Health Committee on April 16th, 2013

[Branden Shepitka]

That's a great question. It would be a physical infrastructure funding program. A lot of these costs have not been budgeted by health care facilities. Most of their funding comes from pay-for-result services, but that funding for physical infrastructure is not there.

With an upgrade in especially wireless technology, we can realize efficiencies in the health care system that by using a fixed computer we just can't get. I know there's been some research regarding patient perception of provider contact. Patients actually feel that if you are face to face and not looking at a computer, instead having a tablet between you and the patient, sitting down rather than standing, the patient perceives that you're actually spending more time with them. So there are great benefits in having these wireless technologies that can improve patient experience as well as clinical workflow.

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

Thank you. That's interesting. I do know that the Conservative government is still putting money into the infrastructure fund and I hope that what you desire can be included in such an infrastructure program. If not, it might be a good pointer for those on the other side of the table.

You also mentioned the software program. I suppose compatibility issues are also part of the problem you mentioned. I would like to have your input on this. Several witnesses mentioned there were some compatibility issues because of all the different software and no regulations to have something unified. For example, patient files at the local drug store cannot be read at the local hospital, and those hospital files cannot be read at the local clinic by the family doctor because there are several authorware and software programs for different reasons.

Is it also a concrete problem that you have in your emergency care?

[Branden Shepitka]

Thanks for the question. That's a great question.

The interoperability aspect is huge, and I know that is one of the funding priorities of Canada Health Infoway, but that data flow among hospitals and external organizations does not exist to the capacity that would benefit the patient. I know in one of the commercials that Canada Health Infoway put out regarding continuity of care, the patient comes into the emergency department and the physician pulls up their medication list. That would be amazing. However, we have to go on to an external portal, we have to sign in with a user ID that expires after I think 90 or 180 days—so if you don't use it, it's not there—and you're only able to view drugs that a patient has been prescribed and paid for through the Ontario disability program.

So the information is very limited, and it's not integrated with our EMR. There are a number of extra steps that have to be taken in order to access information, which leads to a detriment to the patient.

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

Do I have more time?

[The Chair, Conservative, Joy Smith]

You have about 30 seconds.

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

You didn't have a lot of opportunity to talk. Do you have some final words you would like to express regarding concrete needs or solutions?

[Branden Shepitka]

On concrete needs, I really think we need a broad strategy to encourage collaboration in health informatics. Right now, IT is working completely separate from clinical, and that's been our biggest struggle in this project. On this project, there has been me, full time, and then we've had one IT analyst working full time on a $2.4 million e-health implementation. We have four core staff, two nurses and two clerical staff, that are clinical resources for one day, twice a week.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Shepitka.

Now we'll go to Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Madam Chair.

Thank you to the witnesses who are here today on our ongoing study.

One question I have asked of the various panels we've had on this topic was this. Given that health care is administered provincially and there are a number of limited ways we can provide a change of direction federally, I'd be interested in your input specifically on some of those areas, for example, the regulation of medical devices. We had one doctor, Dr. Ballagh, who expressed how difficult it is with the regulation of medical devices in Canada, but we had another one, Dr. Emad Guirguis, who said he thought it was much better in Canada than it was in the U.S.

I'd be interested in the experiences you may have had or opinions you have on federal regulations to medical devices. Obviously, a new device is potentially a form of innovation that could enhance sufficiency in health care, so we want to make sure we have the appropriate process in that regulation.

It's an open question to the panel.

[The Chair, Conservative, Joy Smith]

Dr. McGregor, do you want to try that one?

[Dr. Carolyn McGregor]

Yes, I want to speak to your case in point about medical devices, and specifically in my area of medical devices for clinical decision support.

As it currently stands, we're in a different landscape now to the United States in the regulatory process for clinical decision support systems, in that we have actually relaxed in Canada the clinical decision support system medical device ruling and infrastructure that's required, and testing for that.

One of the things that I think we have to look at when we're looking at devices is to stop thinking about them as boxes at the bedside. We need to have a holistic approach nationally to think about the software. We are slowing down our ability to innovate, and we're slowing down our ability to make that translation at the bedside when we have to think of them as boxes as opposed to the software infrastructure on them.

The step we've taken at the moment with the current landscape for clinical decision support is appropriate. In our case, for the types of tools we're building, we're building indicators and metrics that support a clinician in making a decision. We don't definitively say, “This is now infection, this is now intraventricular hemorrhage”, but we provide analysis and show, based on our gold standard research, that we're seeing the same sorts of correlations.

