Health Committee on Feb. 14th, 2013

[The Chair, Conservative, Joy Smith]

Thank you for that clarity.

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

Thanks. I'm available for part-time consulting work, too.

[Voices]

Oh, oh!

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

Dr. Dibble and Dr. Ballagh, we had a lot of bureaucrats come through here telling us all the things that are happening with electronic medical records. I'd like to hear from you two guys on the state of affairs in Barrie, for example, which is a pretty progressive community. When you see somebody, do you look at a paper file or do you look at electronic medical records? I'd be interested to know.

[Dr. Bradley Dibble]

I'll speak to that first.

I'm still a dinosaur. As much as I love technology, I still have a non-EMR system in my office. However, one of the reasons I've held out is that I'm going to be relocating my practice to a new building within our community just down the street. It's going to open up next year, and I'm going to make the transition then, because it makes sense to do the transition all at once.

But I will say that I held back a little bit because I heard from lots of my colleagues about lots of bugs that had to be worked out. I'm glad now that I held out, because I think the state of the art is good enough for me to be able to manage it.

It's not the same as a family doctor, where it might be very similar practice to practice; a cardiologist in Barrie is going to be a bit different from a cardiologist in Newmarket, who's going to be different from a cardiologist in Toronto. I needed an EMR that could fit my own personal needs.

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

Just before Dr. Ballagh answers, does Barrie have kind of a “vendor of choice” for electronic medical records? Have all general practitioners agreed to use one system, or is it a proliferation of systems?

[Dr. Bradley Dibble]

You know what? I'm—

[Dr. Rob Ballagh]

I think I can answer that.

[Dr. Bradley Dibble]

Okay. Yes, go ahead.

[Dr. Rob Ballagh]

Ours is the largest family health team in the province of Ontario. As such, the family health team went out and kind of led the charge on electronic medical records in our community. They looked at all the vendors and all the products, and they chose one through a very aggressive and big due diligence process.

One of the family doctors is actually their IT lead, their electronic medical records lead, and he's a good friend of mine. When I decided what I was going to get in my practice, I talked to him. I did my own due diligence in an abbreviated fashion, and I ended up using the same one.

In our community, many of the doctors, although not all, use the same system. They all communicate with each other to a greater or lesser extent.

My biggest challenge with electronic medical records is that the patients I see...particularly this lady with dizziness, the complicated case that I presented today. Often the initial consultation request comes with a letter that says “Vertigo?”

By the way, “vertigo” is a symptom, not a diagnosis, so I know, when I get that letter, that I'm really starting from scratch. What I often don't know until the patient is in the office is that they've had two other consultations with other specialists. They have seen a neurologist as well as a cardiologist, and they've had these six tests.

One day I'd like to see an electronic medical record that is available on a memory stick that I can just put in this computer. The patient's electronic medical record can be portable with the patient, and we can actually get that information right in our offices.

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

Here's the funny thing, I think, about this whole debate about electronics. You're working with McMaster University, right? I will guarantee you that a student who starts off their first year of university will have every single record in electronic format that anybody could look at. It's almost amazing that this somehow hasn't happened yet in the health care system.

There's one other thing I'm curious about. When you make your investment in your electronic medical record, is it subsidized through Infoway, or do you pay the entire amount?

[Dr. Rob Ballagh]

At the moment, through a program run by the provincial government, through an organization called OntarioMD, there are subsidies and there are some incentives for us to be early adopters. That's one of the reasons I became an early adopter. We are a progressive practice. We're a relatively young group of otolaryngologists. There are four of us and we knew that we were going to go to five. In fact, our fourth guy, who joined us 18 months ago, is all EMR.

[The Chair, Conservative, Joy Smith]

I'm sorry, Dr. Ballagh, but I'm going to have to interrupt you.

Thank you.

Now we'll go to Dr. Morin, please.

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

Thank you, Madam Chair.

My colleague Mr. Lobb had a good question. So I am going to continue along the same lines.

Not too long ago, when I did my chiropractic training, we weren't using the new technologies much, especially when we had to practise in real life. I would say that I am a fan of technology at home and outside work, but at work, I cannot bring myself to use technology such as the video for the nystagmus.

