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.
Conservative
The Chair Conservative Joy Smith
Good morning, ladies and gentlemen. We have a very busy committee morning.
We have some wonderful guests with us this morning. I would ask that we have all the committee members' attention right now because there's something unusual that we have to do this morning.
From the Ontario Telemedicine Network, we have Dr. Ed Brown. Dr. Brown will be coming to us by video conference.
We also have Dr. Kendall Ho.
Can you hear me, doctors? Is the sound okay?
Dr. Ed Brown Chief Executive Officer, Ontario Telemedicine Network
Yes, we can, thank you.
Dr. Kendall Ho Director and Professor, eHealth Strategy Office, Faculty of Medicine, University of British Columbia
Yes, thank you.
Conservative
The Chair Conservative Joy Smith
Dr. Brown, I understand that Dr. Rossos will also be coming to us by video conference, and that Dr. Rossos is going to have a PowerPoint presentation.
I can see you in the background, Dr. Rossos. In just a moment we will start with your presentation.
We'll start with the video presentations first. Committee, we have three video presentations. Dr. Rossos, who is not only on video, is going to go high tech and do a PowerPoint presentation during his video.
Members, are you all awake to keep track of this? Wonderful. There are copies of the PowerPoint presentation in front of you.
I'll introduce our two witnesses: Dr. Glen Geiger, from the Ottawa Hospital, welcome; and from Canada Health Infoway, Mr. Richard Alvarez. Is it Dr. Richard Alvarez or Mr. Richard Alvarez? You've been promoted this morning.
Richard Alvarez President and Chief Executive Officer, Canada Health Infoway
Or demoted, depending on which way you look at it.
Conservative
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Thank you very much, Madam Chair.
I know we are late because we had a vote and I apologize to the witnesses, but I just wanted to put forward the motion that I have on the table today. We can discuss it later on in committee, but I want to put forward the motion right now, please. The motion is:
That, the committee undertake a study on the subject matter of Part 4 Division 13 of Bill C-45, A second Act to implement certain provisions of the budget tabled in Parliament on March 29, 2012—
Conservative
Liberal
Hedy Fry Liberal Vancouver Centre, BC
—and other measures, and report its findings to the House of Commons no later than Monday, November 5th, 2012.
Conservative
Ben Lobb Conservative Huron—Bruce, ON
Madam Chair, I know you recognized Ms. Fry. I think she realizes that we have witnesses here today. In addition, she has all the power in the world to read her motion during the time that she's allocated to ask questions. Therefore, I would encourage her, if that's what she chooses to do with the time that's she been allocated, five minutes or whatever it is, to do it when it's her turn to speak, if that's her priority today.
Conservative
The Chair Conservative Joy Smith
Dr. Fry, we do have committee business for 15 minutes at the end. Would you be so kind as to allow us to hear the witnesses who have come in?
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Absolutely, Madam Chair. I just wanted my motion to be put before the committee during the public session, because there is a tendency to go into private session and no one knows what goes on.
Liberal
Liberal
Conservative
The Chair Conservative Joy Smith
Great.
We're going to start with the video witnesses. We will begin with Dr. Peter Rossos.
You're going to make your PowerPoint presentation. You have 10 minutes, Dr. Rossos.
Dr. Peter Rossos Chief Medical Information Officer, University Health Network
Good morning, Madam Chair and colleagues. I'm honoured to be here to contribute this morning.
I'll summarize the present state of e-health and telehealth in Canada, and then provide you with an example of telehealth within an organization, the University Health Network. Then I'll suggest a few recommendations for e-health and telehealth.
Given the number of clinicians in the room today, I thought it would be appropriate to start with a case presentation. We have a large country with a small population distributed thinly along the Canada-U.S. border. One of the key variables is that we're all getting somewhat older.
As a result of these and other factors, we see there has been an exponential rise in total health expenditures, and this is challenging the sustainability of our system. In comparison with other OECD nations per capita, we spend toward the top of the cohort.
In looking at the adoption of electronic medical records, I draw your attention to the HIMSS Analytics maturity model for the adoption of electronic medical records within hospitals. It's divided into seven stages. Within the United States, presently over 21% of hospitals are in stages five through seven. In contrast, and this is data from the Ontario Hospital Association, most Canadian hospitals are within the lower half of the scale.
