Health Committee on Nov. 22nd, 2012

[The Vice-Chair, NDP, Libby Davies]

Thank you.

Just to let the witnesses know, we have a little less than four minutes for all of you to reply, so you'll have to keep your responses short.

We'll begin with Madame Prémont and then Mr. Smith-Windsor.

[Marie-Claude Prémont]

So I have two minutes.

You correctly identified the issue around the number of doctors. The problem is felt across the country; everyone points to the doctor shortage, arguing that more doctors would solve all the problems. When you look at the figures, it becomes clear that the issue is more complicated. Indeed, as you pointed out, despite the fact that Quebec has more doctors per capita, residents have less access to family doctors. That means that other variables are at work in a major way.

I would say there are two main variables. The first has to do with how the system is organized, meaning the distribution of doctors throughout the province. Different provinces have introduced policies governing that aspect. Quebec, for one, tried and continues to try to force, to some extent, doctors to provide follow-up care to patients, to treat them on an ongoing basis, especially through the introduction of family medicine groups. The results, however, are not yet compelling. So research is needed.

The other variable has to do with the great compromise Saskatoon made in terms of doctors' compensation. In Canada, we have a model where doctors are paid per act. The model has its benefits, but its drawbacks as well. We can't tell a doctor what to do exactly.

[The Vice-Chair, NDP, Libby Davies]

I'm very sorry to cut you off, but I want to give Mr. Smith-Windsor an opportunity to respond as well.

You have about a minute and a half.

[Kent Smith-Windsor]

Well, concerning rationalization, and this really is where innovation comes from, one of the people who serve on our committee is the CEO of MD Ambulance, in Saskatoon. They conceived, developed, and executed a concept called a “health bus”. This is basically a radically modified, very large mobile home, which travels through the inner city of Saskatoon to deliver health care services directly.

This did not come from the health region. It came from an individual provider who has contracted services with the health region. It was through their constant quest for finding the means to deliver services that they developed this innovation. It has received six national awards. It is being constantly investigated by others as to its potential for implementation.

Another area of activity that we can be particularly proud of is the implementation of Lean management principles within our health care region. We had a very early example of this, which related to lab practices at one of our laboratories. It dramatically improved turnaround time, cost of delivery, accuracy of service, and it freed up space in the health care system. That is now being applied across the province.

[The Vice-Chair, NDP, Libby Davies]

Mr. Smith, I'm sorry. I am going to have to ask you to end. We're now at a quarter to one, and we still have some other questioners to get in.

My apologies for interrupting you.

[Kent Smith-Windsor]

That's just fine.

[The Vice-Chair, NDP, Libby Davies]

If you have other information that you'd like to send in, please do. You can send it in writing and we'll distribute it to the committee. That would be great.

We'll now go to Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thanks, Madam Chair.

My first question is for Mr. Potter.

You introduced a program at the Ottawa Hospital where every doctor and nurse gets an iPad. Obviously, this is a good innovation. Why do you think it's slow in being taken up by the industry?

[Dale Potter]

That's a good question.

The precursor or catalyst for introducing mobile technology was my observation that the introduction of technology had disrupted the natural flow of care. Care was primarily at the bedside or other care delivery sites, which don't necessarily have a PC.

The other thing it did was that it limited the amount of engagement between the patient and the physician. Imagine a discussion at the bedside where a physician is talking about lab results and progress toward better health, and the patient asks how it compares with his condition three months ago. The physician would have to leave the room, do an inquiry, and come back.

So it has radically changed, first, the provider effectiveness. We've branded it back to the bedside. Every physician is required to see every patient every day. We weren't able to impose that before.

The second thing is that it's increased the level of engagement of patients, simply by being able to show an image and say, “Here's where your problem is, Mrs. Smith”, and then engaging in a discussion with all the information at hand.

[Colin Carrie, Conservative, Oshawa, ON]

Excellent.

How is my time?

[The Vice-Chair, NDP, Libby Davies]

You have five minutes.

[Colin Carrie, Conservative, Oshawa, ON]

Okay. I have another quick question for Ms. Webb.

I loved hearing about Rosie, the telerobotics, and things along those lines. I think we will be looking at simulators here at the committee. I was wondering how the Government of Canada investments in e-health benefited health service delivery in isolated communities like Nain.

[Margaret Webb]

Thank you for actually listening to what I had to say. I really appreciate it.

E-health services haven't been used as much as we could have. In northern and isolated communities right now, recruitment and retention of nursing staff is a big issue. When we're able to have people at the community level, a lot of what is happening is emergent hands-on care. The availability of that e-health is there, and is wonderful when you have the time to do it.

For us, Rosie and systems like Rosie will be what will keep staff there with us, working hand in hand. We're finding that the younger generation, who are very interested in electronics and all that it comes with it, are also not necessarily interested in being out in northern and isolated communities.

