Health Committee on Feb. 5th, 2013

[The Chair, Conservative, Joy Smith]

Good afternoon.

Welcome to our study on technological innovation and all the things we're going to be discussing today. We're very pleased that you could come to the committee to share your expertise and your knowledge. We're excited about having you here today.

We'll start with Dr. Jalali, who is appearing as an individual.

You have 10 minutes for your presentation. Thank you.

[Dr. Alireza Jalali, Medical Doctor, As an Individual]

Madam Chair and honourable members, thank you for having me here. I am Ali Jalali. I am a professor of anatomy in the Faculty of Medicine at the University of Ottawa. I also do a lot of research on innovative methods in teaching.

I'm going to start by talking a bit about the innovative technologies we use in medical education and that I've seen being used. I'll talk about some advantages, some disadvantages, and then some main points that I think are important for you to know about.

Why is all this talk about technology coming out right now? It's because of the digital native.

It is because of the new generation that we are trying to teach: a bit in medicine, a bit in nursing, and a bit in physiotherapy. These guys all come from an era when the Internet was always there. These guys were born with the Internet. They were born with technology, so education needs to adapt for them a little bit.

What type of education is out there? Probably you have all heard about e-learning. E-learning is electronic learning, so you really don't need classrooms anymore in many settings. This has its own advantages and disadvantages. The bigger part of e-learning now is m-learning, which is mobile learning. A lot of things can be developed on mobiles and given to people. I will get to the advantages and disadvantages in a second.

The huge thing that is very hot right now is MOOC. MOOC stands for “massive open online course”. Using MOOC means putting online a course that is certified, that people can get credit for, and that is open to everybody. You can have 10,000 people who have this certification from one course that someone has given.

What else do we have out there? Of course, we have Web 2.0, and for those who are not familiar with it, it's Web 2.0 against Web 1.0. Web 1.0 was the Internet, where you could go and have a look and see stuff, but you couldn't interact. With Web 2.0, you can interact with stuff. You can go to a hotel and comment on the hotel. The same thing applies in medicine. The same thing applies in education. A lot of teachers take advantage of that.

There are also a lot of wikis being born. You have heard of Wikipedia. What is Wikipedia? Is it the Internet? People can go there and write stuff on Wikipedia. Similarly, you can try to promote collaboration, communication, and inter-professionalism by using these types of tools.

The other huge Web 2.0? It's social networking. It's Twitter. It's Facebook. These are the things that our students and our residents, the people we are teaching, are using. We should embrace these. We should try to use them in education.

What else? There's simulation, of course. Everybody has probably heard of simulation. As soon as we talk about simulation, people usually think of high-fidelity simulation. They imagine a mock operating room, an OR built in a building such as we have here in Ottawa at the Civic Hospital, with a mannequin sitting on a bed and people working on it. Actually, though, simulation has been around for a while. The first type of simulation was with a standardized patient. To teach students, we brought in actors instead of actual patients.

The other type is virtual reality. I don't know if you have ever heard of a site called Second Life. It's a site that people go to where there are games, parties, and everything. It's a social network. Now in Second Life there are hospitals built by universities, where the students go to train, so this is another part of simulation.

There is procedure simulation. When I was in medical school, we used to do suturing on pigskin. That's another type of simulation. Simulation can be at different levels, but of course now what's hot is high-fidelity simulation, those Harvey mannequins that cost a lot of money and imitate a human being.

Those are the main points about the technologies I've found that are hot now and that I thought you should know about.

As for the advantages, these technologies of course help to adapt our education to the digital native, to these guys who are always technologically savvy and have their technology with them.

They also help with asynchronous learning, so the teacher doesn't have to be there. This saves time, money, and energy. Every four weeks you receive a new resident. A new doctor comes into the office and wants to work with you. You have to repeat the same things to him. Instead of the time that you or the nurses are spending on explaining this stuff to the students, you can just create a self-learning module, put it online, and ask people to look at it before coming to your office, so that when they do come in, they are ready for it. You take a passive technology such as a podcast and get more interaction with the patient out of it.

Those are the advantages. Of course, there also is a minimization of the risk to the patient. As I said, if you are suturing on pigskin, it is much better than doing it in the operating room for the first time.

This also gives power to students and patients. This is where the notion of e-student, to empower the student, and e-patient, to empower the patient, comes in.

If you go on Twitter, there are huge patient societies that talk about this stuff. There is no more of this “I am the doctor. I am the nurse. I am the health provider. I know everything.” No. There are patients who also have their say.

