Yes.
Evidence of meeting #73 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was patients.
A recording is available from Parliament.
Evidence of meeting #73 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was patients.
A recording is available from Parliament.
4:05 p.m.
Conservative
The Chair Conservative Joy Smith
Thank you very much. That was extremely interesting.
There seems to be a thread in all the participants' presentations today. It's really very interesting.
We will continue our technological innovation study by beginning with Ms. Davies.
You have seven minutes.
4:05 p.m.
NDP
Libby Davies NDP Vancouver East, BC
Thank you very much, Chairperson.
Thank you to the witnesses for being here today, and to Dr. Lear for being here via video conference, far from home.
I must say that we're learning a tremendous amount about the new advances that are being made. I find it fascinating, but I also find that increasingly there's a sense of frustration. The stuff that we hear about is so incredible and, across the country, various projects, initiatives, or innovations are under way. What I'm beginning to wonder more and more is, is there a sense of national purpose about what we're doing? We have the Canada Health Act, which lays out the five principles of medicare, including universality. I hope it will be one element that we bring to this study. How do we take what you are doing, which appears to be working very well on the ground, and scale it up to a national level? I think it's a sort of frustration. It's a challenge.
On a personal note, I had an experience here in Ottawa. It was something very simple. I had to go to the ER, the one on Carling Avenue, and the ER doctor said, “Here's my e-mail. If you've got any questions, e-mail me”. I was just blown away. It was the first time I'd ever had a health care provider say, “Here's my e-mail, and if you have any questions when you go home e-mail me”. And I did. I wrote to the doctor and he replied within 20 minutes, instead of my having to go back. It was so simple. I mean, e-mail; what's e-mail? We all use e-mail, but even within the care system I had never had that happen, and it really blew me away.
In hearing about what's happening in B.C., Dr. Lear, with the B.C. alliance, I guess the question I have for you and I think it's also for Dr. Price, is, how can we respond to this in a more institutional way? How can we take what you are doing, find a way to scale it up, and replicate it? It's not necessarily one-size-fits-all. We want local innovation, as that's where the creativity is. How can we make sure that all of this stuff is accessible across the country?
For example, in B.C., I'm curious to know if you did it through the Ministry of Health, or did you have to go to each health authority and convince them to get on board with this or the various projects you've described? To me, that's where the challenge is. How do we put this into practice in a much bigger way so that we all get the benefits?
I know that's a big question. Whether it's the private sector.... I'm primarily interested in the public sector, but if you would care to answer that, I'd be very interested.
4:10 p.m.
Professor, As an Individual
That's an excellent question. I have personally experienced a number of those challenges that you've raised.
My domain is in research, so most of the projects I'm working on have been funded through CIHR, and some of it through the Michael Smith Foundation, which is the B.C. health research foundation.
There is some encouragement that CIHR has done with the requirement of having decision-makers in place for the application. So we apply as a researcher and we also have to have decision-makers.
My work has kind of percolated up from the ground level upwards. Yes, I have had to do basically a dog-and-pony show to various people in the health authorities. They're the ones who are delivering the health care. A lot of it has been word of mouth and that kind of snowball effect. It may not be the kind of cutting-edge answer that we want to get for something like this, but when we start to have one health authority involved and we have connections in other ones, that's how it's branched outward.
It's the same thing when we're recruiting or engaging family physicians. Once we get a certain mass, then it starts to increase. That's what Dr. Price mentioned about the early adopters, the modest adopters, and so on.
We've spent a lot of grassroots time doing one-on-one talks with individual...[Technical difficulty--Editor]...e-mails and that's how it's worked. Then it started to gain some more traction from there.
4:10 p.m.
NDP
Libby Davies NDP Vancouver East, BC
What I find fascinating is that it's almost touch and go as to whom you can talk to. There is no systemic way, and I think that's what we have to get at here. How can we, in a systemic way, help the system to respond? What can we do at a national level?
Maybe, Dr. Price, you'd like to respond to that. In terms of the work you're doing, what could we do, specifically, that would help you bring that to a much bigger community in terms of Canadians and health care?
4:10 p.m.
Chair, Department of Family Medicine, McMaster University, As an Individual
I would agree with you absolutely that it is not a one-size-fits-all. I suspect all of our frustrations are that there perhaps is not the kind of standardization and regulatory requirement for us to speak to one another.
I think one of the huge roles that Canada Health Infoway has, that probably the federal government has at the national level, is to set standards that require interoperability, that require conversations or communication that happens between systems so that as one organization develops a really neat application that enhances care, it is able to speak to other ones. Whether it's proprietary, whether it's institutional, or whether it's organizational doesn't really matter as long as those standards are generalized.
