ARCHIVED - Health Canada

1) Name of Foundation: Canadian Health Services Research Foundation (CHSRF)   

2) Start Date:
1996-1997

4) Total Funding:
$151.5 M

5) Description: Total federal funding for the CHSRF is as follows (CHSRF's programs also receive funding from other sources):

• 1996-2001 - $66.5 M endowment to establish the Foundation and another $35 M to support its participation in the Canadian Institutes of Health Research (CIHR);
• 1999 - $25 M grant to support a ten-year program to develop capacity for research on nursing recruitment, retention, management, leadership and the issues emerging from health system restructuring (Nursing Research Fund or NRF); and
• 2003 - $25 M grant to enhance the skills of health system managers in using research to increase evidence-based decision making (Executive Training for Research Application or EXTRA) over a thirteen-year period.

CHSRF's mission is to support evidence-informed decision-making in the organization, management and delivery of health services through funding research, building capacity and transferring knowledge.  The Foundation's strategic objectives are to:

• create high-quality new research that is useful for health service managers and policy makers (especially in the Foundation's priority theme areas:  managing for quality and safety; management of the health care workplace; primary health care; nursing leadership, organization and policy; and managing and adapting to change);
• increase the number and nature of applied health services and nursing researchers;
• get needed research into the hands of health-system managers and policy makers in the right format, at the right time, through the right channels; and
• help health system managers, policymakers and their organizations to routinely acquire, appraise, adapt and apply relevant research in their work.

CHSRF's work contributes to Health Canada's aim of strengthening the knowledge base to address health and health care priorities.  More specifically, CHSRF's programs further the development of health human resources, provide health managers with tools to improve primary and continuing care, and support nursing research from a health system perspective.

6) Strategic Outcome:  Strengthened knowledge base to address health and health care priorities.

7) Summary of Results Achieved by the Recipient:  Overall key achievements in 2006 include commissioning of research in priority theme areas; the establishment of the partnership and design for the 2007 triennial Listening for Direction III national consultation to identify priorities for health services and policy research (with an increase from a total of six to eight national partners, including Health Canada); the convening of a successful national symposium on primary health care research; the design and piloting of a Decision Support Syntheses Program; and the release of syntheses of research in priority areas such as nurse staffing and patient safety.  In addition, an inaugural and successful National Forum on Knowledge Transfer and Exchange was held; an innovative dissemination campaign strategy for research was launched with a focus on nurse staffing and patient safety, and another on management of the health care workplace; and new series were launched to promote best practices in developing and sustaining networks (Network Notes), and to summarize key research articles in Foundation theme and activity areas (In the Know, Network Digest).  With regard to Nursing Research Fund and EXTRA, the following were achieved:

Nursing Research Fund:  In 2006, a priority-setting discussion was held with 50 nursing stakeholders to set the Foundation's priorities for nursing research for the near future.  A synthesis document, Staffing for Safety:  A Synthesis of the Evidence on Nurse Staffing and Patient Safety, and a dissemination campaign targeting Canada's health and nursing decision makers, were launched.  The Nurse Staffing and Patient Safety Knowledge Network - a collaborative venture between the Foundation, the Canadian Patient Safety Institute, the Canadian Nurses Association, and NurseONE, - held its first two face-to-face exchanges.  

EXTRA:  The third cohort of 26 Fellows was selected in 2006.  This brings the total number of Fellows enrolled in the program since its inception in 2004 to 76.  The first cohort of Fellows graduated in 2006.  Data shows that upon entry to EXTRA, 21% of this first cohort reported using research in their daily work "most or all of the time"; this had increased to 50% upon graduation from the program.  Further, over 60% of these graduates reported "excellent" or "very good" ability to champion evidence-informed working decision making in their home organizations, whereas only 8% felt this way upon program entry. 

8) Actual
Spending
2004-05

9) Actual
Spending
2005-06

10) Planned
Spending
2006-07 

11) Total
Authorities
2006-07

12) Actual
Spending
2006-07

13) Variance
between
10) and 12)

14) Conditional
Grants

0

0

0

0

0

0

16) Significant Audit and Evaluation Findings and URL to Last Audit &/or Evaluation: 

CHSRF commissioned its second International Review Panel Report in 2006.  Significant findings include: CHSRF has developed Canadian health services research capacity, in general, and in nursing services, in particular.  CHSRF has been an innovation incubator, developing innovative programs and activities in the health sector.  The Foundation has been a successful knowledge broker between the research and decision making communities.  CHSRF has become a national and international reference for those working on improving the use of research in decision-making in the health sector.  The Panel noted that the CHSRF should consider expanding its role to become an enabler and support health organizations in implementing the results from research to improve health services delivery performance. CHSRF should also consider broadening the decision-making audience for its work to include clinical leaders, middle managers, and policy makers outside health care who have an impact on health. CHSRF should continue to develop partnerships and alliances, particularly with  professional associations which can be useful intermediaries to reach the Foundation's target audiences.

