Health Committee on Oct. 23rd, 2012

[Roger Girard]

Thank you.

You said we were further along, or we appear to be, in Manitoba than in the rest of the country. First off, I cannot comment on the situation in the rest of Canada. We have contractual commitments with Infoway. That was one of the themes of my presentation, in fact. When we deliver a product across Manitoba using Infoway funding, we have to abide by a legal contract with Infoway, and that determines our direction.

It is very important to understand that we are part of the Winnipeg Regional Health Authority. Therefore, we focus on clinical care. We aren't talking about an imaginary idea, but a tangible reality with an immediate value. So we delivered a clear product. We did, however, need four or five years to develop it. It didn't happen overnight.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Girard and Dr. Sellah.

We'll now go to Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Madam Chair. There have been lots of interesting comments so far today.

I noticed in the brief Mr. Thompson put forward to our committee that:

...First Nations eHealth projects have tended to take a back seat. Investments in infrastructure, applications and capacity development have not been made at a level that would allow for the electronic data exchange required to support health care service delivery to First Nations.

Kathy, perhaps you could comment on that concern.

[Kathy Langlois]

Yes, I'd be happy to comment.

Not to disagree with my colleague here, but I would like to indicate that from a First Nations and Inuit Health Branch point of view, we have worked very hard to ensure that first nations do not take a back seat. Indeed, at last count, our investment total over five years is $131 million—and I'd have to say it is more than that number, because we haven't counted in the aboriginal health transition fund projects. There are elements of those that have also focused on e-health.

So at a minimum, we have $130 million, and counting, over the last five years of investment in this area, in all the areas I have indicated to you. That money has been used to actually leverage provincial investments, working with our partners in the provinces—Manitoba is a great example—to bring multiples of funding, based on any specific investment we've made.

We recognize that our strategy needs to align with the provinces, which work very closely with Canada Health Infoway, in a common approach. We have no interest in taking any different approach than that, just to make sure we are aligned with where provinces and territories are going, so that first nations will both get best advantage of what the federal health services offer and also access provincial and territorial services.

Our goal is to avoid that situation completely.

[Patrick Brown, Conservative, Barrie, ON]

Jonathan, do you feel you are not seeing on the ground the $130 million investment? What advice would you have for making sure we see value for investment that is obviously quite substantial? Obviously it's alarming to see that you feel it takes a back seat.

[Jonathan Thompson]

Certainly I won't argue with the amount of money my colleague has referenced. As this entire panel has mentioned, we're off to a good start, but we have a long way to go.

We have been challenged, as I mentioned earlier, with some of the jurisdictional issues arising out of the emergence of Canada Health Infoway and its more direct relationship with the province. We're working with them on that. I certainly would agree with Mr. Dal Grande's comments on that point, and I referenced that as well.

Again, I'll have to go back to some of the infrastructure issues that need to be addressed in first nations communities, which would allow a more rapid and full expansion of that technology to communities.

I'm not exactly sure I agree with Mr. Dal Grande's numbers around communities that are not yet equipped with sufficient bandwidth to engage with e-health. My numbers are a little higher. But I don't want to quibble about that, really. It's about working together to identify those gaps and getting the right people at the table to address them in a manner that is well thought out, timely, and in alignment with what's happening with the provinces, the federal government, and first nations communities.

[Patrick Brown, Conservative, Barrie, ON]

This is more of a general question.

I remember that at this health committee a few years back we studied electronic health records. At the time, I recall being told that P.E.I. was actually the most advanced in the digitalization of health records and that Ontario was near the bottom. As an Ontario member of Parliament, I found that concerning. Do you have any updates on how you find the province of Ontario is faring?

I know from when I go back home that our local hospital is a wonderful hospital, but it's certainly not digitalized. Given the amount of investment into digitalization we've seen from Health Canada at all levels, my questions are these. When are we going to see it happen, at what stage is Ontario, and why would Ontario be behind other provinces in that progress?

Yes, Ernie.

[Ernie Dal Grande]

My experience in working with eHealth Ontario over the last number of years is that it has taken quite a different track.

Here in Ottawa, as you know, the hospitals have gone to iPads, etc. I know that my family physician, for the first time, has deployed an EMR. We're starting to see a lot more deployment in Ontario.

We have an excellent relationship with the province around first nations. The Ontario Telemedicine Network allows first nations into the provincial network.

