Health Committee on Feb. 12th, 2013

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

Thank you very much, gentlemen, for coming today. My questions will be directed to all three of you. Basically, I have one.

Certainly, Dr. Lear, I wanted to extend my understanding. I come from British Columbia in the southeast corner near Cranbrook. We deal with IHA there, the Interior Health Authority, and to me it would appear, and this is just a statement, Chair, that the health authorities are there as a buffer for the province, and it becomes difficult at times to try to administer something as it moves forward. That's just a statement, Chair.

I live in a small community of 3,000 and we work under the primary health care model. Our hospital was closed some years ago and it worked quite well. But part of the problem, and I want to understand what we can do federally, from you three gentlemen, is how do we convince the general public that either e-health or telehealth is something they can believe in?

The other thing is, what I hear from a lot of people is, “Why do I have to be the doctor? You're the doctor, so why am I doing all this stuff for you?” How do we get them to the point where they're confident with the system, that they understand that this is the next generation and that this is where we have to go, especially in smaller, rural communities?

I'll start with you, Dr. Lear.

[Dr. Scott Lear]

Yes. Thank you, Mr. Wilks.

What we're looking at here is basically trying to change behaviours. What you're asking is no different from how we get people, regardless of where they are, to be physically active. How we do that is to make these solutions the easy solutions, so there's easy access. However that patient is interacting with the system, whether it's through the Internet, telemedicine, through their phone, it's easy. Also, we must build their confidence in it. There are some barriers around health literacy, or e-health literacy, as well, with patients, and comfort levels. Now what we'll see as time goes on is that more and more older people will be using these devices more so, mainly because it's a cohort age thing. As we all age, we'll be still using these systems. So there are these challenges. I don't have, off the top of my head, the single answer that we can do here, but making sure that people have access to that information would be the first thing, and then engaging it and ensuring that the providers....

The other thing that you talked about is whether patients should be their own doctors. We talk a lot about the self-management, proactive patient in primary care. But a lot of patients don't want to be proactive. There are a lot of patients, who you've described, who want to go in and be told what to do and then go and do it.

We have some barriers to deal with there, but I'll stop there to let the other people respond as well.

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

Dr. Price.

[Dr. David Price]

I would absolutely agree with Dr. Lear that around the self-management issue, part of our challenge in training now is training our physicians to understand that the patient is probably going to come in with.... There are two types of patients. They come in with way more information about the specific disease than I have, or they come in saying, “Just tell me what to do, Doc”. The challenge for us as physicians in training our new generation or our next generation of physicians is to help interpret for the patients so that the patient can make the best decision that is relevant to themselves. I think that is part of the comfort, as they get more and more information from the Internet. It's putting it into context for themselves. That's probably key across the board.

The second thing that you asked about was in terms of Internet access and how we make it comfortable for the patients. How do we make it so that the patient wants to do it? One of the things we did at the maternity centre in Hamilton was give all of our pregnant patients access to their own health records and then give them targeted information. So we attached them to websites that we had vetted, we had already cleared. They came from reputable places like Johns Hopkins, Stanford, McMaster, McGill, etc. We told them what was relevant for their particular situation. That was huge. We were able to demonstrate that the amount of time they went to those sites was dramatically different from those patients who had no access to their own records. So that starts to trigger the interest in the patient.

[Paul Lepage]

We focus a lot on solutions, on the benefits to the system of using personal health records for remote patient monitoring in terms of reduced readmissions, reduced hospitalizations.

The reality is that every time there is a hospitalization or an emergency visit, there's a Canadian who is wasting time waiting to be treated in a hospital. As consumers, we're aware of this. It's a service, and if you could avoid going to a hospital, I think you would prefer this as a service.

The other thing we found is that as we supply patients with terminals or with iPhones on which there's a specific program, they take comfort in the fact that they have the ability to interact with a clinician and be supported by a care team rather than have to go to the hospital or to a primary care clinic. There's a level of comfort that develops from a patient perspective.

You're not going to be able to put all consumers, all citizens, all patients into one category. But more and more, as consumers, we're taking charge of what we're doing, in any walk of life. There are more and more patients, more and more consumers, who want to take charge of their health in the same way they take charge of other parts of their lives.

[The Chair, Conservative, Joy Smith]

Thank you so much, Mr. Lepage.

We're now going into our second round, and it's five minutes. It's two minutes less, so you have to be really sharp in watching your time.

We'll begin with Dr. Sellah.

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

Thank you, Madam Chair.

My thanks to all the guests who are here today and to Dr. Lear who is with us by videoconference.

As a physician by training, I also believe that all these electronic tools will lighten the heavy burden carried by practitioners. When I was at Laval University, I had to find the charts of elderly patients. Some of them often had three or four charts. I had to go through them in a few minutes and present the case to our manager. It was a challenge for me. So I feel that this will really reduce the workload.

However, I am concerned about the security and protection of personal health information. I just noticed that we have electronic health records and electronic medical records. I assume that the electronic health records do not include the medical history. Correct me if I am wrong, but that is not what I have read. The electronic medical records could be transferred between various general practitioners or specialists in various regions, even across the country. I know from experience that sometimes you need the patient's consent to request the transfer of the record from another doctor. How is the confidentiality of information protected if patients' records are transmitted electronically?