One of the reasons why health professionals in general do not use those technologies in their practice is the confidentiality issue. Just think of X-rays on the computer, for instance. That poses a risk of data leakage and, therefore, a confidentiality problem. I would imagine that the same goes for that video. It is part of the patient’s record. So it has to be in a secure place.

Dr. Ballagh, could you tell me what you think about that and give me an example of where you need to use new technologies more and still be very careful about the confidentiality of patients?

[Dr. Rob Ballagh]

I certainly can, and I should preface this by saying I'm married to a civil litigation lawyer. Confidentiality has been an obsession of mine since the day I met her, and actually since the day I walked into first-year medicine.

To give you an example, I was quite concerned about the confidentiality of the lady in the video that I showed today. I had reassurance from the committee that it would not be archived or shared on the Internet, and in fact that it would be shared only by the people in the room. I also went to the extent of calling her last Sunday afternoon and explaining to her what I was going to be using it for and got her permission to use it. She is an educator as well and she really wanted you to be part of that experience.

In my practice, with regard to these confidential details, they are not archived; they are simply documented. When I see that, I know what it is and I write it down. I don't need to keep that information, but some things do need to be archived and kept. For instance, if someone had a CAT scan five years ago and this year we find a tumour, we often go back and look at the CAT scan to see if that tumour was there. Did we miss it? How small was it? How could we have avoided that error?

So I think it's important that the information be available, but it has to be available only through the most secure firewalls. Getting through those firewalls, particularly if you're not in the hospital and in the facility inside, can be very difficult. From my office, it can be very difficult. Even though I share an electronic medical record with 85% of the doctors in my community, I can sometimes have a hard time getting that neurology consult, that CAT scan from last year.

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

Thank you very much.

My next question is for the representatives from the Conseil canadien de la coopération et de la mutualité.

I know that health co-ops are well established in Quebec and that there are some in Ontario. Perhaps I missed what you said about this in your presentation, but could you provide us with an overview of how health co-ops have developed? I think this model has been very promising for a number of years, despite possible management abuses. Those are little details. Actually, I think that, when a community takes action to invest in resources, we are talking about a winning model, especially in a context where we have to deal with failing health care systems across Canada.

[Michaël Béland]

Just like with any innovation, there is nothing new under the sun.

Let's look at the evolution. Quebec now has about 50 health co-ops. The first one of this new generation was founded in 1996. In 10 years, 50 or so were created.

There are also 46 home care co-ops in Quebec. In those cases, health care professionals go to people's houses.

Let me just add that co-ops have a significant international presence. In Japan, millions of people are co-op members. The same goes for Brazil. In Canada, this started with the Coopérative de services de santé de Québec, among others. There were also some in Saskatchewan when Tommy Douglas was around. Saskatchewan has four health co-ops. In Winnipeg, Manitoba, in Ontario, in Nova Scotia and in New Brunswick, there is one telehealth co-op. In total, Canada currently has 120 primary health care co-ops.

[The Chair, Conservative, Joy Smith]

Thank you so much.

Now we'll go to Ms. Block.

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

Thank you very much, Madam Chair.

And I want to thank all of you for being here today.

I have a number of questions that I'd like to ask. Some are at a real macro level and then some are at a micro level.

I used to be the mayor of a very small community. I wouldn't call it remote, but it was definitely rural. We had a medical clinic. We provided the space, and then we contracted with the different folks to come in and provide a service.

In Saskatchewan we have health regions. I am wondering if you could describe for me what relationship a co-op may have, if in fact they do, to a health region or to the province or what have you.

[Michaël Béland]

I will talk about the situation in general. Each co-op is autonomous and, as a result, has its own features, but the fact remains that the first partners are usually the municipalities. We make sure to maintain or to create services in municipalities. Generally, people in municipalities are board members and members of health centres. So public servants are board members and partners. The two are always working together.