So these are the advantages I see.

As for the disadvantages, of course you need to learn all this stuff. When you have someone who wasn't born with the Internet—like me, like many of my colleagues—you have to go and embrace these types of technologies, and there's a learning curve.

Some people don't like it. If you say “Facebook” to them, they'll run away: “I'm not going to teach with Facebook. It's unprofessional.” No. You need to learn about it.

Then there's equipment failure. Everybody watched the Super Bowl. See what happens? It can happen. It happens everywhere. That was in the U.S., but it can happen here. When you're depending on technology, you need to have backup.

We need to teach our students about something that's new, which is online professionalism. They need to behave. I always tell my students, “You're a 24-7 MD. Deal with it.” For nurses, it's the same thing. When people look at your photo when you were drunk and under the table, they don't say, “Oh, that was his bachelor party.” No. For them, you're their doctor.

These are things we need to teach. You can't just tell the CMPA to, you know, go after people and.... No. They need to have policies for this.

One other thing that lots of my colleagues are afraid of is that we will lose empathy when we bring technology into teaching. When you have a Harvey mannequin in front of you, you can do whatever you want with the disease. There is no patient there. You can cure the mannequin. But when you're in the hospital, this is someone's grandfather. This is someone's grandmother. This is someone's mother in front of you. So we need to teach the students some empathy and the humanities of medicine.

Technology is great, but there are some main points that I want to get through first.

First we need to have needs assessments. Are you just using technology because everybody's giving iPads out? You shouldn't just hand iPads to people. You should not buy the hype. You need to make a needs assessment, and make sure that the people you want to give iPads to are comfortable with it.

Let's say I develop this great video, high-quality everything, and put it online with the thought that a remote-area patient will have a look at it. But if they don't even have high-speed Internet, then it's a waste of everybody's time and money. That's because I didn't do a needs assessment and didn't realize that these people didn't even have access to that. We need to be careful about this.

At the University of Ottawa, in fact at all the universities, we emphasize using technology that is based on educational theory. You know, have good objectives; know about adult learners; know about constructivism. If you're going to collaborate with each other and communicate, these are the theories of education that people need to know about.

We have two complete facilities—one AIME, the other CAPSAF—doing research in medical education to have the best practices. These things need to be based on solid ground. We need to research them.

As well, we always need to give feedback to people and follow up. You can't just give technology to people and hope that will solve all the problems. There are different levels of evaluation. You don't just give iPads to everybody, ask “So how many people liked it?”, and then write an article, if everybody puts their hand up to show “yes”, saying iPads are great. No. It's not that.

Our main goal in medical education, in health care, is patient care. That's the ultimate goal. Someone should see if this thing reduces the cost, if this things helps with patient care or not. That people are happy with it is not really what we should be after.

Finally, let's not forget about the humanities. If we just go with technology, then empathy may be lost.

Merci. Thank you.

[The Chair, Conservative, Joy Smith]

Thank you very much.

You had only 14 seconds left, so you did very well with that. Thank you.

We'll now go to our next guest, who's from the Association of Faculties of Medicine of Canada.

I think, Dr. Gold, you're the one who will be presenting today. You have backup there with Dr. Steve Slade, vice-president of data and analysis.

[Irving Gold, Vice President, Government Relations and External Affairs, Association of Faculties of Medicine of Canada]

Thank you very much, Madam Chair, and members of the committee, for taking the time and for inviting us to come and speak with you.

At the AFMC we spend a lot of time thinking about and enabling national projects that deal with medical education, and I would echo everything that Dr. Jalali said. There's a great deal of innovation happening in our faculties of medicine and I get to see it in my professional life on a daily basis, and it's very exciting.

I want to preface my comments, though, by saying that while we think of innovation often in terms of high technological innovation, in some ways, and in human health resources, HHR in particular, innovation is really about doing things differently than we are currently doing them. So I want to talk a little bit about health human resources, and I do want to talk about innovation. But it isn't going to be about microchips and it isn't going to be about the Internet. It's going to be about changing the way we think about health human resource planning in the country. I think that's a very important form of innovation.

I don't need to tell any of you about our health human resource challenges in this country. I know you all know them inside and out, backwards and forwards. I will make some points, though, just to show you that we understand some of the elements that I know you're concerned about. For HHR, the challenges we have go far beyond wait times. The effects of our health human resource challenges in this country are affecting consumers of health care, but other players, other people, in this country as well. It's not all about physicians. I'm here from the Association of Faculties of Medicine of Canada, but we play a role in health care delivery. We are not the end of the story by any stretch. Really, it's also more than just about shortages. That's where some of our innovative thinking needs to kick in.

