DHiC 12 – International Digital Health – Learnings for Canada

This transcript was generated by AI and may contain minor errors.

Derek Ritz: Digital health is not what the cool kids are doing. It’s what everybody does.

Katie Bryski: Hello and welcome to Digital Health in Canada, the Digital Health Canada podcast. My name is Katie Bryski, and I am a podcaster turned digital health professional.

Shelagh Maloney: And I’m Shelagh Maloney, a digital health professional turned podcaster.

Katie Bryski: Interoperable? Try international. Today, our conversation spans the globe as we explore international digital health strategies and what learning about other countries, health systems can teach us about our own.

For our season finale, we are pleased to welcome two international leaders to bring the world to digital health in Canada. A very warm welcome and big thank you to Derek Ritz, principal consultant at ECGroup Inc. And Liz Keen, head of Clinical Governance, Transformation and Innovation at Infosys Consulting.

Welcome to you both. Thank you for being here.

Derek Ritz: Well, thanks for having us.

Katie Bryski: Just before we start, officially, my first question, where in the world are you calling in from?

Derek Ritz: Well, I’m actually joining you today from Paris, France, which is where I spend about half my time. I’m back and forth between Paris and Toronto.

Liz Keen: And I am calling from Brisbane in Australia, where we have just passed our first cyclone that’s come through the Brisbane area in about the last 50 years, I believe it was, is the worst weather event. So we’ve still got power coming on in parts of Brisbane, but we’re doing okay.

Katie Bryski: Well, I’m glad to hear that you are doing okay and our thoughts are certainly with Brisbane for a speedy recovery from this weather event.

In addition to talking about where in the world you are, we did also want to talk about your journey through your careers. So to officially start the podcast, wondering if you can tell us about where your career started up, the path that you took, and where you are now. And Liz, why don’t we start with you.

Liz Keen: Thanks, Katie. So I am first and foremost a registered nurse, and I still am a registered nurse and I’m registered in Australia, but I trained in New Zealand as a registered nurse back in the nineties. And since then I moved straight into practice nursing, primary health care nursing. And that was because I simply didn’t want to do shift work.

So I looked for a career I could do that would keep me away from shift work. And having done that for a few years, I then went over to the UK. And worked in what? And now the pilot, or they were the pilot walk-in centers, and I believe they’re now a core part of the UK health service delivery. After five years in the UK, went back to New Zealand, kind of moved away from the clinical space a bit more into service delivery and then.

By pure happenstance, my husband’s work took us to Australia and that’s when I kind of fell into the digital health space in central Queensland, rolling out a shared electronic health record. Then found that Yeppoon, which is a tiny little beach-side community, was just a bit too small for us. So we looked for work in a city.

Didn’t know Australia at all. Landed in Brisbane, uh, working at the, what was around at the time, the National eHealth Transition Authority. And that then merged with the eHealth Department of Health to become the Australian Digital Health Agency, which I continue to work with. In the last few years that I was there, I led their clinical governance function. I’ve since bounced into Bupa and now bounced into Infosys.

And at Infosys, I am head of clinical governance and in this role I focus on how we embed trust, safety, and integrity, and the way we design and deliver our own health technologies. And this is both within our own work and in partnership with others. So this means we reflect deeply on our own systems and behaviors, but we also work with organizations globally to globally to build their governance capability, helping them not just deliver safe care and technologies, but communicate it in a way that earns public trust and confidence, not just in our health technology industry, but in the health sector more broadly.

So I am on a new career trajectory at the moment.

Katie Bryski: An exciting time to be catching up with you, for sure. And Derek, yourself.

Derek Ritz: I think I might give away a few years to Liz. Here I am at the tag end of a, what’s now a 42 year career. I’m a recovering engineer and I spent the first half of that time span working in supply chain management and industrial engineering, and was for many years a serial entrepreneur and sometimes doing very well and sometimes doing not so well.

For the last 20 years or so, I’ve been working in digital health and because I’m a little bit at the end of my career, I’ve been doing quite a bit of mentoring the last number of years. So with the Digital Health Canada Mentoring program and with the ELF program, and I actually can bring something when I’m doing mentoring, that I think is a bit of a different insight because I joined Digital Health as a mid-career professional.

