OTTAWA — Canada’s primary health-care system has been notably slow to adopt technology, even for simple things like booking appointments. Executives at two publicly traded companies that own dozens of medical practices say “corporatization” is the solution, because they can afford advances solo doctors’ offices and small group practices never could. But corporate ownership makes the profit motive much more overt than Canadians are used to seeing.

In its last progress report, Ontario’s eHealth agency said only 85 per cent of family doctors were using certified electronic records systems. And although nearly 107,000 health professionals in the province “are eligible to log on to view their patients’ records,” eHealth Ontario trumpeted that “more than half” of them are doing so “actively.”

For patient-facing activities, uptake is worse. A report this summer by the Information and Communications Technology Council found that in 2019, just 22 per cent of family practices in Canada let patients book appointments online. That had doubled since 2015, but was still far behind the average of 56 per cent in countries surveyed by the Commonwealth Fund, a U.S.-based foundation that researches health policy.

Canadian doctors were also well below the survey average in sharing patient information outside their own practices, from clinical summaries to lab results.

The ICTC report put part of the blame on provincial health-insurance systems, which mostly pay doctors fees for specifically defined services and strive to push costs down as much as possible.

That’s not really it, said Hamed Shahbazi, the CEO of Well Health, a Vancouver-based corporation that owns 74 primary-care clinics in Ontario, B.C. and Quebec. He thinks fee-for-service can promote innovation in pursuit of efficiency; the problem he sees is fragmentation.

“Technology does not live very well in a non-scaled environment,” he said—and a system that relies heavily on sole practitioners and small-group practices for primary care is not scaled.

MCI Onehealth, a Toronto-based corporation with 20 primary-care clinics in the Greater Toronto Area and five in Alberta, is aiming to make its health services more efficient with big data—including an $800,000 grant from the federal government’s AI supercluster.

“How can we sequence all of the things that need to happen? Because you have lab tests, you have specialist appointments, you have patients that have complex diseases, you have patients that don’t have access to transport,” MCI’s chief innovation officer Saleema Khimji said in an interview. “So we’re trying to say, end to end, how can we create efficiencies in that within a public health-care system, to essentially reduce the time?”

Khimji said MCI Onehealth’s model is integration: if it owns family practices, labs, specialist practices and cutting-edge treatment centres and has them all using the same software and records, it can move patients through its “ecosystem” more quickly.

It’s also working on other big-data projects, Khimji said. One with Stanford University, for instance, is seeking to detect early signs of COVID-19 through health information collected from patients’ wearable tech, like Apple Watches and Fitbits.

“Health-care data is only as good as it is large, and the data sets are necessary to be able to come up with the insights that would be necessary for the government to make decisions at a policy level,” Khimji said. “But also advanced research requires a lot of collaboration, even in terms of clinical history or patient data—it’s only as useful as it is rich.”

Cool as the potential uses of big data are, Shahbazi sees automating the scut work of running a practice as the immediate need.

Antiquated administrative systems suck up practitioners’ time and bog down patient care, he said. “Physician burnout is a real thing. Physicians are the care providers, and if we don’t help physicians move forward, we’re going to be in a world of hurt.”

Cybersecurity is a big challenge for any small business and it’s even more critical when health records are at stake. Shahbazi said Well Health’s experience has been that nearly every small clinic it buys is underprotected.

Another thing a group of associated practices can do more easily is virtual care: a doctor who isn’t slammed (or who just prefers this sort of work) can take up some of the load from a busier site with little friction if they’re using the same systems, Shahbazi said.

If these technologies are going to spread more widely and emergency telehealth services permitted during the COVID-19 pandemic become permanent because both doctors and patients like them, it’s going to take money. Both Well Health and MCI Onehealth got theirs through IPOs and investments from people who see profits to be made.

In 2020, Well Health made much of its money delivering publicly funded medical care—$7 million to nearly $8 million a quarter out of revenues between $10 million and $17 million. The “virtual services” it sells to other practices, including electronic records, billing services and telehealth software, made up most of the rest.

In spring 2021, the numbers got a lot bigger and flipped; Well bought CRH, a U.S. company that supplies anesthesiologists to dozens of surgical centres, with sidelines in hemorrhoid treatment and (like Well) contract administrative services.

Since CRH makes its money in the privately dominated U.S. system, Well Health’s overall revenue from private sources swamped its income from publicly insured services in Canada in the second quarter of this year, $34.9 million to $14.5 million—even though its revenue from public care nearly doubled from the quarter before.

MCI Onehealth doesn’t break its numbers out the same way, but in its prospectus before its IPO this year, it said 89 per cent of its revenues were from publicly funded care.

Both have invested in other companies whose technology they think they can use. Besides CRH, Well Health owns part of online pharmacy Pillway, for instance, and bought telehealth platform Insig last November. On Sept. 2, it announced it was buying a majority stake in a U.S. telehealth provider in a US$41-million deal; Wisp focuses on women’s sexual and reproductive health.

In April alone, MCI Onehealth invested in two companies (Acorn Biolabs, which collects and stores patient stem cells, and Ariel Precision Medicine, which uses genetic data to help treat complex illnesses) and bought a third (Khure Health, which specializes in identifying and treating rare diseases). It followed up by buying Toronto-based Polyclinic, a large facility that includes primary-care and specialist practices and labs.

The Logic asked the major political parties competing for votes on promises to improve health care whether they think Well Health and MCI Onehealth have part of the answer to the public system’s problems. Only one party gave a clear answer—the New Democrats, and their answer was no.

The NDP is pledging to eliminate for-profit nursing homes. Spokesperson Charlotte MacLeod said that philosophy extends to corporatized primary care.

“We want to take the profit out of health care, period,” she said.

The Liberals dodged the question of whether they have a position on corporate ownership of primary-care. Campaign spokesperson Thierry Bélair (whose regular job is director of communications for Health Minister Patty Hajdu), pointed The Logic to a segment of the Liberal platform promising to crack down on practitioners billing extra for publicly funded services.

The Conservatives didn’t respond at all.

If a small group of doctors forms a partnership, or one incorporates her solo practice, that’s a form of privately delivered care, Shahbazi argues. Agglomerating a number of clinics under one corporate umbrella isn’t any different.

“We’re seeing the corporatization of health care, and that makes some people very uncomfortable, because corporations have financial interest—but so do doctors, and so do humans,” Shahbazi said. “What’s starting to happen is capital flows are coming in, they’re causing consolidation, but they’re not competing with the government. That’s really the key, I think here, is that we’re embracing the government system, and that we have a single payer.”