Health Committee on April 23rd, 2013

[The Chair, Conservative, Joy Smith]

No: your very interesting questions; very good. Thank you.

[Massimo Pacetti, Liberal, Saint-Léonard—Saint-Michel, QC]

Thank you.

Geez, I passed the test.

[Voices]

Oh, oh!

[The Chair, Conservative, Joy Smith]

Now we go to Mr. Wilks.

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

Thank you very much, Madam Chair.

Thanks to the witnesses for being here today.

It's quite an interesting topic when you think that over the years, and as we progress further into...as years come by, we're going to live longer whether we want to or not, because technology is going to allow us to live longer.

Having said that, what do you foresee, let's say in 30 or 40 years, when the average human lives to 90, on average, and the average physician, who may still be working at 75, says, boy, what's the one thing we can do now to make people live longer?

Dr. Tamblyn.

[Dr. Robyn Tamblyn]

I think the emphasis is increasingly on living high quality longer. Living longer on a respirator is not the way to go, right?

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

I agree.

[Dr. Robyn Tamblyn]

It's really about putting health into the aging years. I think we know an awful lot at this point about the risk factors that make you unhealthy and live a shorter and poorer-quality life. What we haven't really been able to master as well is how you deliver, in an effective way, interventions that turn that around.

That's where I think technology, as we've already discussed, actually has a power that has never been there before to use the right people, health professionals, in a way they've never been used before—at the right time, at the right place, for the right person—and empower people who don't need that intensive help through other means.

I think it's a really exciting time. Now it's a matter of how you harness it in such a way that you don't get a lot of junk out there in the app world and you get things that really matter. How do we marshal the science to make sure we get that kind of evaluation done so that we know how it's going to work?

There was a recent example with dermatology, where they took pictures of skin lesions with two different products, one being actually highly successful. It was reviewed by a pool of consultants. Others were generating an awful lot of false negatives, meaning that they truly had treatable—should have been in there, could have prevented that—skin lesions.

I think this is the kind of thing that we really are quite aware of in the scientific world. We really need to make sure that we cover the full spectrum, from co-innovation of new things to evaluating what's out there, so that we can provide the best guidance.

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

Thank you.

Dr. Sherrard, you were talking about telemedicine, and it sounded really intriguing to me, coming from a rural area of Canada, Kootenay—Columbia.

Would you explain a little more about it? How does it work from the patient's end? I got it from the doctor's end, but how does that work from the patient's end?

[Heather Sherrard]

A patient would go into a facility, wherever there's one of these telemedicine stations. It looks like a television screen, and they sit in front of it. There's usually a nurse or somebody with them; it could be their family doctor, but not usually. You turn the screen on; it has a broadband link. They see the cardiologist at our end who walks them through a health assessment. The nurse at the patient's side has the electronic stethoscope, and she puts it on the patient's chest. The cardiologist says to move it here, move it there—

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

So it's not the patient doing it; it is actually—

[Heather Sherrard]

The patient can. Some of them who are chronic and come for repeat visits do it themselves. The doctor says to move it to the left or move it to the right, and they can certainly do it themselves. On the early visits, they usually have somebody with them.

Everything they need, by way of a diagnostic tool, is linked to that system. The patients just sit in front of a television and use the devices. It's very easy. It has a camera that can zoom in. They have a very good dial-up—it’s broadcast quality, so it's a real conversation and it's not very jerky. Nunavut is a bit jerky because it goes up over the satellite, but other than that, it's pretty good quality. It's a very good interaction, and patients love it. Once you start them on it, they're not coming for the drive.

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

Thank you very much.

To anyone here on the panel, is there more the federal government should be doing within its scope of jurisdiction to support innovative approaches to managing and preventing chronic illness? If so, can you provide some illustrations of that?

Any of you who want to take that on...it looks like Dr. Selby's jumping.

[Dr. Peter Selby]

I think it's what Dr. Tamblyn said: how do we align engineering science with social sciences and telesciences? It goes back to your previous question. If you project that we're going to be living until 90 years of age, it's what we do in our thirties—before we hit 40 years of age—that's going to make the difference.

One is, how do we make it easy for people to do the right thing in how they live, in what they eat, and in what they have access to and those kinds of things? That's where that alignment, if we do that....

