Health Committee on April 16th, 2013

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

I'm wondering if you can, for the benefit of this committee, maybe give an example of where in the last five or eight years you've implemented a certain piece of technology, equipment, or software into the alliance—innovation and savings—and then been able to reinvest those savings back into something else for the benefit of the patient. Are there examples out there you could give?

[Andrew Williams]

One that's not very sexy, I suppose, is around transcription and using remote transcription, which has lowered our costs in the health records area and allows us to reinvest those dollars back into the organization. It's taking advantage of a new technology that does reduce your overall operating costs and frees up money to invest in other locations.

On the information technology side is the example I mentioned about putting technology at home. That significantly saves time and money for the system that we can put back into our mental health program to actually increase the number of patients we can see.

What we're actually trying to do as we identify efficiencies through technology is reinvest in the programs that identify them so we can see more patients. We've got some good examples of that.

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

Again, the area that you're in is obviously the same area I'm in; it's rural and some of it is remote as well. On the mental health side, how does the apparatus work at the person's home? I'm thinking of somebody who could be in a farmhouse where there's no Internet, there's no cellphone coverage, or somebody who may be low income or a senior who doesn't have Internet. How does that machine work in that instance?

[Andrew Williams]

It's an excellent point. One of things we are doing with some of the savings we've realized is actually paying for Internet into the house, because you do have that problem, that accessibility issue.

Going back to the question earlier about how we adopt the cloud technology, a large part of it is driven by your consumers of health care. Up until now, the majority of the consumers aren't into that technology. It's a big challenge for us. We work with our individual clients and make sure they have the tools they need, that they have the Internet and they have the supports. We will do home visits to make sure they're using the technology appropriately, but it is a big challenge. When you're dealing with a rural population and an older population that may not be used to technology, it does require a little more focus.

As it becomes more the norm, as the baby boomers start to really use our health care system, they'll come in and expect certain types of technology, and you'll see the system shift then. Right now, we're kind of in both camps, where we've got a large piece of the population that's not comfortable with technology and a large piece that expects it, so it's having to bridge both of them. But in the home technology we work very closely, individually, with our clients to make sure they are comfortable, and they all love it.

We have one great example of an individual who is going to university in Toronto and needs access to outpatient mental health, and because of this technology that person can actually stay in Toronto and doesn't have to go back and forth.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Williams. That was very insightful.

Thank you, Mr. Lobb.

We're now going to go into the five-minute rounds.

Keep in mind that the bells ring at 5:15, and we'll have to dismiss then.

We'll begin with Dr. Sellah.

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

Thank you, Madam Chair.

First of all, I would like to thank the witnesses who have joined us today, as well as Dr. Vendittoli.

My question is for you, Dr. Vendittoli. I must admit that when listening to your presentation, I was surprised to hear that things are now worse than they were in the past. You mentioned chaotic introduction. I know you are aware of how things are being done elsewhere, for example in Sweden and Australia.

Could you give us more details so that we can correct our problem here in Canada.

[Dr. Pascal-A Vendittoli]

Thank you.

Those who are familiar with the introduction of new drugs into the Canadian therapeutic arsenal, or elsewhere in the world, know that there is a very strict process to follow. In many cases, those costs are covered by provinces or the state. Furthermore, it must be demonstrated that this medication is superior to the current treatment.

In the case of implants, it is quite the opposite. The introduction by the industry of implants into the therapeutic arsenal was never subjected to that kind of performance requirement. To be admitted as a treatment, the implants only had to be safe. That was the main criterion. They also had to resemble an implant that was being currently used.

But why would implants or new technologies being introduced not be subjected to preclinical trials, as is the case for medications? This would allow us to avoid failures, repeated surgeries and enormous costs for health care. It would be even more relevant in cases where pre-existing treatments are working quite well.

In the absence of a functional treatment for patients, an accelerated introduction of drugs or treatments may be desirable, of course. However, when effective treatments are available to us, we should be more particular and ensure we are offering our patients better care, and not worse care than current treatments.

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

Thank you.

My next question is addressed to any of the witnesses.

Could you provide the committee with an example of the situation where health technology assessments allowed the health care system to save money?

[The Chair, Conservative, Joy Smith]

Who would like to answer that question? I can see you're all clamouring to do it.

Okay, Mr. Williams. Thank you for volunteering.

[Andrew Williams]

I can give one example, and it ties in with the orthopedic discussion we're currently having. There has been a lot of research around hip fractures and the impact on outcomes based on how quickly you set a hip fracture. By assessing patients and taking them into the OR within 48 hours, the health outcomes improve dramatically, which lowers the cost on the health care system.

