Health Committee on Feb. 5th, 2013

[David Wilks, Conservative, Kootenay—Columbia, BC]

It certainly is. For first responders such as EMS or police, who are normally first on scene and don't have the benefit of a doctor being there, could you give us some idea of what kind of technological innovation could help them with a person who is in distress at the scene—particularly in rural Canada—when you have that golden hour and sometimes are standing there going "oh, crap"?

[Voices]

Oh, oh!

[David Wilks, Conservative, Kootenay—Columbia, BC]

That was the technological term that is used by police.

[Dr. Alireza Jalali]

Two things come to mind right away. Right now—you may know this, you may not—the stethoscopes that all the doctors have around their necks, these are already out. Nobody uses stethoscopes that much any more. Most doctors still use them. Why? Because ultrasound machines are so portable and much cheaper than they used to be so that many doctors are replacing them with ultrasound.

And on iPhones, all these smartphones, you can actually grab apps and then have hookups to them so you can hook them up and do an ultrasound right away. So that's an area where you don't have to carry that machine with you. The same goes with the EKG. Now you have apps and a cover that goes around this, with a metal back, so you can just put it on the patient and right away it will show you an EKG. It's not that it's coming; it's already there and it has been there for the last four or five years.

So just off the top of my head, these are two technologies that can be used right away.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Do I have any time left, Chair?

[The Chair, Conservative, Joy Smith]

You have about 30 seconds.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Quickly, in rural British Columbia, where I'm from, we practice the primary health care model, which I think is a good thing, but part of the problem we have is that some of the doctors from time to time have to leave to update their abilities, and we have a difficult time getting locums. What types of online opportunities are available to them to keep their skills up?

[Steve Slade]

Very quickly, in terms of keeping up skills, I would leave that aside, but I do think there is a cross-jurisdictional question. A lot of times, locums are about moving across jurisdictions. I think the national effort to develop an application for medical registration in Canada is on the right track, so it is much easier for a doctor to license in multiple jurisdictions now, and it should be.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Excellent. Thank you very much.

Thanks, Chair.

[The Chair, Conservative, Joy Smith]

Thank you so much, and now we'll go to Ms. Hughes.

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

Thank you very much. This has been quite interesting. I have a son who is doing his thesis right now and working at the cancer research centre in Sudbury, so we hear a lot of medical terms.

First of all, I want to thank you for putting your deck together. That was quite useful, and of course, Dr. Fry was actually talking about some of the issues that the medical students brought to us. So we were lobbied this week and I'm just wondering if it was a coincidence that they happened to come at the same time as you're here. Obviously, it's the same message.

You talked about the geriatric need. There's a void there, and I'm quite well aware of that. I have a sister with Alzheimer's and I know how difficult it was for us to get a geriatric specialist to have a look at her. Not that long ago, I think it was two years ago now, we did an HHR study, and the key word was multidisciplinary teams. Although there was some movement there, I think we're still very far from where we should have been, and that's the problem sometimes with these studies. We do get recommendations and not very much gets moved on, unfortunately.

You talked about the legislative environment that hinders especially the area of research. Could you maybe elaborate on that?

I come from a rural area. I have the riding of Algoma—Manitoulin—Kapuskasing in northern Ontario, and we have some of the best doctors there, as far as I am concerned, but it is very difficult sometimes to attract a lot of professionals there. You talked about hospitals as well, and I just want to mention that recently I was in the North Bay Regional Hospital, and it's quite the facility. I think a lot of people see that as a place to really consider as they're looking at graduating.

Could you elaborate a bit more on the legislative environment that's holding things back? And do you have other recommendations?

I know that Mr. Denniss hasn't said very much at this point. You might want to add something in the time that we have left.

[Irving Gold]

I'll be brief and then I'll pass it on.

Yes, it's a complete coincidence, actually, that CFMS was doing their lobby day with the same messages, because we were only invited to present here on Thursday. So they had planned their lobby day long before we were actually confirmed here.

I think the reason their message is the same is that it's an urgent message and I think we're all singing from the same songbook now in terms of health human resource planning and the federal role. I know it was the number one recommendation of this committee's report, in fact, two or three years ago. We've been talking about this for quite a while. I think it's unavoidable that we do some national level planning and all of us are starting to realize that we all need to be saying the same thing at the same time to hopefully get this truck out of the mud because it's stuck. The problem we face—you mentioned geriatrics—is that even if tomorrow we decided to make major changes, we would not see them until 2023. I will be much older and making probably the same presentation if we don't get moving.

