If you live in Nova Scotia, or know someone who does, there’s a good chance you’ve heard a story about a person stuck in health-care limbo waiting for surgery. For years, wait times in the province exceeded the national average, with some patients waiting up to a year and a half or more for surgery.
That can feel like an eternity, particularly for people suffering from painful, mobility limiting conditions such as osteoarthritis, which occurs when protective cartilage around knees, hips and other joints wears away and fails to repair. In some severe cases, the only option for relief is joint-replacement surgery—a procedure that has come with notoriously long wait times in the past.
That changed in 2018 when the Department of Health and Wellness invested millions in the Nova Scotia Health Authority (NSHA) to combat the problem, increasing the number of orthopedic surgeons and creating new programming focused on optimizing health outcomes pre- and post-surgery. Wait times decreased for the first time in years, says Dr. Marcy Saxe-Braithwaite, senior director of surgical services at NSHA.
Concurrently, though, rates of osteoarthritis in Nova Scotia are among the highest in Canada and rising. Rather than accepting a future surge in patients in need of joint replacements as a forgone conclusion, a research team led by Dalhousie’s Cheryl Kozey is seeking a more sustainable solution by studying the positive impacts of early intervention.
“Dealing with a wait list is one piece of the puzzle, but it’s not a sustainable solution to the problem. A system change would be back at the early intervention stage with the primary care providers,” says Dr. Kozey, a physiotherapy and biomedical engineering professor and acting dean in the Faculty of Health. “Researchers need to do a better job at translating and mobilizing information and evidence so that it can be used to improve conservative management decisions.”
That’s just what she has been tasked with doing as lead on a collaborative, province-wide research project underway now through the Maritime SPOR Support Unit (MSSU), a patient-oriented research network. Dr. Kozey’s team includes researchers, clinicians, policy makers and patients. They are looking to link some of the large provincial databases to better understand physical activity levels in individuals with osteoarthritis and the factors that impact these levels, with an eye to providing better evidence to primary care providers and to policy makers to improve joint health, quality of life and outcomes.
The research team is one of several collaborative projects being wrapped into the province’s recently launched Integrated Health Research and Innovation Strategy (IHRIS)—a new approach to health research and innovation in Nova Scotia that brings together health leaders from across the province’s many post-secondary institutions, its two health authorities, various government departments, the private sector and the public to address critical health and health-care delivery issues. By better linking health officials, policy makers, researchers and others, IHRIS will ensure health-care research and innovation becomes better aligned with the province’s major health-care priorities including primary care, mental health and addictions, and continuing care.
Creating a robust infrastructure for sharing health data will be key to the success of IHRIS. –Alice Aiken, VP Research and Innovation, Dalhousie
As Nova Scotia’s largest university and research powerhouse, Dalhousie has played a major role in getting IHRIS off the ground since its launch last fall. Most of the network’s efforts so far have centred around identifying existing research activities and resources and bringing together health data that currently exists. Alice Aiken, Dal’s vice-president of research and innovation, says creating a robust infrastructure for sharing health data will be key to the success of IHRIS. “We need a province-wide system so that everybody doing health research has access to appropriate data and everyone who needs the results of that data knows how to find it and where to go and how to implement it into policies and practices and programming,” says Dr. Aiken, a member of IHRIS’s governance committee.
Efficient knowledge exchange and evidence-informed decision making may seem like obvious principles underpinning health-care strategy, but it has taken time for health systems in Canada to take the necessary steps to integrate and coordinate access to health information. Currently, patients are required to share their health story each time they see a new provider and this can put unnecessary pressure on them in trying times. The goal? To secure and protect a patient’s health data while ensuring that the appropriate health-care providers can access it to provide timely care.
The folding up of nine regional health authorities into one Nova Scotia Health Authority in 2015, with the IWK Health Centre as a separate authority taking the lead on women and children’s care, set the stage for better data sharing and collaboration. With a simplified health-care system and a shared vision among leaders across the province, momentum started to build for an initiative to evaluate how care is delivered.
It also helped that Nova Scotia is a manageable size. “We really believe we are the right size of province to do this,” says Dr. Aiken. “We’re big enough to have impact and small enough to be nimble and get things done.”
Creating a provincially coordinated program like IHRIS in a much larger province such as Ontario, for instance, would be a much tougher, even “monumental,” task, says David Anderson, dean at Dal’s Faculty of Medicine. “Ontario has six medical schools, other universities involved in health research, many more major cities and a much more complex health delivery system than we have here,” says Dr. Anderson, who is also on IHRIS’s governance committee.
Dr. Anderson’s hope is that IHRIS will position Nova Scotia as a health-care leader and innovator in Canada. The province has the benefit of being small enough to experiment in a way that larger jurisdictions may not. But those larger jurisdictions can still learn and implement solutions based on Nova Scotia’s experience.
While collaboration between researchers, government and other stakeholders in the health sector has happened in the past, IHRIS will enable health researchers at Dal and other institutions to become more responsive to what’s happening directly in the health-care system.
IHRIS also sets the stage for more innovation in Nova Scotia’s health-care system, bringing the province’s Department of Business on board to help close the gap between the public and private sector when it comes to health research and potentially powerful health data.
“Public health data is one thing and the province has responsibility for that, but there are all the private sources of health data that people have, too. All the insurance companies and the companies that do fabulous data collection and use it to help make their business better and help their clients,” says Dr. Aiken, noting athlete performance company Kinduct and continuing care firm Shannex as examples.
Rigorous safeguards are in place when it comes to data sharing for those who want to commercialize research. As the province gets more sophisticated and can anonymize personal information and keep it private, there will be new opportunities to support better research and care. The trick to unlocking innovation in Nova Scotia’s health system is figuring out how to navigate those relationships through collaboration so that the private sector is creating ideas and products that are more responsive to the needs of the health-care system and patients, says Dr. Aiken. With IHRIS, Nova Scotia is creating the connections to ensure that expertise in priority areas is being effectively mobilized for maximum innovation and impact.
“We have the highest number of ocean startups in North America, and we have the fastest growing tech sector in Canada,” says Dr. Aiken. “We should be able to have a really robust health innovation ecosystem, too.”