Evidence of meeting #60 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was e-health.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Ed Brown  Chief Executive Officer, Ontario Telemedicine Network
Kendall Ho  Director and Professor, eHealth Strategy Office, Faculty of Medicine, University of British Columbia
Richard Alvarez  President and Chief Executive Officer, Canada Health Infoway
Peter Rossos  Chief Medical Information Officer, University Health Network
Glen Geiger  Chief Medical Information Officer, Ottawa Hospital
Mike Sheridan  Chief Operating Officer, Canada Health Infoway

12:10 p.m.

Director and Professor, eHealth Strategy Office, Faculty of Medicine, University of British Columbia

Dr. Kendall Ho

Thank you very much.

12:10 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you very much.

Now we'll go to Dr. Glen Geiger, chief medical officer for the Ottawa Hospital.

12:10 p.m.

Dr. Glen Geiger Chief Medical Information Officer, Ottawa Hospital

Thank you, Madam Chair, and my thanks to the members of the committee. I appreciate being invited here today.

You've already introduced me. I'm a practising internal medicine specialist at the Ottawa Hospital. I work there as the chief medical information officer. I've been in professional practice for 25 years and most of that time I've spent working on clinical information systems, in addition to taking care of patients.

I truly enjoy taking care of patients. I've worked at some outstanding institutions with truly wonderful people.

For the past quarter century, every single day of my professional life it's been obvious to me that health care is not terribly well structured. The way in which we deliver care is not quite what it should be. It's been obvious from the beginning. As time has passed, other industries have adopted strategies, technologies, and processes that have allowed them to prosper in ways that the health care system has not been able to do. Therefore, the gap, if anything, has grown wider over time.

I recognized this issue when I first started and the disparity continues to grow between what information technology can do for other enterprises and other types of industry, and what health care is less able to do.

I'd like to confine my remarks thematically. Everywhere you look in health care, you're confronted with what I call the fundamental paradox of health care. How is it possible that a system that is staffed by compassionate, intelligent, well-meaning individuals could not be meeting the expectations of the citizenry? If you read the papers, you're confronted by the fact that people feel the system is not doing what they want it to do, yet when I look at the people I work with, they're all extremely passionate about patient care. They truly and fundamentally wish to do their absolute best for patients. I have seldom met a nurse, physician, physiotherapist, or pharmacist who wasn't fully dedicated to doing the absolute best. So how is it that we are unable to create and implement a system that actually makes the citizenry satisfied and confident about the care they're supposed to receive?

People write to newspapers, and there are editorials and comments by pundits, but nobody seems to focus on this fundamental question that we should be asking ourselves. I'm prepared to offer my answer, for what it's worth.

My argument is that these people are so well-intentioned that we have to conclude that they cannot do any better than they are doing now. They are working as hard and as smart as they see themselves able to do. In most areas of health care, most people optimize the practice in their particular area. If you're a CCU nurse or an emergency nurse, you make sure that the workflow in your environment is successful for you and the patients you see, without necessarily understanding its implication downstream for other parties—other nurses, other physicians, or the patients themselves—as they transition from one area or cross gaps from one care area to another. These people are dedicated in what they're trying to do in a specific place, but they are unable to systematize care across a broader range of care avenues and create circumstances where the patients themselves feel they're being cared for along a continuum. Exhortations to these people to work harder, to work smarter, to follow guidelines, or polish more policies will not likely be effective, in my opinion. They are not able to change in that way.

My argument has been, for my professional career, that information technology can allow them to adopt new processes that will optimize care delivery along the continuum for the patient, not just locally for the individual practitioner in that specific encounter with that patient.

Some of the telehealth opportunities you've been hearing about already, as well as some of the other initiatives that are going on in hospitals and advanced institutions across the country, are trying to deliver these kinds of solutions, but they are very hard to do. Technology is not a solution in and of itself. I do not believe in buying technology just because it's technology. It has to be adopted to achieve specific purposes and accomplish specific processes for the patients.

In the work I'm doing at the hospital as well as work I've done elsewhere and talked about, we're trying to change the fundamental processes by which health care is delivered. Initiatives we have going on at the Ottawa Hospital include electronic ordering, which we don't see as a physician step. We see it as a process change inside the hospital. Our electronic ordering for diagnostic imaging at the Ottawa Hospital is paperless from end to end, from the creation of the order to receipt of the order inside the radiology department, to the execution of the order, to the speech recognition of the report, to the return of the report to our information technology here on my iPad.