So I already had a couple of decades under my belt and I have to admit, it served me well, or I think it did. I couldn’t help myself. I kind of saw care delivery networks as great big dysfunctional supply chains and, and in large measure they, they fit that quite well. And then I was able to take some of the things that I did know how to do and apply that to how you address the challenges that great big dysfunctional supply chains have.

In this case, a service supply chain. Of course. Actually, even the supply chain piece is something that I’ve been able to draw on because of some of the work that I’ve been able to do. And that for me has included for the last 15 years or so, a lot of work in low resource environments in, uh, low and middle income countries in Sub-Saharan Africa and in the Middle East and in the Asia Pacific region.

And sometimes the supply chain piece was actually. Also something that had to be addressed in Tanzania. For example, when we were doing the National Child Immunization Program, one of the problems we had is that we would regularly run out of the things you needed to run a program of that scale and scope.

And so I ended up actually helping them with their, their vaccine supply chain and with their needles supply chain. So I’ve come to where I am now through a course that not everybody followed quite a distinct shift in the middle. I have to say, for me, it’s been an astoundingly interesting last couple of decades to see the e evaporate from in front of eHealth.

And I hope we get a chance to discuss that a little bit during the rest of our, of our podcast.

Shelagh Maloney: Derek, you were probably one of the oldest emerging leaders.

Derek Ritz: The oldest!

Shelagh Maloney: Because you’re emerging leader in the, in this particular space. All of our guests, when we ask them about where they’ve come from, a lot of nurses in digital health space, and that seems to be at the core of their being and very interesting journeys through and to digital health.

Once they sort of get here, it’s, this is the place they want to be. And, and the interdisciplinary nature of digital health is something that’s always so wonderful. And, and you have that interdisciplinary approach, but you also have an inter-country approach. I don’t know if there’s a word for that, but you’ve, you’ve both worked in more than one country.

So I’m, I’m curious about how do you see your experiences in other countries benefiting that and what have been the most profound differences that you’ve seen? I’m curious about that.

Liz Keen: Well, I think my days working around the world, I. Were when I was in my clinical stage. So what I found is that the funding models that often support the delivery of healthcare in each of the countries is a fundamental driver for what you do or don’t do.

So if you take New Zealand for example, that’s a paying, I think back when I was a clinical nurse there. It was a, um, per capita funding. So you, the practices in general practice were provided funding around, um, how many people they had registered at their practice. And so they had that much money that they needed to work with, and it resulted in scenarios of having a set group of patients.

And if they went to a different doctor, there was this thing called “claw back,” where they would bring funding back from the practice that they had originally gone to be able to cover the cost and so on. And there’s out-of-pocket costs that go with that in the UK, where seeing a GP, certainly was when I worked there, was free.

So again, a different funding model. So in some ways, the GPs or the general practices of primary healthcare units were forced to think about things differently, because they had a finite set of funding to deliver a service into the community. That’s with a lot of really innovative ideas such as the, um, walk-in centers come through.

So the walk-in centers were nurse-led clinics and they would have a doctor maybe come on for four hours in an evening for any of those tough cases that might’ve popped up during the day. The idea was to take the pressure off general practice and emergency departments. It was obviously a roaring success because it seems to be still going over there.

But that whole multidisciplinary approach that I went into in New Zealand as a baby nurse, I came, graduated into an extended hours practice where there was, um, doctors, nurses, physios, midwives, all in the same place, and more often than not attached to a pharmacy, to going into the UK where there was separate specialty clinics.

But you still had your role to play in the whole team of the, um, multidisciplinary approach. So when we were in general practice as a nurse in the UK, we would have our own clinics. You ran your day, you had your appointment books. It was your design of your day, and if you needed to, there was a GP next door, you could pop in and say, “Hey, I really would, I really need you to come and have a look at this.”

So you felt supported as well as being able to stretch yourself and be an autonomous practitioner. Going back to New Zealand after being in UK for so long, I then came back to what felt more restrictive and it was because the funding model in there meant that a doctor had to come and see what I was doing to claim the funding.