I would also like to ask Dr. Price a question. In your discussions leading to the development of OSCAR, what were the main concerns of health care providers?

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Sellah.

Who would like to begin to answer Dr. Sellah's questions?

Monsieur Lepage.

[Paul Lepage]

To begin with, I think it is important to fully understand the three items.

There is the computerized clinical file, which is used in hospitals by doctors who work there. In clinics, they use the EMR or the electronic medical record.

We have talked at length about the patient's personal record and about patients, regular people, keeping their records. Patients then have some control. They can decide who has access to their personal file. The exchange of information often takes place in a service corridor. Some service corridors develop naturally. In the Montreal area, Montreal, Laval and the south shore represent a service corridor. People will go to primary clinics and then to hospitals. In the Quebec City area, the same types of service corridors exist.

In all those cases, the exchange of information takes place with the patient's consent only. If patients do not give their consent to have their information sent electronically, it will not be done. I am in a good position to talk about this.

Furthermore, I think it all depends on how you ask the question. If patients in the emergency room are asked whether they want the doctor to have access to their information, the answer is always positive. In other situations, the answer is likely to be different.

[The Chair, Conservative, Joy Smith]

Dr. Price, did you want to make a comment on that as well?

[Dr. David Price]

The way I look at it is that if we refer a patient from one person to another and the patient says, “Yes, I will go to see that specialist”, that is implied consent. For that specialist to do the job properly, they need me to send the information to the patient.

The second thing is that, when the patient wants to share with somebody something in their personal health record, the patient owns their personal health record and gives permission to the clinician to view the record.

Does that answer the question?

[The Chair, Conservative, Joy Smith]

I think we're just about out of time.

Pardon me?

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

Is my time up?

[The Chair, Conservative, Joy Smith]

We're right out of time. I'm sorry.

Now we'll go to our next person.

Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

Thank you.

We're looking at technological innovation in health care. One question I have asked of each panel we've had so far, is, how do you feel we are doing compared with other countries? What lessons might you have observed when comparing us with some of our competitors in the delivery of health care? Are there lessons that Canada can learn from other examples that you have seen?

[Dr. David Price]

Perhaps I'll just reply that the countries in the United Kingdom spring to mind, where they've tried to have a one-size-fits-all approach. It has failed dramatically, and that has been a real challenge. For Australia, it's the same thing. It has essentially allowed the marketplace to deliver the innovations that the consumers want and need.

Set standards for privacy security, but look for outcomes.

[The Chair, Conservative, Joy Smith]

Dr. Lear, did you want to make a comment?

[Dr. Scott Lear]

Yes, I have just a brief one.

My focus is on supporting of self-management. There are definitely many different projects going on in the U.S., in Australia, and in the U.K. as well. There's also a lot going on within Canada. Often small clinics will create their own solutions which work very well for them, but we don't hear about these things, because they tend not to pass beyond the walls of that clinic. In different interactions with different health professionals, we start to find these things.

For example, one of the groups I work closely with is in Chilliwack. They all use the OSCAR platform, and some of them have started building on some applications.

I think there's still a lot of good that we can learn within our own country, just trying to look for those diamonds in the rough.

[Patrick Brown, Conservative, Barrie, ON]

I have another question which I asked a different panel. Because health care is administered by the provinces, there are restrictions on areas in which the federal government can have an influence on health care. But one area we do influence when it comes to innovation in health care is the area of medical devices and the regulation of products and the product approval process. Obviously, that's an important part of the process for health care innovation.

What is your opinion on what the federal government could do to make that process more efficient or effective in supporting innovation?

[The Chair, Conservative, Joy Smith]

Who would like to speak to that?

Dr. Price.

[Dr. David Price]

Fundamentally, I would agree that you can't have the wild west in deploying electronic technologies. You have to be comfortable that when my mother's chart is there and a drug is being prescribed, the particular system her doctor is using will recognize drug-to-drug interactions. That is the key aspect. I think it's there that the federal government has a real role to play in ensuring that all systems meet a basic level of security, performance, etc.

[Patrick Brown, Conservative, Barrie, ON]

Do you have any additional comments, Dr. Lear or Mr. Lepage?

[Paul Lepage]

What I would say is that, as you see more and more of these devices, these applications, be it with personal health records or remote patient monitoring, are more and more connected to devices, you're going to be connecting these devices either through a USB port or Bluetooth. The basis here is that whatever device it is would have to follow certain standards, because we're going to be relying more and more, from a medical perspective, on the information coming from those particular devices so that we can diagnose. So more and more information will be coming from devices, fed in either through personal health records or through remote patient monitoring tools, and will be fed back to clinicians.

I would say that from a standards perspective, this is paramount.

[Patrick Brown, Conservative, Barrie, ON]

Do you have any concerns about research overlap? Is there adequate collaboration on innovation with international institutions? For instance, in treating juvenile diabetes, we're investing in an artificial pancreas, and they have a parallel study in Australia. That's one example. I'm sure there is collaboration, but do you believe that we do enough of it?

[Paul Lepage]

I would refer that to Michael, who is our chief medical officer. He's done a lot of research at various universities.