This is how what we're talking about is a process change inside the system. Our lab electronic ordering process is the same. We go from electronic ordering of a lab test to labelling of the blood sample at the bedside by positive identification of the patient, to transporting that sample to the lab, to processing it through the analyzer using the bar-coded information on the sample, to the return of the results to the physician the same way. This is about changes in health care delivery processes.

We're doing electronic medication reconciliation, which is another project to alter the way in which the health care system documents patient medications and follows the patient's medication longitudinally from outside the hospital to inside the hospital to their return to the community. We use speech recognition technology to enhance the timeliness and accuracy of physician documentation and the documentation of our other health providers.

Once again, these are all examples of how technology is not an answer in itself but is an answer insofar as it helps us alter the way we deliver care and provides new tools for these well-meaning people to achieve better patient outcomes and better results for the system and more efficient care delivery. That's the way we see it.

The Ottawa Hospital has been blessed by having received support from government organizations such as eHealth Ontario and Canada Health Infoway for a number of the projects we're doing to enhance care delivery. We've been able to integrate the infrastructure we used at the Ottawa Hospital with the Hawkesbury district hospital. We've been able to connect the two so we support the information technology used inside Hawkesbury. We are rolling out access to electronic medical records to the primary care physicians here in the Champlain LHIN to allow them to see the records of their patients while they're inside the hospital.

These are small steps to begin with, but they're very important ones. I suggest to you that as a government committee you would want to focus on making sure that initiatives you support are focused not just on technology but on making sure that the people who are delivering these systems are going to achieve the process change we're looking for with deliverable outcomes for the patients. That's been the engagement we've had with government agencies to date and we truly appreciate the support we've received.

I thank the committee for the time to speak to you and advocate for continuing your efforts.

12:20 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you very much for your insightful comments, Dr. Geiger.

We'll now go to Mr. Richard Alvarez.

12:20 p.m.

President and Chief Executive Officer, Canada Health Infoway

Richard Alvarez

Bonjour, Madam Chair and members of the standing committee.

Thank you for this opportunity to appear in front of you. With me is Mike Sheridan, our chief operating officer.

It's a real privilege to be on with some of the best clinical innovators that Canada has. I'm very grateful to all of these gentlemen for what they've done.

Canada Health Infoway was created with the unanimous agreement of first ministers to invest in digital health and telehealth systems to improve the quality, access, and productivity of our health care systems. Infoway receives its funding from grants from the federal government, which we then leverage with additional financing from provincial and territorial governments and health agencies.

In the few minutes I have for opening comments, I want to share with you three examples from independent evaluations of how these innovative investments have enabled the expansion and delivery of tools to provide better care for Canadians.

You've heard a great deal from Dr. Brown. I think he's somewhat modest, because the telehealth system he runs is, in fact, one of the finest telehealth systems in the world. It is a way of providing services when patients and clinicians aren't in the same place. We've seen that it's reduced wait times and increased access to care, particularly in the north.

A recent study found that Canada has the world's largest video conferencing network, with more than 5,700 telehealth sites in 1,200 communities, including 423 sites in northern, remote, first nations, and Inuit communities. The result is that a quarter of a million sessions were delivered last year, keeping patients in their communities and close to their social support networks and saving them both time and money by eliminating the need to travel millions and millions of kilometres.

The use of telehealth tools has led to innovative applications in the treatment of mental health and drug addictions, the monitoring of chronic disease patients so that they can remain in their homes, remote wound care assessments for diabetics, and telephathology applications that let pathologists and surgeons communicate and exchange information in real time operating room settings.

The second area is the reducing of wait times and improving access with the use of digital diagnostic imaging, which collects, stores, manages, and shares patient X-rays, CTs, MRIs, and other images and reports. As a result of our investments, over 90% of the most common radiology exams in Canada's hospitals are now digital, up from 38% just six years ago. Research shows that radiologist and technician productivity has increased by 25%, enabling as many as 11 million more exams annually. When fully implemented, we expect annual benefits valued at about $1 billion.

However, the true innovation is when a young child in a remote community has fallen off a bicycle and can have a head injury diagnosed and assessed by a specialist in a major urban centre without having to travel, thus saving much needed time and further injury.