That's just one example of where you apply a research-based study to the industry and set performance expectations and hold the system accountable for that.

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

You have just raised one of the principles of the Canada Health Act, accessibility. You said that results are better if this is done within 48 hours. However, we know very well that our health care system is not perfect for the time being.

How could we correct this?

[The Chair, Conservative, Joy Smith]

You have 30 seconds to correct the health care system.

[Voices]

Oh, oh!

[Andrew Williams]

In our case, where I work, we have 22 hospitals, five of which do hip fractures. What we did was we brought those five hospitals together and said let's look at hip fractures from a system point of view instead of our individual patients. So if someone has a hip fracture outside of one of the five centres, there's a queueing theory and they get right into the mix.

It's by looking at regional systems that we deal with the accessibility piece. In this particular case, it's a challenge, and you have to look at things like standardized databases—

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Williams.

Thank you, Dr. Sellah.

We'll now go to Mr. Wilks.

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

Thank you, Madam Chair.

And thank you to the witnesses for being here today.

My first question is to Dr. Vendittoli with regard to the replacements of any prosthetic limb. What would you suggest is a sufficient test period for a new device, and should it be tested against the ones that are already on the market to ensure that we're not going from bad to worse? It seems to me as though we've heard evidence before that we don't compare what's already on the market with what we're introducing into the market. Do you have any comments on that?

[The Chair, Conservative, Joy Smith]

Dr. Vendittoli, do you want to answer that one?

[Dr. Pascal-A Vendittoli]

With respect to total hip replacements, we are in a very good position to assess the implants' performance. There are methods such as radiostereometric analysis, which allow us to measure any change of position in the implants for a period of two years. If, over the course of those two years, the implant being tested does not demonstrate abnormal migration, we can predict that implant will work well for the next 15 to 20 years.

The National Institute for Health and Care Excellence, in England, and the Dutch government, have asked that preclinical tests using radiostereometric analysis be mandatory before any new hip or knee implant can be marketed. These are national standards set up in England and Holland. It takes approximately two years to do these tests. As you know, these implants are designed to last 15, 20 or 25 years and that is a bit long to wait before being able to market a new implant. That is why we must rely on available, very precise preclinical tests to assess performance properly before marketing anything.

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

Thank you very much for that.

This question is for Mr. Shepitka and anybody else who wants to answer. There was mention earlier of cost savings. I come from the riding of Kootenay—Columbia, which is in the southeast corner of British Columbia, and two of our hospitals in two of our remote areas have been closed and replaced with primary health care models. Although I had some reservations—I was the mayor of one of the towns when it happened—about this happening, what I did recognize over time was that people started to take better care of themselves because there wasn't the ability to just walk in to a hospital.

From that perspective, do you see that in northern Ontario? Could anyone on the panel comment on primary health care vis-à-vis a regular hospital setting?

[The Chair, Conservative, Joy Smith]

Go ahead.

[Branden Shepitka]

In northeastern Ontario you have higher numbers of smoking rates, obesity rates, and chronic disease rates, which have led to our hospital having one of the highest percentages of patients admitted through the emergency department. Somewhere upwards of 20% of patients who present to our emergency department are admitted, so we're looking at different ways we can get back into the community more quickly with resources, especially with our elderly populations. We have a few new programs that have nursing follow-up after discharge. Patients are being visited in their homes. There is also teleconference for follow-up care, so that we can prevent a readmission to hospital due to a relapse in illness.

What was the second piece?

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

With regard to primary health care, the model is that you don't see a doctor as prescribed under a normal system, but you're encouraged to keep better care of yourself.

[Branden Shepitka]

It's partly that. We do have preventative care services, but they are lacking. Over the past 20 to 30 years the focus of health care in Canada has been hospital care. We are trying to make a transition towards primary care, but the dollars right now are being budgeted and it's hard to make that transition, because such an upfront expense is required and the will is not there.

[The Chair, Conservative, Joy Smith]

Thank you.

Thank you, Mr. Shepitka, very much for your answers.

Now we'll go to Dr. Morin.

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

Thank you very much.

I would first like to say that I'm glad to be back with you guys after two weeks being away in my riding.

My questions are also for Mr. Shepitka. You mentioned in your presentation the different challenges to upgrade existing infrastructure to become mobile-friendly work environments. It kind of boils down to money. It is a big question, but if you can answer this, it would be fantastic. What kinds of funding programs do you think would be appropriate to fund exactly what you would like to implement this transition for work environments—hospitals or emergency care—to become mobile-friendly?