Health Committee on Feb. 12th, 2013

[Paul Lepage]

The reality is you're dealing with 13 different jurisdictions. You're dealing with decisions that are made in each province. You're dealing with the reality that some solutions are SAS-based, so there's central software with a terminal in front of the physician. In other cases they're installed directly in the physician's office, so it's a separate database. That is the reality of the landscape we have today.

There is no—

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

We're going to spend $10 billion. We've probably already spent half of it. We're going to spend another $5 billion. What is it going to cost us then to get everything put back together so systems will talk to each other from one province to the other, coast to coast? Is it going to cost another $5 billion to get everything fully integrated from coast to coast?

[Dr. David Price]

My really short answer is when you're funding a solution you require that it does roll up, that it speaks broadly, and that it can export its data. That is the fundamental challenge for everybody, and if we can accomplish that, it makes a huge difference.

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

Okay. The one thing—

[Dr. Michael Guerriere]

Can I add another point?

One of the things about this market is that it's quite dynamic. As the standards are increasing the demand on the different vendors, some vendors are having trouble keeping up with those standards because they're small. So what you're seeing is a consolidation in the market over time to probably four or five vendors who will be big players in the market and they will be able to meet the standards for intercommunication.

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

I know my time is pretty well up, but SAP is a huge player. Oracle is a huge player. I'm sure you guys feel you are a big player in Canada. Why are we even messing with these little guys when we should be dealing with the big ones so it's already there? OSCAR sounds as if it's a fairly big one too in the market. Why aren't we just dealing with these? It seems to me we are almost wasting our money with these little guys. Am I wrong?

[Dr. Michael Guerriere]

I'd be careful because this is a very innovative market. That kind of approach would have said that some of the new starts...just take other areas of technology—

[The Chair, Conservative, Joy Smith]

I'm sorry, our time is way over right now, so I'm going to have to cut this off.

We'll go to Mr. Lizon. You can continue if you choose, Mr. Lizon.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Maybe I have different questions.

Thank you, Madam Chair, and thanks to all the witnesses.

I had another question but this is quite interesting. Therefore, maybe you can continue on this topic.

What comes to mind is when they were building the railway system throughout Canada they didn't use different gauges in different provinces. It happened in Europe in different countries and when you came to the border you had to switch the wheels. I think this is what my colleague is talking about. It would make total sense to build a system whose parts talk to each other, despite the fact we have 13 separate systems.

[Dr. Michael Guerriere]

I think we have the gauge right, but despite the fact that the gauge might be the same, you still have competing companies, different car manufacturers. You still have innovation occurring in the different areas of the market. I think it's important that we get the right balance. We have standards for communication, or as people call it, interoperability. But don't stifle the innovation that's necessary to keep propelling the market forward. I think we're getting the right balance as we put systems into doctors' offices across the country.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

I will ask my original question on the topic that my colleague Mr. Wilks raised about how to convince the general public to be proactive in the use of innovation. I would like you to comment on the opposite side of the problem. Are all the doctors in for all the innovations? I would really like to sit at home instead of going in. I'm not in a rural area; I'm in the GTA, but I don't like driving downtown. Instead of driving in downtown Toronto for an appointment, I would prefer to sit in front of my computer and maybe check something with my telephone, if those applications were available.

How are doctors approaching it? Is there an issue of liability? How does all of this work together?

[Dr. David Price]

Doctors tend to be conservative. We're generally not early adopters. For instance, it gets us into trouble if we try drugs too early. It has to be tried and true. As we move into the next generation, there is increasing comfort with using advanced technologies.

[Dr. Scott Lear]

I agree. In our interactions with primary care physicians, with respect to our projects, we're getting 20% to 25% saying yes. These would be the most progressive physicians, the ones with EMRs. Some of them might have nurses in their clinics. We're not getting the engagements of those at the other end of the distribution, the late adopters, or what we call laggards. The other thing is that patients want to receive their care close to home, and they want to have access to health care professionals. There needs to be a balance. A physician who gives her home number to a patient is probably going to be inundated with calls at home. But you have to manage it so patients are satisfied with their access to that physician. If we can improve that balance a bit, I think the patients will start to adopt some of these programs.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

The question was asked about familiarity. Do you have a link for us? I know Mr. MacAulay asked already, but I didn't hear the answer.

[Paul Lepage]

Yes, we have it. I have it on my key and I can make it available on the link. Some of the videos are also available on our website.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Okay.

[Paul Lepage]

I think all of us today are doing work in the office, at home, and on the move. As patients, we expect to be able to do the same thing, to be able to meet with a doctor, to get more information at home, to get information or enter it on the move. My sense is that one of the things that—

[The Chair, Conservative, Joy Smith]

I'm sorry, we're running out of time. We'll have to go on to the next one. Thank you Mr. Lepage.

We'll now go on to Mr. MacAulay.

[Lawrence MacAulay, Liberal, Cardigan, PE]

Thank you very much.

This is getting interesting, to say the least. With innovation and new technology, just where are we in the world, in the whole scope of things? Are we running behind? How are we doing with this new technology? Either you're in the game or you're out of it. Where are we as a country, would you say, Mr. Lepage?

[Paul Lepage]

We're very close to being the last country in terms of adoption of technology in health care.

[Lawrence MacAulay, Liberal, Cardigan, PE]

That's not good.

I'd also like you to explain a bit about how smart phones and web applications might help people with mental health problems. There are other diseases or problems that also could use this. I'd like you to explain a bit on that.

[Paul Lepage]

I can give you a personal case.

Both of my kids are type 1 diabetics so they are insulin-dependent. They use the bant application, which allows you to take your readings and monitor your readings over time. My kids are a little older now, but when they were adolescents, often they would take their readings and fill out the booklet the night before meeting the doctor; whereas here with this application, you time-stamp it. You know exactly what the reading is, and you have that information. That gives the doctor more information when it comes time to either adjust the insulin doses or make changes to their diet. It allows you to get more information, and it makes it easier for the patient to enter that information at any point during the day.

So it's true for type 1 diabetics, and it's true for mental illness. In this application we're asking the patients at any point in the day to enter how they feel, to enter information, and that information is fed back to the provider. If they are not feeling well, or their mood is poor, it triggers an alert, and that information is sent to the provider, and it triggers a reaction.

So you're creating this ability to support that patient, not quite 24-7, but much more than what my kids would have had seeing their doctor, let's say once a quarter, as diabetics. The use of technology has increased the possibility of that exchange.

[Lawrence MacAulay, Liberal, Cardigan, PE]

Basically what you're telling the committee is that possibly information is better than the miracle of a doctor if having that information works better. I can understand that. They are only human beings too, of course.

[Paul Lepage]

I have two brothers who are doctors, and they are very human, trust me. The reality is I think you're providing the physician more information if they have access to that information that's been captured over a longer period of time than they would have by taking one blood test one morning.

[Lawrence MacAulay, Liberal, Cardigan, PE]

Are there enough dollars? Is there enough government investment? You tell us we're basically behind the eight ball in this country. What needs to be done? Should there be more government involvement, more government dollars, more research dollars? Where should it come from?