Zayna Khayat is a Future Strategist with SE Health (formerly Saint Elizabeth Health Care), a health and social impact enterprise with a major focus on home care. An engaging, thought-provoking and riveting speaker, she is in constant demand as a keynote speaker on the digital health conference circuit. Her career includes a year-long secondment to the REshape Health Innovation Centre at Radboud University Medical Centre in Nijmegan, Netherlands, where she led several initiatives to advance health innovation in the country, and a three-year stint  leading health system innovation with MaRS Discovery District, a major innovation hub based in Toronto, where she and her team helped smooth the path to adoption of innovation by healthcare systems in Ontario and around the world. She is also adjunct faculty with the Rotman School of Management in the Health Sector Strategy stream where she teaches a health MBA course on Healthcare Innovation, has worked with large consulting firms, and has a PhD in biochemistry from the University of Toronto / Hospital for Sick Children.

You can read more about her biography hereGevity: How did you become a futurist? 

ZK: I was working in Europe when I got recruited by the CEO of SE Health. I didn’t want a role with the word “innovation” in the title, because that reflects a broad range of mandates. I had been attracted to the word “future”as core to my next job title; eventually, we landed on Future Strategist. I lead the SE Futures team. We focus on creating, testing and scaling next practices and business models … which allows us to be a bit insulated from smaller “i” innovation that can be handled more effectively in the core business.

Gevity: How do you stay on top of the avalanche of developments on a daily basis?

ZK: Because a big part of my job is to hang out in the future, I have honed a system over the last few years that lets me stay on top of global trends, shifts and developments reasonably well. I know who to follow and have a fairly efficient way to integrate the information so I can access it when I need it. I also am invited onto the podium or panels regularly, and that forces me to regularly capture and distill all the information into digestible stories. By being in the field actually “doing” innovation, I try to keep my thought leadership rooted in what matters to people and their families (versus focusing on innovations for innovation’s sake).

Gevity: Did you join SE Health because they have kind of an irresistible mission statement: to spread hope and happiness? 

ZK: The Hope & Happiness mission statement was definitely a big part of it. The other was the corporate structure of being a social enterprise. We aim to fill gaps in society using the SE Health platform. After more than 15 years as an intermediary in healthcare, I was looking to land somewhere that delivers care to patients. SE Health is focused on helping seniors live their best lives at home. The home is the future of health and care, and seniors’ health has so much unmet need and opportunity. I have also known the organization for quite a while, so I had a good sense of the culture and its long track record of living in the future. I also don’t know many leaders of healthcare that think, act and have a vision like my CEO, Shirlee Sharkey.I truly feel blessed to be part of a team creating the future of seniors’ health and care.

Gevity: November 12-18 is Digital Health Week 2018 in Canada. Have you seen any big advances in Canada over the past year that make you hopeful that we are starting to create the future instead of protecting the past, as you have described it?   

ZK: I have been encouraged by examples of patients, providers and health organizations who are starting to challenge the historical constraints of time, distance, space, labour and knowledge that have stifled innovation in this sector.We are starting to see, for example, a growing momentum of virtual clinical consultationswith services such as Dialogue from Quebec; Maple from Ontario, and Wello (from Calgary). There is also a recent new entrant from the UK, Babylon, an AI-supported virtual primary care platform used in the NHS that Telus Health recently helped bring to Canada. 

Remote monitoring is also gaining momentum: the Ontario Telemedicine Network now offers a remote care coach and home care providers such as SE Health are integrating remote monitoring into hospital-to-home bundled care pathways. 

Another development area is around data and intelligent decision-making, leveraging the vast data sets available to clinicians and health organizations. St. Michael’s Hospital, for example, has started to connect disparate data assets as part of the Li Ka Shing Centre for Healthcare Analytics Research & Training (LKS-CHART), a service- based healthcare data analytics group. I have also been encouraged to see the momentum of the Vector Institute for AI. This gets me really excited, because researchers and policy-makers have been basing decisions using data that is a mere drop in the bucket of what’s now becoming available.

