Health Committee on Feb. 12th, 2013

[Dr. Michael Guerriere, Chief Medical Officer and Vice President, Health Solutions, TELUS]

I think we've done well in our collaboration with various international research entities. You don't want so much collaboration, though, that you end up with group think, because often it's the competition of ideas that leads to innovation and new insight. Just because two countries are doing the same study doesn't mean they're using the same technology or the same approach to try to get at the problem. Sometimes these competitive situations are quite healthy for spurring on innovation.

[The Chair, Conservative, Joy Smith]

Thank you so much.

Dr. Morin.

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

Thank you very much, Madam Chair.

My first question is for Dr. Price.

My colleague Colin Carrie asked a very good question about the standardization of electronic medical records. At first, your answer was not what I expected, but as you answered more questions, you provided more details. You said that you would like to see the federal government do something about how data is entered into that software.

In terms of applications such as OSCAR and MyHealth, which are developed in Canada, I think it is healthy for the companies to compete in the marketplace. All those applications can export data, but the problem is that they are not compatible with each other.

A number of years ago in my riding, when we started to develop electronic records, I was working in a clinic that wanted to implement a system like that. Since buying a program requires private clinics to make a large financial investment, the clinics want value for their money. They want to be able to read their patients' data and that of patients who were referred to them. The problem is that the data are not compatible, although they can be exported.

You mentioned

that the federal government should look at how we enter our data.

Since you know more about electronic records than I do, could you tell me how you think the federal government could contribute to make the data compatible from one software to another?

[Dr. David Price]

I think if you get too prescriptive it doesn't work.

The concept has to be that my data must speak to your clinic's data, and therefore it's up to the companies, to the innovators, to make sure that innovation happens. When I talk to my technical people, they tell me that it's possible, but because of firewalls and different ways of doing the data, it doesn't work. There are at least a couple of innovations I'm aware of in private companies that are taking multiple sources of data, synthesizing it, and transporting it out. This is possible. They are proprietary companies operating in a marketplace. There are at least two or three companies involved in doing this.

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

This is the first time I have heard about a system like that. It is like an RSS feed bringing the data of a number of people together. I think this is something for the committee to think about.

Dr. Lear, you talked at great length about the good work being done through telemedicine to reach as many people as possible, even in remote areas. I come from a rural part of the country, and although the best solution would be to have more doctors to treat more patients, this is not possible to achieve in a short time. I believe that telemedicine can be a way for medical doctors to be more efficient.

Can you tell us more about how medical doctors could be more efficient through the use of telemedicine? Is it by answering e-mails, rather than setting up appointments, as my colleague Libby Davies said, or is it by making video appointments so we save time between appointments? Can you expand on that?

[Dr. Scott Lear]

Yes, certainly.

One of the things that can help is for patients to have the ability to report their symptoms, patient-reported outcomes, and for that information to be transferred, and maybe in the future to populate that physician's EMR so that right when a patient comes in, they know. They see on their screen why the patient is coming in. That would be one thing.

Another thing is that a lot of time is spent on managing chronic diseases and chronic care. With our system, we have the nurse who actually helps to provide the support for both the primary care physician and the patient around those lifestyle, behaviour, and self-management strategies that physicians would otherwise be expected to do, but may not have the time to talk about, such as how exercising is going to improve your blood sugar. These conversations should happen with a patient, but they don't need to happen by the physician.

[The Chair, Conservative, Joy Smith]

Thank you so much, Dr. Lear.

We'll now go on to Ms. Block.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Thank you very much, Madam Chair.

I, too, join my colleagues in welcoming you here and thanking you for being here to share with us your experience and the work you do.

I can't believe it, but it was 15 years ago that I was a member of the board for the Saskatchewan Health Information Network. It seems to me that we were talking about so many of the things that we continue to talk about today. I know at the time we recognized it was going to be a huge financial investment, that even if we had all the money we needed, we were not going to be able to do it quickly. One of the challenges at that time was to create that connectivity, not only within hospitals and within health regions, but within the province. So you had to start by taking very small steps.

Dr. Price, you've mentioned some of the issues, such as no common data, the limited ability to share across jurisdictions, and the need for protecting privacy. Mr. Lepage, you talked about the fact that we spent a decade developing standards. I think we needed to spend time developing standards for the very reasons that Dr. Price has pointed out. But I'm wondering if you could share with us if there are any disciplines within the health sector that are doing it well. I'm thinking, in particular, about pharmacy. There have been some huge gains in pharmacy in this area, and perhaps there are others you could share with us.

[Paul Lepage]

I'd start by saying you would not expect today to see a pharmacist who's part of a chain or a banner, or an independent pharmacist, who wouldn't be using a pharmacy management system. It would be impossible to conduct your business without the technology today.

If you look at the penetration of EMR, one of the issues is if the countries that have been successful in the implementation have combined the technology with changes to the compensation, with incentives for physicians to adopt the technology. So we've started, and some provinces are behind others on that. I know Quebec has just launched its program to incent physicians to adopt EMRs, and the EMR penetration is one of the lowest in the country.

