ARCHIVED - Health Canada

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Up-Front Multi-Year Funding

Grant to the Canadian Institute for Health Information

Strategic outcome: Accessible and sustainable health system responsive to the health needs of Canadians.

Program activity: Canadian Health System

Name of recipient: Canadian Institute for Health Information (CIHI)

Start date: April 1, 2007

End date: March 31, 2012

Description: CIHI is an independent, not-for-profit organization supported by federal, provincial and territorial (F/P/T) governments that provides essential data and analysis on Canada's health system and the health of Canadians. CIHI was created in 1991 by the F/P/T Ministers of Health toaddress significant gaps in health information. CIHI's data and its reports inform health policies, support the effective delivery of health services and raise awareness among Canadians about the factors that contribute to good health.

Since 1999, the federal government has provided funding to CIHI through a series of grants and conditional grants, known as the Roadmap Initiative. More recently CIHI's funding has been consolidated through the Health Information Initiative.

Through the past Roadmap Initiatives I, II and II Plus, CIHI had been provided with about $260 million since 1999. Budget 2005 allocated an additional $110 million over five years (2005-06 to 2009-10) to CIHI through Roadmap III. This has allowed CIHI to provide quality and timely health information, including the delivery of data on a variety of important health indicators and other health publications to support health sector decision-making and improve accountability.

Beginning as of 2007-08, the Health Information Initiative provides conditional grant funding to CIHI, replacing the previous Roadmap II, II Plus, III funding and also provides additional funds for new initiatives. This funding will allow CIHI to continue important work under the Roadmap Initiative and to further enhance the coverage of health data systems so Canadians get information on their health care system, including information on wait times, and continued development of comparable health indicators. The funding will also enable CIHI to respond effectively to emerging priorities. Under this initiative, up to $406.49 million will be delivered to CIHI over five years (2007-08 to 2011-12).

Program Activity

Total Funding: (in millions)	Prior Years' Funding: (in millions)	Planned Funding 2009-10: (in millions)	Planned Funding 2011-12: (in millions)	Planned Funding 2011-12: (in millions)
406.49	161.25	81.75	81.75	81.75

Summary of annual plans of recipient: As per CIHI's funding agreement with Health Canada, the draft 2009-10 Operational Plan and Budget is to be provided to Health Canada by the end of January 2009. At the March 2009 meeting, the document will be brought forward to the Board for review and approval and subsequently submitted to the Minister of Health. The following are Management's proposed key priorities for the upcoming fiscal year:

More and Better Data

• Increase jurisdictional uptake of select reporting systems, with a particular focus on Home and Continuing Care (including long-term care), and pharmaceuticals (NPDUIS)
• Enhance and expand existing reporting systems such as ambulatory care to provide more flexible and timely approach to collecting ambulatory and emergency care data
• Explore new potential data sources to address data gaps in the areas of primary health care and community mental health
• Improving financial data by enhancing the Canadian MIS Database (CMDB) and initiating the development of a patient-specific cost
• Database Improve our collection of patient safety data by launching the Canadian Medication Incident Reporting and Prevention System (CMIRPS)
• Continue to play a leadership role on the promotion of data standards, with particular attention to data standards related to the EHR

More and Better Analysis

• Continue expansion/development of indicators to report on quality/access of care, patient safety, public/population health, system efficiency across health sectors
• Explore and initiate development of pan-Canadian hospital
• Report Develop enhanced infrastructure to support data linkage across select data holdings in a privacy-sensitive manner
• Continue implementation of Long Range Analytical Plan and implement rapid response analysis service

Improved Understanding and Uses

• Develop an organizational strategy and plan for improved understanding and use to guide the development and implementation of priority initiatives
• Continue work on the redevelopment of CIHl's website to make it more user-friendly for our stakeholders
• Continue to develop new e-reporting tools to allow improved access, customization and timeliness of reports
• Accelerate development of ClHl Portal to provide more data in select areas (e.g. MIS, ambulatory care) and support continued adoption and uptake
• Increase organization's flexibility and responsiveness to address local/regional needs, through the appropriate mix of analytic products and services, educational offerings, workshops and conferences

In order to support priority initiatives along our three strategic themes, a sound corporate infrastructure is required. As a result, ClHl will continue to focus on enhancing its corporate processes, IT systems applications and electronic tools

Planned evaluations: Third-party evaluations of Roadmap I and of Roadmaps II, II+ and HICP were conducted and CIHI was found to have met its objectives under the associated funding agreements. Under the HII funding agreement, an evaluation framework of HII activities, including prior Roadmap III activities, must be completed by September 30, 2009. The final evaluation is due to the Minister by September 30, 2010

Planned audits: An audit was conducted by Health Canada internal auditors on the Health Information Contribution Program. Auditors concluded that, in general, the internal controls in place at CIHI to managed the Contribution Agreement were sufficient to meet the terms and conditions of the Agreement with minor exceptions. Risk exposure was not serious

URL of recipient site : http://secure.cihi.ca/cihiweb/splash.html

Canada Health Infoway

Strategic outcome: Accessible and sustainable health system responsive to the health needs of Canadians.