Gevity: It looks like most of these services or apps have targeted the employee wellness market. Is that the case, and if so, is that because that’s the only option to be viable in Canada with our government-funded healthcare system?

ZK: Indeed, the non-formal medicine space is often where a lot of developers of solutions have to start. I remember advising health start-ups at MaRS that if they are trying to sell into the formal health system, there’s a good chance their company will go out of business given the long sales cycles vs the short runway of working capital. So they focus on getting paying customers, often in the private markets / wellness space so they can generate some cash flow (to keep the venture alive), and also to generate a lot of learnings. It’s classic innovating on the fringe, and then coming in closer to the core formal healthcare sector. Armed with data, results and a stronger team and company, you can then try to get adoption in the formal healthcare system.

Gevity: Why do you think Canada is still so far behind other developed countries in digital healthcare?

ZK:  I think it is mostly a mindset issue. We have a lot of history, entrenched interests and unshakeable ideas when it comes to healthcare. For example, we —shockingly – still don’t have seamless access to virtualclinical consultations; on the one hand, there is not a strong will to make it happen; on the other, there isn’t a demanding, frustrated-enough population clamouring for it.

Gevity: How are physicians reacting to this? Are new physicians being trained to work in a digital system? 

ZK: I’m not one to single out docs as a group that needs “training” on digital. I think they are on a similar adoption curve of leaders and laggards like the other actors in the ecosystem, including patients/families, nurses, therapists, pharmacists, payers, regulators, academia, industry and more. The macro situation is that the old world in which doctors were the dominant gatekeeper of the fair share of decisions about diagnostic tests, prescriptions and diagnoses is starting to be disintermediated, decentralized, and ultimately, democratized. There is a growing new set of problem-solvers and tools available to help people and their families make choices about how to cope and self-manage, and this groundswell will be the tipping point to a more seamless physical-digital experience of health and care.

Gevity: Should there be less focus on a nationally interoperable EHR in view of the capabilities patients will have to be able to assemble a very detailed view of their own health using emerging technologies that will soon be much cheaper, easier to use and more widely available? 

ZK: I don’t really have a point of view on whether a nationally interoperable EHR should or shouldn’t happen; what I do know is that digitizing analogue assets and information is a vital first step on the journey to modernizing healthcare. My caution is if we put all our eggs in the EHR+interoperability basket and we have perfectly digitized and interoperable medical records based on the data that currently goes into the record, we are going to miss the boat, since most of where health data (and health in general) will be created is extracellular to formal health systems. The implication is that formal health delivery organizations that are the custodians of a limited set of data are going to need to get savvy fast on connecting to other forms of patient-generated data if they want to continue to be relevant in delivering services that people and families need, want and expect, at the right time, at the right place, at the right price. In essence, if you do not have strong data capabilities as a health organization, it will be challenging to deliver relevant, timely and cost-effective services for a population that is generating most of its health data outside of your institution.

Gevity: How does a publicly funded healthcare system fit into this scenario when you have all these new players seemingly sidestepping it? Are we creating a two-tiered system?

ZK: As patients start to become more frustrated with long waits or poor service in traditional healthcare, we can see how they might choose to pay out of pocket for third-party services that offer a “good enough” value proposition that is convenient, easy and affordable. Will it be at a scale and delta in quality that generates two tiers? I don’t see that from my vantage point. If anything, I see publicly funded formal healthcare systems as vital given they have the levers to accelerate widespread adoption, at a scale that exceeds anything that might happen in the private markets. The state also ensures healthcare services are available to a whole range of people who otherwise might not be able to access them in private markets. A functioning society depends on the public health system getting this right. And, let’s remember, there are many important healthcare services that Canadians have had to figure out how to access on their own, with either no funding, partial funding or very long wait times when accessed via the public pot – mental health services, dentistry, medicines, vision care, long-term care and allied healthcare.

Gevity: One of the big shifts that seems to be happening is that while there are certainly many people who want to take a bigger role in their own healthcare and wellbeing, there is also going to have to be a big educational component to shift the way people have traditionally thought – they put their health in the hands of their doctor and the healthcare system and it is a very passive experience. Do you think that will evolve naturally or will there have to be a big push to make that shift happen?