So for example, I might change a dressing and that dressing is claimable. If it’s not claimable under their ACC program, which is Accident Compensation Corporation. Or even sometimes when it was. There would have to be a doctor to view it, to be able to claim the funding, to cover that interaction. So you felt like you were, um, more closed in, less autonomous in your practice.

And so that kind of pushed me away a wee bit more. And then as I said, we followed my husband who happens to be a mechanical engineer, his journey into Australia, who now works in medical devices. Funny how our worlds come together. Because I came over seven months pregnant, I was involved in the healthcare system very quickly and through that journey of my own, I could see that practice nursing in Australia really wasn’t for me.

So that’s when I started exploring other opportunities. And at the time, the divisions of general practice, which no longer exist in Australia, they’ve kind of morphed a couple of times and now I believe they’re called Primary Healthcare Networks. They were rolling out a shared electronic health record in the local area, and so I jumped on board with that.

I thought, this is great, and I guess that’s probably the key differences for me was the clinical application of, you know, the autonomy of practice for nursing.

Katie Bryski: Funny that you bring up funding models, because I can’t count how many times I’ve traced back a, a feature in the Canadian health system, or at least here in Ontario, to fee for service.

Derek, I see why your supply chain expertise plays so nicely in this space.

Derek Ritz: I have to admit, when I’m looking at country examples, first of all, it as I’m sure for all of us, we can say that it’s a very sobering moment when you realize that if you’re going to give somebody advice, they may well take it.

I’ve been in the last, uh, you know, couple of decades in my career in a position where people have been asking me for advice and. The opportunity, especially as I started to work in low and middle income countries, to see different ways of approaching care delivery made me feel a bit like a honeybee. You know, I’d, I’d been, uh, I could pollinate, I could cross pollinate and, and take things that I’d seen that worked in one place or another place and try to apply them.

I can tell you for me, when I first started working internationally, it was quite a stark change. So my first country that was in Canada was South Africa, and it was a very different care delivery network. Fundamentally different care delivery network than Canada. Actually, to be fair, about 23% of the care that’s delivered in South Africa is pretty much the same as it is in Canada.

It’s the rest of it that is fundamentally different. They have two care delivery networks. One is the private one and one is the public one. And I found that in many of the countries that I was working in, especially as I was working on donor funded projects where the, uh, funding to the Ministry of Health, sometimes almost half of it was coming from development partners like World Bank or like Gates Foundation or you know, others that were stepping up to assist.

And some of the things that I found most interesting is to watch countries. To be able to contrast to how it is in Canada now, make no mistake, we’ve still got a lot that we have to do to improve our care delivery network in Canada, but we’ve had universal health coverage in Canada since I was three years old.

I’ve been involved in a dozen universal health coverage projects in countries where you don’t all get access to care. You get access to care if there’s something that’s close by and available and funded by somebody. Or you get access to care if you do have money and you’re paying out of pocket and availability of care and how it gets managed and how it gets paid for, there’s a, a huge array and it was really an immediate stark difference to what I knew from lived experience.

And it was astoundingly interesting to see how much we assume in Canada because it’s just sort of always been there or, or we don’t remember when it wasn’t like that. Things like electricity, things like medication supply chains that worked and didn’t have to be made to work through sheer dearth of effort on behalf of the Ministry of Health.

And for me, that was very, very eye-opening as I went to more and more places. You know, you say in when you’re trying to navigate that, it’s useful to be able to triangulate, you know, to have multiple set points so that you can figure out where you are. And as I got more experience in these other environments, firstly, I came to appreciate Canada in ways that I could never until I, I got a chance to see just how much it was that we had and just how much we we could take for granted because it had been there for so long.

But second of all, I could see how different ways of approaching things could help some of the countries I was invited to help get. Closer and closer to something that I had experience of a working system for all the things that we want to improve about the Canadian Care Delivery Network. We live in a working system.

