Health Committee on Feb. 12th, 2013

[Paul Lepage]

My sense is—

[Lawrence MacAulay, Liberal, Cardigan, PE]

Or should the companies do it?

[Paul Lepage]

The companies are going to do it. The companies are going to continue to invest in health care, because it's a very large market.

[Lawrence MacAulay, Liberal, Cardigan, PE]

But you say we're behind the eight ball. Why?

[Paul Lepage]

I think one of the reasons we're behind the eight ball is that we need to focus our dollars in the right place. I think part of the focus has to be not only on outcomes, but—

[The Chair, Conservative, Joy Smith]

Just be mindful that Dr. Lear does want to answer the question as well, so could we go on to Dr. Lear, because there is only about 30 seconds left.

[Paul Lepage]

I would just say the funding has to go towards outcomes.

[The Chair, Conservative, Joy Smith]

Thank you.

Dr. Lear, go ahead, please.

[Dr. Scott Lear]

Thank you.

Just briefly, one of the things, going back to what I mentioned in the opening presentation, was about shifting some of the CIHR dollars to more applied research that can look at health services that can look at e-health and technology.

I think we need a mix of both private and public inputs to get this done.

[The Chair, Conservative, Joy Smith]

Thank you so much.

We're going to go back to the seven-minute roster, because the members opposite would like to have more time to answer. We still have 15 minutes to question.

We'll begin with Dr. Morin, for seven minutes, please.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Mr. Chair, thank you very much for allowing us to ask the witnesses more questions. We have some excellent witnesses with us today.

A number of committee members who are here today are very concerned about the staggering amounts of money that the federal government has invested in electronic records. I personally believe that they are important, but compared to the money being invested, I don't think we have had an adequate or satisfactory product yet. In his questions, Mr. Lobb also identified this issue as a priority. In addition, I am happy to know that this is also important for a Liberal MP.

Mr. Lepage, please be brief. You said that the funding should be outcome-based. I need to ask you to further explain what you meant by that.

[Paul Lepage]

What I was trying to say was that it is important to consider the models that have been recently implemented in the United States. We are looking for some indicators. We are focusing on outcome rather than on dictating how it is obtained. In addition, standards are obviously in place. Dr. Price talked about them. It is important to follow basic standards, but, if we want the system to evolve, we need some innovation. We must let the market find the right solutions to meet standards. The idea is to provide rewards when those standards are met, not to dictate exactly what we want to be done. Instead of dictating what needs to be done on major work sites, it is better to focus on an outcome and let people decide what the best way is to achieve it.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

I'm going to give more time to Dr. Lear also to explain his point of view. You only had a short answer.

[Dr. Scott Lear]

Oh, I'm sorry. I didn't have anything to add to that.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

I'm giving you more time to answer the question you were asked earlier.

[Dr. Scott Lear]

Oh, sorry.

As I pointed out, the CIHR funds can go through a balance. Right now there are the four health pillars within CIHR: biomedical, population health, behavioural social and clinical health services. I think there could be more shifting of funds to more of these applied sciences where we do see things funded around primary care transformation and a development of health services models, and something that a development of technology can also feed into.

In my experience, that has been quite positive because our platforms have been developed through CIHR money and then when we're interacting with health authorities we don't have to say this is going to cost them x amount of dollars because we've already developed them.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

I have a quick question before I let my colleague, Djaouida Sellah, ask one.

Mr. Lepage, earlier you said that we must let companies innovate. I also agree with you, but when I look at...

[The Chair, Conservative, Joy Smith]

Dr. Morin, can I interrupt you? I'll give you some time, but I think Dr. Price wanted to make a comment.

I didn't notice, Dr. Price. My apologies.

[Dr. David Price]

Very briefly, and that is, define a question and look for an outcome. For example, with a chronic kidney disease, what is the problem? It's too many individuals moving down the slope towards dialysis. How can we address that? That has to be your outcome, so what are the innovations to address it?

Don't tell me what to do. Tell me what the outcome has to be.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you.

Mr. Lepage, the data that we have received over the past couple of hours indicate that between 80% and 90% of doctors use electronic records in some countries. We are talking about 50% in the U.S. and 40% in Canada. I am a big fan of our made-in-Canada products. But should we not look at what is happening around the world and copy what others do exactly as it is? Do our nice Canadian system and the very complex jurisdictional issues make the situation impossible? I also don't think the solution is to invest more money. In my view, that would not solve the problem.

[Paul Lepage]

To answer the first part of your question, I think the private sector is ready to play a bigger role and to try different models to solve the problem. Instead of receiving billions of dollars, we can choose models that are similar to those used by telephone companies, for instance. That means developing systems where you pay for usage. Many players, including Telus, would be fully open to the idea of letting the private sector develop some of those solutions in exchange for compensation when those systems are used.

As to the second part of your question, you asked what the winning formula is. Many studies show that it does not depend on one factor only. When you are at a turning point, a number of factors come into play. I still believe that changing the compensation system for doctors is a good idea. I am not saying to increase the wages, but to change them. In my view, doctors also need to be encouraged to use those technologies. Finally—and this is a key factor—we must ensure that some standards are in place. At some stage, some players will drop out of the race.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you.

[The Chair, Conservative, Joy Smith]

I think you've run out of time.

We'll go on to the next one.

Dr. Carrie and Mr. Lobb, I understand you're sharing your time. We'll begin with Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Actually, Mr. Lobb had a point.

[The Chair, Conservative, Joy Smith]

Mr. Lobb.