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Up-Front Multi-Year Funding


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

2. Start Date: 1996-1997

3. End Date: N/A

4. Total Funding: $151.5M

5. Description:

1996 - $66.5 M endowment (received over five years) to establish the CHSRF;

1999 - $25 M one-time 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 a $35 M one-time grant to support the CHSRF's participation in the Canadian Institutes of Health Research (CIHR); and
2003 - $25 M one-time grant to develop a program to equip health service professionals and their organizations with the skills to find, assess, interpret and use research to better manage the Canadian health care system (Executive Training for Research Application or EXTRA) over a thirteen-year period.

CHSRF's mission is to improve the health of Canadians by:

  • Capturing the best evidence about how healthcare and other services can do more to improve the health of Canadians;

  • Filling critical gaps in evidence about how to improve the health of Canadians, by funding research and evaluation; and

  • Supporting policy makers and managers to develop the skills needed to apply the best evidence about services to improve the health of Canadians.

CHSRF's work contributes to Health Canada's aim of strengthening the knowledge base to address health and healthcare 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(s): Accessible and sustainable health system responsive to the health needs of Canadian

7. Summary of Results Achieved by the Recipient:

CHSRF began to implement its new five-year strategic plan in 2009. The three strategic priorities are:

  1. Engaging and supporting citizens
  2. Accelerating evidence-informed change
  3. Promoting policy dialogue

Engaging and supporting citizens
Throughout 2009, considerable efforts were made to identify the requirements for developing an effective health governance capacity-building strategy in collaboration with others. Accomplishments included:

  • hosted a meeting with key Canadian stakeholders to identify healthcare governance needs and strategies

  • commissioned several public engagement and health governance research reports

  • presented findings from commissioned research reports at various venues and to a variety of audiences including the National Healthcare Leadership Conference, the New Brunswick Health Research Foundation (NBHRF), and through the CHSRF Researcher On Call (RoC) webinar series

  • a citizen engagement strategy was generated, partnerships were secured and planning began on a governance educational module

Accelerating evidence-informed change
In 2009 both past programming activities and a new suite of initiatives were implemented to lead innovations in health services. Accomplishments included: Executive Training for Research Application (EXTRA)

  • ongoing cohort management (fellows participate in four residency sessions over two years during which they study six curriculum modules)

  • 28 new fellows were accepted through competition into EXTRA (four physician executives; seven nurse executives; and 17 health services executives)

Capacity for Applied and Developmental Research and Evaluation (CADRE)

  • network meetings
  • transition reports
  • conference presentations

Regional Partnership & Capacity Development

  • A research contract between CHSRF and the Nunavut Department of Health and Social Services was established and titled, "Nunavut Health Services Strategy. The research team visited 10 communities and consulted 95 individuals. Based on the initial findings, an abstract was submitted to the 14th International Congress on Circumpolar Health.

Innovations in Health Systems

  • Seven Researcher on Call (RoC) events were hosted.

  • Six issues of Promising Practices were published, both in print and online.

  • Six issues of Insight and Action were published online

  • CHSRF initiated a new award, Excellence through Evidence, which recognizes the critical role of leadership in successfully implementing evidence-informed innovations in healthcare.

  • CHSRF issued its 10th annual Health Services Research Advancement Award.

Nursing Research Fund (NRF)

  • The initial funding agreement with Health Canada for the Nursing Research Fund (NRF) was to expire 31 March 2009. In 2008, CHSRF received an extension to 31 December 2010 to use the remaining funds to offset its remaining NRF-related commitments and its ongoing work with the broader nursing health services, policy and research community. Although the NRF program wound down in 2009, the remaining monies continue to be expended in pursuit of the original mandate of the fund which was to contribute to new knowledge and training to build nursing research capacity.

Promoting policy dialogue
In 2009, CHSRF and its partners began to implement programming to support its goal of increasing research use in the process of developing policy and management decisions. Accomplishments included:

Policy Dialogue on Health System Issues

  • The Quality of Healthcare in Canada: A Chartbook was produced in 2009.

  • Three reports on primary healthcare were commissioned and received in 2009.

  • A dissemination plan for health reform research was developed in 2009 and will be executed through a research grant to be administered in 2010.

