Chapter 1

The spark

In December 2004, Desmond Entwistle was in a Montreal hospital undergoing treatment for leukemia. Chemotherapy had weakened his immune system, so when his fever spiked, the medical team administered penicillin to fight a suspected infection. They didn’t notice the MedicAlert bracelet on his wrist.

“He was severely allergic to penicillin. He went into shock and died six days later,” remembers his son, Darren Entwistle, Telus’ President and Chief Executive Officer.

As he grieved the loss of his father, Entwistle asked himself how medicine in the digital age could still be dependent on relics such as paper records or metal bracelets to warn of allergies or other life-threatening conditions.

How could it be, in a country that was home to some of the best oncologists in the world, that a cancer patient could die because no one noticed he was allergic to a common antibiotic?

There had to be a better way to handle such crucial medical information. As a telecommunications CEO, Entwistle was in the business of storing, moving and sharing data in a secure and reliable way.

As he contemplated his father’s needless death, he became convinced that Telus could be part of the solution. It could leverage its world-class broadband and wireless networks, technology and culture of innovation to help improve health care in Canada. Investing in the health care sector would also be a bold and unconventional strategy to grow the company.

At the time, the company’s competitors were diversifying into content. Bell Canada Enterprises, for example, had made a majority investment in BellGlobemedia, owner of the Globe and Mail and CTV, but Entwistle believed that such moves would create future regulatory challenges and produce lower than expected financial returns.

Health care was uncharted territory for a major telecommunications company, and Entwistle saw an opportunity. There was a strong business case, but also a social imperative.

With Canada’s population aging rapidly and the percentage of provincial budgets being devoted to health care on the rise, a funding crisis loomed. The growing number of patients with chronic diseases accounted for a larger share of health care spending. And as Entwistle’s personal experience demonstrated, thousands of Canadians needlessly died every year because of avoidable medical errors.

Information and communication technology, Entwistle was convinced, could help prevent these errors, save money and put patients at the centre of health care in Canada. Telus could help improve the way doctors, clinics, pharmacies, hospitals and health care systems functioned.

Entwistle believed that ultimately, patients and their families would drive the revolution in health care, demanding access to their medical information online and the ability to make appointments or renew prescriptions by email or text.

At the time, the federal government and the provinces had begun to lay the groundwork for the shift from paper to electronic health records, a complex task that would prove enormously challenging given the nature of Canada’s provincially-run health care systems and the rapid pace of technological change.

Smartphones were still a novelty.

But Entwistle was preparing to take TELUS in a new direction, and show that a telecommunications company could help drive the transformation of Canada’s health care system.

Chapter 2

The deal

In 2007, Telus made its big move with a $763 million bid for Emergis, a former Bell Canada Enterprises division based in Montreal.

The deal caught some analysts off guard. Emergis earned $150 million annually through electronic health-related claims processing, health record systems, pharmacy management and other services. But why would a phone company like Telus want to sell electronic health records?

“The reaction was. “What the hell?,” says Entwistle. “People were saying `What the hell does a telecommunications company have to do with health care transformation?’’’

In a teleconference call, he justified the deal to investors. Entwistle said he was as excited about the prospects of health care data processing today as he had been about wireless seven years earlier when, after only six months as the CEO of Telus, he made a bet on wireless, paying a top-of-the market price for Clearnet Communications.

Telus’ share price plummeted in the aftermath of that deal against the backdrop of the global tech market meltdown of 2000/2001. In time however, the Clearnet purchase came to be seen as a resounding success. Entwistle predicted the same would be true for Telus’ health care venture.

“What could be more important than health care?”

Emergis was the first of many acquisitions as Telus developed a broad cross-section of digital solutions for major stakeholders in the health care system, including hospitals, health care authorities, physicians, pharmacists, physiotherapists, chiropractors, insurance companies and consumers.

The company has invested more than $1.5 billion in what is now a crowded and competitive field: There are now thousands of health care apps available and myriad of services and products from a wide range of companies.