If we look at electronic medical records and hospital information systems across Canada, there are some general trends. Community-based electronic medical records tend to be local, smaller vendor solutions. They have been incented through provincial and national programs, and they tend to focus on primary rather than specialty or interdisciplinary care.
On the hospital side, most of us have foreign vendor solutions, many of them on legacy platforms. To bring this information together, we have existing or emerging regional electronic health records. Many of those involve consortia between large Canadian companies, Telecom Canada, for example, and foreign commercial off-the-shelf solutions.
It's important to remember that part of our battle, at least on the health care organizational side, is that most of these legacy systems were not initially designed for credible care. This has created challenges in workflow, database structure, and interoperability.
On the health care side, there are challenges having to do with standards, interoperability, customization, fragmentation of the marketplace, regulation, and user adoption. Standing back, we have to think what we can do that's affordable, achievable, effective, scalable, and supportive of the spirit, structure, and values of the Canada Health Act.
Over the past 10 years, Canada Health Infoway has taken us a significant way on this journey. Here I present our pan-Canadian electronic health record service blueprint. Certainly, Mr. Alvarez will comment further.
At this point, I'd like to highlight within a single health care organization how we've applied some of these information and communication technologies by featuring the telehealth program at the University Health Network here in Toronto.
We use information and communication technology to deliver health service, expertise, and information over a distance. This can be either real time or store-and-forward telepathology or teleradiology. We use telehealth to advance our patient-centred care initiatives to reduce travel, costs, time, discomfort, and, for many patients, the significant risk of travelling to receive specialized care that's not available closer to home. We've also calculated environmental benefits. That appears in an appendix to the slide deck. In the end we're all committed to this as the right thing for our patients.
At UHN, most of our telehealth occurs through two-way video conferencing over secure networks, very much as we're interacting today. We try to replicate the same workflow as face-to-face visits through our Ontario telemedicine partner, which you'll hear a little more about from Dr. Ed Brown. We also provide interprovincial care, despite significant regulatory barriers.
In this particular graphic, you can see that at most tertiary and quaternary hospitals, the focus of our care is around advanced medical and surgical care, cancer care, and transplantation medicine. The next geographic slide illustrates that our volumes have been increasing exponentially over the past 10 years, despite relatively fixed program costs and a very small team. Geographically, most of our care is provided within Ontario; however, we have a number of programs that have spread nationally.
I'd like to offer a few respectful suggestions for next steps.
First of all, I think it's important that we address issues around designing our health care IT systems and our strategies for telehealth. We must address chronic disease to better deal with morbidity and costs to bend the curve that we demonstrated earlier in the presentation. We must better connect patients and providers from the perspective of efficiency and quality, empower patients to better manage their disease and self-efficacy, and connect providers to reduce medical error.
Second, on the technology side, there is much we can do. To better leverage economies of scale, we can consolidate, upgrade, and replace systems, and we can improve connectivity and interoperability between existing systems. Then to fill the significant gaps we can support and fund innovation in an entrepreneurial fashion by supporting technology research and development and commercialization initiatives, and by creating and reinforcing clinical communities that will advance best practices, standards of care, reporting, and adoption. We can leverage best practices within IT itself, through lower cost agile development, the use of web technologies, better application of analytics, and moving toward more personalized medicine and care.
Certainly, as a third paradigm, none of this can occur without appropriate governance and accountability. That's where leaders like you, obviously, have to help us with alignment of our efforts around patient-centred care and chronic disease management, and with international comparisons and benchmarking to ensure we're meeting targets around health outcomes, access, quality, and safety, and ensuring that investments within our health system are aimed at the performance and adoption targets that we set forth.
As part of the Canada Health Act, we need both patients and providers who have appropriate mobility, and we support universality and accessibility through telehealth and the reinforcement of care communities.
As an individual clinician who has been involved in this process now for almost 15 years, I remain extremely optimistic and passionate. I think we can all work together as patients and providers, payers and managers, industry and innovators to achieve these goals. I think the work you're doing is a very positive step. Once again, I thank you for allowing me to contribute today.
October 25th, 2012 / 11:50 a.m.
