By Ezinne V.C Onwuekwe
In recent years, digital health solutions have surged in popularity, promising to transform healthcare delivery and improve public health outcomes. These innovations range from mobile health apps to telemedicine platforms and artificial intelligence (AI)-driven diagnostics. While many digital health projects show promising results during pilot stages, a significant proportion fail to scale and achieve widespread adoption. The Canadian context presents unique challenges that contribute to these failures, despite the country’s advanced healthcare system and growing digital infrastructure. Identifying and overcoming these challenges is crucial for realizing the potential of digital health to improve healthcare accessibility, affordability, and effectiveness. Here are six factors that have been identified to impede sustainability.
1. Navigating a fragmented regulatory and policy landscape
Canada’s healthcare system is provincially and territorially managed, leading to a fragmented regulatory environment. While the federal government oversees aspects such as health product regulations (via Health Canada), provinces set their own policies for how healthcare services are delivered. For digital health ecosystem, this results in a complex regulatory framework.
An example of this challenge is seen in the rollout of telemedicine across the country. During the COVID-19 pandemic, telemedicine saw a sharp rise in adoption. According to the Canadian Institute for Health Information (CIHI), the rates of virtual care use in Canada rose from 10%–20% in 2019 to 60% of all health care visits in April 2020. However, scaling these telemedicine platforms across provinces has been hampered by regulatory differences like the reimbursement of telemedicine services. While Ontario’s Health Insurance Plan (OHIP) supports video consultations, not all provinces have comparable policies or payment structures. This lack of uniformity limits the ability of telemedicine companies to scale nationally.
Additionally, regulations around data privacy differ across provinces, with acts like Ontario’s Personal Health Information Protection Act (PHIPA) setting stricter standards than federal laws like the Personal Information Protection and Electronic Documents Act (PIPEDA). As a result, companies with a successful pilot phase face challenges when expanding services to provinces with different regulatory environments. This slows down the scaling process and increases operational costs for startups.
2. Interoperability challenges
Interoperability remains a critical issue preventing the scaling of digital health solutions globally and in Canada. According to a 2024 survey by Canada Health Infoway, only 29% of physicians can exchange patient clinical summaries with care providers outside their practice. This means that different hospitals, clinics, and healthcare professionals often work with siloed data, preventing seamless care coordination across settings. Solutions like virtual care apps require integration with provincial systems for maximum effectiveness, however, most of these apps face challenges syncing with disparate health record systems across the country, making it difficult to provide a consistent patient experience or integrate care across healthcare settings.
3. Economic and funding limitations
While Canada’s public healthcare system promises universal access, digital health scaling often falters due to inadequate financial models for long-term sustainability. Digital health startups typically rely on grants or private funding during pilot stages but struggle to find reimbursement models as they expand.
The startup landscape in Canada is challenging for digital health innovators. Canadian investors tend to be conservative, focusing on shorter-term returns, making it harder for digital health companies to secure long-term funding needed for scaling. This is evidenced by the Canadian Health Tech Funding Report which tells of a 40% reduction in announced deals in 2023 compared to 2022.
4. Challenges in adoption by healthcare providers and patients
Healthcare professionals’ reluctance to adopt new technologies stems from unfamiliarity, perceived workflow disruptions, and concerns over patient safety. A 2024 Canadian Physician and AI report found that 41% of healthcare providers expressed apprehension about using Artificial Intelligence (AI) tools to supplement their diagnostic and treatment recommendations. This resistance, coupled with insufficient training on integrating AI tools into clinical practice, has slowed the expansion of these digital innovations in Canadian healthcare system.
On the patient side, digital literacy challenges also play a role in resistance, which can be more pronounced in healthcare settings where there has been less exposure to digital innovation. Patients may be wary of using digital tools that they perceive as impersonal or difficult to navigate. Without widespread patient confidence and familiarity, even well-designed digital health apps face challenges in scaling beyond urban centres.
Scaling digital health solutions thus requires not only technological adoption but also a cultural shift within the healthcare system—a challenge that can be difficult to achieve at scale.
5. Digital infrastructure and connectivity
Digital health innovations often rely on robust digital infrastructure like high-speed internet for success. Canada’s digital divide poses a substantial challenge, especially in scaling telemedicine and remote monitoring solutions to rural and Indigenous communities. While telemedicine platforms saw increased adoption in urban settings during the COVID-19 pandemic, Indigenous communities in Northern Ontario and Nunavut face internet connectivity challenges. According to the Canadian Radio-television and Telecommunications Commission (CRTC), 62% of rural Canadian households had access to broadband speeds of 50/10 Mbps in 2021, compared to 91.4% in urban areas. This lack of reliable internet infrastructure hampers the scaling of digital health solutions to underserved areas.
6. Lack of user-centered design and adaptation
Too often, digital health interventions are designed in isolation, without sufficient input from the healthcare providers and patients who will ultimately use them. As a result, these solutions may not align with the realities of clinical workflows or patient preferences. This failure to account for user needs has hindered the scaling of many solutions that initially show promise during pilots.
Solutions that work well in an urban pilot may not be effective in rural or Indigenous communities, where healthcare needs, cultural practices, and technological adoption may differ significantly. A one-size-fits-all approach to digital health is unlikely to succeed in a country as geographically and demographically diverse as Canada.
Scaling digital health interventions in Canada is a complex process that goes far beyond the success of pilot projects. By addressing these issues with more cohesive national policies, investments in digital infrastructure, and better alignment between digital health solutions and user needs, Canada can unlock the full potential of digital health, ensuring that more innovations can move beyond the pilot stage and deliver meaningful healthcare improvements nationwide.
Ezinne V.C Onwuekwe is a pharmacist with industry specialization in data analytics, informatics and digital health. She is a certified project manager with a history of working on multi-million dollar healthcare programs and partnering with international institutions to address prominent issues around healthcare data management and digitization. Ezinne is an international speaker and capacity builder committed to social change by working with organizations to create positive impacts in the digital health space. She is the founder of The VC HealthTech Hub (an online community empowering healthcare professionals in the digital age). Ms. Onwuekwe is currently a senior clinical informatics analyst at Nova Scotia Health, Canada where her current contributions are focused on provincial digital health transformation project called One Person, One Record (OPOR).