Health Committee on Oct. 23rd, 2012

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

Okay.

Mr. Cafazzo, it's the same question on immigration. You talked about the app on the iPhone for kids who are doing their diabetes.... Do those results go into the EMR?

[Dr. Joseph Cafazzo]

We're somewhat agnostic at this, but we used some personal health record tools such as Google Health, which is now defunct. There are others, like Microsoft HealthVault, and the Canadianized version of that is TELUS health space. There are others that FedDev have invested in called the Connected Health and Wellness Project out of York University.

Y es, we believe the data cannot be orphaned. It has to be part of a personal health record that's shared with the provider. In the instances that we've used it, the endocrinologists at SickKids actually had access to that information through TELUS health space. Eventually, TELUS health space could be integrated with the EMRs, and the EHRs as well.

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

It's not there yet, but down the road it could be.

[Dr. Joseph Cafazzo]

That's right. Absolutely.

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

Mr. Girard, I'm just wondering about software companies.

Obviously, there are a lot of jurisdictions to deal with. I guess the provinces would be free to pick whatever software provider they want. Is there a software provider today that is leading the way in getting the job done for the provinces? Are there a variety of different software companies that provide this? Could you shed some light on this here?

[Roger Girard]

Unfortunately, when we're dealing with physician's offices—if we can just limit the discussion to physician's offices and the automation of physician's offices—we have three vendors in our province. We worked with the doctors to select three vendors. They tend to be vendors that are more regional. If you look at the way the industry is set up in Canada, they tend to be vendors who have regional perspectives. Very few operate Canada-wide.

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

With that comment, then, that's going to create some problems down the road when you try to connect each province. I'm not questioning the strategy because obviously we need the health records and the whole thing. This isn't the first time a country has embarked on this initiative. Are we looking at repeating some problems, or are we creating some problems that are going to occur down the road? If so, how are we going to fix them?

[Roger Girard]

We don't believe so. We believe we can handle those three different vendors. There is information sharing amongst physicians who are using different ones of these two or three vendors, and maybe across in Saskatchewan, if you're in a border community, and so on.

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

I'm from Ontario, so let's use Ontario as an example. Are there any vendors that Ontario uses that you would use as well?

[Roger Girard]

I'm not sure of the total. Ontario has a very long list. I suspect we have vendors that are on their list.

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

It could be or it could not be. Let's assume it may not be, and let's assume Quebec also uses software companies that are not the same as yours or Ontario's. What is the strategy, in a couple of years, five years down the road, for connecting all this together, so that if Jim moves to Manitoba and then moves to Quebec, it follows him through. I guess that's the initiative. That's going to be a problem, obviously.

[Roger Girard]

It's going to be a very pleasant problem to have, because the information we will have will be automated. It will already be captured electronically and I'll actually be able to send it over. Hopefully, it will make sense when you get it and it's not Greek. The Manitoba version may be Greek to Ontario. That level of standardization has not yet occurred. It's occurring slowly but surely. It would be a pleasant problem to have.

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

In Manitoba you're fairly well along here now. Obviously, we're doing this for two reasons. One reason is to have more information quicker, to provide better care. Also, you mentioned cost savings. If you're looking at a return on investment, cost savings versus costs, I wonder if you can bring us up to date on what Manitoba projects as a cost saving and also what they've spent to date on e-health records.

[Roger Girard]

I mentioned in my presentation that we spent $240 million roughly since the beginning of the year, of which roughly $67 million came from Infoway. The savings were identified by Canada Health Infoway many years ago as roughly two to one, a $10 billion cost and a $20 billion return on investment. We're still dealing with that level of investment. I could show you studies that show the savings and the efficiencies in hospitals and in doctor's offices, and so on, but that's pretty much it.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Girard.

We'll now go to Mr. Kellway.

[Matthew Kellway, NDP, Beaches—East York, ON]

Thank you, Madam Chair, and thank you to all of you today for providing such interesting and informative presentations.

Dr. Cafazzo, I want to start with you. I think it was slide—I can't really tell—2 or 3 from your presentation, which unfortunately I can't read right now, but it's about the costing.

