAHO The Council of Academic Hospitals of Ontario (CAHO) is the non-profit association of Ontario s 24 academic hospitals and their research institutes. CAHO provides a focal point for strategic initiatives on behalf of these academic hospitals. As research intensive hospitals, CAHO member hospitals are fully affiliated with a university medical or health sciences faculty. Our hospitals provide Ontario residents with timely access to advanced patient care services; train the next generation of health care professionals; conduct leading-edge research; and act as a connector and partner with others in the system, thereby building capacity for all. AN AGENDA FOR ONTARIO S HEALTH INNOVATION LEADERSHIP 13

14 ONTARIO THUNDER BAY SUDBURY OTTAWA KINGSTON OTTAWA LONDON TORONTO HAMILTON CAHO s Member Hospitals BAYCREST HEALTH SCIENCES BRUYÈRE CONTINUING CARE THE CENTRE FOR ADDICTION AND MENTAL HEALTH TORONTO THE CHILDREN S HOSPITAL OF EASTERN ONTARIO HAMILTON HEALTH SCIENCES CENTRE HEALTH SCIENCES NORTH HOLLAND BLOORVIEW KIDS REHABILITATION HOSPITAL HÔPITAL MONTFORT THE HOSPITAL FOR SICK CHILDREN HOTEL DIEU HOSPITAL KINGSTON GENERAL HOSPITAL LONDON HEALTH SCIENCES CENTRE MOUNT SINAI HOSPITAL NORTH YORK GENERAL THE OTTAWA HOSPITAL PROVIDENCE CARE THE ROYAL OTTAWA HEALTH CARE GROUP ST. JOSEPH S HEALTHCARE HAMILTON ST. JOSEPH S HEALTH CARE LONDON ST. MICHAEL S HOSPITAL SUNNYBROOK HEALTH SCIENCES CENTRE THUNDER BAY REGIONAL HEALTH SCIENCES CENTRE UNIVERSITY HEALTH NETWORK WOMEN S COLLEGE HOSPITAL 14 THE COUNCIL OF ACADEMIC HOSPITALS OF ONTARIO

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