“Today, you look around the world at our peers, and what do they all have religion on? Their role in health care transformation. AT&T, Telstra, Telefonica, Orange and Deutsche Telekom are all driving like maniacs on health care reform,” says Entwistle.

But there is still a long way to go. Canada lags behind other countries on eHealth, despite significant public investment and a growing body of evidence that information and communications technology can help put Canadian health care on a more sustainable footing for the future.

Chapter 3

The challenge

Almost half of all provincial budgets are now spent on healthcare, squeezing out investments in education, infrastructure and social programs. By 2020, government healthcare spending is expected to reach $250 billion a year.

Canada’s population is aging and more people are suffering from chronic diseases like diabetes and hypertension. Chronic disease management costs the healthcare system more than $80 billion per year, almost 40 per cent of total healthcare expenditures.

The system is showing signs of strain. Compared to 11 other OECD countries, Canada consistently ranks near the bottom in the areas of access to a doctor or nurse, the highest use of emergency rooms, and delays in appointments. Studies also show Canada lags behind the top OECD, G7 and G9 countries on eHealth.

Most health care systems spend 16 cents of every dollar on administration. In the financial services sector, the comparable figure is three cents on every dollar. A few, seemingly simple steps could dramatically improve efficiency and make life easier for patients. If Canadians could communicate with their doctors via email, renew prescriptions electronically, and see their test results online, it would save 47 million visits to a health care provider a year, according to a Conference Board of Canada study.

But there isn’t one health care system in Canada – there are 14, and they don’t adopt change quickly. Some doctors and specialists still use photocopiers and fax machines while others have adopted digital tools. This makes it difficult to bring different players, such as general practitioners, specialists, pharmacists and their patients, together electronically.

Globe and Mail health columnist André Picard, who regularly delivers speeches on the future of health care in Canada, says the problem is a structural one.

“The health system itself is in silos so it’s difficult to create a seamless health record. There’s no real incentive to do so – except for patients, and they don’t have much of a voice.”


Chapter 4

Building bridges

Still, there has been progress. In 2007, only one in four Canadian doctors used electronic medical records (EMRs). In 2014, the National Physician Survey found that 75 per cent of physicians had adopted them; leading to enormous cost savings, but also better care. EMRs are now considered a building block of a modern health care system in which mobile access allows doctors to update or review charts from their phones or tablets.

Canada Health Infoway, a federal Crown corporation founded in 2001 to help bring health care in Canada into the digital age, hired PricewaterhouseCoopers LLP (PwC) to analyze the cost savings derived from using electronic medical records in Canada between 2006 and 2012.

The accounting firm reported EMRs saved the system $1.3 billion over that period. But it also found that electronic medical records reduced adverse drug events and unnecessary medical tests – a clear benefit to patients.

EMRs are about more than moving from paper to electronic records, says Paul Lepage, President of Telus Health. They are an important tool to improve health outcomes by getting the most out of the information doctors, nurses, and other members of a health care team record every day about their patients.

Still, Canada’s EMR adoption rate is relatively low compared to countries such as Denmark, Norway, the Netherlands and the United Kingdom – where almost all doctors use them.

And there is still a big problem with interoperability; many electronic records are used in isolation and are not connected with larger hospitals or provincial systems.

Many hospitals – with billion-dollar budgets – still rely on paper records. Patients can pay the price, especially during transitions between different parts of the system or even different departments within a hospital.

“Transitions are when patients fall through the cracks,” says Picard.

Linking different technologies into a seamless system can be difficult. Denmark is widely considered a leader on eHealth and spent 20 years incorporating multiple technologies into its system. But researchers say the Danish system remains fragmented, and has challenges to overcome in terms of coordination and exchanging clinical data.

In Ontario, the ConnectingGTA initiative, developed in partnership with Telus and eHealth Ontario, represents progress.