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

Or you'll be in need of them.

[The Chair, Conservative, Joy Smith]

And I would be amazed.

[Irving Gold]

That's right.

My plea is that the writing has been on the wall for a very long time. There's a reason why our slide deck is called “From Analysis to Action.” We are in analysis paralysis. We keep talking about this issue. It needs to get done.

The amount of money we're talking about—and everybody who comes to this committee with an ask says this, I know—is what the government probably spends on coffee whitener. Really, it's a very small amount of money. The potential impact it will have across this country is monumental. There are very few opportunities I think for the federal government to do such a big thing in health that's clearly within its mandate and scope for such little money.

If I seem passionate about it, it's because I really don't want to have difficulty finding a geriatrician in 10 years.

[The Chair, Conservative, Joy Smith]

Dr. Gold, you have done a super job, and I think you will live forever with your enthusiasm and positive attitude. You have done a great job.

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

Do I have time left?

[The Chair, Conservative, Joy Smith]

Now we'll go to Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

My first question is, since the federal government has a role in the regulation of medical products, what could we do to improve medical devices? What could we do to be more efficient in allowing that innovation to take place? It's a general question.

[Dr. Steven Denniss]

I'll take a crack at that. If you put yourself in the shoes of a medical device maker, they have to make certain decisions during the product development cycle in trying to gather requirements and functionalities and put them into a product or service. I know sometimes they have to take guesses on whether that product is going to pass regulation. They have to make that guess, which could be costly. It all goes into the cost of the product in the end. They make that choice because they don't get that feedback from Health Canada, for example, on whether that would or would not pass.

Then it goes there, and let's say it doesn't pass. Then they have to go back into an expensive product development cycle. Then the total cost, which has to get passed on to the customer, which is ultimately the hospital and the government, goes up.

I think my answer would be if at all possible to be a little bit more responsive and engage with the company that's saying, this hospital wants to develop this. I see this need in your community. I want to develop this, but I want to make sure as we go along and there are certain key decisions made, you can tell us up front whether that's going to pass regulation when it comes to the point in time when someone signs off on it. That would be my view.

[Patrick Brown, Conservative, Barrie, ON]

I have another question. I remember when we had the Juvenile Diabetes Research Foundation before this committee. They have been on the Hill a few times. They were talking about building an artificial pancreas here in Canada where they are doing clinical trials. They were saying we have a chance to do that in Canada, but in Australia they are also working very quickly towards that.

How are we doing internationally when it comes to supporting research innovation when it comes to that type of technology? Do you have any observations of where Canada stands compared to other countries in the type of environment we're creating?

[Irving Gold]

That's outside of my scope of practice. I don't know.

[Patrick Brown, Conservative, Barrie, ON]

There's another area I wanted to touch on, and maybe there would be a general comment. I know we've put a lot of money into electronic health records, and you would think the technology would be enhancing very quickly across the country. When I go to my local hospital, as much as it's a fantastic hospital, and I go to my local doctor, or go to get a vaccine, there doesn't seem to be evidence of that on the ground.

What is missing? What are the missing links in the sense that, if you go to a credit card company they can tell you your history for as far back as you want to know, and it's all digitalized. Yet if you want to know what vaccines you have taken because you might forget what you took five years ago, there is no common record.

What type of leadership do you think we need to see, to have that type of efficiency, given the fact that money doesn't seem to be the solution because there have been huge amounts put into the digitalization and that funding has gone to the provinces?

[Steve Slade]

I would observe that over the holidays I had an inappropriate charge to my credit card and my bank account dipped into, so I would suggest part of the issue here in health care is the firewalls in place to protect patient information. I think that's a real and probably valid concern around the protection of personal health information. I think that's a hurdle we have to get over. I think probably your privacy officer of Canada is one place to look at in terms of some of the protection there. I think that's one.

Before you get to the “how do we have a better platform, a more common platform, so that labs can talk with clinics and they can talk with the pharmacy as well”, I think there has to be more of a forum to have that conversation in.

[Irving Gold]

My editorial comment there—and I'm not speaking based on evidence or on behalf of my organization at this particular moment—is that I think it takes more than money to change culture. What we're talking about is changing the culture of an entire profession, and that is not going to happen just because a lot of money flows to the provinces. I think uptake of electronic health records is a monumental change for many folks practising medicine, and it's going to take a little bit of time for that to happen.

In terms of the very specific challenges, though, no one would be better to outline those than Canada Health Infoway, I suspect.