Health Committee on Dec. 6th, 2012

[Gail Turner]

Probably the most important thing for us is health equity. If you look at a map of Canada and you look at an Inuit travel map, most of the care that's beyond primary for Inuit of Canada is done somewhere else. It's in another province of Canada. It costs a lot of money in terms of dollars spent, but on the human side, one always has to travel for medical care. Inuit embrace technology that allows them to stay in their home community and have a physician consult without having to leave. The other piece, which you didn't see clearly, was the ability for the support staff in Nain to also be present. They're learning along with the consult and increasing their level of confidence in their nursing knowledge. Also, if necessary, it would be good to have an interpreter with the client so you could have the care translated into Inuktitut if necessary. The people love it. They love any opportunity not to have to travel for medical care.

[Colin Carrie, Conservative, Oshawa, ON]

What you're doing is wonderful.

You mentioned that you are in control of the non-insured health benefits yourselves. I wonder, kind of going along with Ms. Davies, have you had access to any federal grants that have helped to possibly impact the community of Nain and the challenges people face, being so rural? Do you know offhand?

[Gail Turner]

That's a difficult question to answer because Nain is part of the new land claim. The funding for health care delivery comes through a five-year fiscal finance agreement between the province and the federal government, which would include the non-insured health benefit system as part of that. We are also citizens of the province of Newfoundland and Labrador and, as such, we also gain from the provincial health system, which subsidizes some of the medical travel. It's a bit of a complex financial environment in which the health care is being delivered, and a bit of a jurisdictional quagmire, but it works.

[Colin Carrie, Conservative, Oshawa, ON]

I think we're all aware of that.

Madam Chair, I'll pass it over to you.

[The Chair, Conservative, Joy Smith]

Thank you for offering to share your time with me. We're watching our time carefully. We each have seven minutes.

We're very interested in listening to this, Dr. Mendez.

Dr. Mendez, as you know, Leona Aglukkaq, the federal health minister, is from the north. She has repeatedly talked about the isolation and the lack of equitable care. All of us around this table are trying to improve that, so it was very exciting this morning to see what you have done.

In the health care in remote areas in Nunavut and in the most remote places, how many robots would you need to provide service for the people? What we saw this morning was excellent, but to provide service to other communities, what would you say is actually needed? Are you familiar enough with the terrain and the area to be able to comment on that?

[Dr. Ivar Mendez]

Yes, as I said before, we have a lot of experience in this. The really interesting thing is that one of the portable systems I showed you, that works with cellular phone connectivity, can be bought by saving two trips on a plane. For example, the robot in Halifax that we sent to Sydney in Cape Breton paid for itself within two months because of the number of trips by air transportation that were saved. These systems allow us to provide more effective clinical care in a cost-efficient manner.

One of the really interesting things—and Dr. Jong and Gail can tell you as well—is about the lion's share of the health costs in the north. This is a very interesting statistic: Nunavut has the highest per capita health expenditure in the whole world; nowhere in the world compares to Nunavut. However, the indicators of health are not good because the model relies hugely on transportation. If an electrocardiogram is needed, the patient, plus an accompanying individual, would need to fly to a centre where they can see the cardiologist, and they could stay there for a week. This will be able to cut those expenditures, which can then be used to do what's necessary, such as to take care of the people who have the lowest indicators.

One of the biggest applications is going to be mental health. What we can do, for example, is we can send the psychiatrist in a box with a nurse to the home of a teenager who needs mental health care, so teenagers don't kill themselves at the age of 12 or 13.

[The Chair, Conservative, Joy Smith]

Well, this is absolutely amazing. You people have been so helpful to this committee, to give us these kinds of insights. I thank you for that.

My time is just about up. Mr. Easter, I'll go to you and give you 30 seconds of my time.

[Wayne Easter, Liberal, Malpeque, PE]

Thank you, Madam Chair.

I'd like to thank you folks for a really impressive presentation, which I think outlines the possibilities with new technologies when combined with health care.

I remember that around 1997 or 1998, when Allan Rock was Minister of Health, in Ottawa they did an ultrasound on a woman in Iqaluit in about an hour. I was impressed by that, but this is light years ahead of that.

This question is for either doctor, or perhaps Gail. My wife is a nurse. One of the things I really believe in terms of patient care is that stress is a huge factor in terms of whether or not you get well. I expect this system for isolated communities would be unbelievably helpful in terms of reducing stress.

Would you like to expand on that?

[Gail Turner]

There's no question about that. We've already seen the positive impacts in the retention of the nurses in Nain. It's created a whole different working environment for them. They now feel that they have a physician beside them. It's technological, but they do feel that presence. It really has made a big difference in how they work.

For the community as well, there's new confidence now that should something happen, which it sometimes does in Nain, the response will be immediate with a physician from Goose Bay through Rosie. There's that piece as well.

It's hard to put in words how the community feels. It's wonderful.

[Dr. Michael Jong]

I'd like to add that to me, the nurses in Nain and all those remote communities are like angels out there. I personally feel very rewarded by what they express when they save a life. They're so proud, and I'm so proud of them.

There was nothing like that before, and now it's possible to do that. It's almost like a sin not to have it happen.

[Wayne Easter, Liberal, Malpeque, PE]

What has to be done from a federal and provincial perspective to expand the continued investment in this kind of technology? Number one, you certainly have a base number of robots at the moment, Rosies, as you call them, but what has to be done to ensure that we continue to make progress in this area from a federal-provincial perspective? Is it just money? Is it regulations? Is it coordination?