ConnectingGTA offers a portal that allows health care practitioners to pull up critical data on a patient, including recent lab tests and medical history. So if someone had heart surgery at one hospital in the Greater Toronto Area, but then a year later goes into cardiac arrest and is taken to the ER at another hospital, doctors there can pull up the file.

Lepage says younger physicians are helping to drive change because they want to use the same kind of tools they use in their personal lives, such as smart phones and tablets, in their practices.

“If you are looking at any new physician they are expecting those tools to be there.”

EMRs offer new ways for doctors to better manage patient care, he says. For example, dashboards allow a doctor or staff to analyze information and look not only at individual patients but at their entire cohort. They can look at the blood oxygen levels of all their patients with congestive heart failure and schedule follow-ups based on that data. They can consult more quickly and efficiently with specialists and be more proactive in managing their patients.

Continuous innovation is a hallmark of Telus’ approach, says Josh Blair, Telus’ chief corporate officer and executive vice-president of Telus Health. Telus uses a lean, start-up approach to develop new features, relying on focus groups of doctors and other professionals to test and fine-tune new functionality, such as software that allows a doctor to take smartphone photos of a rash or acne and have them go directly to the patient’s EMR.

Chapter 5

Looking ahead

Today, Telus Health has 1,700 employees – including 100 doctors, nurses and other health care professionals – and generates more than $600 million in revenue a year.

It manages insurance claims and benefits for 13 million Canadians in ways that cut costs and reduces red tape. It helps pharmacists and doctors work together so patients get medications that are covered by their insurance providers, which means fewer prescriptions go unfilled.

Looking ahead, Lepage says Canadian physicians will use EMRs to keep their patients with chronic diseases out of emergency rooms and create better outcomes.

Canadians can also use technology to stay well. Online personal health records (PHRs), which allow people to keep track of everything from blood sugar levels to the state of their mental health, will be the next step in the eHealth revolution, he says. Notably, the governments of Alberta and Saskatchewan have partnered with Telus and are trialing the use of PHRs by their citizens with the intent to deliver province-wide availability in the near future. “Citizens are ready to play a bigger role in managing their health,” says Lepage.

Telus Ventures, the venture capital arm of the company, is investing in companies that tap into that market. It is also spending capital on young firms that are working on privacy and security – issues critical to the future of eHealth and significant areas of focus for Telus Health.

The private sector has shown it has a role to play in transforming health care in Canada, says Lepage, but it is early days in the eHealth revolution.

“Solving our healthcare challenge is in part a technology conversation, but we need patients to be more proactively engaged and we need the private sector to innovate using a different mindset, one that is open to collaboration across an ecosystem, and one that implies a team approach where we accept that no individual caregiver holds the key to everything.”

Entwistle is convinced that the day will come when fax machines and photocopiers will be found in museums, not hospitals. Patients will have access to their tests and health records online. And digital systems will warn medical teams about potentially deadly allergies in ways that will be hard to overlook.

Would the medical error that led to his father’s death be less likely today than it was in 2004? That would depend on the hospital where he was being treated. Some are more advanced than others, and there is still a lot of progress to be made before Entwistle’s vision of helping address Canada’s health care crisis is a reality. In fact, the opportunity to help find solutions to the challenges facing health care in Canada is one of the reasons Entwistle returned as CEO in 2015.

Improving the efficiency, effectiveness and humanity of healthcare in Canada is the number one social challenge of our lifetime, he says. And he believes the opportunity is one that will continue to galvanize the passion and creativity of his team.

“What could be more motivating than leveraging our culture and technology to address that challenge?”


Anne McIlroy

Freelance Journalist | Globe and Mail

Anne McIlroy, a former Globe and Mail reporter, is a writer based in Ottawa. She worked for the Globe for 16 years as science reporter, parliamentary bureau chief and as a political correspondent. A graduate of Carleton University, she began her career at the Ottawa Citizen and was the Montreal correspondent for Southam News. She has reported from across the country and around the world, including assignments in Africa, the Middle East, Asia and South America.