BIG DATA AND THE HEALTHCARE REVOLUTION FORD+SSPG 2014

2020 Decision Context  Canada and US last in public sector data analytics  Healthcare costs increasing, but not performance  Changing demographics  Changes to healthcare in U.S. and Canada  Privacy concerns  Technology is improving and advancing How can big data improve quality, cost effectiveness, and equity in healthcare delivery?

Option 1: Mobile Health Initiatives Utilize new mobile devices, apps, and technology to significantly increase information on individual choices and behaviors, permitting more effective, cost-efficient and equitable healthcare services. Projected Outcome: More individual-level data available at low-cost to create healthier neighborhoods and communities, with wide-reaching social welfare benefits. Key Considerations:  Lowest cost option (it’s an app!)  Puts responsibility and accountability on individuals  Incentives, such as tax credits, to increase use of devices  Ensuring quality data that can be utilized to understand users’ health to increase preventative care and information on chronic illness (diabetes, etc.), thereby reducing number and length of costly visits  Individuals choose with whom to share information (HMO, doctors, etc.), addressing privacy concerns  Ensure privacy via biometric data and tech  Short, medium, and long-term benefits

Option 2: Capacity Development Increase government, industry and citizen capacity and awareness of existing big data initiatives in order to improve healthcare equality, cost effectiveness and equity. Projected Outcomes: development of infrastructure, increased government knowledge of data analytics and opportunities, engaged and informed citizenry Key Considerations:  Long-term planning; lack of an immediate response (5-year rollout)  Ongoing evaluation to ensure flexibility  Allows sufficient time for information gathering, consultation and planning  Coordinating and aligning contrasting stakeholder interests  Intergovernmental oversight, responsibility and accountability  Mid-level cost option

Option 3: Horizontal Integration Leverage Electronic Health Records to inform clinical decisions and service delivery. Projected Outcome: More targeted interventions; improved health outcomes and lower costs. Key Considerations:  Competitively-chosen private contractors with federal agency oversight to build and maintain infrastructure for big data analytics  Strong government oversight over privacy, management and control  Investment in data management needed  Data is anonymized and aggregated; patients must give consent for data to be used  Machine learning and large datasets can help recommend treatments based on individual or social characteristics, and change service delivery  Complete overhaul of databases and a review every 5 years  Most costly of all the options

Horizontal Integration Risk Assessment Risk - Privacy - Insufficient technology to sustain big data collection and analysis - High cost and resource intensive - Lack of consensus regarding data- gathering priorities - Lack of compliance on behalf of health care institutions and providers - Insufficient resources to analyze data Mitigation Strategy  Development of a long-term data privacy strategy, compliance with existing privacy laws, strong government oversight and control.  Partnerships with private sector to incentivize innovation in health care data collection and analytics  Build on existing data collection systems and health networks, leverage existing knowledge base  Extensive consultation with health providers, health institutions, advocacy groups and citizens  Enforcement through legislation and incentives  Intergovernmental partnerships to leverage resources and identify key research priorities (and M.P.P.s!)

Next Steps Phased Adoption: build capacity toward horizontal integration (#3)  Assess existing initiatives and best practices (including foreign government provisions)  Launch pilot programs  Begin citizen engagement and awareness campaigns  The impact of these policy recommendations will increase international competitiveness and reduce economic inequality in the long-term