What will get us from A to Z to see that other communities have this kind of capability?

[Dr. Ivar Mendez]

Maybe I'll start, and then Dr. Jong can continue.

The barriers to implementation of this technology are not technological barriers. The barriers have to do with such issues as jurisdiction, remuneration, competing interests, and a lack of policies that would allow the use of this technology for the future.

One thing I can tell you is that this technology is unstoppable. It is actually going to happen whether we want it to or not. In Canada we are at the leading edge, and we can be leaders in the world.

The other thing that will happen is that although the technology may be used first in remote communities, it will impact on mainstream delivery of health care. We have a centralized health care system, which is a bottleneck. If you have a problem, you have to go to the hospital, get all the tests done in the hospital, and see your doctor. Everybody comes to a centralized location. This technology will allow us to do point-of-care diagnosis and management.

We're behind the banking industry and the airline industry. The banks now charge you for doing all your work in terms of your account.

This is what's going to happen, and I think we have a tremendous opportunity to do that here in Canada.

Michael.

[Dr. Michael Jong]

Yes. For the remote communities I think right now for, say, Nunavut, it's to be able to get this broadband access. You need to get that technology.

A second point is that we need to train people to use it. The application is fine, but people need to know how to use it.

[Wayne Easter, Liberal, Malpeque, PE]

Some around the table might say I live in a remote community, but I live in Prince Edward Island and for us when it comes to health care, we are always sending people either to Halifax or to Saint John, so it is a problem. They're always sent out by medevac. There may be possibilities there.

I do want to make a point regarding what you said, Dr. Mendez. Last weekend I was in Austin, Texas, to attend a meeting where the big issue was health care in the United States. While a lot of the discussion was on the fiscal cliff and the deficit and so on, one of the higher-ups in the treasury department said that he had been at the OECD. He was talking about the huge cost to the American health care system as compared to anywhere else in the world. He put it this way. He said that when he had to go to a doctor when he was in France—he was there for 10 years—he saw a secretary or an administrator and the doctor. When he came back to the United States, when he made an appointment to see the doctor, he saw four people first. The doctor recommended he have an MRI and an X-ray. Part of the problem in the United States is that the doctor owned the equipment, so there was a charge for the MRI and the X-ray whether he needed them or not, and he felt he didn't.

Madam Chair, I raise that point because I think that's one thing we have to keep in mind—

[The Chair, Conservative, Joy Smith]

Mr. Easter, I have to stop you now because you're way over time. Unfortunately we can't hear the answer right now, but you certainly contribute—

[Wayne Easter, Liberal, Malpeque, PE]

Even with your 30 seconds.

[The Chair, Conservative, Joy Smith]

Even with my 30 seconds, and you contributed in a major way at this committee. Thank you.

We have to go now to sharing time between Mr. Strahl and Mr. Lobb.

Mr. Strahl.

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

Thank you, Madam Chair.

First, I know Mr. Lobb was very excited for this meeting. He misheard that Eva Mendes was coming today, and not....

[Some hon. members]

Oh, oh!

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

Mr. Easter asked some of the questions I was going to ask about the technology.

Obviously if you're able to connect via cellphone from here, there isn't a high level of sophistication required, just a significant connection. I assume either a land line or a satellite phone or anything could work there.

As well, and you touched on it briefly, I was wondering how it worked for a doctor who is stationed in Halifax to perform a procedure in Nunavut? Does the doctor have to be licensed in each jurisdiction? Does the Government of Nunavut pay the bill? How does that work? Maybe you could explain some of the challenges that come with being located in one place and performing your procedures remotely in another.

[Dr. Ivar Mendez]

Those are the potential barriers in the future, issues that have to do with medical legal issues. For example, if you are in Halifax and you are taking care of a patient in Toronto, who is responsible? Is it you or someone else? Of course there is also the issue of remuneration.

However, there has been a lot of work done already in telemedicine, which has paved the way for this next stage, which is remote presence in medicine. Those barriers will be worked out over time.

When I said that technology is unstoppable, I was talking about the idea that 20 years ago you had to go to a bank and stand in line if you wanted to take out $10. All the issues that have to do, for example, with encryption and security have already been worked out. People, believe it or not, are more concerned about their bank account than they are about their health. They are willing to put in their data in terms of managing their account. The regulations will come together. Technology is obviously so helpful that as it advances, all these regulatory issues will have to accommodate this technology. That's what will happen in the future.

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

Right.

I know we talked a lot here about remote communities, but obviously you were dealing in a hospital in Halifax when you did your demonstration for us. Does this also have the potential to address specialist shortages? You're just in your office and you can be in six hospitals in Halifax as opposed to running around. In the future, will every hospital have a Rosie or a Rosie Two in it because it's so much more practical than getting to a specialist? Certainly delivery services in British Columbia, where I'm from, are regionalized. Not every hospital has the same service, so perhaps—

[Dr. Ivar Mendez]

That's exactly what it is. There are no neurosurgeons on Prince Edward Island. If you have a brain tumour, you have to go to Halifax.

A robot that would be able to access a specialist in real time, wherever they are, should be in that emergency room in Prince Edward Island. I think that is the key issue. The issue is timely access to health care. There are only a number of specialists. That will allow us to manage our resources better. Specifically, it will allow us to provide that access to the individual who needs that access at a specific time. That is what's going to happen: a robot will go to P.E.I. pretty soon.

[The Chair, Conservative, Joy Smith]

Mr. Lobb.

[Ben Lobb, Conservative, Huron—Bruce, ON]

What do I have left, about five seconds?