Health Committee on Oct. 23rd, 2012

[The Chair, Conservative, Joy Smith]

I'm sorry, Mr. Lizon, your time is up.

Could you just quickly reply to that, Mr. Girard?

[Roger Girard]

Urban settings are much easier to solve. I think if you went into Mississauga, you would see that the hospitals in and around the Mississauga area are doing that today.

[The Chair, Conservative, Joy Smith]

Thank you.

Go ahead, Dr. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much, Madam Chair.

I'm going to come back with the question I originally asked, because I think it follows on Mr. Lizon's question. The question Mr. Lizon asked was, basically, is it possible to share best practices. The other question is, why aren't all provinces doing it? I'm going to ask it again.

When the 2004 health accord was signed, money was given to all provinces on a proportional basis to initiate this. Why didn't they all do it? That is my question. Were there any challenges other than lack of money?

I was given some very good examples by Mr. Thompson with regard to aboriginal peoples for whom the federal government is personally responsible, and I still didn't get an answer from the federal government about why they didn't get doing this in 2004, even given the challenges you told me about, Mr. Thompson, with regard to infrastructure needs, etc. So I'm asking it again.

This isn't only about innovation for innovation's sake, right? This was all meant to be able to look at how we can sustain medicare, how we can bring down costs, how we can have better chronic care, fewer hospital beds, and people who live in isolated and rural areas having better access to health care.

This is all a part of a really big question. I still haven't got the answer as to why everybody didn't do what they were supposed to do with that portion of money allocated in the 2004 health accord. I'm still asking that question, and I would really like to get an answer.

Maybe you guys are the wrong people to give me the answer, but I'm still trying to figure that one out, because it hasn't happened really. Some people have done well, but other provinces have ignored that. What did they do with the money?

[Dr. Joseph Cafazzo]

Are you asking specifically around the Infoway infusion?

[Hedy Fry, Liberal, Vancouver Centre, BC]

Yes.

[Dr. Joseph Cafazzo]

Well, I think as Mr. Girard mentioned, although it was a significant amount of funding, there was always the expectation that there would have to be provincial matches, even down to the local level—in Ontario, the LHINs. Even at the hospital level there would need to be substantial investments to realize that.

Working within the University Health Network, a large academic heath science centre within Toronto, I can tell you that even with the Infoway money, even with some provincial initiatives...the hospital has lots of priorities in terms of delivering patient care, and interoperable health records is just one priority. Certainly, patient self-care is just another of a long list of things it needs to do.

Quite frankly, with the situation in Ontario right now with the provincial finances and our hospital with a 0% increase in base funding, it's very hard to just maintain and tread water, let alone look to the future and innovate in that respect. That's just the reality of the situation.

So, yes, there was money set aside, but as Mr. Girard has already said, there was never an expectation that would fully cover the cost of doing a pan-Canadian electronic health records system.

[The Chair, Conservative, Joy Smith]

You have about a minute and a half.

[Hedy Fry, Liberal, Vancouver Centre, BC]

All right.

I don't want to belabour this. I won't beat it over the head, but it still doesn't answer my question. I still think there's political will involved here and at the local levels in deciding whether provinces are going to make a decision to do what they were asked to do and what they were given money to do or to take it and do something else with it.

This could have moved us down the road to looking at savings. I don't know, what was it, $12,000 a year, that was saved per patient with regard to something as small, in terms of a group, as a cohort of people doing dialysis at home? But we're talking about other things, like the management of chronic disease, blood pressure, diabetes, etc. Those all could have realized savings in the system that could have gone to other things within the same system. That was the whole idea of it.

We heard from the reports that came out on the accord that some of this wasn't happening as well as it could. And the sharing of best practices was part of that objective. People were supposed to say, look what I'm doing in Manitoba and here's how it's coming about, and look at how well we're doing—and that still hasn't happened.

I'm not going to beat it about, but my big question is, what sorts of other savings did you note—travel costs being one, etc.—to the system that could come out of using some kind of electronic e-system, in terms of managing chronic disease and managing some—

[The Chair, Conservative, Joy Smith]

I'm sorry, Dr. Fry, your time is up.

Would someone like to briefly go through that?

[Roger Girard]

Let me try it. I'm sorry for this, but there isn't a single, simple answer. Unfortunately, that's just the nature of health care, and you know this very well.

I can use the example of hospitals. There are many studies showing that electronically enabled hospitals are far more efficient and can save lots of money, just in the hospital sector alone. If we could move people out of the hospital to be cared for in the community, that would save larger sums of money. Moving it out of the community into the home would save even more money.

Without information systems, you can't do these transitions. Do you have the political will to go out there and make the changes that are fundamentally necessary to the health care system? Maybe that's the question.

[The Chair, Conservative, Joy Smith]

Thank you very much.

Ms. Davies.

[Libby Davies, NDP, Vancouver East, BC]

It's been a very good discussion and we appreciate all of the information.

First, I want to follow up on a point Mr. Kellway made. Then I have a second question.