Beyond wait times, I can say that we are concerned at the AFMC not only about unacceptable wait times, but things like lack of adequate chronic disease management, lack of care close to home, major health disparities among communities across the country, and a significant lack of coordinated, inter-professional care. I think I speak for all of our deans of medicine, whom I represent, and I'm sure everyone here, when I say we should be and could be doing a lot better in all of these areas.

Yes, the public feels the pinch of our health human resource challenges, but so do the provincial jurisdictions that are trying to plan their health care systems, and our national health human resource challenges affect their day-to-day lives. Every elected official I've met at the provincial, municipal, and federal levels hears stories on a daily basis from constituents about the challenges they are facing, so you all deal with this on a daily basis as well. You feel the pinch.

Our learners who are in our faculties of medicine, either at the undergraduate or postgraduate level, are facing enormous challenges just trying to decide what part of medicine they want to practise. “What should I be?” Our health human resource system and our lack of data and national modelling is making it difficult for them to make choices. Those days where we used to joke, “There's no such thing as an unemployed doctor”, are coming to an end, if they're not already here.

Finally, the provincial regulatory authorities are having a difficult time with our challenges, so this is about the patient for sure. It is about Canadians in general, though.

I'm not going to dwell too much on beyond physicians again. We all know that the role of the physician and other health care providers is changing and should be changing, but we all need to re-calibrate. I know that those charged with health human resource planning, using the current tools that are available, are not able to do this as well as they could. Forecasting scope-of-practice change and the changing role of the professions needs to be more front and centre.

Again, it's not just about shortages. For a very long time, everybody thought that our health human resource problems were presenting themselves in terms of shortages, but we now have anecdotal evidence, if not hard data, around surpluses in certain areas. In a country that faces the challenges we have, I don't think we want surpluses. The cost of training a physician is quite significant. We need to be thinking of the cost that the taxpayer pays to educate a physician as a major investment and we should be using those investments properly. An underutilized physician is an issue. They're not underutilized because they don't want to be working; they're underutilized in many cases because we haven't planned the supply properly.

You hear about geographic misalignment every day. Consumption of health care services is not the same in every province across the country, and certainly it's not the same in rural, remote, and northern communities. We have a major misalignment between supply and the needs of Canadians, I would argue. Canada has changed, and I don't think our workforce balance has changed to keep up with the times.

Finally, we have a disturbingly homogeneous workforce. We won't have the time to discuss this specifically right now, but the data clearly shows that those who are graduating and entering medical school represent a very thin slice of the upper end of the socio-economic pie in Canada. This is concerning to us.

I'm going to back up to what is innovative and what we want to bring to the table—and again it isn't rocket science but it isn't being done—and that's national collaborative data sharing and analysis.

We've heard in the last few weeks of three provinces that are using fairly sophisticated tools to measure needs in their jurisdictions, and the supply of people practising medicine that they are creating in terms of physicians in their province. And that's four, so that means there are several jurisdictions that are not currently using a robust tool for HHR modelling, but even among those that do, they face the immense challenge, which has been exacerbated I think of late by the extreme mobility of physicians. Provinces can no longer plan their physician workforce within a provincial lens. It's very difficult to do that with people moving around as much as they are, and that's the same for other health professionals.

So what we're missing I think, what we think at the AFMC, and we've been saying this for quite a long time, is a national approach to health human resource planning, a national tool that the jurisdictions can draw on, feed into, that would in fact examine the needs of Canadians from coast to coast to coast, and the supply today, tomorrow, and in 5 years, and in 10 years. Where are we going? Again, it takes between 8 and 12 years to train a physician. So when we play with admission levels today, we don't feel the impact of that for 8, to 10, to 12 years, and yet we make changes and two years later we undo those changes. We have this constant desire to play with the numbers before we've even seen the benefits of our actions.

I want to make sure there's enough time for questions and answers. I'm just trying to put on the table what it is we're coming with, and that is what I believe is an innovative approach to a national data and analysis modelling centre, which is the word that we're using. We used to say observatory, but people really didn't like that term for whatever reason, so now we've renamed it, but underneath the hood it's the same idea. It's a tool that the federal government could invest in, which would allow the provinces to share and aggregate their data and have a look at what Canada as a whole needs, and what Canada as a whole is currently producing.

