Health Committee on Oct. 23rd, 2012

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much, Madam Chair.

I must say that way back before the 2004 health accord, when among the objectives were e-health and telemedicine and the use of these new mediums, everyone knew what it could do because there had been discussions about what it could do. I want to say that the presentations here today have shown us that the evidence proves that it actually does work.

Looking at chronic care management, as you talked about it, when you don't need a physician, but you can get your digital MRI, you can get quick work done to be able to say what should be done in an immediate manner in isolated areas. We've talked about aboriginal health because many aboriginal people live in isolated and rural areas, so that is obviously important.

The ones that really impressed me were the education and information and the incentives that go to the patients themselves. I think the youth incentive is extraordinary, with the apps and giving them IT for whatever...that was a real incentive to get young people who don't tend to take their illnesses seriously to be able to do so.

Again, the ability to get acute care in a timely manner—when you talked about the digital MRI, whether it allowed people to make a decision with regard to their chest X-ray, etc., I think all that tells me that this is important. One thought it would work in 2004 when the premiers and the Prime Minister decided to bring in the accord; one thought it would work when one put money into the accord over ten years. You have shown through evidence that it is a good way to save money, in terms of delivery and management of health care, which can be put into other things that we need to look at.

Money was set aside within the accord for this as a prime objective, so why don't we see all provinces moving to this? Having put the money aside for this, why don't we see more work done through direct care for aboriginal peoples? What are the challenges and the glitches that are preventing this from being done?

[The Chair, Conservative, Joy Smith]

Who would like to take that question? Please go ahead.

[Jonathan Thompson]

Thank you.

From the first nations' perspective, one of the challenges does remain at a very fundamental level, and that is in relation to connectivity. A number of communities still don't have what it takes to operate this technology. I can't speak for the provinces in terms of the pace at which they've undertaken this work.

As Mr. Girard mentioned, Manitoba started off maybe a little behind, but they focused their efforts and moved on. It is a very complicated issue when you start looking at electronic health records, electronic medical records, privacy, and data sharing. All of these issues have to be undertaken.

I'm sure all of those factors, along with many others, had a role to play in terms of the pace of the provincial uptake of this technology. One of the challenges for first nations remains jurisdiction. Of course, we do work with Canada Health Infoway to some extent. We would like to work with them more, but their primary relationship is with the province. Again, we're somewhat challenged by trying to manage the jurisdictional patchwork for provision of health care services for ourselves, certainly for first nations, and that extends to this issue as well.

So there are some really fundamental issues for our first nations communities, like connectivity and capacity. The jurisdictions certainly have to have or have to find that capacity to undertake the work that needs to be done to ensure that the technology they put in place is not only appropriate for their needs, but also is able to speak to the provincial jurisdictions. That's the point I made earlier about our clientele going from the federal jurisdiction to the provincial jurisdiction and the need for that. All of those systems need to be talking to one another.

[The Chair, Conservative, Joy Smith]

Thank you.

Yes, Mr. Dal Grande.

[Ernie Dal Grande, National Manager, eHealth Program, Primary Health Care and Public Health, First Nations and Inuit Health Branch, Health Canada]

We talked about being a country of pilot projects. I'd like to add, from the first nations health system, that this sparked the nation to change. Without the pilot projects in the last 10 years, we wouldn't have had the clinicians and the health managers actually seeing the benefits of e-health. In the first nations system, when we began we started to see the benefits of telehealth and electronic health records. So I think it's a natural evolution that has happened.

In the jurisdictional discussions between the provinces, the federal government, and first nations, with three partners having to work together...e-health has actually brought the three jurisdictions together to have a complex discussion around policy. This is the area on which we've spent the last four or five years working with the Assembly of First Nations, around aligning our policy discussion and our strategic vision.

Each of the provinces has their own e-health strategy. With the federal government, through FNIHB, we have an e-health strategy. We're working with AFN. We now have three strategies that are aligning around the vision of a blueprint through Canada Health Infoway, provincial strategies, and federal ones.

