Health Committee on March 11th, 2008

[The Chair, Conservative, Joy Smith]

Thank you so much.

Now we'll go to Mr. Keddy.

[Gerald Keddy, Conservative, South Shore—St. Margaret's, NS]

Thank you, Madam Chair.

Welcome to the witnesses.

This is not usually the committee I sit on, so I'm finding this discussion quite interesting and a little alarming.

There's the whole discussion on informed decision-making. If you don't have a process that's entirely transparent and you don't have that risk versus benefit list, how can you make informed decisions? I guess that's more of a rhetorical statement than anything else, but it's very difficult. I don't know how you do that.

The other thing I'm quite shocked about is the electronic health records. I listened to my colleagues talk about doctors' handwriting, which is an old joke, but they're not alone. Most people have illegible handwriting today. There's hardly a kid in school who can write so you can read it, but everyone can use a keyboard.

I think we've looked in the wrong area. We've been blaming the doctors when we should be giving them more assistance in filling out the electronic records. They're busy; they're trying to see as many patients as they can in a day. Frankly, there's no reason why a doctor shouldn't be able to tell their assistant to fill out a prescription for the pharmacy so that it comes to you in typed format.

I don't understand why we don't have a complete electronic record in this day and age, especially at the hospital level. It just doesn't make any sense. It would be easy to do. You wouldn't even need a patient's sheet to write on. You would have a keyboard instead. It would come up on the screen and automatically go out to everybody.

I don't know how many drugs are allowed into Canada and registered every year, but I assume there are hundreds of them.

[Diane Brideau-Laughlin]

There are 23,000 medications.

[Gerald Keddy, Conservative, South Shore—St. Margaret's, NS]

There are 23,000, so no one person can keep all those drugs in their head, nor can they know what the adverse effects of one drug are on the other 22,999. If you have a patient with multiple drugs in their system for various issues, without an electronic database how do you do that?

[Diane Brideau-Laughlin]

I think we're all in agreement on that.

[Gerald Keddy, Conservative, South Shore—St. Margaret's, NS]

I don't know if that's a question or a statement, but I marvel that it's not there already.

[Diane Brideau-Laughlin]

I think we all agree with that. With the difficulties that have been encountered in the hospital setting, the electronic record is definitely where we need to go. How easy is it to implement? In a small hospital like ours, we have 3,000 staff people. Of those 3,000, probably 1,500 need to be able to use this system, and the system has to be readily accessible to them at the moment they need it. We don't educate our staff in that world, so that is part of the problem. It's part of the challenge, and it needs to be addressed very early in the training.

You also have a lot of dinosaurs who've been out for a long time--

[A voice]

Be careful where you look.

[Some hon. members]

Oh, oh!

[The Chair, Conservative, Joy Smith]

Order.

[Diane Brideau-Laughlin]

Thirteen years ago I absolutely would not have turned on a computer; I would not have been able to turn on a computer. Now my question to myself every day is, “How did I ever work without it?” You need to evolve into it.

When you're teaching clinicians to be clinicians, you're not teaching them to be IT people. It's not part of the role, so that needs to be incorporated. It needs to be part and parcel. In some way they need to almost be mandated to do that. Institutions start doing that and then the learning curve comes into place. That's where you have a lot of resistance.

[Gerald Keddy, Conservative, South Shore—St. Margaret's, NS]

It's not mandated in any way, shape, or form. So we have 23,000 drugs being listed every year in Canada for use, and there's a very difficult.... I don't think we can just simply put it back on the shoulders of the physicians. I think we all have to take a little responsibility here.

[Dr. Yola Moride]

In Quebec there has been a very strong movement toward what we call integrated care or chronic disease management, where the patient not only navigates through a fragmented health care system but through a team. In order for that team to be functional, everything needs to be electronic, because it's going to include the physician, the case manager, nurses, pharmacists, etc. By definition, as a consequence of that, what you're suggesting will be implemented.

You're right that we're not there yet. We're just starting to implement it.

[Gerald Keddy, Conservative, South Shore—St. Margaret's, NS]

The other issue that was being discussed here is the whole after-market question. You have a drug that's put on the market, now it's being prescribed to more people, and all of a sudden we're finding...you know, the Vioxx story, or others. The only way, I would suggest, to follow that in any realistic manner in real time would be to have electronic monitoring. So all of a sudden you'd start flagging this issue. It's coming up, and it has happened a dozen times, instead of 12,000 or 50,000 times.

That's all.

[Dr. William Hryniuk]

I'll respond to something you said.

I think the practical solution to the 23,000 drugs problem is one that I encountered when I was practising in Detroit, at the cancer centre there. The pharmacist was in the clinic with us, and he or she had access to the electronic database. At about every second patient, we would have to interact as a team to make sure the drugs were the right drugs--and not just the cancer drugs, but all of the other drugs. So there are practical solutions to that.

To answer Mr. Fletcher's question about having just been released from the park because I've promised to use electronic systems, the synoptic reporting system that is being introduced in a wide variety of clinical circumstances will greatly simplify that. You just tick off the boxes, and the questions are arranged in a way that you can't escape giving the right answer. That system actually works quite well.

[The Chair, Conservative, Joy Smith]

I want to thank you very much. We've come to the conclusion of the questions the committee wanted to ask today.

I really want to thank each and every one of you for having come here today and given your expertise and your advice. This is a very important study, and a lot of your information has been very insightful and very useful to all of us. So I certainly want to thank you for that and wish you well. I look forward to hearing more from you in the future, I'm sure, on other topics as well.

For the committee, there is another committee coming in, so we are going to be adjourning very shortly.

Next committee, Thursday, we have just a small group of witnesses coming in, and we will also be doing committee business at that time.

Thank you, ladies and gentlemen.

The meeting is adjourned.