I know that all of these issues touch on provincial jurisdictions, and that's a challenge, although I think in the area that we've identified there is certainly much precedent for federal intervention in terms of data analysis and data collection. I do think that the federal government really would be well positioned to assist the provinces in doing this work.

[The Chair, Conservative, Joy Smith]

Thank you very much for your very insightful comments.

Now we'll go on to our next guest, who is appearing as an individual.

Dr. Steven Denniss, please.

[Dr. Steven Denniss, As an Individual]

Good afternoon, Madam Chair and honourable members of the committee. Thank you for the introduction.

My name is Steve Denniss. I've been invited here today to this committee to offer my view on the sub-topic of training health professionals as it pertains to technological innovation in health care in Canada. I would like to thank the committee for inviting me to participate. I am here today to present to you my view as an individual.

As a matter of context, I will take a minute to briefly give you my background and experience as it relates to health, technology, and innovation. I have a bachelor of science degree in kinesiology, an Ontario Graduate Scholarship-funded master of science focused on human pathophysiology and disease, and a Natural Sciences and Engineering Research Council-funded doctorate of philosophy focused on integrative biology and mechanisms of disease, for which I received a Governor General’s gold medal.

Motivated by a growing interest and passion for health innovation and entrepreneurship, during the latter years of my doctoral program I began to independently seek out and take advantage of barrier-free opportunities to engage in government-sponsored business and entrepreneurship education and developmental programs, among which include the MaRS Entrepreneurship 101 program, the Ontario Centres of Excellence Value Added Personnel program, and the Mitacs Step program.

In further pursuit of a growing interest in health innovation, entrepreneurship, and business, I have spent the past year employed as a post-doctoral associate at the International Centre for Health Innovation. Within this role I have gained experience working to drive the success of innovation adoption research projects requiring the engagement and management of industry-academic-health care partners and interdisciplinary teams, as well as teaching aspiring health and business professionals. Currently, I am pursuing opportunities in the health and wellness and health-care consulting space. I am taking advantage of barrier-free business and entrepreneurship development and services, including science and technology business start-up competitions.

From my view, with respect to training health professionals as it pertains to technological innovation, I have the following key message that I would like to convey to the federal government through this committee: keep doing what you’re doing in funding barrier-free entrepreneurship and innovation initiatives, consider making a few adjustments to promote their widespread success, and be patient.

First, in support of the message to keep on doing what you're doing in funding barrier-free entrepreneurship and innovation initiatives, I offer the following viewpoint and recommendations to consider.

If one thing is certain, the need for innovation and those who can deliver it is upon us. In the health and health care sector of the economy, this is especially certain. From the overwhelming health demands of the aging and chronically ill populations and an ever-increasing exposure to competitive global marketplaces, these needs are real.

While Canada has got better and better at scientific and technological discovery, it has not made the same progress in becoming better and better at innovation, which may reflect that Canada has got very good at generating a highly educated and highly skilled workforce, but has not made the same progress in generating a science, technology, engineering, and mathematics workforce that is also highly innovative.

As for the demand for and the desire of such trainees to pursue more innovative careers outside a classic corporate academic role, for example, I think it's there. A case in point for supporting this view is the biomedical scientist workforce. I would point to the findings of a recent National Institutes of Health study, which found that only 23% of Ph.D.-trained biomedical scientists were in tenure or tenure-track academic positions and that as many as 49% were engaged in industrial research, science-related non-research, and non-science-related employment.

While unable to find comparable Canadian statistics, I am confident that, if measured, they would be at least similar. With this view, it is encouraging to see a growing number of government-funded scholarship programs to help financially support trainees, fellows, and practitioners who wish to engage in industry or industry-academic research initiatives, and who are able to find such opportunities that are a good fit for both the company and for them. However, with a limited number of such companies in Canada in need of a specific set of scientific or technical/technological knowledge, skills, and experience, this option is quite limited at this time.

Also encouraging, the Canadian Institutes of Health Research offers a science-to-business scholarship program, which provides partial financial support to Ph.D.-trained scientists in a health or health care-related field to pursue an M.B.A. This is indeed a great opportunity for those who wish to gain and apply such breadth and depth of business skills and experience. However, these scholarships are few in number and this path has a number of significant barriers, including additional financial costs, opportunity costs, and the risk of those who complete an M.B.A. program deciding to leave the health and health care field.