The third example is drug information systems which allow authorized clinicians to access, manage, and share patient medication histories, thus avoiding harmful drug interactions. They are used by one in three community pharmacists and half of the hospital emergency rooms. They help avoid harmful drug interactions and manage medications.

Research results show benefits valued at $436 million per year. Pharmacists surveyed as part of the study rated improved access to patient information, increased patient safety, reduction in fraudulent medication, and a reported 9% productivity gain as the top four benefits.

Last year, much in keeping with what this committee is doing in its investigation, we initiated and funded projects intended to stimulate and spread clinical innovation. We began by launching a website inviting Canadians to share their best ideas to improve health and health care using information technology. In a period of 13 weeks, more than 1,000 Canadians participated in the challenge.

We also launched an awards-based outcome challenge to clinical teams who demonstrate the use and growth of innovation solutions for electronic scheduling, for medication reconciliation, for patient access to their own health information, and for clinical synoptic reporting—much of what Dr. Kendall spoke about earlier.

We now have 31 teams with 300,000 users participating in the outcomes challenge. Their innovative clinical solutions have been used well over a million times.

Generally speaking, as you look across Canada, a lot of the digital infrastructure is now in place, or is in the works of coming into place over the next 18 months. It's time now to further capitalize on our collective investments and to drive out new innovation applications for consumers and clinicians.

That view was confirmed when Infoway conducted a pan-Canadian consultation with over 500 stakeholders comprising consumers, governments, administrators, clinicians, physicians, thought leaders, and researchers. The aggregated result of these consultations and opportunities pointed to five clear innovative and transformative directions for building and expanding on the successes of Infoway and the jurisdiction investments to date.

The clear message was that focus now needs to turn to the consumer by bringing care closer to home, by providing tools for making access easier, by supporting new and better patient-centric models of care, and by using technology to improve patient safety, and at the same time harvesting the electronic health information data for analysis and research to enable a high performing health care system.

Responding to the stakeholders' priorities and shifting the focus to consumers is a big cultural and management change in health care. Quite frankly, we don't get there in one step. Getting there and further harvesting the benefits from doing that will require ongoing commitments to practise improvements from thousands of dedicated clinicians across the country, continued renewal of investment, and strong alignment of legislation, regulation, and policy. We need to keep our eyes focused on the future and recognize how much more innovative digital solutions can be for Canadian health care consumers and providers.

I want to end, Madam Chair, by thanking the federal government for creating a creature such as Infoway, which is really a mechanism for you to help with the modernization of the Canadian health care system.

That concludes my remarks. Thank you.

12:25 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you very much.

Today we had bells. My apologies. We were late starting committee due to the votes in the House of Commons, but we've moved along very nicely. We have some absolutely dynamic witnesses with us today.

We are going to have to shorten the Qs and As to five minutes, and it will be one representative per party.

We'll start with Dr. Morin.

12:25 p.m.

NDP

Dany Morin NDP Chicoutimi—Le Fjord, QC

I would like to thank the witnesses for joining us.

My first questions are for the representatives from Canada Health Infoway.

I am not sure if you remember the 2005 report that you had commissioned through Booz Allen Hamilton, a consulting firm. This report tried to anticipate the costs that Canada Health Infoway would incur, as well as the benefits that the organization could have on our various health care systems in Canada. The net savings were estimated at $39.8 billion over 20 years.

Do you remember that report? If so, could you tell us about those estimates? Have the numbers changed seven years later? I know there have been additional costs for implementing Canada Health Infoway. Could you tell me more about the study on investments and benefits?

October 25th, 2012 / 12:25 p.m.

President and Chief Executive Officer, Canada Health Infoway

Richard Alvarez

Thank you for your question.

I will begin and then maybe turn it over to Mike.

Yes, we've actually had two reports done in terms of the cost and the benefits. One was by McKinsey and the other was by Booz Allen. I can't remember in 2005 which one it was. I think it was the Booz Allen one. At that time, when it was all said and done, the costs were in the range of $10 billion to $12 billion, and the benefits would range anywhere from $6 billion to $7 billion on an annual basis.

One of the things we've done, which is quite unusual to Canada in this particular field, is very early on we brought in some of our top researchers in Canada and international researchers and we set up a benefits evaluation framework. For everything we invest in, we do the evaluations. I gave you examples in telehealth, in drugs, and in diagnostic imaging. We can show the benefits occurring from each of them.