Program activity: Canadian Health System

Name of recipient: Canada Health Infoway (Infoway)

Start date: March 31, 2003*

* Infoway's original allocation (2001) was governed by a Memorandum of Understanding. Infoway is presently accountable for the provisions of three active funding agreements, signed in: March 2003 (encompasses 2001 and 2003 allocations), March 2004, and March 2007. The first three allocations (totalling $1.2B) were provided as lump sums, whereas the 2007 allocation ($400M) is subject to new conditions; these funds flow to Infoway on an as-needed basis.

End date: March 31, 2012**

**As per the 2007 funding agreement, in the event that any portion of the funding remains unspent and uncommitted by April 1, 2012, Infoway may use this amount in its sole discretion as long as the purpose of this use is consistent with the objects in Infoway's Letters Patent.

Description: Infoway is a federally funded, independent, not-for-profit corporation with a mandate to foster and accelerate the development and adoption of electronic health information and communication technologies with compatible standards on a pan-Canadian basis.

Funding has been allocated to Infoway on four 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 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 the development of a pan-Canadian health surveillance system; and $400 million as a part of Budget 2007 to support continued work on EHRs and wait times reductions.

It is anticipated that Infoway's collaborative approach, where the federal, provincial and territorial governments participate toward a common goal of modernizing Canada's health information system, will reduce costs through the coordination of effort and avoidance of duplication. It is further anticipated that eHealth technologies will significantly improve access to health care services, patient safety, quality of care and productivity.

Program Activity

Total Funding: (in millions)	Prior Years' Funding: (in millions)	Planned Funding 2009-10: (in millions)	Planned Funding 2011-12: (in millions)	Planned Funding 2011-12: (in millions)
1,600.0	1,361.73	To be determined***	To be determined***	To be determined***

***As per the 2007 funding agreement, funds are to be disbursed according to the annual cash flow requirements identified by Infoway. These requirements are to be submitted to the Department within thirty days of each new fiscal year. Infoway has not yet provided an advance estimate of its 2009-10 to 2011-12 requirements.

Summary of annual plans of recipient: Infoway's overarching goal is that: "By 2010, 50% of Canadians and by 2016, 100% of Canadians will have their electronic health record available to their authorized health professionals".

In its 2008-09 Corporate Business Plan, Paving the Way to Collaborative Care, Infoway indicated the following action plans, which will continue into 2009-10 and build upon Infoway's existing business strategies:

• Participation in Healthcare Renewal: Infoway will continue to support national, jurisdictional and local initiatives to strengthen health care in Canada through a focus on improving patient safety and access. Infoway will also continue to engage with stakeholders on issues such as heart health, cancer, mental health, primary health care, and health indicators and reporting.
• Collaboration with Partners: Infoway will continue to work with public and private sector partners to implement the pan-Canadian health infostructure. This will include: developing a strategy to implement its Vision 2015 (for a robust and comprehensive eHealth system); actively engaging stakeholders to discuss EHR challenges and opportunities and to identify opportunities to collaborate; working with P/Ts to align their three-year plans with Infoway investments; and communicating with vendors.
• Targeting the Investments: As of March 31, 2008, Infoway had approved over $1.5 billion to support more than 250 projects across the country. Infoway will continue to accelerate investment in, and replication of solutions that support health system transformation and innovation. Infoway intends to deliver $100-120 million in new project approvals by the end of March 2009.
• Supporting Solution Deployment: Infoway will continue to provide expertise to support its partners as they successfully implement secure eHealth solutions and will monitor projects to ensure cost and risk are well-managed. This will include: standards development, national solutions (such as pricing agreements), and collaboration with jurisdictions to focus on privacy solutions.
• Promoting Solution Adoption and Benefits Realization: Infoway will continue to enhance its change management services, collaborate with P/Ts and health providers on knowledge dissemination, implement eHealth support networks, and evaluate and communicate benefits. This year Infoway will also communicate results from Innovation projects launched over the past three years.

Planned evaluations: Infoway will continue to work with jurisdictional and research partners to conduct electronic health records benefits evaluations. During fiscal year 2008-09, Infoway will also have an external firm carry out an evaluation of its overall performance in achieving the outcomes identified in section 4.2 of the Addendum Agreement governing the pan-Canadian Health Surveillance System.

Planned audits: An audit by Health Canada's Audit and Accountability Bureau, Chief Financial Officer Branch, began in December 2007. This audit had both an internal (Health Canada) and an external component, for which interviews with Infoway officials were conducted. The audit is intended to provide the Deputy Minister with assurances that an appropriate Management Control Framework is in place within the Strategic Policy Branch and Infoway for the monitoring and administration of Transfer Payment funds; and that Infoway is using funds in compliance with the terms and conditions of the funding agreements. It is expected that this audit will be complete before March 31, 2009.

During fiscal year 2008-09, Infoway's regular annual financial and compliance audits will be carried out by independent audit firms.

The Auditor General is undertaking an audit of the implementation of electronic health records and is expected to table its report in November 2009.