It’s been a top 20 care delivery network, the entirety of my lifetime. Where we are in that top 20, we lament a little bit because we really should be getting, in my view, more value for our money. But it’s a top 20 care delivery network. And the 150 countries that aren’t in the OECD have very different experience.

There’s experience I got in Namibia that was especially interesting for me. I. Because they were just transitioning from being a low income country to a middle income country, which meant they were transitioning from being grant eligible to loan eligible. And what they immediately started to do was take the malaria care program that had been funded by the President’s Malaria initiative and the PEPFAR program, the HIV care program that had been funded by the President’s emergency plan for AIDS relief.

The immunization program that UNICEF had helped them fund and that each of these separate silos, and their immediate reaction was, well, there’s no way we would ever run our care delivery network this way. This was set up as silos because each of the donors had this hard walled focus. But now that we’re gonna have to pay for this, we actually want to fund primary care and say, well, you know.

If you show up and you’re pregnant, we’ll give you antenatal care. If you show up in your HIV positive, we’ll give you HIV care. And if you’re HIV positive and pregnant, we’ll do this Prevention of Mother to child Transmission Protocol, the effectiveness and the importance of being able to coordinate your activities and successfully do some of these interventions.

It made a an astounding difference for me. One of the things that became quite addictive a little bit is to be involved in those. Super high impact initiatives that really have the chance to make fundamental change in population health outcomes, because we’d made those ages ago in Canada, but I can tell you.

When you start to hit herd immunity, when you’re immunizing your babies, your under five mortality rate plummets, and you literally see a step function in the life expectancy of an entire population. And so when I was doing some work with UNICEF on child immunization programs, you could tell that you were doing something that was at the foundation of, of what a a well-functioning care delivery network should be doing, and then you tried to build from there.

Shelagh Maloney: It’s interesting because there’s so many things that just have come out in that one or two comments and questions and Liz, you talked about like that incentive driven models and, and the example Derek is exactly like that, right? And so, you know, you go to where the money is and then siloed delivery. You know, when you’ve got one party paying for this, this is what they will do.

And this is their tool. They have a hammer. So everything is a nail. I wonder if you can talk a little bit, obviously you’ve, you’ve both been and experienced different health systems. What can we learn in Canada from what it is that you’re doing or Canadians working internationally? What does that look like for you?

Or how do you think that’s helpful or not helpful as the case may be?

Liz Keen: That’s a great question because I, I mean, I really like the way that Derek couched it from a very high level kind of perspective and the connection across countries rather than the lower level operational. What does this look like on the ground?

So what, from what I understand of Canada, we in Australia, same as Canada, we have a similar geographical layout where we’ve got significantly remote and regional locations where connecting up healthcare is really, really challenging for our regional remote people, so we need to make sure we don’t lose sight of them and get caught up in the cities.

I think we also have a real priority around what we call “closing the gap” for an Indigenous population and making sure that we also don’t lose sight of what they need and, and the healthcare requirements that they have. So I, I think those are some similarities that we have with Canada.

In the digital health space, it’s really important that we do lean on each other because we’re all at different stages of our digital health journey. Um, I did read, read somewhere that Australia’s strategy direction is second in the world to Estonia. And that’s really good, but we need to not get caught up in that because, you know, we’ve got there because we’ve learned a lot from other countries and other ways of doing things.

And similarly sharing, you know, the guardrails and the pillars for our digital health technologies. So all of the technologies that enable healthcare. So it’s interesting, Derek, that you mentioned the dropping of the E, so let’s bring that one up. So, you know, eHealth, what actually is that? You could also argue what is digital health?

Because it is health. And for me, digital health is a technology that enables healthcare. So I think the different ways that countries are describing them is really important to make sure that we stay engaged because we can follow their lead UK, for example, have. Mandatory standards in the digital health space.

We don’t have that yet in Australia, but we are watching what they’re doing. ’cause we’re thinking, do you know what? It’s gonna come our way too. So it’s the same as understanding what Canada, for example, might be doing in the interoperability space and thinking, Hmm, is there something that’s gonna be coming in our direction?

What regulation are we seeing around the world? Is it that irregulation innovation, chicken and the egg first, second thing. So how’s it working in other countries? We’ve got a lot we could learn certainly in the technology space around the world.

