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Table 7: Conditional Grants (Foundations)

1) Name of Foundation: Canada Health Infoway Inc. (Infoway)

2) Start Date: March 9, 2001

3) End Date: N/A

4) Total Funding: $1.6 B*

*Infoway received $1.2 B as lump-sum grants between 2001 and 2004. The $400 M allocated in 2007 was subject to new conditions - these funds flow to Infoway on an as-needed basis.

5) Description

Canada Health Infoway Inc. (Infoway) is a federally funded, independent, not-for-profit corporation with a mandate to foster and accelerate development and adoption of electronic health information communication technologies with compatible standards on a pan-Canadian basis.

Funding has been allocated to Infoway on four occasions: $500 million in 2001 in support of the September 2000 First Ministers' Action Plan for Health System Renewal to strengthen a Canada-wide health infostructure (with the electronic health record - EHR - as a priority); $600 million in the First Ministers' Health Accord of February 2003, to accelerate implementation of the EHR and Telehealth; $100 million as part of Budget 2004 to support development of a pan-Canadian health surveillance system; and $400 million as part of Budget 2007 to support continued work on EHRs and wait times reductions.

It is anticipated that Infoway's approach, where federal, provincial and territorial (F/P/T) governments participate as equals, toward a goal of modernizing the health information system, will reduce costs through coordination of effort and avoidance of duplication. Infoway estimates that preferred pricing agreements and other procurement efforts have helped save between $135 and $165 million to date.

6) Strategic Outcome:

Strengthened knowledge base to address health and health care priorities

7) Summary of Results Achieved:

Investment Strategy - Infoway is a strategic investor, with a funding formula covering up to 100% of territorial and 75% of provincial project development and implementation costs. Infoway provides a portion of system development costs and supports project oversight while P/T partners are responsible for actual system development, implementation and overall funding, including ongoing operational costs. Infoway approved $311.5 million in new projects, bringing its cumulative value of investments to $1.457 billion. By the end of the year, 99 projects had been completed and 155 were under way, for a total of 254 projects since Infoway's inception.

Electronic Health Records - Infoway's goal for EHRs, endorsed by all jurisdictions, was expanded to include mention of health information systems, and to specify a year for 100% population coverage: "By 2010 every province and territory and the populations they serve will benefit from new health information systems that will help transform their health care systems. Further that by 2010, 50% of Canadians and by 2016, 100% of Canadians will have their electronic health record available to their authorized health professionals."

Key components of an EHR include: Diagnostic Imaging, Drug Information and Laboratory Information Systems, as well as Client and Provider Registries, all of which will ultimately be connected by Interoperable EHR systems. These component systems are being rolled out by P/Ts. Infoway reported the following rates of population coverage for EHR components: 71% for Client Registries, 29% for Provider Registries, 64% for Diagnostic Imaging Systems, 24% for Drug Information Systems, and 30% for Laboratory Information Systems. An estimated 7% of the population was covered by an EHR.

Telehealth - Infoway's goal is that by 2010, Canadians residing in northern, rural, remote and official language communities, in all jurisdictions, will benefit from telehealth solutions. There has been acceleration on telehealth by P/Ts working with Infoway to improve access for citizens living in remote and rural communities. Telehealth strategic plans are in place in most jurisdictions, with the goal of implementation by all jurisdictions by December 31, 2009. Infoway continued to invest in telehealth initiatives, with a focus on Aboriginal, official language minority, and northern and remote communities. Infoway had over 40 telehealth projects under way, representing a cumulative investment of $78.2 million.

Public Health Surveillance - Infoway continues to support development and implementation of a pan-Canadian Public Health Surveillance System (Panorama). Panorama will facilitate identification, management and control of infectious diseases that pose a threat to the public's health, by providing public health professionals with software tools to manage cases, outbreaks, immunization, materials/vaccine inventories, notifications and workload. The goal is that by 2010, Canadians in every jurisdiction will benefit from public health surveillance solutions. Progress was made on Panorama development, public health surveillance standards and jurisdictional implementation planning. Infoway approved a cumulative total of $122.7 million for surveillance projects.

Patient Access to Quality Care - As a result of the 2007 budget, Infoway created a new, $50 million investment program. Patient Access to Quality Care is intended to support management of wait times, primarily through funding demonstration projects featuring information management systems. Projects are expected to begin in 2008-2009.