I think it's a combination of factors. What are we incenting physicians to do? There's an element there. If we're focusing more on health outcomes and not just on a transaction, and we're looking at how we're going to fund health outcomes over time, then if you're going to track patients.... It's not a question of physicians not wanting to do this. My point is that if they're being compensated to fund and to follow a patient from an outcome perspective, over time they will need tools to track that. I think that will increase the adoption of technology.

If you look at the countries that have been successful, it's been a combination of more than one factor that has driven a higher use of technology.

[Dr. David Price]

You can look at dentistry, for example. We all receive reminders from our dentists. If we can start to do that electronically, that's going to make a big difference. I'm not of the opinion that we should be incentivizing physicians to do things. It should be a part of their day-to-day world. I'm not sure we need to pay them extra money for it, but it needs to be part of the system. It needs to be enabled so it's not a frustration and a coster, a net cost for them.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Dr. Lear, do you have anything to add?

[Dr. Scott Lear]

I agree with Dr. Price about having it a part of current processes in schedules for physicians. I don't have anything else to add to that.

[The Chair, Conservative, Joy Smith]

Thank you very much.

We'll now go to Dr. Sellah.

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

Thank you, Madam Chair.

Let me go back to the question that Dr. Price did not have time to answer. It had to do with the concerns of health care providers in relation to the OSCAR system that you implemented.

As a general practitioner, I have some questions about this whole technology. I am not saying that it is bad, on the contrary. It is very useful. It enables us to save a lot of time and to have access to our patients' records. But I am wondering what place the industry is giving to the doctor-patient relationship.

I am probably old-fashioned, but I see that some patients who go to the doctor's office do not have an organic disease. Instead, they need someone to listen to them. Sometimes, it takes a number of appointments to realize that the patient has a psychological problem rather than an organic one. If doctors relied on what patients say, they would be tempted to order a series of tests.

How can we work with this situation? My colleague Dr. Carrie talked about a physician who was using a BlackBerry to measure patients' heart rates, to monitor their hearts, and so on. In this industry, I still think that the role of physicians, particularly general practitioners, is based on trust and on the relationships they have with their patients.

How do you see this in the future?

[Dr. David Price]

I completely agree. It really has to do with the doctor-patient relationship.

I'm sorry to move into English.

The important concept has to be that we need to make sure that the doctors are trained to have that relationship. It may be so they get to the point where it's a cardiac problem and Dr. Lear's technology is important, but you have to go through it. It's not just about training our young physicians around technology. It is, to coin Sir William Osler, to put the patient at the centre of the therapeutic discussion. You're absolutely right in that sense.

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

Thank you.

I will share my time with my colleague.

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

Thank you very much.

My question is for Dr. Price.

Earlier I talked about my beef that I have with the data itself.

In your presentation you talked about searchable data which would help with public health, for example. Do you think that the current data being produced by that software is searchable? Otherwise, we're still going to have problems if we don't make sure that the data is searchable in a usable way.

[Dr. David Price]

In certain instances it is not searchable; in others, it is.

I will speak just to OSCAR, which I know well. In our particular EMR it has already been adopted by at least three or four public health agencies in the cities in Ontario. All of that is very searchable. We can actually amalgamate the information from multiple jurisdictions and run large-scale data. We've just had a paper accepted on influenza surveillance and we're actually able to pull it, not just from one or two practices, but from different cities and compare data.

[The Chair, Conservative, Joy Smith]

Thank you.

We'll now go to Mr. Lobb.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Thank you very much, Madam Chair.

Mr. Price, would you consider the industry for electronic medical records fragmented since there's really no one clear leader in the industry, or is there a clear leader in the industry that has 25% or 30% of the market?

[Dr. David Price]

It's fair to say there are a number of leaders.

I'm going to come back to the car analogy in that it will work out that there are going to be major leaders over the course of time. But there's always going to be the need for boutique solutions. Perhaps the ideal is that the boutique solutions will overlay or sit on top of basic electronic medical records.

[Paul Lepage]

I think the industry is like any industry when you start with a certain level of maturity and you're going to see a consolidation of the industry over time.

It's no secret that, from a TELUS Health perspective, we're actively looking at acquisitions in the space. We've already done a first acquisition in B.C., Alberta, and Quebec. The purpose here is to consolidate a very fragmented industry, but also we're focused on players that had solutions that were SAS-based, solutions where you could take all that data and have access to that data so you are looking at data from 2,000 physicians at once and you can denominalize that data and use it. That's what we focus on.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Just so I'm clear, in my understanding of the Infoway contracts—and I'm from Ontario—the basic architecture must be the same regardless of what software company designs it so in the eventuality you're talking about, they will speak to one another. Is that correct or not? I think we had some officials from Ontario tell us this.

[Paul Lepage]

From our perspective, our goal is to get to a national platform as we acquire and consolidate various players.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Why would the federal government fund projects that wouldn't consistently have the same basic architecture? I just don't understand why we would do that. Is there any logic behind that?