Derek Ritz: I think that Canada has an absolutely astounding amount that can be learned from everybody else and should be willing and happy to learn from everybody else.

I lament a little bit that. There’s this very patronizing reference to reverse innovation when it’s coming from a low and middle income country back to a rich country. And I just don’t like that because all of these countries that I’ve worked in are filled with astoundingly intelligent, motivated people.

They just don’t have as much money as we have. Honestly, we should all be given snorkel. We swim around in so much money and we don’t realize that I. It’s because we’re wealthy that we have this conceit about how we should be approaching digital health. And the conceit in my view is that you could no more run our care delivery networks absent the digital infrastructure than you could run a bank without having digital infrastructure.

Or you could run a supply chain network without having digital infrastructure. And I think that’s why the E is evaporated in front of eHealth. There’s no more reference to e-banking and the idea that digital isn’t part of the healthcare system and woven into the fabric of the healthcare system is just not a a correct idea anymore.

I think that should change how we look at this, and I don’t think that we should ever again think of digital health as this cool little add-on thing. Digital health is not what the cool kids are doing. It’s what everybody does. Digital health is the blocking and tackling of what we should do every day, all day, every day, everywhere.

And if we think of it that way, I think we’ll approach our investments in digital health differently. I like very much some of the. The new language about this as infrastructure investments. Looking at it the same way as you think of every other infrastructure investment, this is the money that we should spend as a capital investment and this is the money we should spend every day as an operating investment because that’s the infrastructure.

I’ve been part of the choir of people that have been sing for a long time in Canada that we have to connect funding. To the infrastructure and the consistency of that infrastructure should be driven by the funding, meaning you have money for putting in the interoperable infrastructure that makes it go well.

And you have no money for doing anything that’s gonna be idiosyncratic as a $3 bill and it’s just gonna make everything harder. And I think if we thought of it that way, the same way that you don’t have your water system with a different size of pipe everywhere and a different size of manifold everywhere.

No, you standardize it so it will work. Our digital health infrastructure in Canada has to be standardized, so it will work now. That doesn’t mean that if we think of the waterworks, not everybody has the same color and size and shape of tap in their bathrooms. They don’t have to, the infrastructure has to be the same.

You can do what you need to do at the edge of the network, but the infrastructure should be completely standards based. I do think before the end of my career, I am gonna see that moment where in Canada we have a consistent infrastructure. I can tell you for any of the countries that are in the, the Greenfield situation where they’re, only now coming to the point where they’re going to make their national digital health investments. None of them are thinking of setting up all kinds of little idiosyncratic silos all over the place and then hoping against hope that they can connect them. At the end of the day. The countries where I’m working in that aren’t in the OECD are very carefully and deliberately looking at how they will make.

National scale, durable, reusable digital health investments in infrastructure that can support all of the edge cases, uh, that will be different in a pharmacy versus a small clinic versus a large hospital and so on. But the infrastructure piece is where I think us as digital health professionals should be, should be showing a little bit more impatience.

I say that because of Covid, we should be quite vocally. Pointing at the decision making processes that we adopted during Covid and saying, yeah, this isn’t gonna take a decade. This is gonna take five weeks. You know, like it did when we were, all of us having to make some changes very quickly because of Covid.

So let’s not expect it to take a decade. Let’s expect it to take 10 weeks. Because why would we have to run as hard as we were running during Covid?

Liz Keen: And I think if I can loop back, Derek, on something you said earlier and. The countries that might be considered the lower socioeconomic countries in their development in digital health countries like Kenya have got, from what I understand, a really well established digital health shared record happening.

The Philippines, for example, have hundreds if not thousands of islands that they need to connect up and you know, imagine that kind of challenge. And then there’s those of us that have gone ahead who’ve made some mistakes along the way, and were able to share those. Someone’s gotta go first. But also I think, to your point, Derek, around the asset versus finance budgetary item, there’s a paper put out by, um, Clair Sullivan and her team at the University of Queensland on exactly that topic, and she couches it in the most amazing way.