	8) Actual Spending 2005-06*	9) Actual Spending 2006-07*	10) Planned Spending 2007-08	11) Total Authorities 2007-08	12) Actual Spending 2007-08*	13) Variance between 10) and 12)
14) Program Activity	0	0	$38.7 M	$38.7 M	$38.7 M	0

15) Comment(s) on Total Authority and Variance:

The federal government has invested $1.6 billion in Infoway to date, $1.2 billion of which was provided as lump-sum grants between 2001 and 2004. As part of Budget 2007, $400 million was earmarked in the fiscal framework for 2006-2007. These funds were payable on passage of the Budget Implementation Act 2007 and Royal Assent, authorizing the Minister of Health to make a statutory payment directly from the Consolidated Revenue Fund. Payment is made on an as-needed basis, on receipt of Infoway's annual Cash Flow Statement. In 2007-2008, one payment was made for $38.7 million out of the $400 million.

* The pace at which funding is expended is at the discretion of Infoway and is largely driven by the rate of progress of its P/T partners. Annual spending is as follows:

• $117.8 M in 2005-2006
• $174.6 M in 2006-2007
• $271.7 M in 2007-2008

16) Significant Audit and Evaluation Findings and URL to Last Audit and/or Evaluation:

Financial and compliance audits were completed by independent third parties. Financial auditor Ernst and Young stated that the financial statements fairly represented Infoway's financial position, and the results of its operations and cash flows. The annual compliance report was carried out by Mallette and the auditor stated that Infoway complied with the main terms and conditions of funding agreements. As well, Health Canada's Audit and Accountability Bureau began an internal audit and results will be finalized in 2008-2009.

17) URL to Foundation:

http://www.infoway-inforoute.ca/en/Home/home.aspx

18) URL to Foundation's Annual Report:

http://www.infoway-inforoute.ca/Admin/Upload/Dev/Document/Infoway_Annual_Report_2007-2008_Eng.pdf?ireff=13

1) Name of Foundation: Canadian Health Services Research Foundation (CHSRF)

2) Start Date: 1996-1997

3) End Date: N/A

4) Total Funding: $151.5 M

5) Description:

Total federal funding for the CHSRF is as follows (CHSRF's programs also receive funding from other sources):

• 1996-2001 - $66.5 M endowment (received over five years) to establish the Foundation;
• 1999 - $25 M for a 10-year program to develop capacity for research on nursing recruitment, retention, management, leadership and issues emerging from health system restructuring: Nursing Research Fund (NRF); and $35 M to support the Foundation's participation in the Canadian Institutes of Health Research (CIHR);
• 2003 - $25 M grant to enhance the skills of health system managers in using research to increase evidence-based decision-making: Executive Training for Research Application (EXTRA) over a 13-year period.

CHSRF's mission is to support evidence-informed decision-making in the organization, management and delivery of health services through funding research, building capacity and transferring knowledge.

Strategic objectives:

• create high-quality new research that is useful for health service managers and policy makers (especially in the Foundation's priority theme areas: managing for quality and safety; management of the health care workplace; primary health care; nursing leadership, organization and policy; and managing and adapting to change);
• increase the number and nature of applied health services and nursing researchers;
• get needed research into the hands of health-system managers and policy makers in the right format, at the right time, through the right channels; and
• help health-system managers, policy makers and their organizations to routinely acquire, appraise, adapt and apply relevant research in their work.

6) Strategic Outcome:

CHRSF's work contributes to Health Canada's objective of strengthening the knowledge base to address health and health care priorities.

7) Summary of Results Achieved:

Research granting and commissioned research

In 2007, the CHSRF held two successful research competitions: the 2007 Research, Exchange and Impact for System Support (REISS) program grants and the 2007 Postdoctoral Awards. The CHSRF also completed six commissioned research projects (e.g. primary health care, knowledge transfer training needs, work-life environments and public reporting of health care quality). Three commissioned research projects were initiated on: a competency framework for health leaders, deliberative processes; and governance for quality and safety. One synthesis project was completed in 2007 on managing continuity, and another synthesis project was initiated on interprofessional teams and primary health care.

The third Listening for Direction consultations were undertaken in spring 2007, resulting in identification of 11priority health services research themes. There were eight national funding partners in this round (two more than for LfD II in 2004). In addition to the five regional and one national consultation workshops, Health Canada provided funding to conduct workshops in the territories for the first time - in Whitehorse, Iqaluit and Yellowknife. Key findings were incorporated into the national report; a separate report on the northern dialogues was prepared. The two reports will be published in 2008.