Clearly, it's enabling policies that can help this. Is there some reason alcohol can cost the same amount no matter what latitude you're at, but fruit becomes exponentially more expensive the further north you go? That makes a difference in what people choose to consume, right?

Can we do something like that, which can reduce that inequity, that isn't going to happen through a health system—it's outside of the health system—and can help people be healthy? Those are the things.... I would focus on the 30-year-olds who are going to be getting to 90 years.

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

Thank you very much.

[Dr. Robyn Tamblyn]

I have a quick one on that.

One key thing we really need is...the alignment of the tri-councils can be achieved fairly readily through collaborative work. We've already gone down that pathway.

But the alignment with industry policy hasn't been as successful. We don't have...we could have more industry-friendly policies, we could have a strategic investment in the e-health industries aligned with what's going to happen in the health and engineering research councils—we could make that alignment. That's what's been successful in these other countries; they made that alignment.

We don't have a military like Israel’s that generates new ideas, but we do have the Canadian Space Agency that does do that. New technologies and innovations come from that alone, and could be highly relevant to our geographically remote populations.

That's number one.

Number two is that we build it in Canada, but then we don't buy it. I think that's a big issue. In Finland, they built it in Finland and they bought it. They had a more friendly procurement policy. When we have companies that do this unbelievable work—like TelASK, for example—why is that not being widely adopted? Look at what they've done—

[The Chair, Conservative, Joy Smith]

Thank you very much.

We now have to go into our second round. It's a five-minute round.

Dr. Morin, you're first.

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

Thank you very much, Ms. Chair.

Thank you for wearing the daffodil today.

Ms. Sherrard, I was fascinated by your example of a nurse being able to treat 30 patients during her shift, or during her day—contrary to five, or something like that—and for only an additional investment of $5,000.

My first question is, why is it not done this way in every hospital across the country? Our ERs in hospitals are overburdened with patients waiting hours and hours and hours because we lack the manpower, for example.

What are your thoughts on this?

[Heather Sherrard]

It's an interesting question. I think it's about knowledge translation and spread, and I think someone has talked about that.

In Canada you get these pockets of innovation, and it is very difficult to spread them. In the cardiovascular community we talk to people; they know about it. But this is an adoption for which you need an innovator. Dr. Keon at the time was the innovator behind this. He invested in it. We had partnerships with Nortel, etc. We put this up without any money, and not everybody will do that.

I think the other point, to address Robyn's comment, is that once you have good things that work, how do you enable them to spread, and how do you say, “Okay, this works, so stop playing around the edges now and start implementing it”? It's the way the system is actually set up. There are individual boards, there are individual regions, and it's very hard to spread it.

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

Do you think the federal government or its agencies have a role to play to spread this knowledge across the country?

[Heather Sherrard]

I'm not an expert on what the federal government can do, but yes, I think the spread nationally is very important. I think bringing people together like this, people who can contribute information as you make your deliberations, is good. There's a spread that happens just by doing that.

There are also probably some broad policy pieces as well, not at the funding level but just from a strategy point of view. We've seen a number of big health strategies come out of the federal government, and support for these kinds of initiatives would be very important. That leads provinces to start thinking that way.

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

That's interesting.

Later in your speech you talked about—

[The Chair, Conservative, Joy Smith]

If I could interrupt you, Dr. Morin, Dr. Selby wanted to make a comment.

Dr. Selby, go ahead.

[Dr. Peter Selby]

Thank you.

I think there are some things we can learn about implementation from south of the border as well as from Canada. There is a research methodology of implementation called implementation science. Whereas right now we're just letting it happen, where we need to be is to make it happen. I think that's where we need that alignment across society, because when that happens, things can be implemented, and there's a science behind it. There's a lot of investment in the research behind it happening in the U.S. We're looking forward to having that kind of implementation science research happening here in Canada as well. I think that might help us better understand why something that works well in one community just doesn't take off in another, and what adaptations need to be made so that people can actually adopt it.

[Dr. Robyn Tamblyn]

I just want to add that in the area of technology, you do need to have an industry-friendly environment for small and medium-sized businesses, since they are the ones who partner with these innovators like the Ottawa Heart Institute. These are the people who actually make it happen, but they get knocked out of the game when it comes to the spread, and I think that's where you can make a truly big difference.