But it’s basically, as you say, it’s a requirement now. You know, what was desirable five years ago is critical now, and we need this. You know, it, it’s not about is it coming, it’s here. Now we have the technologies, we now need to embrace it and do it in a safe and quality way.

Katie Bryski: I appreciate the, the optimism.

I wanna maybe be a little bit provocative or be devil’s advocate a little bit and just poke at that a little bit more. Because I read an article recently that was essentially five years on what did we get wrong about how we thought the world would change post covid. And the very first one was virtual care is here to stay.

And we’ve also had, Derek, you alluded to a long kind of history of. Looking to try different things and fund this integrated system. So I, I am with you. I would love to see this integrated system within the next few years, but I want to explore kind of the reasons that give you hope and the reasons that make you optimistic that that will come to pass.

Liz Keen: Oh, I do with, with what’s happening in Australia. I think we’re definitely heading in the right direction. We’ve got some fantastic programs being led with partnerships, so there’s a lot of partnerships happening across Australia with. The likes of the Australian Digital Health Agency, CSIRO, the Australian, uh, the Department of Health and Aged Care, and between the three of them, they’re leading programs such as the SPARK Program, which is getting the FHIR standards out there and focusing on.

The international patient summary, which of course you’re probably aware of through the global digital health partnerships work as well, so there’s a lot of work happening. There’s focus on a health information exchange in Australia and bringing that standardization, Derek, that you mentioned earlier across the health sector in Australia, I guess like.

We always refer to the rail gauge. The train can keep going and doesn’t have to stop and change its wheels before it can move to the next one. There’s a significant wave in Australia around person centeredness. We need to be creating systems that work for people, not systems that work for systems. And I think we probably all have personal stories we could share around engagements with hospitals where it totally driven by the system and doesn’t work for the person.

So I think that we are definitely going the right direction. I think for the most part, the right voices are being heard. We are seeing healthcare providers and consumers at the table through design and development processes. We’ve still got a long way to go, but the partnership and the person centeredness to me is being driven by our biggest organizations in Australia.

So it’s, to me, that’s super positive.

Derek Ritz: I’m gonna be laid in my grave as the never ending optimist, so I, I do. Completely believe that things are getting better, that they’re going to keep getting better, and that we’re going to succeed at some of the things that we’re setting out to do. I agree with Liz that one of the things that for me and that I’ve seen really in only the last 20 years, I’ve seen this see change in a focus on person-centeredness.

That is an absolutely astoundingly important change for the healthcare system. To make, and we haven’t successfully made it yet, but things like the efforts in Canada to have a patient summary that follows me around wherever I go and that the Care delivery network participants are custodians of my content, but that’s my content and it follows me.

I think that that and the focus on that and the connecting of money to that idea is what’s going to be really, really important. I. I also think that in only the last five to 10 years, there’s been a recognition of the importance of the social determinants of health. I had a chance to, uh, hear Danielle Martin speak at a UFT event not so long ago, and she was talking about the fact that the repair shop, so if we think of the care delivery network as the repair shop that’s responsible for 20% of your health outcome.

The other 80% is do you have a friends network that is actually supportive? Do you have a roof over your head? Do you eat well? Do you exercise? Your health and your enjoyment of good health is 80% related to the social determinants of health. We’ve been doing some research for quite some time.

There’s a hospital in Toronto, I think it’s St. Mike’s, where there was a research program that clinicians could actually prescribe money to, people whose biggest problem was food insecurity, or whose biggest problem was shelter, and they would prescribe a. Money to them and they would receive social assistance that would keep them out of the emergency room.

They did it as an RCT and the, the results were published and we’ve been doing some work in Canada on that, and we’ve started incorporating social determinants of health into how we organize care delivery. We are actually a global case study regarding our stratification of covid vaccine delivery based on postal code.

We did that in the Toronto area because certain postal codes were predominantly populated by new Canadians. And new Canadians were more likely to have multi-generational homes. And were also more likely to be working in environments like factories or you know, Amazon warehouses where you were working closely with other people and your covid vectors loved that kind of work environment.