Right now we are doing investigations in the expenditures for EMR records in doctors' offices and in laboratory results as well. I must say the benefits that are starting to occur are absolutely tracking in the same way as were the forecasts from both Booz and McKinsey.

There are some swings. At times you'd think you're going to get possibly a reduction in duplicate testing. That doesn't always materialize because clinicians want to reorder a test. There are other areas, in aspects of drug abuse, for example, where we've underestimated what the benefits should be.

Absolutely, we are tracking in those directions. We believe that in the last five years the cumulative benefits from just three programs is over $6 billion.

12:30 p.m.

NDP

Dany Morin NDP Chicoutimi—Le Fjord, QC

Thank you. In that case, I will stick to more recent figures.

On February 9, 2011, you yourself announced an investment of $380 million to set up electronic health records. Also, your objective was to encourage 8,000 to 9,000 additional doctors and nurse practitioners to sign up by March 2011 for the electronic health records program for the doctors' offices in their province or territory.

The deadline has passed. At the end of the day, have you managed, with the $380 million investment, to convince those 8,000 or 9,000 additional doctors and nurses to register for the program?

12:30 p.m.

Mike Sheridan Chief Operating Officer, Canada Health Infoway

The answer is yes, absolutely. We had set targets during the planning process of the program. We set the target at 9,000 clinicians. According to the current data, at the end of this fiscal year ending March 31, we will have 12,000 clinicians registered for our electronic health records program.

12:30 p.m.

NDP

Dany Morin NDP Chicoutimi—Le Fjord, QC

Thank you very much for the information.

In the short time that I have left, I am going to ask you one last question.

The federal government has invested a total of $2.1 billion in the Infoway. According to the Auditor General of Canada, experts have estimated the total costs of implementation at $10 billion.

So who is right? Will the cost be $10 billion, as the Auditor General of Canada suggests, or $2.1 billion, as the Government of Canada estimates?

12:30 p.m.

President and Chief Executive Officer, Canada Health Infoway

Richard Alvarez

First, I should say those are estimates. Clearly the system only has an appetite to digest so much money at any point in time. The issue here, on many occasions, is the take-up rate. The way Canada Health Infoway funds is very simple. From an accountability perspective, if we don't get deliverables, we don't pay out any money. We hold back money until we get deliverables.

If you take the $2.1 billion, as I said earlier in my remarks, those dollars are basically matched in terms of provincial and territorial dollars.

12:30 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you so much, Mr. Alvarez.

12:30 p.m.

President and Chief Executive Officer, Canada Health Infoway

Richard Alvarez

There's a large spend in there.

12:30 p.m.

Conservative

The Chair Conservative Joy Smith

I'm keeping the time tight so everyone can get in.

Thank you so much, and thank you for your questions, Dr. Morin.

Dr. Carrie.

12:30 p.m.

Conservative

Colin Carrie Conservative Oshawa, ON

Thank you very much, Madam Chair.

Again, we have excellent witnesses. I wish we had little more time to ask questions.

I did want to ask Health Infoway to clarify something. I think in our last meeting one witness said that these electronic health records and digitization are great, but he saw that there could be problems with integration and interoperability. On your website you refer to the concept of connection as the final component.

I was wondering if you could go over how things are set up. My understanding is that from one province to another, there is going to be that ability to have that interoperability, the integration.

Could you comment on that?

12:30 p.m.

President and Chief Executive Officer, Canada Health Infoway

Richard Alvarez

Thank you, Dr. Carrie.

You saw from the first presentation from Dr. Rossos that one of the first things Canada Health Infoway created was its architecture and blueprint. Quite frankly, if you don't follow that architecture and blueprint, we don't fund you. You have to follow the standards.

The issue when we got into this business is not to create health records that are specific to just a hospital or just a doctor's office or just a lab; it is about the patients. How do you bring all that information around the patient and have interoperability in those various systems?

Certainly if you follow the architecture and you follow standards, that will start to happen. I must say it's not an easy situation because a lot of the products out there are closed products. We have to incent the venders, and certainly the folks who are bringing on the venders, to make sure they open up the systems, that they can pull data in from the various systems and bring them together.

If you want a living laboratory, go to Alberta. No matter where you are in that province, they can pull up all your medication history, your lab results, your immunization, etc. That is a living example of integration and interoperability working.

12:35 p.m.

Conservative

Colin Carrie Conservative Oshawa, ON

Excellent, thank you very much.

