JMIR Publications

ABSTRACT

Background:

Public health systems are increasingly looking to the private sector to provide digital solutions to meet the healthcare demands of a population growing both in size and complexity. However, there are several barriers to private innovators entering the market of the public health system. Creating an environment in which emerging solutions meet the needs of a public healthcare system requires that these private entities develop sustainable business models. Insights from small- and medium-sized enterprises (SMEs) attempting to create scalable initiatives within the constraints of a public system is critical to creating more symbiotic partnerships between the public system and private industry.

Objective:

This paper analyzes a series of case studies to identify current health system barriers faced by SMEs developing digital health technologies in Canada and proposes system-level solutions to encourage a more innovative ecosystem.

Methods:

To help SMEs increase their innovation capacity and take their ideas to market, the National Research Council partnered with Women’s College Hospital to establish a consultation process for SMEs. The consultation involves the SME filling out an onboarding form, review of this information by an expert committee using guided considerations, leading to a recommendation report provided to the SME. This paper reports on the characteristics of 25 SMEs who completed the program and qualitatively analyzes their recommendation reports to identify common barriers to digital health innovation.

Results:

Qualitative review of consultations with 25 SMEs reveal two common barriers to system integration: 1) lack of formal evaluation, with SMEs having limited resources and opportunities to conduct such an evaluation; and 2) the public health system’s current structure disincentivizes use of digital solutions by clinicians, which threatens the sustainability of SMEs’ business models. Vendors faced significant challenges in engaging users and payers from the public system due to perverse economic incentives. Physicians are compensated by in-person visits, which actively works against the goals of many digital health solutions of keeping patients out of clinics and hospitals. Further, reluctance from health systems, institutions, and providers to engage with digital health often relates to deficient evidence of clinical value. Funding for the evaluation of such innovations, including resources for proper implementation which is costly for resource-constrained recipient sites, is lacking in public health systems.

Conclusions:

There are specific tensions between economic incentives of clinical organizations and use of tools that would benefit patient wellbeing, due ultimately to a disconnect of the primary beneficiaries of tools and those who pay for and use them. There is need in publicly funded health systems for dedicated funding for evaluation of digital solutions, streamlined pathways to clinical integration, and system entry points through aligned incentives of users and payers to improving patient outcomes. Clinical Trial: N/A