Thank you very much for inviting me. It's a true pleasure to be able to speak to you about the use of technologies for chronic disease prevention and management.
As my other colleagues have mentioned, I think we're all aware that we are aging well in Canadian society, as people are in many other countries. We are now essentially facing a situation where many people have chronic conditions that they live with for a fair length of time, including the cancers. This has meant that we've had to retool and rethink how we deliver health care. You don't do that through the emergency department or through acute hospital beds.
Most countries that have made a lot of progress here have invested in building a very different kind of community-based primary health care system. CIHR, along with its partners in the provinces and territories, has put funding into this area to try to create some innovations at the front line. I think that's very exciting.
One thing that will be a key enabler and an accelerator of change will be the appropriate use of e-technologies within these new models of care. My colleagues have actually provided examples of the wonderful things that can be done. I think this is really where we could actually see transformative change and a way of delivering care that you could never have had before, in a way that's cheaper, faster, and better. That's hard to believe. We aren't Walmart yet, we're not Amazon.com, but we could really make dramatic changes in the way we deliver care that would improve the experience for patients.
In thinking about Canada, telehealth and tele home care are two areas where we can make huge strides, not only in the rural and remote areas, but even in downtown Toronto. We may be able to actually monitor what's going on at home, so you wouldn't need to be trotting down to the downtown hospitals in Toronto.
To see how we could build some traction in this area, CIHR began funding what we call catalyst grants, simply getting a handle on what was there. Some very exciting things happened, and I think this is because we have research talent and a very highly educated workforce who are incredibly creative and very frustrated about how things are going, and they want to do it better. I think it's an exciting time.
In this particular small area—and it was not a huge investment—we had a number of phenomenal examples of improving the patient experience. For example, the Hospital for Sick Children created this new peer-to-peer support mentoring system for adolescents who had juvenile arthritis. Juvenile arthritis is a really rare condition. To get a bunch of kids in a room—10-year-olds and 8-year-olds, and so on—so that they can collectively learn from each other and share their experience would be impossible. It is now possible through social networking and technology.
Similarly, for adolescents who are confronted with the challenge of having cancer, they set up a new communication tool. Teens like to text—we don't, but they do—so they set up this new collaborative way of actually connecting to their team in a way that was cool. It was not cool to have cancer, but this was a cool way of actually getting more timely and accessible health care.
A McGill team actually developed an e-health promotion program to deal with cardiovascular risk factors. They provided not only encouragement and incentives for doing that, but a way of monitoring and showing progress for people who are using that program, to reduce blood pressure, overweight, and so on.
We've seen some very exciting things happen with only a small bit of investment, so we know there is huge talent and huge potential out there. I'm speaking now from the funding agency perspective. The question is, what's the recipe for ramping up the progress? What's the recipe for putting Canada in a leadership position here, as we have assumed in the area of telehealth, for example?
In looking at the pieces, what we definitely need is a high-functioning science and technology innovation system. We need some alignment between what we're doing in industry, what we're doing in research, and what we're doing in clinical care. We need these three things to be aligned.
We spent some time looking at Israel this past year because they are at the top of the leader board in this area. A number of lessons were learned in our visit with them. It has to do with really getting the right people—and I think we have the right people—getting an interest sectoral science agenda between engineering, social sciences, and health, and connecting with the industries that could develop a high-content capacity in this area.
I'm simply delighted to hear Heather's story, because that's exactly the kind of thing we think could really happen.
To look at where we go with this and in what three target areas we think we can make big changes in a short period of time, one is in the area of ramping up people's capacity to manage their own conditions, through patient portals and so on. This is using technology to empower people to manage their chronic conditions. It includes linking to primary and secondary service delivery through their personal health records or through web-based communication; developing intelligent monitoring algorithms, so that, for example, when you're monitoring someone's glucose, weight, and blood pressure, you in fact have computerized algorithms that say this person is in trouble and you should get going in a certain direction, similar to the way they've used their interactive voice recording system to monitor those kinds of things; having a capacity for personal social support and innovative social networks for people who have specific conditions, and not just in Canada but around the world. We have really great examples, such as PatientsLikeMe for people with ALS, which is a very rare condition, being able to share that condition with each other.
The second area in which we think we'll see real capacity to do something much needed and very creative is in going down the route of individualized advanced decision support—supporting health professionals in doing the right thing at the right time for the right person—and being able not to target it to the average, but to say people like you, who have these preferences and want to see these outcomes in this period of time and who have this kind of genotype profile, should do this for it.
If you take, for example, antidepressants, half of the first antidepressants you use don't work. You can't predict right now who it is going to work in and who it is not going to work in. We will soon have the capacity to do this. Then it's a question of how you deliver it right to the point of care—to patients themselves, to pharmacists, to physicians who are actually prescribing those medications.
That's a second exciting area.
The third exciting area has to do with population and health system monitoring. We have pioneered the capacity in Canada. We have a social health care system, we have a lot of population-level data, and we have shown how we can use it to assess variations in practice, the risks and benefits of medications, and epidemics and infectious disease outbreaks. We could do much more of that.
Big data and big data analysis, such as you see in the private sector, could come to health care, and it could dramatically change how we do things. You would have more just-in-time information to manage. You would know, for example, whether the vaccination rate was falling in certain regions, and the corollary—that we now have a measles outbreak or, worse yet, a polio outbreak—could be something you would learn now and not two, three, or four months later, as we did in the case of Walkerton. So there are opportunities there.
We feel this needs to be taken from a global perspective so that we're sharing the experience, sharing in the innovation, and sharing in the marketplace, where Canadian innovations can go. We think that's an important piece.
Along with that is that Canada has really excelled in being able to run a health care system with a single payer. Lower- and middle-income countries are wanting to move down that pathway. We have the talent. We could build the tools to allow them to do that well.
We have some challenges. One challenge that I'd say has been very difficult for us is in the capacity to use the data assembled through these multiple sectors to create new knowledge, to create new intelligence, and be able to monitor how things are going in health care. We have some privacy issues that we have not successfully dealt with. We worry about data travelling across city lines, regional lines, provincial lines, and even national lines, so that's getting in our way.
Canada, which once led in this area, is now falling behind, because we do not have a policy framework that will successfully manage this way of providing access to managers of the health care system, providing access to researchers, and being able to deliver this point-of-care information back to citizens who need to know it now, not later. I think there are solutions, which we hope to push in that direction as a collaborative, and I look forward to your feedback and suggestions in that regard.
Finally, let me mention that I think we see the e-health initiative being nicely married with the strategy for patient-oriented research, which truly is trying to transform the way we connect research to the backbone of the care delivery system and change outcomes, not when the study is done, but as knowledge is accumulated through time. I think that's one of the most exciting things we're doing. It will be in the area of community-based primary health care and mental health, which we see as some of the early strategic priorities, and we're looking at other areas in which we think we can excel as Canadians.
We see this as a way forward. We have assembled an international advisory group of small and medium-sized industry representatives, scientists, leading clinicians, and funders from around the world to help us understand how we could do this collectively.
Thank you very much for your attention. I look forward to any questions you might have.