Health Committee on April 23rd, 2013

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

It's fitting that you reply to my question, because my next one is for you, and it is based on similar ground. You talked about the need for a policy framework to ensure the sharing of medical information between the different lines. At present there's a lack of coordination, and there are a lot of hurdles between provinces and the federal government and so on.

What do you think the federal government can do to improve the situation? I know the federal government has poured in a lot of money. Is the solution more money, or is it basically to play an active role as a leader?

[Dr. Robyn Tamblyn]

I think it's to play an active role as a leader. I think the two arms would be to foster this kind of interesting partnership that PHAC has been maintaining with the private sector. We're all in it for all sorts of reasons, and we actually have to transform how we're delivering health care. We need to create healthier communities, and in fact the private sector has a big role to play in that.

The second thing is, again just to reinforce it, that you can't beat up these small, innovative companies and tell them they're not going to get a place in health care, and that's what happening right now.

[The Chair, Conservative, Joy Smith]

Thank you very much.

I must say this is a great conversation. And based on this innovative technology report we're doing right now, this is part of that solution. So it's exciting to hear what you're saying today.

Mr. Brown, you're next.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Madam Chair.

Thanks for all the commentary today.

We talked a lot about cutting-edge technology, but I know one basic thing in the health care system that's always frustrating is the slow pace of transition to digital records, electronic records. I know we've invested a lot federally into that. I find it perplexing that if I go to the MTO with my licence, they know if I've gotten a traffic ticket; they know everything very accurately. Yet, in the health care system, something so fundamental, there is no data; there is no registry of our health. I think most people deal with several doctors in different manners based on their own health needs, so if there's ever a need to have a central registry or a central repository of information, it would require electronic health records.

How come we've put so much money in and there's not really any evidence of success? Do you have any comments on that?

[The Chair, Conservative, Joy Smith]

Dr. Selby, and then Ms. Tamblyn.

[Dr. Peter Selby]

I've been perplexed as well. When I practised in India, the poorest of poor people kept all of their own health records and brought them to the visit. Then I came to this country, where most people are educated, have the highest level of education in the world, but have no access to their health information. My observation has been that the end-user, the stakeholder, the individual, the families who have the most interest in making sure this is happening, have no control over it. It's left to us as physicians and health care providers, and the lack of agreement has left us with this situation. So it's not about the money; it's about the voices and the stakeholders. I think the stakeholder, the patient, and the families around them, is what hasn't been able to drive this process. That, I think, is one issue that really gets in the way of us having this good system. That's just my observation.

[The Chair, Conservative, Joy Smith]

Ms. Tamblyn.

[Dr. Robyn Tamblyn]

I think there are a couple of things we've learned from other countries. Number one is, I'm not sure we've had what you might call the magic carrots. The U.K. system was built on the fact that there was terrible inefficiency in having to refill prescriptions every 30 days. They started off by getting every U.K. physician on board—making it so it was easy to renew prescriptions online through a computerized system. It saves them a heck of a lot of time. We didn't really have those kinds of magic carrots in our plan, so that the end-user said “we need this, we need this”, and they pushed the envelope on adoption.

Another approach was used in New Zealand, and they were being pushed by the end-users to make it happen. We didn't quite take that approach. We didn't invest in the end-user. I think Canada is now doing that. Canada Health Infoway is now doing that, investing in the end-user to hook up to what will be very interesting pooled data on drugs and labs and imaging. These are the kinds of things that you don't want to repeat over and over again. They're critical for health care, and they will drive efficiency if we get people hooked up.

We have neglected the fact that in other systems, particularly the U.S., the consumers drove the system. They drove it by saying, “I want to have access to my labs”, and there are certain other things they want to have. They want to be able to book appointments online. They want to be able to do these kinds of things. If we were to go that route—we can steer the ship in a slightly different direction and get it going on that route—it would drive demand in a big way and empower consumers. We really should go down that pathway.

[Patrick Brown, Conservative, Barrie, ON]

If a phone company can tell you what phone call you made a year ago at four in the afternoon, to what city and what number, there really has to be a means to do this.