In 2007, the CHSRF identified four of the LfD priority themes to guide its research and knowledge exchange programming over the next three to five years: change management; values-based decision-making; quality and safety; and health care work force and work environment.

With respect to the NRF, in 2007, the Fund contributed:

• $300,000 to one program of research funded under the Foundation's "nursing leadership, organization, and policy" priority theme as part of the 2007 REISS competition;
• $195,000 in matching funds for two successful projects in the 2007 Partnerships for Health System Improvement (PHSI) competition administered by CIHR; and
• $535,000 to the Nursing Care Partnership Fund for research on nursing care, administered by the Canadian Nurses Foundation. The Nursing Care Partnership also continued to leverage existing funding by creating new partnerships that support research on nursing care issues. Each Nursing Care Partnership dollar spent leveraged $1.85 in partnership funding.

Building research capacity

The NRF sponsored two nursing-related postdoctoral students, continued to support five nursing-specific CHSRF/CIHR chairs and two nursing-related chairs (10-year awards), and two CHSRF/CIHR Regional Training Centres (10-year awards).

The CHSRF/CIHR Regional Training Centres collaborated on a special issue of the Healthcare Policy Journal on the training centres (released in spring 2008). The CHSRF/CIHR Chairs launched a major book project in 2007 that will be completed in 2008-2009. The aim is to collectively document the experience, contributions and impact of the Chairs' training programs and various approaches to capacity development in applied health services and policy research.

The CHSRF signed the Healthy Healthcare Leadership Charter from the Quality Worklife-Quality Healthcare Collaborative in December 2007, and provided leadership and guidance to the Knowledge Exchange Working Group.

Decision maker capacity building, knowledge exchange and transfer

In 2007, the EXTRA Program saw a noticeable increase in requests for applications (96 in 2007, up from 61 in 2006). CHSRF enrolls 24 senior fellows annually in the two-year EXTRA training program. In 2007, a decision was made to admit up to four fellows from policy environments, on a marginal cost-recovery basis. The Merit Review Panel selected the first organizational application (three "linked" fellows) - a program stream incorporated into the 2007 call. The CHSRF also formalized a Community of Practice for the post-program fellows. In addition, in 2007, the EXTRA Program was formally accredited by the Université de Montréal and Royal Roads University. Accreditation discussions are under way with the University of Toronto and a curriculum module of the EXTRA program was developed by the National Institute of Public Health in Mexico.

In 2007, the CHSRF produced and released four Mythbusters publications and published these in the Journal of Health Services Research and Policy . As well, the CHSRF developed the Mythbusters Teaching Resource for university academics interested in using Mythbuster s to teach graduate-level students in health service administration and nursing how to deliver plain-language research summaries that increase the uptake of evidence. The CHSRF also produced and released four Evidence Boost summaries under the new Evidence Boost for Quality sub-series, focusing on patient decision aids for "grey zone" decision-making (e.g. self-management education for the chronically ill; lay health workers; and visiting-specialist services for isolated populations). CHSRF launched a new series, Insight and Action , which attempts to link people undertaking knowledge exchange with evidence-informed resources. Tools to Help Organizations Create, Share and Use Knowledge was launched with 47 resources and another 70 new resources are under review. In addition, the Promising Practices in Research Use inventory has grown to include 16 stories about organizational innovation in this area. Five of the articles showcased intervention projects by fellows in the EXTRA program. Other targeted dissemination activities included production of four columns in Healthcare Quarterly , three special journal issues featuring a 28 articles on EXTRA intervention projects, and the launch of two Electronic Video Documentaries (EVD).

In the area of knowledge exchange, the NRF funded development of Stories for Safety: Sharing the evidence about nursing and patient safety electronic video documentary (EVD) on nurse staffing and patient safety, a Nurse Staffing and Patient Safety Knowledge Exchange in Charlottetown, and participation in various conferences.

In 2007, the CHSRF continued to provide opportunities for researchers and decision makers to dialogue on health systems issues, including funding five exchanges bringing together researchers and decision makers around issues such as knowledge transfer, new practices in nursing, translating information into action and healthy workplaces; launching "Researcher on Call," a one-hour series that links participants by teleconference with researchers and decision makers who are making progress in improving health care; and hosted Research Use Week (Northeastern Ontario) in Sudbury, Ontario. Eight organizations partnered with CHSRF to co-sponsor the event, providing $32,000 in sponsorship support.

