Health Committee on Oct. 23rd, 2012

[Ernie Dal Grande]

We have spent an enormous amount of time together with health professionals and with first nations leadership just discussing the concept of e-health and telemedicine in many of those sessions. I think we're at a tipping point now where people actually understand the benefit: our health colleagues were resisting change—and change is not an easy thing—so it was not only with first nations, but internally within the federal bureaucracy. Our own program people who are busy did not embrace the concept of technology, but that attitude has changed.

That was probably the number one challenge, the capacity to understand what e-health was. It's a complex term. We throw around different terms all the time: m-health, mobile health. It keeps changing. The technology keeps advancing, so it's hard to keep up sometimes with leadership. But I think first nations health managers have taken the leadership on this and are not asking, why e-health, but when e-health.

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

Okay, good.

Anyone else?

Are there other technologies that can be used in the future to make health care in first nations communities better and more effective?

[Ernie Dal Grande]

I think what we're seeing in the area of telehealth, which has been where we've invested most of our resources over the last 10 years...we constantly see change in that area to more mobile technologies now: the use of iPads, tablets, iPhones, etc. The technology is getting easier to use from a remote. Tele-ultrasound—where before you might need a technician there—can be manipulated from a distance. We're piloting that in a B.C. first nations community right now, monitoring ECG from a distance.

I think there's such a broad range of technology that could impact the communities. The real challenge is getting the health professionals to decide which one and where's the best cost benefit.

We're just completing an e-health evaluation in first nations, the first comprehensive evaluation at the community level. It's being conducted by the University of British Columbia and Calgary. That report will be due in February. I think we'll get a really good idea of what's going on and where communities want to go, so I'm pretty excited about that.

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

Thank you.

[The Chair, Conservative, Joy Smith]

You have about 45 seconds, Ms. Block, if you want it.

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

I guess I would follow that up with a question. Just in terms of the community members and individuals who do end up accessing health care through e-health services, is there a downside for them to accessing health services through telehealth instead of having that personal contact, that face-to-face contact with someone?

[Ernie Dal Grande]

I think that's exactly it. In most cases where you have, for example, a physician who flies into a community, has a relationship, and then leaves the community and actually uses telehealth, I think the building of that personal touch with community members has been vital and important, and it has brought the health professionals together.

[The Chair, Conservative, Joy Smith]

Thank you very much.

We'll now go to Mr. Lizon.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you very much, Madam Chair.

Thanks to all the witnesses for coming here today.

The first question I have is for Dr. Cafazzo, to continue with the amazing story of Yvonne, who does this self-dialysis. You've already mentioned that this procedure is available to about 25% of patients.

[Dr. Joseph Cafazzo]

Up to 25%.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Up to 25%.

Now, as for the machine itself, is it designed for a specific case or is it standardized?

[Dr. Joseph Cafazzo]

No. In the cases of the home hemodialysis programs that you see now, they are conventional machines. As you perhaps can see in one of the photographs, they're designed for a 5'4'' nurse standing in front of the machine to operate it, so initially the patients had quite a lot of difficulty with operating the machine from their bedsides. A lot of them do it overnight—nocturnally.

So yes, these machines are conventional machines that were designed for hospital settings. Only recently have a few companies been addressing this directly and creating machines that can be operated from the bedside and that have been greatly simplified for patients and informal caregivers to operate.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Who does the maintenance? Someone has to maintain the machines.

[Dr. Joseph Cafazzo]

It's still based out of the hospital setting or the clinics, so the training is done by nephrology nurses. It usually takes six to eight weeks to train a patient on how to perform home hemodialysis. The maintenance and the supplies are all done through the hospital or clinic.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

So basically this is a hospital machine.

[Dr. Joseph Cafazzo]

Yes.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

It's owned by the hospital.

[Dr. Joseph Cafazzo]

Yes.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Are there any other treatments planned in the future? For example, can a patient be trained to have an infusion pump or other things at home?

[Dr. Joseph Cafazzo]

Well, the point I want to make is that I can't actually think of a form of self-care that is more exceptional than home hemodialysis, other than performing surgery on yourself.

[Voices]

Oh, oh!

[Dr. Joseph Cafazzo]

If patients are able to do something as invasive as home hemodialysis, imagine just managing blood sugars or blood pressure.

The point I was trying to make is that patients have this immense capacity if the circumstances are right. Again, these patients are not unique. There are thousands of patients who are doing this around the world now. I think that's just an indication of what's possible—again, if the circumstances are right.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you.

My second question would be for Mr. Girard. While it's very good to hear that there is a system that works in one province, can you share your opinion with us? My home province of Ontario does not have a lot that the province of Manitoba has in the system. Is it possible for provinces to get together and, instead of reinventing the wheel, get one system in place and work on it?

[Roger Girard]

Would it be possible? Anything's possible, but it's very unlikely in the system we have. There is the question that one size does not fit all. A solution for Manitoba doesn't always fit in Ontario, because Ontario is ten times its size.

I would encourage you in Ontario to look a little closer at.... Ontario may have had difficulties, but it has also had some tremendous successes. A short while ago, Mr. Dal Grande mentioned some of the innovations that are taking place in the Ottawa region, which we're very familiar with. An ex-Manitoban is helping to lead some of those challenges. The same is true in Hamilton. The same is true in London. The same is true in places in Toronto and so on. It's innovation at a different level, perhaps, and the difficulty that Ontario and some of the big jurisdictions have is that they perhaps lack the infrastructure elements at the province-wide level.

I will point out that Alberta also has a system like ours. I believe somebody mentioned Prince Edward Island. Some of the Maritimes are coming very close. We're getting there. Certainly, Saskatchewan is there, and they're rolling out their system as we speak.

We're there. It's just in time. As somebody says, this is the perfect moment for a lot of this. This overnight sort of transformation has taken ten years.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

We were talking about remote areas. The riding I represent is an urban riding in Mississauga. What's proposed for people in urban areas? We have another challenge that they don't have in remote ridings that—