Most important are the first nations and listening to what the communities want to do, so we have spent our time going through needs assessment processes, really trying to listen and learn what the communities want, and what are their priorities.

I think 10 years was required, but I think we're at a very good point to go forward.

[The Chair, Conservative, Joy Smith]

Mr. Girard.

[Roger Girard]

If I might add a few more words, just to step back a little, from a province-wide point of view, first of all, I believe.... You could probably get a copy of the scorecard from Infoway. Infoway actually measures the performance of every province. I believe there are activities that are quite similar in every province of Canada. Obviously, the provinces are at different stages, and that's just the nature of the beast. It's 10, 12, or 13 different jurisdictions trying to move towards a common goal, and we're at different places in time.

I remember 10 years ago Infoway came out with a very high-level estimate that it was going to cost $10 billion for the country. They also said there was a $20 billion return on investment for that, but it was going to cost us $10 billion. I think they were a little bit low on that estimate, as all these types of projects go. But if we take that as a given, we're just beginning this journey. It's going to take us a while, so the idea is to sustain it, and part of the problem is that we're just beginning.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Girard.

We'll now go to Mr. Strahl.

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

Thank you, Madam Chair.

Thank you for the presentations.

My riding in British Columbia has over 30 first nations communities, so my questions will focus on that, largely.

You mentioned, and it's a good point, that obviously it's not possible to deliver telehealth services if there is not sufficient broadband infrastructure in those communities.

For Ernie or Kathy, I wonder what percentage of first nations communities in Canada have access to sufficient broadband network for these types of services.

[Ernie Dal Grande]

The number, which I just looked at today, is that 90% of first nations either have consumer-grade or industrial-strength...so 10% still don't have connectivity in very remote areas, but we're working towards it. We've made big improvements over the last 10 years in working with Aboriginal Affairs and with Industry Canada, the two main departments, so I think we're making great strides.

What is happening, though, is that as there are more and more business demands from our health professionals, it's putting a strain on the bandwidth at the community level. So we work together in a holistic way with Aboriginal Affairs...to the school, to the health station, to the band office, to the water treatment facilities. The amount of bandwidth continues to increase, and we're seeing that.

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

Thank you.

I have another question for you. We were excited to announce the tripartite agreement in British Columbia last year, I believe. How has that agreement improved with the coordination of the delivery of e-health or telehealth services in first nations communities? Has it made it easier, and if so, are we close to similar agreements with other provinces if there has been an improvement in the delivery?

[Ernie Dal Grande]

I'll speak to the B.C. activity in e-health.

B.C. first nations have always been leaders in e-health, and there is an acknowledgement that that's going to really improve access to care and changes.

The most important thing is that it's brought three jurisdictions around the table, which is chaired by first nations; so the head of the first nations health authority actually sits there with the provincial government and the federal representatives, and the first nations make decisions around what are their priorities in e-health.

They just received Canada Health Infoway approval of $4.5 million. We'll be deploying telehealth to a number of first nations over the next couple of years. They have investments in the health-grade network to all their communities, so B.C. first nations, over the next two or three years, I think will see great improvements to health care.

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

Excellent. Thank you very much.

I want to go now to Dr. Cafazzo.

You mentioned the vast improvements and the cost savings that have been realized through your project. Whenever there's change, there's resistance to change. What has been the reaction of health care workers to seeing a patient do a job for themselves that they may have previously done? How have those front-line health care workers reacted? Have they been cooperative, or has it been a challenge to bring them onside with this?

[Dr. Joseph Cafazzo]

That's a great question. In the case of home hemodialysis, the cost savings are essentially the fact that the patient is taking over the role of the nurse, which is significant. Nursing ratios went from 2:1 to 20:1 as a result. Quite honestly, with the increasing prevalence of diabetes and end-stage renal disease, there's plenty of work for nurses to do. This problem will just get worse, and the fact is, because of some of the technological barriers right now, we can offer only about 25% of the patients with end-stage renal disease a service such as this. I don't think that was a particular problem, and those nurses at Toronto General are still employed—they're just dealing with more patients coming through the door now.