With respect to informal caregivers, I was at a breakfast this morning where the whole topic was work-life balance, and one of the points I made at that breakfast was that we now have 1.7 million Canadians who are caring for 2.3 million seniors. What was interesting was that 70% of those people are working, so you're talking about people who are already really busy and stressed out. Then suddenly they're caring for an elder parent. Maybe this is a whole other area of application, which leads to my second point.

If you could project 10 years from now, where do you think we will be, and where do you think we should be? Are you confident we're going to make some pretty major advances, or have we reached some sort of peak? Is there still a lot of stuff that's going to happen? Where do you think we'll be in 10 years on this issue?

[The Chair, Conservative, Joy Smith]

Could we get a comment from each individual panellist on that? It's a very good question.

[Dr. Joseph Cafazzo]

I think the 10-year timeframe is a good one. It's not moving as quickly as I would like, and I've been in this for 15 years. We need to reprioritize the initiatives around the referral practices for patients so that the interoperability of records and the flow of information is such that patients have access to that information sooner.

We're preoccupied with provider-to-provider information right now, both in Infoway strategies and eHealth Ontario's strategy. They have mentioned the patient, but it is always in the subsequent phase. Informal caregivers need this information as well in order to manage the care.

Personally, I would like to see a reprioritization of patient initiatives so that we don't necessarily need to wait for 10 years for easier access to information. You have electronic access to lab results in British Columbia. That is an innovation. It's an incomplete record, but things are moving along in B.C. and Alberta. Health services are planning a personal health record within the next few years.

[Libby Davies, NDP, Vancouver East, BC]

You mean the patient would actually have access to this information?

[Dr. Joseph Cafazzo]

Yes, the patient and her informal caregiver.

[Libby Davies, NDP, Vancouver East, BC]

Right.

[Dr. Joseph Cafazzo]

That's critically important.

[The Chair, Conservative, Joy Smith]

Mr. Girard.

[Roger Girard]

I think a 10-year horizon is necessary because the job in front of us is so large. I'm an optimist. I believe in 10 years from now you're going to see some huge improvements.

I caution against the silver bullet syndrome. There is a tendency for us to believe there's a chunk of money, and we're going to turn the corner on this particular problem. That's dangerous. It doesn't work that way.

I wouldn't want to be admitted to a hospital that isn't automated. They hurt a lot more people than hospitals that have these types of technologies, and that's just the bottom line. The evidence is there.

To operate a hospital in 2012 without these kinds of technologies is dangerous for a doctor. Many doctors have commented on this. For a doctor to practise without an electronic medical record is dangerous. To allow anybody to practise without the information and the tools he needs to practise safely is not on, in my opinion, and we need to address all of those things.

I fully agree with Dr. Cafazzo that it's moving into the home and to the individual, and self-care is where the action is going to be. I'm hoping 10 years from now that we're going to start seeing some real progress in that area, but we have to deal with the basics.

[Jonathan Thompson]

Where will we be in first nations communities in 10 years? That's a good question. I would certainly like to see several regions be well on their way to keeping pace with what's happening at the provincial level. Of all the aspects that these gentlemen referred to, certainly self-care, home-care, I think would be a hugely important thing to focus on, particularly for many of the communities we're concerned about.

As well, one of the other things that was kicked about earlier today is the pilot projects. We certainly need to get away from that in first nations communities, such that we can count on adequate, sustainable, predictable funding going forward, so that the work that needs to be done in a very thorough, well-thought-out manner can happen, so that we're not planning year to year, but for five and 10 years. We'd love to be able to plan 10 years out and know what the dollars would be to support that work.

[Kathy Langlois]

Thank you.

From a First Nations Inuit Health Branch perspective, our overriding goal is to ensure a more integrated system—not a parallel system between what is federally funded and delivered on first nations communities and then a parallel system with the province, but rather an integrated approach, where all of the services are working together in a continuum of care.

My colleague here, in that context, has a few ideas that he would like--

[The Chair, Conservative, Joy Smith]

I have to cut this off now. I'm sure we all have lots of wonderful ideas, but there are only five minutes left. I'm sorry about that, but we went quite a bit over that time.

Because your input is very important, I have the privilege to ask you the last question from my side of the House and as chair of this committee.

What we're hearing is a thread through all committees. Number one, we have an aging demographic. Number two, a big part of the federal pie and the provincial pie, money-wise, is put toward health care. Everyone is saying now that we need to think outside the dots. What I'm hearing over and over again is that for the first time the patient is an integral part of that. The patient is not only someone who goes to the doctor and gets cured or gets fixed; the patient is now an integral part of that procedure.

We're hearing a strong emphasis on healthy living and preventative medicine. With those components, and thinking outside the dots in terms of e-technology, how would you make sure that the patient does get the electronic health records? We have privacy laws. We have all sorts of different factors that go into that, and there's a very complicated distinction between federal and provincial jurisdictions.

Having said all that, are there any very good innovative ideas that someone would like to come forth with in about three minutes?

Mr. Cafazzo.

[Dr. Joseph Cafazzo]

Very quickly, as far as the privacy issue is concerned, there is absolutely no reason why we cannot have patients access their personal health information. The legislation is clear in terms of them being the owners, and the providers are custodians.