In addition, if the passion and ambition of a health scientist or practitioner, at least in the early stages, is simply to find a successful means by which to translate their great idea into an innovative solution worth implementing, a full-blown M.B.A. program may not be the best fit for such individuals, as one does not necessarily need an M.B.A. to become an entrepreneur or to begin innovating successfully.

For the increasing number of aspiring and seasoned health and health care professionals seeking to gain innovation skills and experiences that meet their needs, I believe that financially supporting entrepreneurship and innovation initiatives such as local innovation hubs, incubators, and competitions so they can be barrier-free is a worthwhile allocation of government funds in supporting the training of health professionals to facilitate technological innovation in the Canadian health care sector.

Second, in support of the message to make a few adjustments to promote widespread success, I offer the following viewpoint and recommendations to consider.

There is still a majority of potentially interested, willing and able, aspiring and seasoned health and health care professionals who are unaware of government-funded, barrier-free entrepreneurship and innovation initiatives available to them. The adjustments I would suggest that the government consider to help promote the widespread success of such funded entrepreneurship and innovation initiatives include the awareness of available resources, and adjunct support for local competitions.

Regarding the awareness of available resources, while it is a great and necessary step to have in existence a growing number of local, barrier-free entrepreneurship and innovation resources that aspiring and seasoned health and health care professionals can engage in, a key factor in realizing the full potential of those initiatives lies in how aware and informed those individuals are of such initiatives.

Without the conception and rollout of an elaborate and expensive campaign, I believe there are a number of relatively straightforward and low- or no-cost steps that could be taken to promote awareness of such resources using existing channels and supports within institutions.

For example, each department head of a university or a health care facility could send out an approved email to their staff with information on such barrier-free supports, services, and competitions available within their institution and/or the surrounding community to be passed along to health students or front-line staff. If there happens to be an innovation champion within the department with industry-academic, and/or entrepreneurship experience, have that individual as a consulting resource and/or a provider of a department seminar to even further contextualize such initiatives.

Regarding adjunct support for competitions, there is a growing trend for institutions or local innovation hubs to put on government-sponsored competitions in hopes of attracting health science, technology, engineering, and mathematics students and/or working professionals with the next big discovery or idea.

However, beyond a set of requirements and an application form with a list of business plan-related questions to answer, there is rarely an offering of adjunct support to help educate these non-business trained individuals on the right set of business fundamentals and frameworks upon which to build a great idea into an innovative solution worth implementing.

Such adjunct support for competitions would serve the important purpose of helping to prevent false hope and setting competition entrants up for failure, and of not wasting the precious time, energy, and resources of both the participants and the evaluators. The latter are typically individuals in key academic, clinical, and business positions.

Again, without the conception and rollout of an elaborate, expensive, and localized educational seminar series that reinvents the wheel for every competition, I believe there is a relatively straightforward and low- or no-cost step that could be taken to offer such adjunct support services using existing channels.

For example, Toronto-based MaRS runs a free Entrepreneurship 101 course taught by credible and seasoned individuals in entrepreneurship, who teach participants the necessary and sufficient business fundamentals and frameworks needed to evaluate the potential of any next great idea. Because each session is offered and archived as a webcast, this resource could be used as an adjunct support by anyone putting on a competition.

Lastly, in support of the message to “be patient”, I offer the following viewpoint and recommendations to consider. It takes time to change a culture. This is especially true in situations where things are polarized into specializations and heavily set in traditions and practices such as they are in both health care and education. It’s said that even if you’re doing everything right, it can still take up to seven years to successfully change a culture of an organization or a society. So if at all possible, this should be borne in mind when the government evaluates its metrics of the chosen measures of success of its entrepreneurship and innovation funding initiatives to decide whether to persist or to pivot.

With those elaborations, I will end by restating my key message: “Keep doing what you’re doing in funding barrier-free entrepreneurship and innovation initiatives, consider making a few adjustments to promote widespread success, and be patient.”

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Denniss.

We're now going into our Q and A session for technological innovation.

We will begin with Dr. Sellah, for seven minutes.

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

Thank you, Madam Chair.

If I may, I would like to introduce a notice of motion on drug shortages. We have been thinking about introducing this motion for a very long time. I am giving you the notice of motion today. The motion deals with drug shortages.

If I may, I will read it.

That the committee undertake, following its study on technological innovation in health care, a study of at least five meetings on the progress of the implementation of the motion adopted on March 14, 2012 by the House of Commons aiming to establish a nationwide strategy to anticipate, identify and manage shortages of essential medication right, and that the Chair report the Committee's findings to the House.