As for the hypertension study, you're absolutely right that when we first approached them about this, family doctors did not like the idea. They felt they were going to be looking at reams of new data that they didn't get paid for, but they are also faced with a situation that they're not totally equipped to deal with—this influx of patients with serious chronic conditions. We designed the system so that they only receive exceptional readings, so very high blood pressure readings need attention, but most of the time they see nothing from the patient. As we've shown, there was no increased number of visits and so on.

I think if you ask most physicians, if a patient is doing well and their workload is not impacted, it’s a win-win for both parties.

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

Great.

Do I have any more time?

[The Chair, Conservative, Joy Smith]

You have two minutes.

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

Mr. Girard, you mentioned the answer to changing things started in 2006, when you created Manitoba eHealth, with an increased commitment in funding. Where did that funding come from? Did you find efficiencies in your current funding envelope? Was there a reallocation of funds or an infusion of new funds, or perhaps a combination of all those things?

Every level of government is obviously...today, I heard the term “economic tightening”. I believe that's a new phrase for me.

How did you come up with this new funding to move forward?

[Roger Girard]

As you suspected, it was a little bit of everything. Certainly, the availability of Infoway dollars and some of the projects I mentioned were key because it created the right kind of momentum for the province to co-invest according to the standards of Infoway. A lot of these projects, the digital imaging project and so on, were funded probably about 50-50 with the province.

That was a big ticket, a very important one. There are savings, there's no question. The evidence is clear that a system that is well automated is more efficient than a system that isn't. We can demonstrate the savings in many different ways—savings, efficiencies, patient safety, those types of things. However, in the health care system it's hard to extract those benefits, to monetize them, and that's been a challenge.

[The Chair, Conservative, Joy Smith]

Thank you.

Now we're going to go to our five-minute Qs and As. You have five minutes, not seven.

We'll go to Dr. Sellah.

[Djaouida Sellah, NDP, Saint-Bruno—Saint-Hubert, QC]

Thank you, Madam Chair.

I want to start by thanking the witnesses for being with us today to speak about technological innovation in health care.

My first question is for Mr. Thompson of the Assembly of First Nations. If I still have time after that, I will have a question for the Manitoba eHealth Program representative.

Realistically, given the conditions first nations peoples are living in today, would you say you need technology or, more importantly, decent housing, drinking water and affordable food?

Having visited some of these areas at the beginning of the year, I am clearly thinking about the situation facing the Attawapiskat First Nation and the price of food in the northern communities. People there have to pay more than $50 a kilo for roast beef, over $8 for a 2-litre carton of milk, $14 for a kilo of dry spaghetti on sale, and $20 for a cabbage.

I am not trying to say that meeting people's basic needs and encouraging technology and innovation are mutually exclusive. However, what do you think needs to be done to ensure that first nations have access to quality health care and a better quality of life? It is clear that prevention is paramount when it comes to health.

My second question is for Mr. Girard.

Why do you think Manitoba is further along in adopting electronic records than the rest of Canada?

[The Chair, Conservative, Joy Smith]

Mr. Thompson, would you like to take those questions to begin, please? Then maybe we'll go to our other aboriginal section.

Go ahead.

[Jonathan Thompson]

Thank you, Madam Chair.

It's funny, I was thinking about whether I might get that question today: what's the one thing? I think I alluded to it earlier when I said e-health and telehealth are very important. But it isn't a silver bullet; it's not the one thing that is going to radically remove, or quickly remove, or magically remove, the health disparities for first nations people, particularly in those more northern and remote communities.

Absolutely, social determinants to health play a huge role—housing, education, poverty, mental health addictions, and the list goes on. So, really, that is the answer. It is a multitude of things.

But in terms of e-health and telehealth, technology is something that those communities can take advantage of to bridge that divide and increase access to certain health professionals.

That would be my answer.

[The Chair, Conservative, Joy Smith]

There is also Ms. Langlois.

Did you want to comment on it, Ms. Langlois?

[Kathy Langlois]

No.

[The Chair, Conservative, Joy Smith]

Okay.

Now go on to the second part of the question, Mr. Girard.