Introduction

Many innovative solutions are underway to address some of the HHR challenges facing health care systems in Canada. This chapter highlights the innovations occurring in health care delivery across the country, focussing in particular on interprofessional collaborative practice and health information technology. It also identifies ways in which the federal government could further promote and sustain these changes.

Interprofessional Collaborative Practice (IPC)

It has long been acknowledged in Canada that changing health care delivery models to include a broad range of health professionals is a key strategy in addressing shortages in HHR, as well as improving efficiency in health care delivery. Indeed, in the 2004 10-Year Plan to Strengthen Health Care, First Ministers committed to 50% of Canadians having access to multidisciplinary health care teams by 2011.[69] Interprofessional Collaborative Practice (IPC) refers to the provision of comprehensive health services to patients by multiple care givers who work collaboratively to deliver quality care within and across sections.[70] It recognizes that the skills required to meet health care needs do not reside within one professional or even one profession. Closely linked to the full realization of IPC, is the need to change the way health professionals are educated so that they have the necessary knowledge and skills to work effectively in interprofessional teams, which is referred to as Interprofessional Education and Training.[71]

The Committee learned that Health Canada had invested in more than 32 interprofessional practice projects, as part of its Pan-Canadian Health Human Resource Strategy.[72] Health Canada officials told the Committee that these projects had focused on increasing awareness and sharing of best practices related to collaborative care; enabling the provision of mandatory interprofessional education courses by educational institutions; and increasing both the number of educators who are able to teach interprofessional practice and the number of health professionals trained for collaborative practice.[73]

The Committee also heard from other witnesses that many innovative IPC models had been developed across the country as a result of the funding received through the Health Reform Fund for Primary Care as part of the 2003 Accord on Health Care Renewal[74] , as well as funding received from Health Canada. For example, the Committee learned about the Somerset West Community Health Centre (SWCHC) in downtown Ottawa, an interprofessional collaborative practice that included the services of doctors, nurse practitioners, dietitians, social workers, kinesiologists, acupuncturists, chiropodists, social service workers, nurses, health promoters and administrative support staff.[75]

The Committee learned that the SWCHC was governed by a community board of directors and reflected the population health needs of its community, including its desire for the inclusion of traditional Chinese medicine. Witnesses further indicated that the IPC model of practice at the SWCHC had resulted in significant cost savings due to its effective use of nurse practitioners.

The Committee heard that alternative health professionals were also being successfully integrated into intercollaborative practice across the country. For example, the Committee heard that naturopathic doctors were contributing to providing innovative integrated care to cancer patients at InspireHealth, one of four clinics in Vancouver currently conducting research in the area of service delivery for cancer patients as part of the Canadian Partnership Against Cancer.[76] The Committee also heard that chiropractors had been integrated at the Joe Sylvester Anishnawbe Health Toronto clinic, an urban multidisciplinary clinic that offers health care to urban Aboriginal populations.[77] Alternative health professionals appearing before the Committee articulated that their inclusion in the broad range of health care services offered in the context of interprofessional collaborative health care teams served as a means of easing some of the workload of mainstream physicians by providing preventative medicine and complementary treatments for chronic conditions and musculoskeletal disorders.[78]

Despite the numerous examples of innovation in health care delivery to incorporate different health professionals, the Committee heard that there had not been widespread change in health care delivery across the country. According to witnesses, funding mechanisms such as the Health Reform Fund for Primary Care had provided a mechanism to promote innovative pilot projects, but it was not sufficient to create sustainable change across the country.[79] They called for the Health Reform Fund to be extended into the next iteration of the Canada Health Transfer due in 2014 in order to promote sustained change in IPC across the country.[80] Other witnesses pointed to systemic barriers to establishing IPC, including provincial legislation governing the scope of practice of professionals, a lack of interprofessional education and training opportunities, payment schemes for health care providers, and liability issues.[81]

While witnesses recognized that these systemic barriers remained under provincial jurisdiction, they articulated that the federal government could address systemic barriers to IPC within its own jurisdiction both in the context of federal client groups and the federal public service. For example, the federal government could address barriers to IPC within the Public Service Heath Care Plan, such as the requirement that physician prescriptions are necessary to access non-physician health care services such as physiotherapy.[82] The Committee also heard that the federal government could include treatments and care offered by alternative health professionals such as chiropractors and naturopathic physicians as part of the services and benefits that it offers to federal client groups.[83]

The Committee fully respects that many of the issues related to the implementation of inter-professional collaborative practice fall under provincial jurisdiction. However, the Committee also recognizes that the federal government could examine ways to eliminate barriers to collaborative practice within its own jurisdiction, including federal client groups and the health benefits provided to its employees through the Federal Public Service Health Care Plan. The Committee also supports witnesses in their view that sustained funding mechanisms need to be dedicated towards the implementation of IPC in provinces and territories. The Committee therefore recommends that:.

Recommendation 7:

The federal government identify and address systemic barriers to the implementation of interprofessional collaborative practice within its jurisdiction, including its responsibilities as the employer of the federal public service and the health benefits and services it offers to federal client groups, including: First Nations and Inuit; RCMP; veterans; immigrants and refugees; federal inmates; and members of the Canadian Forces.

Recommendation 8:

The federal government consider the possibility of establishing sustained funding mechanisms devoted to promoting interprofessional collaborative practice within the provinces and territories..

Health Information Technology

Witnesses appearing before the Committee also emphasized the importance of health information technology in addressing HHR challenges. Health information technology refers to a broad range of integrated data sources that provide timely access to patient health information that can be communicated to different health professionals, as well as the patient and can include: Electronic Health Records for patients, electronic prescription of medications, and telehealth, which is the use of telecommunications technologies, such as the telephone or videoconferencing, to deliver health care services.[84] The Committee heard that current efforts towards development of Electronic Health Records (EHR) in Canada through Canada Health Infoway Inc. will promote interprofessional collaborative care by facilitating information sharing between different health professionals.[85] Furthermore, the Committee heard that health information technology was empowering Canadians to take responsibility in their own care, in turn easing some of the workload of health professionals. For example, information technology was enabling Canadians to conduct home monitoring of blood glucose levels, saving trips to the doctor.[86]

Indeed, the Committee was able to witness first-hand during its fact-finding mission to Nunavut the importance of health information technology in addressing HHR challenges in rural and remote areas. While visiting the Qikiqtani General Hospital in Iqaluit, the Committee learned that information technology allowed for the digital transfer of medical imaging, which reduced the need for travel to the south by patients, as well as visits to the North by specialists to assess medical test results. In addition, video conferencing was being used effectively for dermatological and mental health assessments, continuing medical education, visitation with family members and patient follow-ups with specialists. Information technology had resulted in reductions in health transportation costs, which currently represent 18.5% or $50 million of Nunavut’s total budget for health and social services. In addition, information technology had further allowed Inuit residents to receive health care within their communities, reducing the cultural burdens and stress associated with travel to urban centres in the south.

The Committee therefore continues to support the federal government’s ongoing investments in health information technology, including electronic health records, electronic prescribing and telehealth through Canada Health Infoway, as a means of addressing HHR challenges across Canada. To date, the federal government has invested approximately $2.1 billion in Canada Health Infoway.[87]