Sadly for us all, COVID loved to get hold of a senior or anybody else who was in a, in a immune compromised kind of a situation. And so we stratified after age, we stratified by postal code because that was a good proxy. I. For the social determinants of health. And we published that work and it was really groundbreaking stuff.

And I’m very optimistic about the fact that SDOH is gonna be something that will greatly inform how we invest in health going forward. And I’m happy to say that some of these lessons learned, and some of these ideas are ones that I’ve had an opportunity to do my honeybee stuff and cross pollinate.

Shelagh Maloney: I think you just want people to call you honey, Derek.

Derek Ritz: Am I that transparent? I must be.

Shelagh Maloney: I’m of the same ilk and I think I absolutely agree with your comments around the patient-centered care. We used to say that all the time. Now we really mean it and we’re really trying. The other thing I’ve seen is collaboration, and particularly around covid.

Like we’ve seen collaboration like we’ve never seen it before. And Liz, you mentioned those organizations working together in Canada. We’ve got partnerships between Infoway and the Canadian Institute for Health Information, CIHI, and people are actually coming together and more collaboration at the international scale with the Global Digital Health Partnership that both Katie and have been fortunate enough to be involved in.

We are seeing international collaboration more so than we’ve ever seen it. And I think that definitely is something that we would like to see continue. And it’s making a difference and, and I think when you get really smart people together and you have a cause and you have a drive that drives the future, I.

We always wanna start with people talking about their career paths, because that’s really interesting. And this is a podcast about digital health, but it’s also a podcast about leadership and you two have both, uh, been very significant leaders in all the countries in which you’ve worked. And so I’m wondering for those who are listening to this podcast, potentially people who are in the digital health space or in the technology space, maybe people who are interested in international work.

What advice would you give people who are maybe just starting out in their careers in this area? Maybe Liz, we’ll start with you on this one.

Liz Keen: I think certainly working the digital health space is, I’ve found my tribe. I love the digital health space. It is a community of innovators and drivers, and they really wanna make a difference.

It’s a really great place to be. I think as a nurse being in the digital health space. I think it’s important to never lose the reason or the purpose that you went down that pathway to become a nurse in the first place. As I’ve gone through my career and moving away from clinical, you get the, oh, you’re not a real nurse, or you are just a nurse.

You are never just a nurse and you are always a real nurse. So I think, you know, and moving into the space that I have in clinical governance, patient safety. Quality care and that continuous improvement loop remains the focus of everything I do. So whilst I might not be putting my hands on people anymore, I, um, am absolutely having an influence over the technologies that are supporting the care that goes forward.

So never lose that healthcare provider background That brought you on this journey because it’s so important as you move forward into the digital health space.

Derek Ritz: I take to heart the, uh, definition that we have in Canada that Digital Health Canada has published about what health informatics is and, and how it’s different from health it, and the, the notion of the three-legged stool that, that health informatics is that triumvirate of clinical science, information science and management science.

And the reason I think that that’s important is because for anybody who’s entering into digital health now, or who’s mid-career and who’s really gonna be making their difference over the coming, uh, years and, and decades, what if scale was the innovation? We do have a lot of shiny object stuff that gets talked about in terms of digital health.

Oh, there’s this cool thing, or there’s that cool thing. Scale is the innovation, then how are you going to leverage digital health in ways that will matter day in, day out, in every care delivery point of service, everywhere across your entire care delivery network? And now you have to take all of those three things into account.

You have to say, well, listen, what is the most clinically relevant things that we should be doing for our population? You have to do good information science, but if scale is the innovation, you can’t be doing the last tricky thing and oh, well, yeah, there’s a bug, but let me just recompile it tonight. Look, if scale is the innovation, then you have to be working in terms of it around the timeframes of a national deployment of the technology, not the last build of the cool thing.

And then that calls in the last of the three, the management science. There is no such thing as a technical solution to a socio-technical problem. And so you have to have this sense of project management and this sense of, well, what’s the context within which this digital, uh, thing is gonna have to live and work and thrive?