Conservative
The Chair Conservative Joy Smith
Thank you so much. I appreciate your PowerPoint presentation.
We're going to go on to our next witness, and then we'll go into a question and answer time after that.
I would ask the committee to be mindful of our very important guests as well, over the video conference. I'm so glad they've taken the time to do this.
We will now go to the Ontario Telemedicine Network. Dr. Ed Brown is the chief executive officer.
Dr. Brown, you have 10 minutes.
Chief Executive Officer, Ontario Telemedicine Network
Thank you very much, Madam Chair and members of the committee. It is a great pleasure and honour to come before you today to tell you the story of the Ontario Telemedicine Network.
We're an independent, not-for-profit corporation. We provide telemedicine services for the Province of Ontario. We are funded primarily by the Government of Ontario through a transfer payment agreement. We have several key delivery partners we work with—Canada Health Infoway, Keewaytinook Okimakanak Telemedicine, and eHealth Ontario.
We're one of the largest and most active telemedicine networks in the world. As Canadians, we tend to be a modest bunch, but probably we can acknowledge that OTN and Canada are actually world leaders in the field of telemedicine.
I also know you're all quite aware that Ontario is a very large place. It's more than one million square kilometres and has a population of about 13 million. Many of us live in rural areas and about one million people are scattered across the vast northern part of the province.
Telemedicine began here in the late 1990s to address the challenge of delivering health care to this very widely distributed population. We use two-way video conferencing, electronic medical devices, such as digital stethoscopes, hand-held patient exam cameras, ear, nose and throat scopes, and other devices. By these means, physicians and other health providers can examine a patient over a distance just as if they were in the same office.
Back in the early 1990s, we started with four or five hospitals working together to deliver a few services, such as orthopedics and cardiology, to a handful of patients who lived far away from their specialists. In our last fiscal year, 2011-12, more than 200,000 patients received care that way across Ontario. It was delivered by nearly 1,700 consultants in almost every specialty, including mental health, internal medicine, oncology, surgery, and rehab. You just heard from one of our very special partners, Dr. Peter Rossos of the University Health Network.
We currently support more than 1,500 sites across the province. There are more than 3,000 video-conferencing platforms in action. There's participation from every hospital, more than 125 family health teams, 72 community health centres, 350 mental health agencies, 94 long-term care facilities, 65 community care access centres,10 aboriginal health care access centres, and even 13 prisons, including 8 federal prisons located in Ontario. All six medical schools use the network. One of our most important partnerships is with Keewaytinook Okimakanak Telemedicine. By integrating with them we're able to reach 30 remote communities in the far north of Ontario.
When patients use telemedicine from one of these sites, they avoid having to travel to receive care. If you total up the avoided travel, patients who use telemedicine last year avoided about 207 million kilometres of travel. That's about 275 trips to the moon and back, or about 5,200 circuits around the equator, just to give you an idea of the volume of travel avoided.
In addition, people in northern Ontario receive a travel subsidy from our government when they do have to travel, and because we avoided about 108 million kilometres of travel last year, that's about $45 million saved in avoided travel grant subsidies last year. Since OTN's base funding is only $22.5 million, about half of that, we feel that we're probably a rather good investment for our government on that one point alone.
The other exciting part is that using this level of travel enabled us to avoid burning 22 million litres of gas last year, which in turn avoided 57 million kilograms of pollutant being dumped into the atmosphere. It's kind of accidental because we set out to improve patient care, but it turns out that telemedicine is also very green and eco-friendly.
Besides these routine consultations that I've been describing, OTN also supports a number of emergency services. We have a province-wide telestroke initiative, teleburn, sign language, a mental health crisis service, critical care services, and a trauma pilot.
We also use the same technology to deliver a very active education program. That supported about 14,000 educational events last year, plus about 16,000 meetings, just like the meeting we're having here today. That translates into an average of about 18 education events, every single hour of every single business day, all year long.
In recent years, we've also been introducing some very exciting new technology services into the health care system. We have a tele-homecare service that supports remote monitoring and nurse coaching for people living with serious chronic disease. Our pilot program in that area, which we completed several years ago, included 800 patients, who experienced a two-thirds reduction in their hospitalization rates. It’s very exciting.
