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Monday, February 4, 2013

Spreading innovation across Canada

Mark Dobrow, Director of Analysis and Reporting, Health Council of Canada

The CMAJ recently published a news article that reports on the Health Council of Canada’s new Health Innovation Portal. I was interviewed for the story, as was a family physician who was described as a specialist in medical information technology. As this physician/article makes several assumptions about the Health Innovation Portal, I wanted to provide more background on what motivated its development.

Health systems are complex, with many moving parts. This necessitates that good ideas and innovative solutions to the challenges faced come from a host of health system participants and stakeholders, including but not limited to physicians. The Health Innovation Portal was never intended or designed as a tool to inform physicians’ specific clinical practice decisions. In fact, one of our three inclusion criteria is that a practice for the Health Innovation Portal should not be a specific drug, surgical or medical intervention. The reason for this inclusion criterion is that there are well developed methods for evaluating these types of interventions and disseminating the findings. In addition to databases like Medline and Cochrane, there are an increasing number of databases that synthesize available evidence in the form of clinical practice guidelines (e.g., CMA’s Infobase).

While the Health Council clearly appreciates the importance of these evidence-based approaches to clinical decision-making, which we reported on in our recent video series on CPGs, the reality is that there are still a vast number of challenges facing our health systems that are not specific drug, surgical or medical interventions. These innovations often relate to decisions that organizations, regional health authorities and/or governments need to make to foster improvement. Yet, there are few places to go to get information on these types innovations. In large part, it was this gap, recognized by the federal/ provincial/ territorial ministers of health, which led them to specifically add the identification and sharing of health innovation to the Health Council’s mandate. The Health Innovation Portal is the beginning of a response to that request.

The CMAJ article suggests that the Health Innovation Portal is simply curating articles and that information is not ‘run through the evidentiary gamut.’ There are, in fact, very few peer-reviewed articles on the health innovations we profile on the Health Innovation Portal, and the critical appraisal tools appropriate for drug, surgical or medical interventions are not relevant to a broader set of health innovations. I agree with his note that there are ‘no accepted metrics.’ This is why our Council emphasized the need to develop an explicit and transparent approach to evaluate innovative practices, the Innovative Practices Evaluation Framework, before launching the Health Innovation Portal.

The article further states that ‘…physicians don’t make decisions to change their practices in a vacuum.’ We fully agree that physicians, and all other health system participants and stakeholders, must contextualize information as part of any strong decision-making process. That is why the Health Innovation Portal was specifically designed to assess the influence that contextual factors may have on the spread of an innovation. Two of the four evaluation criteria that make up the Innovative Practices Evaluation Framework focus on context, including the applicability and transferability of an innovation from one setting to another. While no information source can provide all necessary contextual information, an important focus for the Health Innovation Portal, in addition to information on applicability and transferability, is to provide direct links to individuals who led the development of the practice and are in position to provide insight into how best to interpret and adapt the given practice for another context/setting.

We are at an early stage in the development of the Health Innovation Portal, but the feedback we’ve received has been overwhelming and positive. Since we launched the Health Innovation Portal in November 2012, governments, organizations, and other health system stakeholders have contacted us, eager to share more innovative practices. We are hard at work adding new content to the Health Innovation Portal and look forward to more feedback. Send your thoughts to

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