We're terrible at picking winners, either as individuals or as government. It's really hard to say which are the three solutions or the 23 solutions that are going to succeed. What we can do is say that everything has to have certain safety requirements, privacy requirements, data standardization, and also standardization for how we communicate.
February 12th, 2013 / 4:10 p.m.
Conservative
Colin Carrie Conservative Oshawa, ON
Thank you very much, Madam Chair.
I want to thank the witnesses. I find the sessions we're having here so exciting because, as you were saying, it seems we're right at the precipice of getting all these things implemented.
We've had witnesses in the past, Dr. Price, from Health Infoway. One of the things they did tell us is that they do have standards and they do have requirements for interoperability between the provinces. I think, though, there are a lot of really good products out there, especially what you're talking about with OSCAR and what you're doing on the ground. It makes common sense that we should be doing that across the entire country.
Some of the frustration we have is that I know the federal government invests in a lot of this. I think you've received money from CIHR and Infoway yourselves in the past, haven't you? Here we have people on the ground such as you and the people you work with, and you're doing really good work, but then suddenly there is an obstacle to getting the technology implemented. As I said, we've had witnesses in the past, and it seems that Ontario and Quebec are having a really hard time getting things implemented, whereas I think in P.E.I. and Alberta they do have some electronic health records implemented already province-wide.
What are the obstacles to getting this technology implemented?
Were you in discussions with the provincial governments when you were gearing up with this technology?
4:15 p.m.
Chair, Department of Family Medicine, McMaster University, As an Individual
To answer the latter question, yes, we've been in conversation. I think one of the things that Ontario has started to do well is that they have set up conformist testing, saying all of our electronic health records must have certain things in place and if they are in place, we're certified and we're eligible. That has made, I think, a huge difference.
Canada Health Infoway has moved into ISO certification saying that you must have a quality system from start to finish. Whether it's from the development of the software to the implementation, it has to be in a standardized quality format. I think that sort of initiative really starts to break down the barriers.
Where the barriers are still frustrating is where a province or an organization says they're not going to speak with one particular technology because they want to set up a barrier. That's what has to be broken down so there's a standardization. This means a hospital will speak to one technology and a technology will speak to another one because there's comfort that their standard is there, the data is protected, that there is security, privacy, etc.
4:15 p.m.
Conservative
4:15 p.m.
President, Health and Payment Solutions, TELUS
From my perspective, if we're asking what can be done, I see two areas, and I have some comments on the notion of standards.
From my perspective, we have to continue to focus on primary care reform in Canada. We're at 40% penetration, 39% depending on the numbers, of EMRs within clinicians using EMRs. Many countries are sitting at 90% or a percentage in the high eighties. So we have a huge gap just in terms of moving information into an electronic fashion and then making it accessible.
I think primary care reform.... The focus on putting EMRs with physicians is going to help us drive a lot of the other programs that we're trying to put in place around chronic disease management, medication management, etc.
The second comment I would make is that as Canadians we have spent the better part of 10 years focusing on standards, from 2000 to 2010. From my perspective, what we need to focus on is what we are trying to achieve in terms of health outcomes. Let's not fund on meeting a certain standard; let's fund on getting to certain meaningful uses. So let's fund outcomes. Let the market sort out, frankly, the notion of standards. We've spent so much time, a good part of 10 years, on a blueprint and on standards, and we haven't moved the bar.
One of the things we need to do is.... I would say the latest funding that was done with Infoway was funding that was more around projects and innovation and bringing solutions to market. For example, our Lawson project with the Lawson Health Research Institute was partially funded by Canada Health Infoway, but it was not funded on meeting a certain standard; it was funded on meeting a certain outcome.
From our perspective, we need to shift our funding from standards-based to funding that's outcomes-based. The U.S. is doing a pretty good job on that right now.
4:20 p.m.
Conservative
Colin Carrie Conservative Oshawa, ON
Thank you very much for that comment. It makes a lot of sense to me.
I wanted to talk to Dr. Lear as well.
You have probably heard of a doctor down there in California, or you may not have. I think his name is Eric Topol. He's doing a lot of things with cardiac. He's doing a lot with self-care. He's doing a lot with apps and cellphones.
We've had some witnesses here in front of us who are talking about the wonderful things that could be done with these apps, and the work that you're doing for remote communities, things along those lines.
We see these apps that could be used for diabetes, where people will put a sensor on their skin and they can read their blood sugar levels. We see where you can do an EKG that used to be a 12 lead when I was in school, and now it's just two fingers and you've got an EKG. You can do these things cheaply with a $199 app in remote communities, so the technology is there.