  • A series of videos focused on storytelling were created and a pilot social networking website for the purposes of encouraging inter-professional collaboration was launched. Six editorial cartoons were designed, published and disseminated as part of CHSRF's promotional and branding activities.

The Mythbusters program expanded its scope to include universities, developing a teaching resource to help instructors of graduate-level classes teach students how to write research summaries for policy makers, managers and others. Two Mythbusters were published, promoted, and disseminated in 2009. Two students received Mythbusters awards in the amount of $1500 each and their papers were subsequently published on the CHSRF website. The call for the next award was issued in late 2009.

  • The 2009 CEO Forum was successfully delivered. The topic was "Service-Based Funding and Paying for Performance: Experience, Evidence and Future Prospects".

  • CHSRF organized the 2009 annual Canadian Health Policy Briefing Tour for Harkness Fellows. The call for the 2010-11 Canadian Harkness Award was posted on the CHSRF website in December 2009.

Additional information is available in CHSRF's 2009 Annual Report which was submitted to Health Canada in May 2010.

14. Program Activity: Canadian Health System
($ millions)

8.
Actual Spending 2007-08
9.
Actual Spending 2008-09
10.
Planned Spending 2009-10
11.
Total Authorities 2009-10
12.
Actual Spending 2009-10
13.
Variance(s)
$0 $0 $0 $0 $0 $0

15. Comments on Variance(s)

Conditional grants to CHSRF (see list in section 5 above) were all issued prior to the 09-10 reporting period.

16. Significant Evaluation findings by the recipient during the reporting year and future plan

The first two phases of the December 2008 teamwork workshop evaluation were completed. Due to the significant changes in the CHSRF's strategic priorities, it was decided not to continue the Teamwork Workshop initiative.

A summative evaluation of the 2009 knowledge brokering initiative was conducted.

The modules of the EXTRA residency sessions were evaluated. Based on evaluation feedback, on-site adjustments to the modules were made. Focus groups were conducted following the residency session to ensure continual program improvement.

The evaluation program for EXTRA in 2009 included a continuation of the ongoing "learner level" evaluative activities, and was expanded to eight additional evaluation studies to investigate higher level outcomes of the program and their linkages to CHSRF's achievement of its mandate. These projects are continuing and will be reported in 2010. In 2009 an EXTRA Evaluation Dashboard was designed and launched to automate and streamline the evaluation and monitoring functions of the EXTRA program. Data from different sources are integrated around the respective cohorts and fellows.

17. Significant Audit findings by the recipient during the reporting year and future plan

The 2009 external financial and pension plan audits showed no major concerns, with the auditors reporting clean audits with no evidence of fraud or illegal acts.

The 2009 internal controls review examined the operational area for purchases, cash management, and capital assets. The recommendations from the internal controls review will be implemented in 2010.




1. Name of Recipient: Mental Health Commission of Canada -- Conditional Grant to support Research Demonstration Projects in Mental Health and Homelessness

2. Start Date: April 1, 2008

3. End Date: March 31, 2013

4. Total Funding: $110M

5. Description:

As part of Budget 2008, the federal government committed $110 million in funding to the MHCC to support five research demonstration projects in mental health and homelessness over five years (2008-2013). Among the important objectives, these projects will contribute to building knowledge on how to increase access to adequate housing in combination with the provision of necessary support services, and will result in the development of best practices that will support future interventions and long-term improvements to the lives of Canada's most vulnerable.

A total of 2,285 homeless people living with a mental illness are expected to participate over the course of the study. Expected results include:

  • the development of a knowledge-base accessible to all jurisdictions;

  • the identification of effective approaches to integrating housing supports and the Basket of Necessary Services or other "prerequisites";

  • the development of Best Practices and Lessons Learned; produce data that is reflective of mental health issues among Canada's homeless population;

  • the identification of unique problems and solutions for diverse ethno-cultural groups within this population;

  • and support improvements at each project site to address fragmentation through improved system integration and support.

