Thank you and good afternoon.
My name is Dr. Danyaal Raza and I'm a family doctor here in Ottawa. I'm here today on behalf of Canadian Doctors for Medicare. We are a physician-led organization supported by thousands of Canadians, and we advocate for the improvement of our public health care system.
Thank you for the opportunity to appear before this committee and for allowing us to contribute to your study on health and innovation.
As a physician, I see the effect that innovation has on a personal level in my practice and with my patients. Today I'd like to start with a focus on the human side of innovation and the critical role it plays in making the best use of the technology that we have. I'll then discuss why it's an area where Canada has been falling behind despite our investments in research and technology. I'll end by encouraging the committee of the important role the federal government can play in encouraging health care innovation through the renewal of our health accord in 2014.
Canadians are fortunate to have access to some of the most cutting-edge technology available, but its utility in and of itself is limited. Its potential to improve the health of Canadians is only realized if the professionals using it are finding smart ways to put it to best use for patients.
An e-consultation project here in the Ottawa region is one such example. It's having a dramatic impact on the way patients experience their health care and on their health itself. Before this project began, family physicians seeking specialist input for a complex health issue typically sent a paper referral via fax to the consultant. This e-consultation project is bringing this process into the 21st century. Now an Ottawa primary care physician like myself has the option to do something entirely differently. To a secure online portal, they send the specialist details of their patient's health history along with the questions around the unresolved health issue. Rather than waiting the average three and a half months for a patient to see the specialist, the project has reduced turnaround times of the consultation to less than one week.
In addition to drastically reduced wait times, the e-consult project has resulted in the elimination of 43% of traditional paper referrals that would have been done otherwise by in-person specialist visits. For referrals that were still needed, family doctors were better able to prepare specialists through suggested lab tests and other diagnostic studies.
The project improves access to care, and both primary care physicians and their specialist counterparts feel that they're better able to determine what's best for their patients, and they feel that they're working together efficiently. Clearly this is the kind of innovation that both reduces wait times and saves money, but it also requires that e-consultation now be included in payment models for physicians. It's also a question of how we can spread this practice to other provinces and cities, not just Ottawa.
There are also other innovations that focus on coordination and interdisciplinary collaboration to provide more efficient high quality care for Canadians. Many of you also know about the success of the Alberta Bone and Joint Health Institute, where innovative approaches to hip and knee surgeries resulted in drastically reduced wait times. They decreased from 82 weeks to just 11 weeks. How? Through methods that included centralized intake of patients, assessment diagnosis, non-surgical treatment in single purpose clinics, and the use of multidisciplinary teams.
For example, if a patient needs to improve strength to be a candidate for surgery, a physiotherapist works with them to create a pre-operative strengthening program. Dieticians work with patients who need to make weight or nutritional improvements. Most importantly, there was a willingness to try something new. It took a little bit of investment but the payoffs were huge.
A virtual ward project in Toronto is another innovation that requires changing the way that we work. Patients who are at high risk for being readmitted to a hospital are provided with an around the clock care environment at home similar to that found in hospital. As virtually admitted patients to a hospital, they're able to call their care team with concerns until being transitioned to their regular doctor. It has helped keep patients physically out of hospital, has connected them to community care, and has prevented them from falling between the cracks.
As you can see, innovation isn't just about the newest developments in technology. Often it's about finding better ways to work together and to use the tools and technology already at our disposal. It's fundamentally about changing the way we approach health care, moving towards integration, coordination, and collaboration.
How do we do this, and what can the federal government do to improve the use of innovations in Canada?
Well, to move forward, we also have to look at what we've done so far. The 2004 health accord recognized that investments in science, technology, and research were necessary to support innovation. The federal government made some fruitful investments in this area. But the accord also recognized the importance of new models of care, including prevention and chronic disease management, and it’s in this area of innovation where Canada has been falling behind.
The Senate Standing Committee on Social Affairs, Science and Technology noted the lack of progress in its report “Time for Transformative Change: A Review of the 2004 Health Accord”.
The committee chair, Senator Ogilvie, stated that the system is “replete with silos, with no overall accountability, and that true innovation is rarely recognized and implemented within the system”. He stated:
It is critical that the additional funding added to the health accord…be largely directed to developing and implementing innovative models that actually deliver a modern whole-life health care opportunity to Canadians.
The committee recommended a number of ways to address this shortcoming, including both federal funding and federally led networks to identify and scale up innovations and best practice models in health care delivery.
Canadian Doctors for Medicare has repeatedly called on the federal government to get more involved in the sharing of health care innovations. Canadians are currently without any signals from the federal government that there will be another health accord despite the need for united action on these priorities. We'd like to ask this committee to support a 2014 health accord in any of its recommendations on this subject, and to make sure that innovations are shared and that all provinces are benefiting from them.
One way to do this is to reverse the shift to a per capita tied-to-growth funding model, where less populous provinces may not have the funds to keep up with technological innovation. We also propose that Canada develop an umbrella for innovation and echo the Senate’s call for federal funding and coordination to do so. The creation of a body that looks at innovation from a national perspective instead of piecemeal by province is critical to this effort.
The Health Council of Canada is currently tracking some of the best practices in the country through its innovation portal. With a broader mandate that includes funding and scaling up of those best practices and innovations, it could be part of that solution.
We also suggest a national body tasked with continuously reviewing evidence on new medications, diagnostic tests, and other interventions. By issuing guidance to health care providers on these matters, free of industry bias from pharmaceutical companies and medical device manufacturers, similar to what the National Institute for Health and Clinical Excellence does in the U.K., the quality of Canadian health care would improve and cost savings would be achieved. This is already happening on a smaller scale through the therapeutics initiative in British Columbia. When it comes to innovation, the federal government must be involved in setting standards and applying the best of our knowledge throughout the country.
Although some provinces have shared their innovations, Canadians believe it is up to the federal government to make sure that innovative care is available to all, not just some, and we need a 2014 health accord that makes innovation a funded priority for all Canadians. We urge this committee to consider a strong federal role in innovation that forges partnerships with the provinces to deliver the best in health care for all Canadians.
Thank you for your time.