In addition, the Foundation commissioned two important internal controls reviews: a mini internal controls review of its payroll system, which cited significant improvements from the 2005 internal controls review, and the second compliance audit of its funded research programs and projects.  The Foundation also developed an Internal Audit Plan for the period 2008‑2013 to ensure it assesses the various levels of controls throughout the organization.  Both reports and the Internal Audit Plan are available upon request.

http://chsrf.ca/about/ga_accountability_impact_ol_e.php

1) Name of Foundation: The Canadian Institute for Health Information (CIHI)

2) Start Date:
April 01, 2006

4) Total Funding:
$19,740 M

5) Description

The objectives of the Roadmap Initiatives, which include Roadmap III, are to:

• Help provide the information necessary for the health care providers and managers to measure and report on performance;
• Help provide the evidence base necessary for the health care providers and managers to make informed decisions about health system renewal;
• Help create the information necessary for Canadians to make informed decisions about their health and the use of health care services; and,
• Expand the sharing of health information through a comprehensive approach to data dissemination that respects the privacy of Canadians.

Roadmap III also included as an objective, improving data collection and reporting of health performance information, particularly as it related to progress made in the 2004 F/P/T Health Accord.

6) Strategic Outcome: Strengthened knowledge base to address health system priorities

7) Summary of Results Achieved:

CIHI reported the following results achieved:

• Released the flagship publication Health Care in Canada 2006;
• Implemented the long-range analytical plan including analytical projects relevant to priority themes including access to care, quality/outcomes, health human resources, and patient flow/continuity of care;
• Expanded the range of collaborative and analytical activities including the release of special reports on health services themes (changes in home care, waits for emergent and planned orthopaedic surgery, falls in continuing care settings and renewal and exits in Canada's nursing supply);
• Developed, compiled and disseminated new and existing health indicators to address priority information needs with a special focus on hospital standard mortality ratios, primary health care and wait times;
• Continued work related to the implementation, monitoring and ongoing compliance of CIHI's data quality framework across all data holdings; and,
• Produced policy relevant analytical reports in the areas of health expenditures, health human resources, and health services.

8) Actual
Spending
2004-05

9) Actual
Spending
2005-06

10) Planned
Spending
2006-07

11) Total
Authorities
2006-07

12) Actual
Spending
2006-07

13) Variance
Between
10) and 12)

14) Program Activity

0

0

$19,740M

$19,740M

$19,740M

$0

15) Comment on Variance: N/A

16) Significant Audit and Evaluation Findings and URL to Last Audit &/or Evaluation:
CIHI is required to have an independent third-party evaluation of its activities and projects under Roadmap III by March 31, 2011.  Currently, Roadmap II and II+ are being evaluated with the final report due in September 2007.

17) CIHI

18) Annual Report

1) Name of Recipient: Canada Health Infoway Inc. ( Infoway )

2) Start Date:
March 9, 2001

3) End Date:
N/A

4) Total Funding: 
$1.6 Billion*

5) Description
Canada Health Infoway Inc. ( Infoway ) is an independent not-for-profit corporation with a mandate to foster and accelerate the development and adoption of electronic health information systems with compatible standards on a pan-Canadian basis.  Recently, the growing recognition in Canada that electronic health records (EHRs) telehealth and public health surveillance systems will significantly improve not only access to health care services, but also patient safety and care,  was underlined with financial investment by the federal government.  With 'Modernizing our Health Care System" as a goal, Federal Budget 2007 committed 'an additional $400 Million for Canada Health Infoway to support provincial and territorial development of electronic health records that will reduce wait times, reduce the risk of medical errors and will lead to better outcomes." *This latest addition brings to a total of $1.6 Billion funds the federal government has invested in Infoway  to date.   

Funding had  previously been provided to Infoway on three occasions: $500 million in 2001 in support of the September 2000 First Ministers' Action Plan for Health System Renewal to strengthen a Canada-wide health infostructure, with the EHR as the key priority; $600 million in the First Ministers' Health Accord of February 2003, to accelerate implementation of the EHR and Telehealth; and $100 million as part of Budget 2004 to support the development of a pan-Canadian health surveillance system, with a particular focus on infectious disease.  At the time of  this Report, these areas of work remain Infoway's  three main priorities, and results for each are described in  Section 7, below.