Thank you.

[The Chair, Conservative, Joy Smith]

Dr. Sellah, we have witnesses here right now and this is a different topic. Did you wish to take your seven minutes to discuss this right now?

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

Yes, I am going to ask questions. It was just a notice of motion, because I wanted it to be presented in public.

[The Chair, Conservative, Joy Smith]

Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you, Madam Chair.

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

I have some questions.

[Colin Carrie, Conservative, Oshawa, ON]

I have a motion to go in camera.

[The Chair, Conservative, Joy Smith]

Okay, we'll do that.

[Colin Carrie, Conservative, Oshawa, ON]

We just did a full meeting on the business, but if she'd like to discuss it—

[Hedy Fry, Liberal, Vancouver Centre, BC]

I have a point of order.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

It was just a notice of motion, just to clarify.

[The Chair, Conservative, Joy Smith]

Excuse me. I want to tell you that we need 48 hours to discuss this motion. You have tabled it now, but you can continue asking the witnesses questions. We'll continue there.

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

I understand what you mean about the subject under discussion, Madam Chair. It was just a notice of motion. I am ready to ask my questions now.

First, I would like to thank our witnesses for coming here to shed some light for us on technological innovations in health care.

We know that advances in pure and applied research and in technology are leading to the development of new diagnostic and treatment modalities. Heath professionals have to be able to understand these advances and to use them safely and effectively.

Could you give the committee some examples of the way in which the new diagnostic and treatment modalities have been built into programs of study in Canada?

The second part of my question is whether medical schools have made any effort to train students to use these cyberhealth technologies, particularly in terms of electronic medical records.

[Steve Slade, Vice President, Research and Analysis, Association of Faculties of Medicine of Canada]

I think to come to your first question on the adoption of new technologies in our educational curricula, there are a number of ways we do that. I think probably the big hammer we have is accreditation. All 17 of our faculties of medicine undergo a very rigorous process of accreditation on a regular, ongoing basis. There are about 140 criteria and standards on which our faculties of medicine are reviewed on an ongoing basis, including factors such as the safety of the learning environment for both learners and patients in those environments. I think that's a large piece.

As part of our recent reviews of medical education at both undergraduate and postgraduate levels, we are talking increasingly about competencies and shifting away from a paradigm of looking at the length of time you're in a training environment and, instead, looking at the competencies and the milestones that mark your progress towards those competencies. That is a bit of a paradigm shift within our faculties of medicine.

I think Irving can speak more directly to some of the technologies that help to ensure those standards.

[Irving Gold]

Thank you for the question.

I can tell you that the timing is perfect. We have just completed a study in partnership with Canada Health Infoway, so to speak to the second question around what is happening in our faculties of medicine with respect to electronic health records, the report will be released in the coming weeks, but I can tell you things are perhaps better than we thought. We have large clusters of faculty members who are really driving curricular adaptation to reflect the realities of an e-health-enabled environment.

The challenge we face, though, I must say—and this is perhaps somewhat of an editorial comment—is that it's very difficult. The faculty of medicine needs to equip a medical student or a graduate to be able to practise in a real environment. The real environment, the practise environment in this country in terms of electronic medical record adoption, is probably not where we would like it to be. Because so much learning happens in the field, for lack of a better word, we can only educate students in the field if they are getting their training in an enabled environment. The two go hand in hand, but I think we are keeping up as much as we can.

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

Thank you.

I would also like to benefit from your presence here, Mr. Gold.

You mentioned human resource challenges. I see that in terms of the provinces, politicians, students, regulatory bodies and medical educators. You mentioned the need for a tool at national level.

Could you be more specific about that tool and about what you are expecting from the federal government?

[Irving Gold]

Once again, thank you for the question.

As I mentioned, each of the provincial jurisdictions is making an effort to do its own provincial-level analysis, although the variance in sophistication of the HHR modelling is quite broad. There are some provinces that are just not equipped to do a whole lot and then there are other provinces that are investing quite significantly. What we are looking for is quite simply a federal role, a leadership role to enable a national platform. What we would be talking about is a tool—and I'll pass it over to Steve, because he's much more familiar with the mechanics of the tool—that will assist us to collect data from all of the jurisdictions not only reflecting the needs of the citizenry within those jurisdictions but what—

[The Chair, Conservative, Joy Smith]

Dr. Gold, I'm sorry but your time is up. I've been trying to signal you. Thank you so much for your comments.

We'll go to Dr. Carrie.