And so I do think for people that are embracing digital health: look to the Canadian definition of health informatics. You know, have that sense of those three things so that you can make the strongest, uh, contribution. And then lastly, these things are important things and we should be urgent in doing some of them.

You know, we shouldn’t be doing anything less than improving the health and wellbeing of every Canadian. Maybe lastly, be skeptical. I. I hate seeing the hype cycles in digital health because I think it’s too important to think, to get all dewy eyed and weird about, I think we should be focusing on those really genuinely impactful things that we should take to scale because I.

The E is gone from eHealth. This is how we’re gonna do healthcare and, and we should take seriously. We have to do it well.

Shelagh Maloney: I’m sure a lot of buzz will be generated from this, uh, podcast. To be curious, be impatient, be ambitious, be skeptical. Now, we’ve gone too far. This is a good place to end.

Thanks so much everyone.

Katie Bryski: Well, that was a whirlwind tour.

Shelagh Maloney: You know, between the two of them, they probably have a dozen countries under their belts even maybe more than that. And it’s kind of envious, you know, like sort of been and lived, worked in Canada, and lived in Canada my whole life. I always envy people who have had so many different international experiences. You and I sort of, kind of through our work with Global Digital Health Partnership have had that experience, but, gosh, to live in so many countries and work with so many countries, what a, what a great advantage they both have.

Katie Bryski: And I think it’s so cool too, that again, they came to digital health from other fields. If you think about the three-legged stool that Derek mentioned, between the two of them, they also have all three between their professional experiences.

Shelagh Maloney: And both of them have been in this space for a while.

So it’s, it’s always nice. And you, and I know this is the Digital Health Canada’s 50th anniversary and so have been thinking a lot about how far we’ve come in the progress we’ve made. And I really took to heart the comments of that patient-centered care. And we’ve always said it, and I think it was in 2013, that.

For that. If patient engagement was a drug, it would be the blockbuster drug of the century. And that was the aha moment that everybody had. But it’s taken us this long to, I think, go beyond lip service to actually doing it. And so that patient-centered care and, and the collaboration is something that’s relatively new and in any kind of earnest way and attention to social determinants of health like.

Those are great advances. But the other one, of course, from the perspective of this one is that digital health and e-health, it is what we do. We all know that. But just having that sort of, the way Derek phrased it in that different perspective and to say. It’s the common infrastructure that we all need.

And let’s not, let’s get our own bells and whistles when we want to and at the different level, but let’s all agree on the pipes. And pipes are not fancy, and pipes are not where you put your signature. Pipes are the table stakes, and everybody should have the pipes exactly the same way, and then add your bells and whistles and your fanciness and your customization beyond the pipes when you get higher than the pipes.

Katie Bryski: I actually quite liked the idea of what could you do if you actually have certain constraints in place? Because sometimes just having free reign and free budget, you actually don’t get the most creative solution or the most optimal solution. And it makes me think of my past career where it’s like, no budget, no supplies, no problem.

If these are your boundaries, what can you do? And how? How does that force you to think differently than if you just had a blank cheque?

Shelagh Maloney: Absolutely and no money and an urgent need. Covid was a great example for us. Like we accelerated virtual care and I read the same article that you did around, you know, we thought virtual care, we made these great strides and now we’re kind of coming back and we, we didn’t swing the pendulum the whole way, but enough that I think we’ve lost some of that momentum.

And if we could keep that same level of. Urgency and get things done more quickly. I’d love to be able to put in a bee analogy in there somewhere, but it’s too early in the morning for that and it’s probably, uh, good for the listeners not to have another bee analogy.

Katie Bryski: Perhaps not, but it has been a great season on the podcast and a wonderful conversation. As always, you can find many, uh, resources and opportunities to learn and connect on the Digital Health Canada website. And we’ll see you next month right here on Digital Health in Canada, the Digital Health Canada podcast. Thank you for listening to today’s episode.

Digital Health Canada members can continue the conversation online in the community hub. Visit digital health canada.com to learn more. Be sure to subscribe to the podcast to get new episodes as soon as they’re available and tell a friend if you like the show. We’ll see you next month. Stay connected, get inspired, and be empowered.