Its strategy, from what I understand, is to start in greater Toronto and then to move out to other parts of the province. I think we're seeing progress, from my—

[The Chair, Conservative, Joy Smith]

I'm sorry, your time is about up. Thank you.

Now we'll go to Dr. Morin.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you very much.

My first question would be to Mr. Girard. My colleague, Libby Davies, asked you a question earlier, but I think you ran out of time to answer.

Do you remember the question?

[Roger Girard]

No. Could you repeat it?

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

It was about the importance of sustainability of those great pilot projects and how we can make sure they are implemented throughout Canada and that their level of funding is available each year.

[Roger Girard]

There are two parts to this answer. First, if you look at e-health writ large, the large issue of e-health, it divides up into two pieces. There's one piece that is funded by Infoway, so Canada Health Infoway has a program of funding. Generally speaking, to my understanding, the provinces are all tracking pretty close to each other on that part of it. It's a fairly small piece. For the sake of the discussion, say, it's 20% of the cost, so everyone's working on registries and the components of the Infoway blueprint.

I'll stop there, and if you have any questions, I'd be glad to answer them later.

Where we see difficulties today across Canada—it's a little bit the answer to the Ontario question and others—is on the 80%. Infoway doesn't fund hospitals. Until recently, Infoway didn't fund EMRs, doctors' offices. Since the last tranche of funding from Infoway, that's being funded. Those gaps are closing very, very quickly in the provinces that have taken up those investments. But hospitals are out, the community is out, long-term care is out, home care is out, the personal health record that we talked about is out, etc. There are lots and lots of gaps in the system yet. We've made some huge progress, don't get me wrong, but there's lots to come.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Okay, thank you.

My next question is to Mr. Thompson.

I don't know if you remember, but in 1997 there was the Royal Commission on Aboriginal Peoples, which recommended that we needed 10,000 aboriginal health care providers. Although I think it's great that we can make sure that technology and e-health can help those communities, do you still believe we need more aboriginal health care providers on the ground?

[Jonathan Thompson]

Thank you.

Yes, we certainly do. There have been some efforts, through some of the work we've done with them on that issue, but, yes, absolutely. One of the biggest challenges, for instance, in a lot of the communities and the nursing stations is recruitment and retention. We would certainly love to see efforts geared toward that. But it's not only the nursing profession; it's MDs as well, and mental health professionals. It's a long list. Certainly that ties, of course, into the education discussion, which I'm not sure we want to get into today, but that certainly is still a goal, and there's a big gap that still needs to be filled there for sure.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you.

Dr. Cafazzo, you mentioned how important health care is, and I fully agree with you. In your opinion, how could this type of self-care help those communities?

[Dr. Joseph Cafazzo]

We actually did do a pilot in Chapleau, Ontario, a couple of hours out of Timmins. Again, with the significant type 2 diabetes population, some of the challenges we faced at the time were infrastructure problems. The use of the mobile phone in some of those rural areas was difficult. I think those have been addressed, but because of the lack of access in those remote areas, it's actually a fantastic opportunity to deploy in those regions. Again, some of the studies that we did were in the mid-2000s. Since that time, a lot of the infrastructure issues...and the use of mobile phones as a conduit for self-care can be very effective in those communities.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you very much.

I believe my time is up.

[The Chair, Conservative, Joy Smith]

You have about 30 seconds, if you talk fast.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you very much for your presence today.

[The Chair, Conservative, Joy Smith]

Thank you.

Dr. Morin always contributes so many good things, and I thank you for that, Dr. Morin.

We now have Mr. Lobb.

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

Thanks, Madam Chair.

My first question is for Mr. Girard. I'm talking about integration and digital imaging. Obviously, this has been around for quite a while. If I go into the X-ray department and get an X-ray on my shoulder, does that X-ray automatically go into my EMR?

[Roger Girard]

No. The EMR is the record that is usually being used by the physician. It's semantics, I realize that. The electronic medical record is being used by the doctor in their clinic, supporting their clinic. The image itself usually doesn't go into the EMR. The report will go into the EMR, so it will be the transcription.

What we'll do is put the image in a big repository and the doctor can get access to it anytime they want. It's not technically inside the EMR.

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

Okay. The report would be from the radiologist who puts it into the EMR.

[Roger Girard]

Correct.