We've also introduced an e-consult service, where primary care physicians can send data and a picture to a specialist for an opinion. For example, if somebody here had a mole or a rash, a primary care physician could take a picture of it, bundle that up with a bunch of other electronic data and send that to a dermatologist. The dermatologist would look at it that day or that week, and send back a diagnosis. Specialists are way more efficient this way, and the patients get care much faster. In our focus groups, for example, whereas it can be a six-month wait or longer for a dermatology appointment if you go in person, patients using this service were getting their consultation back in five or ten days at the most. That’s a very, very significant improvement in access.
We're very busy scaling up these programs. We recently introduced lower cost PC-based video conferencing and mobile video conferencing, with the intent of enabling video conferencing to happen everywhere. We're aggressively growing our tele-homecare and e-consult programs to more people and to more specialties. We're doing this because we think these services are absolutely critical, absolutely central, to improving access to care, and in fact to creating a health care system that's sustainable. If we want a sustainable health care system, we need to leverage the innovation. We need to leverage the improvement in process that this technology can provide to the health care system. We're working double-time to make this happen in Ontario. The reality is that even though we have some fancy numbers, we're still scratching the surface. There is a lot of work left to do to make telemedicine a part of mainstream health care in this country.
Before I close, I want to thank all of you, specifically because you may not be aware of the enormous contribution the federal government has made to telemedicine in Ontario over the past number of years.
The federal government, through the Canadian health infostructure partnerships program, CHIPP, funded three start-up telemedicine networks in the province. In fact, there probably would not be telemedicine at the scale it's at today without that initial CHIP investment. Then later on in 2006, Canada Health Infoway partnered with the Ontario Ministry of Health to fund the integration of those three start-up networks to create what is now the Ontario Telemedicine Network.
Since then, Canada Health Infoway has funded a major expansion of OTN, called STEP, the scalable telemedicine expansion project, and has partnered with the Ontario Ministry of Health here to fund that tele-homecare pilot program, and now our tele-homecare expansion program. Our work with the federal government, particularly with Infoway, has been wonderful. It's been an enlightened partnership. I just want to make sure that you get the credit for all the support you've provided in helping us to start out and now to grow and succeed.
Thanks again for inviting me.
Conservative
The Chair Conservative Joy Smith
Thank you very much, Dr. Brown. It's really nice that you acknowledged the good work that's happening through the government. The committee appreciates your kind remarks.
We'll go to Dr. Kendall Ho, director and professor, at the eHealth Strategy Office, Faculty of Medicine, University of British Columbia.
Welcome, Dr. Ho. Thank you for being here. You have 10 minutes to give your presentation.
Director and Professor, eHealth Strategy Office, Faculty of Medicine, University of British Columbia
Thank you, Madam Chair.
Honourable members of the Standing Committee on Health, it's my privilege and honour to participate in and contribute to this session on e-health and telemedicine.
According to a 2012 report, more people globally today have better access to mobile phones than to electricity and safe water. Modern information and communication technologies such as smart phones, portable computing devices, and computers to access the Internet, social media and apps surround Canadians and are used by them every day for banking, travel, checking on investments, and accessing government services. Not surprisingly, Canadians turn to these technologies also for information to address their health needs and to live healthier lives. In 2010 Statistics Canada found that 8 out of 10 Canadians age 16 and older use the Internet for personal use. Out of them, 64 out of 100, almost two-thirds of them, search for medical and health information online.
E-health, the use of computers, smart phones, and other computing devices technologies to provide health services, is not only a theoretical possibility but it has clearly been demonstrated to improve health. Some examples of this have already been cited. For example, people in rural and remote parts of our country see doctors and nurses in medical centres for health services and consultations that they cannot physically access in their own communities. Citizens use text messages to help them quit smoking or as reminders to take medications so that they can reap the full benefits of medication provided to them. People use smart phones to monitor their own heart rates, to monitor how far they have walked or how long they have exercised, or to automatically send out an email for help when they fall at home. Governments monitor the health status of citizens through electronic health records to more smartly invest health care dollars to address the population's unique needs.
The evidence that e-health can improve our Canadian health care system is irrefutable. The opportunity and the challenge that lie ahead of us are not whether e-health can help, but how to integrate e-health throughout our health system in Canada.