We heard from my colleague. I thought he asked some really good questions about how this technology is saving the country hundreds of millions of dollars. Do you have any idea what we can expect to save this year, if you had to give it a number?

12:35 p.m.

President and Chief Executive Officer, Canada Health Infoway

Richard Alvarez

As I say, in each of the investments that we are doing, we look at the annual gains that we're making.

We have been looking at them on a year-to-year basis, and I know the number that is in my head over the last five years, the accumulated, has been over $6 billion. We have, as the good member said, now started investing in the EMRs and the lab systems, so those numbers will absolutely grow.

12:35 p.m.

Conservative

Colin Carrie Conservative Oshawa, ON

Excellent.

Also, I've read that you've created thousands of sustainable, knowledge-based jobs. I was wondering if you could give some examples.

12:35 p.m.

Chief Operating Officer, Canada Health Infoway

Mike Sheridan

Part of the notion of innovation and using technology is the spinoffs that benefit not just the patient but the whole economy. We did some work with the Conference Board of Canada based on the last grant we received from the federal government, which was $500 million. When you invest in innovation you can also leverage those investments. We leveraged this half a billion dollar grant by another almost quarter billion dollars from jurisdictional partners. Looking at the investments, we should over four years create about 10,700 full-time person-years of employment.

As to types of jobs, we're looking at systems integration, hardware producers, software producers, change management, a whole gamut across the board. The media, I think sometimes pejoratively, has labelled some jobs in the service area as “McJobs”. It's a characterization of lower wage service jobs. The jobs coming out of the investments in the technology we're looking at are high-tech and professionally driven jobs, with a high probability of remaining, if you look at the analysis from the Conference Board of Canada.

12:35 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you so very much.

We'll now go to Dr. Fry.

12:35 p.m.

Liberal

Hedy Fry Liberal Vancouver Centre, BC

Thank you very much, Madam Chair.

I want to thank everyone for the excellent presentations. Many of the witnesses whom we heard via video conference today, and Dr. Geiger from Ottawa, have continued to confirm that e-medicine, telehealth, etc., are excellent ways to provide care, to improve patient outcomes, and to save costs to the system.

I have heard lots of questions about costs to the system. Have you done any evaluation on how this improves patient outcomes?

We heard from other witnesses at the last meeting about the challenges they face. One of them is that not every part of Canada is connected. What do you intend to do about that? How do patients get connected? What about infrastructure for the patient and the community of nurses, nutritionists, and home care to help the patient and bring down hospital admissions?

Finally, there is the issue of privacy. Patients are worried that everybody is going to hack into the system and get all their information. Privacy is a big issue.

12:40 p.m.

Conservative

The Chair Conservative Joy Smith

Good question, Dr. Fry.

12:40 p.m.

President and Chief Executive Officer, Canada Health Infoway

Richard Alvarez

There are a lot of questions, Dr. Fry. I will attempt my best.

First, in terms of outcomes, wherever possible, obviously, when we do our evaluations, we measure outcomes. Certainly, in the drug studies, what we found in those measurements is it absolutely reduces drug-to-drug adverse reactions. Here's an example. We just ran a study with three doctors' offices that are still on paper and three that are now computerized. We asked them to find the patients who had a heart attack a month ago, find the patients who are undergoing cancer therapies. We named two drugs and asked if they were recalled, could they find the patients who were on them. After 40 hours the practices that used paper gave up. Within just one hour, those that were automated were able, with great confidence, to pull up the names of the patients. That is a heck of an example of outcomes.

In terms of the rest of Canada, it's our two largest provinces, where there are a lot more points of care and it's a lot more complex, that are taking a while to come on board. Atlantic Canada is moving very well. Certainly, the west has moved very well. Manitoba got in pretty late, but they've played catch-up. I would say that over the next 18 months, fingers crossed, Ontario and Quebec will make progress, though. As we've said, in telehealth, and in EMRs and doctors' offices, Ontario is doing extraordinarily well.

In terms of aspects of new models of care, one of our new strategic directions, and Dr. Kendall Ho talked about it, is that there's absolutely no reason we shouldn't be moving to e-consultations. Again, the Conference Board just came out with another study that showed there were 50 million unnecessary in-person visits to doctors' offices, which amounted to over 70 million lost hours, unproductive hours by Canadians who were spending three hours, on average, taking off work or school for a 10-minute to 15-minute appointment.

Some of those things could be done through e-consultation.