All of these things are part and parcel of what we need to do our work better—e-health, electronics, robotics—but we have to find methods that will keep staff out there at the community level. We see this as something that will be useful.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much.

I think Mrs. Block had some questions.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Very quickly, I want to give a little bit more time to Mr. Smith-Windsor to continue sharing with us some of the good examples, the positive examples, that he had begun to share with us in response to another question.

Mr. Smith-Windsor, perhaps you wouldn't mind continuing on in that vein.

[Kent Smith-Windsor]

I just was completing an example within one of the early beta tests within the Saskatoon health region to apply Lean principles, which was applied to a given lab relating to in-surgery testing, where there were dramatic improvements in performance; significant improvements in turnaround times; significant improvements in accuracy; and more interestingly, a freeing up of 1,000 square feet in the lab space.

This is very incremental in nature, but it's indeed transformational, because it engages front-line staff in identifying things that will save steps and improve customer focus.

One of the individuals who is participating as a volunteer on our committee happens to be serving on the health region. As they have broadened their implementation of Lean principles in Saskatoon over the last 18 months or so, they have been able to reduce components of their surgical wait list from 24 months in 2010 to an objective of three months in 2013. They are on track to achieve that objective. There are eight innovation sites occurring within the health care system in Saskatoon. They have a target relating to implementing Lean principles to their emergency room wait procedures through 2013.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Thank you.

[The Vice-Chair, NDP, Libby Davies]

There is actually a minute left. I misread the clock. Sorry.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Oh, okay.

I think it's interesting that chambers of commerce are stepping up and having these conversations around how to address innovation in the health care system and how we can foster innovation and also drive the economy. Could you give a quick comment on any examples from Saskatchewan where you are turning your attention towards drivers in the economy and health care?

[Kent Smith-Windsor]

Actually, as I had indicated, it's occurring at the grassroots level—everything from Prairie Plant Systems, that's dealing with the medical use of marijuana. It started out as a drug research activity in terms of using minds in northern Manitoba for the application of pure plant genetic training that became applicable, in this case, to marijuana. A local company by the name of Phenomenome Discoveries has been using metabolomics for early tracking of cancer treatment and some potential markers relating to Alzheimer's.

We have a local firm of two people that is using RFID tracking to potentially free Alzheimer's-stricken patients to be able to walk freely within their treatment centre so that the staff team can continue to track where they might be residing or moving through the centre. These are very grassroots people—

[The Vice-Chair, NDP, Libby Davies]

Mr. Smith, thank you very much for the examples. Again, I'm sorry to have to interrupt. We'll move on to our final question now, but if you do have other examples, please send them to us.

Mr. Hsu, welcome to the committee.

[Ted Hsu, Liberal, Kingston and the Islands, ON]

Thank you.

I think innovation and improving productivity are challenges across all the sectors of our economy, but different sectors have different challenges. Health care—just thinking about the hospital back in my riding of Kingston and the Islands—is a little bit special because, first of all, it's publicly run. The bottom line is not in dollars. Back home in Kingston, the hospital is also a research hospital. It's also a teaching hospital. So there are a lot of constraints.

To Mr. Potter, considering these constraints and considering the fact that the adoption of new technologies and innovation in health care has proceeded at a different pace, I would say, compared to certain other sectors of the economy in the private sector, I was wondering if you had compared some of the different challenges between the health care sector and other sectors of the economy.

Are there places where you think the health care sector can do better than it has in comparison with the private sector? Or are there just certain challenges where we have to be patient because it's a different kind of bottom line and a different kind of environment?

[Dale Potter]

Thank you for the question.

I'll start answering the question by finishing answering the prior question I had, which was around the reason for slow adoption given all the good benefits we've seen around mobility. It seems in health care there's a high degree of skepticism, a high degree of risk-averse behaviours, which would be appropriate in a health care setting, although for things like increasing access to information and other things, through mobility or other technologies, I don't think we can do worse than we're doing now, when much of our information is on paper.

An approach that has been persistent in health care for some time is we identify a problem and we try to adapt the technology to meet that problem, and then we move on to the next problem. So what we've done is we've created a number of good solutions, but they address micro-problems.

My suggestion in my briefing note is to elevate our view of the problems in health care to a higher level so that we can look at integration across the entire health system, from health promotion through to long-term care and the acute—

[The Vice-Chair, NDP, Libby Davies]

Mr. Potter, if I could just interrupt for a minute, the bells are ringing again—it's one of those days—so we have another vote. I assume it's a half-hour bell.

Is the committee okay that we just continue until a couple of minutes after one o'clock to hear this final round of questioning?

Is everybody all right with that?

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

Just until one o'clock.