I think we are on the right track with the way we are currently mandating and regulating medical devices, but I do think we need to start looking at how we can make that process move through more quickly and smoothly by considering the software as opposed to a hardware-type device.

[Patrick Brown, Conservative, Barrie, ON]

Are there any additional comments on that?

The other question I had, and I've raised this as well with different panels, is on the issue of collaboration. Are we seeing enough collaboration, specifically in research? Obviously a lot of innovation stems from research. I remember when we had a panel on juvenile diabetes, they talked about the research being done on artificial pancreas in Australia and in Canada, and in that case they were collaborating. I remember when we had the Minister of Health before our committee talking about the collaboration we were doing in Europe on Alzheimer's and dementia with France and the U.K. and Germany. I was certainly excited by that.

Are we seeing enough of that? Are we seeing enough collaboration in research? In any of the fields that you're involved in, do you think there are opportunities for more collaboration when it comes to research and innovation?

[The Chair, Conservative, Joy Smith]

Dr. McGregor?

[Dr. Carolyn McGregor]

I think it's coming. Certainly in my research we have quite an interdisciplinary team. We have anyone from computing and electrical engineers, computer scientists, health informaticians, nurses, pediatricians, obstetricians, neonatologists. When you bring everyone together, that is really when you bring the innovation through, because everyone's working towards that common goal of trying to improve the care at the bedside.

I think there's more that we need to do. One of the challenges we have in working in that interdisciplinary space is that we all speak a different language. As a computer scientist, I needed to learn a lot about the conditions in the medical domains I'm trying to support and the types of care outcomes they're trying to work to. It's something I've needed to do and have worked towards over a number of years, so when I give presentations people assume now that I'm a neonatologist, when I'm not. I just have listened; I've gone on rounds and I've learned.

We need a lot more of that. We need fundamental mechanisms in our educational system, which is why I made the point before about the fact that clinical informatics really needs to be a subspecialty. It needs to be formally recognized across the nation in many different disciplines in health care.

[The Chair, Conservative, Joy Smith]

Dr. McGregor, I'm sorry, we're out of time.

There are two people who want to make a comment, but I have to do that with your permission, Mr. Kellway, because you're up next. Do you want to ask questions, or could we have two more comments?

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

I do have some very interesting questions I'd like to ask.

[The Chair, Conservative, Joy Smith]

Go ahead. It's your turn. The bells may interrupt you.

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

That may in fact pick up on where you were going.

Primarily to Mr. Williams and Dr. McGregor, and Mr. Williams first, with a fixed budget—and you're talking about technological development as an investment—how do you know when to dive in on a particular investment so that you don't over-invest in something as technology keeps changing?

[The Chair, Conservative, Joy Smith]

Dr. Vendittoli raised his hand. Did you see him?

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

Oh, did he?

[The Chair, Conservative, Joy Smith]

Yes.

Dr. Vendittoli, do you want to answer that?

Yes, go ahead.

[Dr. Pascal-A Vendittoli]

Yes, if you will allow it.

I believe we have extraordinary research teams here in Canada, and that they have an impact across the world. However, in most cases, research teams can only demonstrate the value of new technologies that were introduced retroactively. That is much too late. The assessment is being done after the technology has already been introduced into the health care system.

But a technology's performance should be assessed beforehand, using very small samples of patients. In cases where performance has been demonstrated, a more widespread use of that technology can then be recommended. Unfortunately, the current manner of proceeding goes in the opposite direction.

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

Thank you very much for that kind of retrospective analysis.

When you're looking at a fixed budget, how do you know when to go in, in advance? Do you have decision-making criteria?

Dr. McGregor, I'd like your views on this because you were talking about policies and funding frameworks, and maybe on a more global scale, you have some sense of what those funding frameworks and policies might look like to make sure we invest in the right technologies and we don't over-invest or under-invest in light of the pace of innovation.

Mr. Williams, perhaps we'll have you first.

[The Chair, Conservative, Joy Smith]

I have to forewarn you that if the bells ring, we'll have to cut it off—my apologies in advance.

Dr. McGregor, would you like to begin, and then Mr. Williams?

[Dr. Carolyn McGregor]

Just quickly, with the patient journey modelling approach that we had and with the balanced scorecard-driven approach, you can really drive your innovation based on the patient need, and I think that's my take-home message for you today. If you want to improve the health care system, you take it from the patient need, the savings you're trying to make with a patient, and let the technology support that initiative, rather than trying to do it the other way round. Often people do it the other way round; they think they have this great technology and they try to make the patient care fit.

I'll leave some time for Mr. Williams.