Here is a very concrete example. In Beauce, Quebec, a co-operative set up shop on the same floor as the emergency room to be able to provide that service at the clinic when the emergency room is not open. In this case as well, the municipalities were the first to invest. There is a very strong partnership between all those players. That is really the key to the success of co-operatives.

But that is not the same thing you were talking about in terms of the co-op being open to the whole community. It is not the municipality that is in charge of the clinic. We invite everyone to become a member. There are about 3,000 to 4,000 members on average. All those who become members make their contribution and participate in a democratic process. They identify the types of services they want and how they want them to be organized. So we work very closely with the constituents. We determine what services people want in the community and whether additional services need to be provided, and we check to see if the people are ready to pay the bill that comes with those services.

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

Thank you.

My second question would be for you, Dr. Ballagh.

You talked about how you wished your patients would come in with all of their information on a memory stick. I don't understand all of the regulations around the sharing of information. I know that we are protected through privacy legislation. But you say that the first question that comes to your mind is, who owns what? When that person has a memory stick with all of their information, does it include your records and everything that you might have notated when you're treating them, and then, of course, that gets put on the memory stick, and then the next doctor and the next doctor? I have a hard time understanding the protection of the information.

Do you own some of the records, or do the patients own the records? Does it all go on the memory stick and you don't mind that whatever you've notated is going somewhere else?

[Dr. Rob Ballagh]

It's a complicated question because it is the patient's information.

First of all, this is a dream, the memory stick; this is not a reality yet. And it's a dream that we can collectively, hopefully, have together this afternoon. There needs to be a comprehensive medical record on that medical stick, and it should include, very quickly after the patient sees me, the record of my visit with them that day, and it should be contiguous with all the records, hopefully dating back right to their birth.

In terms of who can access it and to what depth they can access it, and can the patient access it, these are very difficult questions that have to be hashed out. Patients, when they read their own records, can sometimes misinterpret things or be offended. We're very careful in our language, but sometimes they can come back in with concerns about the way things were documented and things like that.

At the same time, not having that information, and particularly if I can't get that information during that very short patient visit—our patient visits are not long, and in my specialty they're 20 minutes—sometimes that guarantees another visit. Many of my patients come from miles and miles away to see me for that critical first visit, so we try to get as much done as can. But if we had that extra information, it would just be so much easier to get more done in a single visit.

[The Chair, Conservative, Joy Smith]

Thank you so much, Dr. Ballagh.

We'll now go to Mr. Kellway.

[Matthew Kellway, NDP, Beaches—East York, ON]

Thank you very much, Madam Chair.

Thank you, folks, for coming to see us today.

There has been lots of talk today about access to doctors in rural and remote communities. I never actually thought of Barrie as being particularly rural. Since I come from Toronto, it's just kind of up the road, with lots of suburbs in between.

Setting that aside for the moment, I was watching The National last night and there was a story about paramedics in Toronto being rerouted seven times in the course of three hours and a woman eventually dying over that period of time.

If I may, I'll share my own personal experiences with trying to access a doctor. I've had the same doctor for almost 20 years in Toronto. I thought I could book an appointment for a checkup with two months' notice, but apparently that's not correct. It required six months' notice. Then I had to miss that one, so that set me back another five or six months. By the time I got my annual physical booked, a whole year had gone around. In my family, my son and I—the boys in the family—have stuck with this particular doctor. Once my girls grew up, they decided to go to a female doctor in our neighbourhood, and it's really just this constant rotation of doctors through a clinic where you never see the same doctor twice.

With all of that, I accept the issues of remote and rural communities, but in our cities we have a huge problem with accessing health care and doctors on a consistent basis as well.

I should add that even in downtown Toronto, because of this condo boom we've experienced, even though there are a whole bunch of hospitals up and down University Avenue, as you know, they have simply been overwhelmed with the population in downtown Toronto.

My first question, after that lengthy introduction, is to the cooperative folks. You talked about pretty much all rural cooperatives. Is there any application of this model in an urban context?

[Michaël Béland]

Yes, of course.

Certainly there are some in Saskatoon, Regina, Winnipeg, and Vancouver, so there are some in the urban areas for sure. There is one currently being formed in Montreal.