I think what all of your presentations implied to some extent is that e-health implies patient self-care, as your presentation does, and probably a higher amount of home care for folks. There's been a lot of discussion and justification of e-health and home care on the basis of the economics of it all.

I wonder if we are accounting for the costs. I don't question that it's more economic and that there are other benefits to that in your presentation, but I wonder if we're actually accounting for the costs of home care properly. This occurs to me because I was asked to speak at a conference on respite services in Canada, and in my research into the issue I found there were enormous hours being put into health care by non-health care professionals at home, and an enormous burden with health care outcomes on the folks people rely on, depend on, for their so-called self-care or home care.

When we do the economics of home care, are we including all the right measures for this?

[Dr. Joseph Cafazzo]

I think you make a very good point. We do not really capture the informal caregiver's contribution. That family member who has decided to retire early to care for a spouse in the home—those are billions and billions of dollars of unaccounted for informal caregiving within the system. The point I want to make is that those individuals are left in the dark in terms of how to manage the care of a loved one. They don't have the information. They are left unable to coordinate care or have information about the loved one they're caring for.

I'm sure there have been studies on trying to capture that informal caregiving, but we should be leveraging that. We should be encouraging that, and we should be enabling them to do it more effectively. A lot of them have made many personal sacrifices in order to do this, and we still don't give them the basic tools in order to make themselves and their loved ones healthier and happier in the end.

[Matthew Kellway, NDP, Beaches—East York, ON]

The other issue that arose from your conversation—and I'm looking at Yvonne here and her wonderful and really heartwarming success story. I do wonder, too, what percentage of the population are Yvonnes. How many folks are in fact able, for whatever reason—social determinants, maybe their particular health issues—to participate in this e-health patient self-care?

[Dr. Joseph Cafazzo]

As it stands now, for something as serious as renal failure, it's estimated that only about 25% of patients are eligible, largely because of cognitive limitations, physical dexterity, and vision issues. Some end-stage renal disease patients have other serious comorbidities. Yvonne was young and relatively healthy otherwise. However, it has been 10 years, and the mounting evidence has shown that there is strong evidence to suggest that this is the way to go, to home hemodialysis. What's encouraging is that there are new technologies coming out that have been built specifically for the patient to operate or for an informal caregiver to operate.

You saw the image of the machine there. That was designed for a nephrology nurse to operate. They're unnecessarily complex. The marketplace has been adjusting now to create technologies. That 25% could be 50% or 75% of people being able to do dialysis effectively in the home.

[Matthew Kellway, NDP, Beaches—East York, ON]

Thank you.

Mr. Thompson, I was wondering—

[The Chair, Conservative, Joy Smith]

Sorry, Mr. Kellway, you're out of time.

[Matthew Kellway, NDP, Beaches—East York, ON]

Madam Chair, I was looking over at you this time for my signal and you were busy chatting, so—

[The Chair, Conservative, Joy Smith]

I know you were. I was just tending to business here.

Thank you very much.

Ms. Block.

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

Thank you very much, Madam Chair.

I too want to welcome you here. It's been a good discussion so far. I had the privilege of being a board member of the Saskatchewan Health Information Network 13 years ago when it was first created. It seems to me that some of the compelling reasons we had for creating...Treasury Board was to address the challenges of providing equitable health services to individuals living in both rural and remote communities, and also wanting to move from a provider-centred health system to one that does prioritize itself to the patient, as you've mentioned.

I guess seeing where we are today, seeing all of the progress we've made and hearing some of the examples that Health Canada has shared with us, what I'm wondering is, in terms of all of the partnerships that need to be developed when you're moving forward with an electronic health record.... Again, I recall having to get physicians onside, nurses onside, pharmacists onside, and developing platforms that were going to work for all of these different groups. It wasn't easy, and there was an observation that even if we had all of the financial resources in place, this was going to take time, and I think that's borne itself out.

I'm wondering if you could talk a little bit about some of the challenges you faced, and in particular address some of the issues for our first nations communities.

If anybody else wants to add something to that, I'd open it up for that.

[Kathy Langlois]

My colleague is the one who has been managing these challenges, so I'll let him speak to it.