6. Strategic Outcome(s): Accessible and sustainable health system responsive to the health needs of Canadians

14. Program Activity: Canadian Health System
($ millions)

8.
Actual Spending 2007-08
9.
Actual Spending 2008-09
10.
Planned Spending 2009-10
11.
Total Authorities 2009-10
12.
Actual Spending 2009-10
13.
Variance(s)
$0 $0 $0 $0 $0 $0

15. Comments on Variance(s): n/a

16. Significant Evaluation findings by the recipient during the reporting year and future plan: As per the terms and conditions of the funding agreement, the Commission must carry out an Independent Evaluation within 5 years and 180 days to measure the Commission's overall performance in achieving the purpose of the Grant funding. This initiative is also to be included as part of the overall performance evaluation for the Commission which is scheduled for 2010-2011.

17. Significant Audit findings by the recipient during the reporting year and future plan: As outlined in the funding agreement, the Commission must engage an independent auditor to conduct a full audit of its financial statements each Fiscal Year. The 2009-10 audited financial statements have now been completed and were presented to the Board of Directors for approval during the meeting on June 6, 2010.




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

2. Start Date: March 9, 2001

3. End Date: N/A

4. Total Funding: $2.1B*
*Infoway received $1.2 B as lump-sum grants between 2001 and 2004. The $400M allocated in 2007 was subject to new conditions - these funds flow to Infoway on an as-needed basis. An additional $500M for Infoway was announced in Budget 2009 and confirmed in Budget 2010. In March 2010, Health Canada and Infoway signed a related funding agreement. The $500M funds will flow to Infoway on an as-needed basis, with an initial amount expected to flow in summer 2010.

5. Description:
Canada Health Infoway Inc. (Infoway) is an independent, not-for-profit corporation established in 2001 to accelerate the development of health information and communication technologies such as electronic health records, telehealth and public health surveillance systems on a pan-Canadian basis. Its Corporate Members are the 14 federal, provincial and territorial Deputy Ministers of Health.

Since 2001, the federal government has committed the following funding allocations: $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 electronic health record - EHR - as a priority); $600 million in the First Ministers' Health Accord of February 2003, to accelerate implementation of the EHR and Telehealth; $100 million as part of Budget 2004 to support development of a pan-Canadian health surveillance system; and $400 million as part of Budget 2007 to support continued work on EHRs and wait times reductions. Also, as part of the Economic Action Plan, and as indicated in Budget 2009, the Government of Canada announced an additional investment of $500 million in Infoway, to support continued implementation of EHRs, implementation of electronic medical records in physicians' offices, and integration of points of service with the EHR system. Following a due diligence process, Budget 2010 announced the government's intention to move forward with the transfer of the funds. In March 2010, Health Canada and Infoway signed a related funding agreement, which includes enhanced accountability provisions.

It is anticipated that Infoway's approach, where federal, provincial and territorial (F/P/T) governments participate as equals, toward a goal of modernizing the health information system, will reduce costs and improve the quality of health care and patient safety through coordination of effort and avoidance of duplication.

6. Strategic Outcome(s): Accessible and sustainable health system responsive to the health needs of Canadians.

7. Summary of Results Achieved by the Recipient:

Investment Strategy - Infoway is a strategic investor, with a funding formula covering up to 100% of territorial and 75% of provincial project development and implementation costs. Infoway provides a portion of system development costs and supports project oversight while P/T partners are responsible for actual system development, implementation and overall funding, including ongoing operational costs. In 2009-2010, Infoway approved $68.6 million in new projects (11 projects), bringing its cumulative allocation of investments to $1.634 billion (294 projects since Infoway's inception).

Electronic Health Records - Infoway's goal for EHRs, endorsed by all jurisdictions is that: "by 2010, every province and territory and the populations they serve will benefit from new health information systems that will help transform their health care delivery system. Further, by 2010, the electronic health records of 50 per cent of Canadians and by 2016, those of 100 per cent of Canadians, will be available to their authorized health care professionals." Infoway estimates that as of March 31, 2010, the core components of an EHR were in place for 22% of Canadians.

Infoway and the P/Ts have made progress on the various components of the EHR - client and provider registries, laboratory information and diagnostic imaging systems, drug information systems and clinical reports. For example, more than three-quarters of the country's diagnostic imaging (such as X-rays, CT and MRI scans) are now digitalized. Infoway's drug information systems (DIS) program is available in several provinces. As an example, British Columbia's PharmaNet DIS captures every prescription dispensed in the province's pharmacies and provides alerts to pharmacists. In 2007, more than 47 million prescriptions were reviewed via PharmaNet, resulting in the identification of 2.5 million significant drug interactions.