I have another question within the federal jurisdiction; it's on the regulation of medical devices. We've heard testimony on both sides that we're slower than we should be in Canada. We had one witness who said it was actually very good. What are your comments on what can be done to make the system more efficient?

[Dr. Robyn Tamblyn]

There is an interesting model that's been developed in the Ontario health technology assessment, and I think that would be very well worth looking at as a model for Canada. It provides much more upstream.... If this is your innovation, these are the kinds of things you need to collect, this is the data you need to collect in order to get into the health care system. People hate developing the technology, and all of a sudden you're at a brick wall that says you're not getting into the health care system because you haven't shown it's more cost-effective than the devices we already have. You need to go upstream, educate the industry, as it's moving in, and provide these pre-assessments so you have things like an environmental scan. You're actually working in partnership with the industry. That's the Ontario model, and they love it. I think we need to set up a framework. What is it going to take in order for new technology to be adopted?

[The Chair, Conservative, Joy Smith]

Thank you so much, Ms. Tamblyn.

I've allowed you to go over time, but I want to make sure everyone gets their very important questions in. Your answers are extremely good and very helpful to us. I'm not trying to cut you off or be rude. I just need to be balanced with everybody on the committee.

We'll now go to Mr. Kellway.

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

Thank you, Madam Chair.

Thanks, folks, for coming today.

I'm a bit skeptical, frankly, about technology such as CANRISK, for example, and the notion of these health-related apps that people are supposed to use and that are supposed to be effective. The basis for my skepticism, I think, is that I thought the path you were taking, Dr. Selby, when you were talking about all of us, when we get to whatever age we're at.... Maybe it's because I'm one of those 45-year-olds who's about to have a heart attack, I don't know, but at some point in time—

[Voices]

Oh, oh!

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

We've been conditioned throughout our lives. We have all sorts of experience. We've developed perhaps modifiable but deeply ingrained habits. They may even cluster, and we're a part of communities where we have these habits, as you describe.

I guess the question is, what's the science behind these apps and CANRISK that suggests a guy like me is going to walk into a pharmacy and submit myself to some kind of test, or that someday I'm going to go online and say I wonder how close I am to that heart attack, or whatever? I just don't see that, frankly.

[The Chair, Conservative, Joy Smith]

Who would like to answer that?

[A voice]

All of us—

[Voices]

Oh, oh!

[Heather Sherrard]

Let me start.

There are tools. We call them “readiness to learn”. People will engage in changing their behaviour when they're ready to do it. There are four different ranges that you get, and you have to help people move through those things. You will not move until you're ready, and there is a whole science behind how you do that.

In our prevention and rehab program, we test people. We know where they're at. Sometimes we just say this: “You know what? You're going to have a problem in five years.” That's the best you can do. Sometimes they're much more ready. There are many behavioural change models that are used in different settings, and they work when they're done properly and you understand where people are. It's possible to help people change.

[Kim Elmslie]

Just very quickly on CANRISK, we spent about two years working with our provincial and territorial counterparts in communities, testing the validity of the tool so that we weren't putting anything out there before we were sure it would be a benefit to those clients using it.

But remember, these are only tools and, in the case of CANRISK, one tool. Really, we are talking about complex changes in behaviour that are always going to require many different types of approaches for different people. One won't work for everyone.

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

One of the things that got me thinking about this was something on the news recently about all the science that goes into the food we eat. It was suggesting we're really being victimized here, that somebody's tugging at some biological things here.

It's leaving us without a lot of choice, in a sense, about what it is that we're going to eat, what we're going to reach for when we're hungry, and there's a science behind creating these habits and addictions in us. Yet the response is to offer an app for someone to go to. It's a bit like the knife at the gunfight: this isn't going to work. That's my sense of it.

[Dr. Robyn Tamblyn]

That question is so big that we couldn't—

[The Chair, Conservative, Joy Smith]

This actually means I have to pass on Mr. Kellway's cookies—

[Voices]

Oh, oh!

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

I had my cookie, but no fruit today.

[The Chair, Conservative, Joy Smith]

That's more information than I needed, Mr. Kellway.

I'll give you extra time: one minute and 30 seconds. Go ahead.