URL of recipient site: www.infoway-inforoute.ca

Canadian Health Services Research Foundation

Strategic outcome: Accessible and sustainable health system responsive to the health needs of Canadians

Program activity: Canadian health system

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

Start date: 1996-97

End date: N/A

Description: At the time of its establishment (1996-97), CHSRF received a $66.5 million endowment. In addition, it received additional federal grants for the following purposes:

• 1999: $25 million 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)
• 1999: $35 million to support the CHSRF's participation in the Canadian Institutes of Health Research (CIHR)
• 2003: $25 million to develop a program to equip health system managers 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.

It should be noted that CHSRF's programs receive funding from other sources through various partnerships.

CHSRF will implement new strategic priorities in 2009 as a result of its Board of Trustee's endorsement, in December 2008, of a new strategic plan 'CHSRF Strategic Directions 2009-13' which included the following revised role and mission:

CHSRF works 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 gaps in evidence about how to improve the health of Canadians, by funding research; and
• Supporting policymakers and managers to develop the skills needed to apply the best evidence about services to improve the health of Canadians.

The Foundation's work contributes to Health Canada's aim of strengthening the knowledge base to address health and health care priorities.

Program Activity

Total Funding: (in millions)	Prior Years' Funding: (in millions)	Planned Funding 2009-10: (in millions)	Planned Funding 2011-12: (in millions)	Planned Funding 2011-12: (in millions)
151.5	1996 - 66.5 1999 - 60 2003 - 25	N/A	N/A	N/A

Summary of annual plans of recipient: The CHSRF's 2009 budget provides for $15. 3 million in total program expenditures for the Foundation's strategic priorities. The new strategic plan identifies three strategic priorities that the Foundation will pursue over the next five years:

Strategic Priority 1: Engaging Citizens

The CHSRF and its partners will undertake programming which will:

• Assist healthcare organizations and providers to do a better job of engaging the public, including exploring ways to report effectively to the public about healthcare quality.
• Help healthcare providers access and apply information about the patient experience, particularly in primary healthcare.
• Connect citizens, via web-based strategies, with information about what they should expect from their interactions with healthcare systems.
• Invest strategically in implementing and evaluating community-based initiatives designed to improve health.

Strategic Priority 2: Accelerating Change

The CHSRF and its partners will undertake programming which will:

• Fund research that provides a better understanding of the processes of change and learning within innovative Canadian health organizations, and that identifies lessons learned about overcoming major barriers and catalysts for change.
• Provide a national resource centre to support local change initiatives, which will include linkages to expertise in operations research and evaluation.
• Support communities of practice that allow for better sharing of information among organizations and providers.
• Lead a series of organizational learning initiatives that bring organizations together to focus on some of the most persistent problems in Canadian healthcare, supported by research, evaluation expertise, and best practice.
• Continue to invest in building the capacity of senior managers to understand and apply research evidence in their work, by capitalizing on the success of the Executive Training for Research Application (EXTRA) program.

Strategic Priority 3: Promoting Policy Dialogue

The CHSRF and its partners will undertake programming which will:

• Provide formal and informal opportunities for sharing policy challenges and emerging strategies across Canada's provincial health systems.
• Actively promote the social and economic benefits of investment in health services research and its application in Canada.
• Work with the research community to ensure that credible, relevant and helpful commentary is available to the news media on emerging health issues.

CHSRF will continue to enroll 24 senior fellows annually in the two-year EXTRA training program designed to achieve: knowledge of research evidence; capacity to draw on system thinking; development of collaborative professional relationships; and the ability to introduce and manage evidence-based change. The admission criteria allows up to four additional fellows from government ministries or departments on a self-funded basis, with the organization providing funds to cover the marginal cost of adding these fellows to the cohort. EXTRA aims 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.

The NRF normally supports research personnel, research dissemination, and research projects on nursing management, organization, and policy at a level of $2.5 million per year. The aim is to create high quality new knowledge; increase knowledge exchange between researchers and decision makers; and increase the capacity for evidence-based decisions. The NRF is due to wind down in 2009.

Planned evaluations:

Teamwork Workshop Evaluation

CHSRF's Evaluation of the December 2008 teamwork workshop and follow-up activities will continue during 2009 and be completed in 2010.

Knowledge Brokering Evaluation

A summative evaluation of the knowledge brokering initiative will be conducted by CHSRF in 2009 and presented to our wider community.

Extra Program Evaluation

The Foundation conducts an annual evaluation of the EXTRA program. As well, an evaluation and review will be undertaken of all of the Intervention Projects (IPs) conducted within the EXTRA program.

A Director for Impact and Evaluation has been recruited with a start date of January 22, 2009. The individual will be responsible for developing a new evaluation strategy and plan for the Foundation in the first quarter of 2009.

Planned audits: The Foundation conducts an annual financial audit as well as an audit of its pension plan. The Foundation's five-year Internal Audit Plan, approved by the Board of Trustees in May 2007, identifies a mini internal controls review each year. In 2009, the Foundation will conduct an internal controls review of one operational area.

URL of recipient site: http://chsrf.ca

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