Telehealth - Infoway is working to implement solutions that facilitate the delivery of health information and services between patients and providers over distance, with a focus on Aboriginal, official language minority, northern and remote communities. Telehealth strategic plans are in place in most jurisdictions.

Public Health Surveillance - Canada Health Infoway continues to support development and implementation of a pan-Canadian Public Health Surveillance System (Panorama). Panorama will facilitate identification, management and control of infectious diseases that pose a threat to the public's health by providing public health professionals with software tools to manage cases, outbreaks, immunization, materials/vaccine inventories, notifications and workload.

Patient Access to Quality Care (PAQC) - As a result of the 2007 budget, Infoway created a new, $50 million investment program. PAQC supports investments to demonstrate how technologies can improve access to care and reduce wait times when deployed in an integrated manner.

14. Program Activity:
($ millions)

8.
Actual Spending 2007-08
9.
Actual Spending 2008-09
10.
Planned Spending 2009-10
11.
Total Authorities 2009-10
12.
Actual Spending 2009-10
13.
Variance(s)
38.7 122.9 64.49 64.49 64.49 0

15. Comments on Variance(s):
The federal government has invested $2.1 billion in Infoway to date, $1.2 billion of which was provided as lump-sum grants between 2001 and 2004. As part of Budget 2007, $400 million was earmarked in the fiscal framework for 2006-2007. These funds were payable on passage of the Budget Implementation Act 2007 and Royal Assent, authorizing the Minister of Health to make a statutory payment directly from the Consolidated Revenue Fund. Payment is made on an as-needed basis, on receipt of Infoway's annual Cash Flow Statement. In 2009-2010, one payment was made for $64.49 million out of the $400 million.

* The pace at which funding is expended is at the discretion of Infoway and is largely driven by the rate of progress of its P/T partners. As such, there is a lag-time difference between Infoway's allocation of $1.634 billion and the total spending (program and operating) of $1.117 billion since 2001.

An additional $500M for Infoway was announced in Budget 2009 and confirmed in Budget 2010. Payment will be made on an as-needed basis, on receipt of Cash Flow Statements from Infoway. Funding has not yet started to flow; however, an initial amount is expected to flow to Infoway in summer 2010.

16. Significant Evaluation findings by the recipient during the reporting year and future plan:
In March 2010, Infoway released an independent evaluation of its performance in achieving the purpose, principles and outcomes of the 2007 Funding Agreement between Infoway and Health Canada. The midterm evaluation report found that Infoway complies with the purpose and principles, and has met or made progress on the Agreement outcomes.

In fiscal year 2010-2011, Infoway is expected to release an independent evaluation to measure its performance in achieving the objectives of the 2003 Funding Agreement.

17. Significant Audit findings by the recipient during the reporting year and future plan:
On November 3, 2009, the Auditor General of Canada (OAG) released an audit on EHRs, which considered whether Infoway: carries out activities consistent with the funding agreements, exercises due diligence in the use of federal funds, reports on progress, and has appropriate governance mechanisms and management controls in place. From a Health Canada perspective, the audit sought to determine whether the department is able to ensure Infoway's compliance with the existing funding agreements.

The audit, which was generally positive in terms of Infoway, included recommendations for Infoway to enhance: reporting on progress, contracting of goods and services, and verifying conformance of EHR systems with Infoway standards. To address the OAG recommendations, Infoway implemented an Action Plan, comprising more than 40 action items which were completed by March 31, 2010.

During 2009-2010, governments undertook a series of audits of EHRs, including the Auditor General of Canada's Fall 2009 audit and corresponding audits in Alberta, British Columbia, Nova Scotia, Ontario, Prince Edward Island and Saskatchewan. The Auditor General's overview report, entitled Electronic Health Records: An Overview of Federal and Provincial Audit Reports, was released on April 20, 2010. The report synthesizes the federal and provincial audits and articulates several go-forward challenges for consideration by all governments and Infoway.

18. URL to recipients site:

www.infoway-inforoute.ca