I wanted to ask you the same question. I know you've received federal funding, CIHR grants, things like that, but what do you find? Now that you've got the model, are you having trouble with the B.C. government? Are they prepared to start supporting you and financing these in your initiatives?
It seems that as the federal government we can do the role on the research side of things, but to actually get this implemented we have to have the provinces to buy in and it seems that there's a real stopgap there. What do you see being the obstacles?
4:20 p.m.
Professor, As an Individual
I agree that there is a stopgap and sometimes a disconnect between the federal research funding and then the implementation. At the end of the day, we're all here. All the researchers want to make a difference and want to see their projects actually on the go and working.
I mentioned earlier about some of the ways CIHR has tried to do it by involving the health authority decision-makers on the application. That's taken one step. Still when I approach these people, their first question is as to how much work it is going to take, because the health authority decision-makers already have full-time jobs. When I go up and knock on their door, most of the ones who are participating believe in it and are champions, but it's not necessarily part of the vision of the health authority. It's not part of the vision or the job description of that individual to participate in research. There are some things that could be done there to enhance it or greater incentives for the health authorities to get on board.
4:20 p.m.
Conservative
The Chair Conservative Joy Smith
I'm sorry, Dr. Lear, we're way over time. So I have to go to the next question.
You'll have to watch when I try to give you a signal, and I know it's hard to do via video.
We'll go to the next one.
Mr. MacAulay.
4:20 p.m.
Liberal
Lawrence MacAulay Liberal Cardigan, PE
Thank you very much. Being new on this committee, it's certainly interesting for me.
Dr. Lear, you were saying that the chronic diseases are much more prevalent in rural areas. Is that because of Internet access? Also, you were telling us that you can take a heart rate, blood sample, and pretty well read the condition of a patient from a rural area. Is that correct?
4:20 p.m.
Professor, As an Individual
I'll just make a couple of clarifications. With the heart rate, this is a regular off-the-shelf heart rate monitor that people strap on. It can record their heart rate when they exercise. When they come home they can link the monitor to their computer and then it sends the information to our website so that the exercise professional nurse can view the heart rate and look for things. These are things such as whether they are warming up properly, because this can lead to chest pain in these patients, or whether they are within their target heart rate range.
Things like cholesterol measures can actually be done. Those can be done at the local labs in the communities where the people live and then the results can be transferred down onto our website as well.
In terms of the increased risk, the Internet access is low, but what we tend to find is that there's a greater prevalence of smoking in smaller communities and rural areas. There's also a greater prevalence of obesity. These are two big risk factors for chronic diseases: heart disease, diabetes, lung diseases, and cancer.
4:20 p.m.
Liberal
Lawrence MacAulay Liberal Cardigan, PE
Dr. Price, I think you wanted to take a little more time on telemedicine, and I'd be interested in hearing that.
Mr. Lepage, on your video, is it possible for us to get that? I would like to see that video. I'll leave you my card. I'd like to see it.
Go ahead.
4:20 p.m.
Chair, Department of Family Medicine, McMaster University, As an Individual
On the telemedicine, Canada is a huge country geographically and when you're working up in a small rural community one of the things that is very frustrating often or very nerve-racking for the family doctor is that you don't have instant access or soon access to a specialist. Telemedicine has huge potential. I think you've seen across the country a large expansion of that in the last few years. As we start to see, though, as the technology improves is that it's just a video link.
One of the frustrations that the specialists seem to have is that they don't have access to all of the patient records. They end up repeating tests or making decisions because they don't have all of the patient records. So whether you use a portal into the electronic health record, whether you use a personal health record, it doesn't matter. The key here is how you have access to the patient data to inform the clinician to make appropriate decisions.
4:25 p.m.
Liberal
Lawrence MacAulay Liberal Cardigan, PE
Thank you very much.
The electronic health records and the medical health records, just for the public, what is the security on that and what is the difference between the two?
4:25 p.m.
Chair, Department of Family Medicine, McMaster University, As an Individual
When I was talking about standards, I would agree that it's about outcomes and innovations, but you need to ensure that whatever it's doing, it is secure, it's something that does meet privacy regulations, that the data is organized in a standard way. One of the challenges we have right now is that there is no data that is common. So whether the cholesterol is entered in a certain way, it's very difficult to compare them. That's one of the key things we have to have. That's where I think the federal government can play a huge role in helping us to understand how we enter our data so that it is common and as researchers we can compare data across jurisdictions.
4:25 p.m.
Liberal
4:25 p.m.
Chair, Department of Family Medicine, McMaster University, As an Individual
Absolutely. So you have to ensure that the integrity of the privacy is maintained so that patient privacy is always maintained.
4:25 p.m.
Conservative