ZK: My sense is there is a role for awareness at the level of the mass market. Canada Health Infoway has been doing some of that campaigning.  However, I think the natural market evolution of patient/family pull will get us there. We are already so much more savvy about disintermediating long-held gatekeepers of knowledge in a number of industries – lawyers, real estate agents, investors, travel agents, marketing firms, music/book/film producers, car dealerships, mass retailers, funeral agencies, etc. These new patterns of consumer-led decision-making and production are emerging in managing one’s health and wellness, irrespective of large-scale education campaigns. Look at LifeLabs – without a big advertising blitz, more than 1 million Canadians have accessed their own lab results within a year of making those results available online. Similarly, Toronto’s University Health Network has experienced high numbers of patients accessing their records on a personal patient portal.

Gevity: One of the issues Canada Health Infoway has identified as slowing the pace of digital health in Canada is the model of conducting pilot projects that are difficult to scale up. Do you agree with that assessment, and if so, what are some potential solutions?

ZK: Pilots in of themselves are not wrong, nor the problem. The problem is starting a pilot that is not designed with the intention to scale after proving (or disproving/refining) your assumptions. No company would go to product testing and then act surprised afterwards if it was successful. Yet we do this all the time in healthcare. If pilots were only done when there was explicit intent and machinery for widescale spread, I think that more than half of funded pilots would never have gotten off the ground. The issue is that we treat the pilot as the end game. You simply shouldn’t start a pilot if it isn’t part of a broader roadmap. If we fixed this, I don’t think pilots would get such a bad rap because the things we do pilot would be done with intentionality around spread and scale.

Gevity: Another issue that has been identified as slowing the pace of modernization is that Canada has been reluctant to embrace the policy and regulatory changes needed to really advance in ways other countries have, such as the Netherlands. You’ve mentioned a few examples of health system funding reform and outcomes-based funding in Ontario as positive steps but are there any big provincial or federal policy changes you think we should make that would help us really move forward in a more substantial way? Do you see the will to make those happen? Also, are governments really looking far enough down the road to be able to plan ahead with enough vision to adapt to what is coming? 

ZK: A key lesson I learned from my year in the Netherlands was the value of governments and large organizations that set a bold vision with hard targets for what they want to achieve. In the Netherlands, they were just as behind as we are on digital, but they set a BHAG (big, hairy, audacious goal) that, in five years, 80 per cent of citizens with a chronic illness will have access to their digital medical health record, will have seamless access to remote monitoring and will be able to consult with a clinician in whatever modality they choose. They set a bold target based on evidence – and then they took the role of helping get the system barriers out of the way.

Gevity: One of your messages is that change is coming, like it or not, and you can’t quality improve your way out of what patients expect. How have other jurisdictions that have embraced digital health more extensively been able to bring along those who feel most threatened by these changes?

ZK: I take a lot of inspiration from places like Kaiser Permanente in the US, the Netherlands and the UK.  The way to manage through the change and deal with resistance and entrenched producer interests is to lead with the value proposition to patients, health professionals and the system. Doing what is right and necessary for patients is the big equalizer.

Gevity: You have your finger on the pulse of the most interesting developments in digital health globally. What are the most exciting initiatives you’ve seen to date?

ZK: I have been intrigued lately by the use of voice recognition as a digital biomarker to predict exacerbations or disease using AI/predictalytics. I also get excited about services that provide patients and families with more choice and greater control over things like scheduling, email/text/voice consultations, and data sharing. Finally, innovative business models are emerging as we shift from fee-for-service to fee-for-health, which will make things really interesting in this era of severe fiscal restraint despite escalating demand for services.

Gevity: Do you use any digital heath apps or services yourself and if so, what have been the benefits?

ZK: I’m generally healthy so I mainly use well-being tools such as my Apple watch / Apple health platform, myfitnesspal (for tracking food and exercise), and my Muse meditation wearable for mindfulness practice. For the odd urgent care needs, I keep credit in my virtual doc account at Maple; as the mom of three kids, I use it for unanticipated health issues such as a sore throat on a Friday night. I also use if need to locate services at odd hours.