Leveraging of federal investments

The total amount of CHSRF funds spent on partnership-eligible programming in 2007 was $4.9 million. This includes payments towards ongoing multi-year activities as well as new activities for which 2007 payments were made. The total amount of partnership contributions on these same activities was $9.16 million. In other words, for every $1 of Foundation funding, $1.87 was contributed by partners. Considering that total CHSRF program spending was $23.7 million, and partner contributions were $9.2 million, the CHSRF's net draw on the endowment of $9.5 million yielded a leveraged ratio of 1:2.49; that is, $2.36 was spent on the Foundation's objectives for every $1 spent from the Foundation's capital in its endowment.

In 2007, the CHSRF partnered with 50 direct partners and entered into 42 new partnership agreements, with an additional nine under negotiation at the end of the year.

For the second year in a row, the CHSRF was named by Canadian Business magazine as one of the "Best Workplaces in Canada," recognizing the organization's commitment to a healthy work-life balance and family-friendly policies that promote a work environment that focuses on quality of work done, positive performance management, and a culture of respect.

	8) Actual Spending 2005-2006	9) Actual Spending 2006-2007	10) Planned Spending 2007-2008	11) Total Authorities 2007-2008	12) Actual Spending 2007-2008	13) Variance(s) between 10) and 12)
14) Program Activity:	0	0	0	0	0	0

15) Comments on Variance(s) :

The conditional grant was paid to CHSRF in instalments prior to the 2005-2006 reporting period.

16) Significant Evaluation Findings and URL(s) to Last Evaluation(s)/Future Plans:

The second five-year international review of the CHSRF was completed in 2007

[ http://www.chsrf.ca/about/ga_accountability_impact_ol_e.php ] and findings were discussed by the Board of Trustees. Actions to respond to the findings will be undertaken in consultation with the research and decision maker communities, and under the leadership of the incoming President and Chief Executive Officer, in 2008.

An overall evaluation of the components of the Capacity for Applied and Developmental Research and Evaluation (CADRE) in Health Services and Nursing Program was undertaken and the final report was completed in 2007. Recommendations were addressed by CADRE awardees and by CHSRF staff.

A team has been commissioned to conduct an evaluation of the NRF to determine the lessons and consequences of investments made through the NRF since its inception in 1999 to the end of 2007. The evaluation was commenced in 2007 and will be completed in 2008.

The evaluation report on the second EXTRA cohort revealed a continued high level of satisfaction from fellows, and confirmed that the program is highly valued by the fellows and their organizations.

Copies of these reports are available upon request.

17) Significant Audit Findings and URL(s) to Last Audit(s)/Future Plans:

The second compliance audit report of funded programs and projects, completed in March 2007, revealed that all files selected were in compliance with grants, awards, partnership, and finance policies and procedures, and that the recommendations from the first compliance audit had been implemented. Additional recommendations from the second compliance audit are to be implemented in 2008.

A three-month and a six-month evaluation of the managed payroll system were conducted in 2007 to ensure that the system addressed segregation of duties and other related objectives.

A preliminary 2007 external financial audit was completed in October 2007 and showed no major concerns. The full external financial audit was conducted in February/March 2008.

The Foundation's pension plan was audited in February 2007 and showed no major concerns. The going concern liability in the January 2006 valuation report was funded by the CHSRF to ensure the pension plan can meet its forward commitments.

Copies of these reports are available upon request.

In late 2007, CHSRF participated in a Health Canada compliance audit. This audit was part of Health Canada's Multi-Year Risk-Based Audit Plan. The audit report will be shared with CHSRF in 2008.

2007 Audited Financial Statements:
http://www.chsrf.ca/about/documents/CanadianHealthServicesResearchFoundation-english-fs07.pdf
http://www.chsrf.ca/about/documents/CanadianHealthServicesResearchFoundation-french-fs07.pdf

18) URL to the Foundation site:

www.chsrf.ca

19) URL to the Foundation's Annual Report:

http://www.chsrf.ca/other_documents/annual_reports/documents/WEB2011354_chsrf_ar_e_final.pdf
http://www.chsrf.ca/other_documents/annual_reports/documents/WEB2011354_chsrf_ar_f_final.pdf

http://www.chsrf.ca/nursing_research_fund/documents/NursingReport_E_rev3_FINAL.pdf
http://www.chsrf.ca/nursing_research_fund/documents/NursingReport_Fr_rev4_FINAL.pdf

http://www.chsrf.ca/extra/documents/EXTRAReport_E_rev3_FINAL.pdf
http://www.chsrf.ca/forces/documents/EXTRAReport_Fr_rev3_FINAL.pdf

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