For example, six years ago my son, who was 12 years old at the time, asked me why we couldn't make an appointment with our doctor online. I submit to you that this is still a relevant question today for the majority of our citizens across Canada.
What about accessing our own health information, laboratory results, X-ray results, biopsy results online, and then have our own doctor or a nurse help us understand their relevance?
Things are improving. Thanks to the leadership, such as from Canada Health Infoway and Health Canada, we're seeing positive changes. The question is how to accelerate this change so Canadians can benefit from e-health faster, better, and safer.
Based on experience here at the University of British Columbia, Faculty of Medicine, eHealth Strategy Office, I'd like to submit a few suggestions for the Standing Committee on Health to consider.
First, how do we involve our health professionals to use e-health in partnership with our patients and the general public? It has been shown that patients whose health care providers use technologies are much more likely to turn to e-health themselves. While many health professionals are actively using e-health, many more are currently not, because this is not their current practice pattern, or there's a lack of familiarity or understanding of the range of e-health that is there or the benefits for their patients.
We need to encourage practising health professionals through continuing education. We need to embed e-health training into medical schools, nursing schools, pharmacies, and other health professional training programs to increase the uptake of e-health. We need to encourage health professionals to work with and work in partnership with the general public to explore how technology can improve communication and to support patients to optimize their health in truly living out the concepts and practice of patient-centred care.
At UBC, our medical school is integrating e-health training into our medical student training. We are planning conferences and continuing education to help health professionals in British Columbia—doctors, nurses, pharmacists—to immediately integrate e-health in the province into their practices. We are working in partnership with the B.C. Ministry of Health's patients as partners program to involve our public as partners in e-health.
These are some examples of how we might engage the public and health professionals in working together on e-health.
Second, we need to explore gaps in our current health system and identify ways e-health can fill these gaps—mind the gap, as subway systems would remind us. Let's not introduce the latest technology, the leading edge, into our health system, just because we can. How do we find innovative and cost-effective ways existing technology can help address the challenges we have in our health system?
How can technology help citizens at home who have trouble leaving their homes to access needed health services? How can we leverage technology to help patients being discharged from emergency departments or from hospital—I'm an emergency physician myself—who need a little bit of extra help and monitoring at home before full recovery? What about rural citizens not needing to travel long distances to urban centres, spending hours and sometimes a full day on the road, just to have a 15-minute appointment with a specialist for a routine follow-up after surgery, perhaps, or a few weeks before. Think about the inconvenience, discomfort, and challenge of that travel.
These situations and many more do not require cutting-edge technologies to improve wellness and quality of care. What we need to do is find ways to integrate the technologies we have today to help them.
Third, we need to innovate on health policies that guide the progressive introduction of e-health into our health system. This policy hopefully would be informed by evidence as to what types of e-health can best improve access, quality, productivity, and cost-effectiveness. Health policy-makers, working hand in hand with e-health researchers, clinicians, patients, and industry partners, can most effectively design sound policies. Our partners can help monitor the successes and help improve and refine these policies based on progressively improving outcomes.
The UBC Faculty of Medicine has been very fortunate to contribute to some of these evidence-based policy efforts. For example, we carried out a literature review on telemental health for the Ministry of Health. We have undertaken a national benefits evaluation of e-health in first nations aboriginal communities, working hand in hand with the Health Canada first nations and Inuit health branch. We contributed to the World Health Organization Global Observatory for eHealth 2011 report on telemedicine for underserved communities.
The International Telecommunication Union in Geneva declared in November 2011 that broadband communications are a basic universal human right, on par with the right to food, health, and housing. In Canada, we're blessed with excellent broadband infrastructure, a great health system with dedicated health policy-makers and professionals who want to improve it, and citizens keenly interested in accessing digital technology for health and wellness. We can and must use e-health effectively, cost-effectively, and responsibly to improve our health system and the health and wellness of our citizens.
Academic institutions like the UBC Faculty of Medicine would love to support, contribute to, and work, with you, to advance this cause. The evidence is there. We simply need to work together to bring the evidence into routine practice in our Canadian health care system to achieve our desired goal. Citizens will be able to find and trust health services online to help them live well and thrive.