Infoway's collaborative approach, where the federal, provincial and territorial governments participate as equals, toward a common goal of modernizing Canada's health information system, is already reducing costs through coordinating effort and avoiding duplication.  Joint work to develop and implement common standards to enhance interoperability, as well as on purchasing to help reduce costs, and sharing best practices as successful initiatives are replicated across the country appear to be working for the parties involved.

6) Strategic Outcome(s): Strengthened Knowledge Base to Address Health and Health Care Priorities

7) Summary of Results Achieved by the Recipient
Investment Strategy - Infoway is a strategic investor, along with provinces and territories that are ready to implement projects.  Its funding formula covers up to 100% of territorial and 75% of provincial project development and implementation costs.  Infoway's focus in 2006-07 shifted to implementation - the phase in which 68% of its projects now fall.  Investments of $518M in 64 projects exceeded its original investment target of $385M.  (In total, Infoway has approved $1.176 Billion in projects, or 98% of its earlier $1.2 Billion allocation as of March 31, 2007.)  It should be noted that while Infoway provides expert advice and shares funding with its public sector partners, it is the provinces and territories that are responsible for the actual systems development, implementation and operating costs associated with their projects.  (See explanation in section 15 for more information)

Electronic Health Records - Infoway's goal for EHRs, endorsed by all jurisdictions, is to put into place the basic elements of an interoperable electronic health record for 50% of Canadians by the end of 2009.  By focussing mainly on implementation of seven key building blocks - drug, laboratory and diagnostic imaging systems; infostructure; registries; interoperable electronic health record systems and innovation and adoption initiatives, Canada Health Infoway achieved an interim goal of having 4% of the Canadian population with an interoperable  EHR by March 31, 2006.  As well, collaboration with and funding by Infoway has contributed to six provinces and territories having concrete plans to achieve 50% coverage of citizens in their jurisdictions with electronic health records by 2010, with five more P/T's  indicating they will have many of the key iEHR components in place by that time

Telehealth - Infoway has invested in/continued to invest in projects to expand and sustain telehealth initiatives, particularly in rural and remote communities, including Aboriginal and official language minority communities.  It continues to work on linkages between telehealth and electronic health records systems, and the integration of telemedicine activities into mainstream healthcare service delivery.  Telehealth strategic plans are now in place in most jurisdictions, with the goal of implementation of telehealth solutions by all jurisdictions by December 31, 2009. 

Health Surveillance - Infoway continued to fund the British Columbia Ministry of Health to manage the pan-Canadian Public Health Surveillance System project (Panorama) during 2006-07.  Panorama  is expected to comprise modules for Case Management, Outbreak, Immunization, Vaccine Inventory and Alerts.  With vendor selection complete, work began on system design, with an anticipated release date of March 2008.

8) Actual Spending
2004-05

9) Actual Spending
2005-06

10) Planned Spending
2006-07

11) Total Authorities
2006-07

12) Actual Spending
2006-07

13) Variance Between 10) and 12)

14) Program Activity

$73.7M

 $117.8 M

   $385M  

$518M*
Approved spending*

 $174.6M

  See note  in #15

15) Comment(s) on Variance(s):  While not "variances" per se, this explanation references the operational realities that produce differences  in  the amounts entered in  the table above.  As Infoway explains in its Annual Report, "(Infoway) program expenses are recognized on a milestone completion basis - when partners can match funds and deliver the projects.  Many factors can have an impact on this aspect, including jurisdictional readiness, competing priorities, procurement procedures and vendor product readiness.  Consequently, there is an inherent lag between project approvals and project expenditures... Overall, current expenditures tend to lag approvals by 24 to 36 months."

16) Significant Audit and Evaluation Findings and URL to Last Audit & / or Evaluation
Financial and compliance audits were completed in 2006/07 by independent third parties, and approved by Infoway's Board of Directors in May 2007.  The financial auditor, Ernst and Young, stated  that in their opinion, the financial statements fairly present Infoway's financial position, operations and cash flows, and the auditor does not raise any significant issues.   The annual compliance report was carried out by KPMG Chartered Accountants and in the opinion of the auditor Infoway has complied in all material respects with the terms and conditions of the funding agreements.

Independent performance evaluations will be done every five years.