Health Committee on April 23rd, 2013

[Dr. Peter Selby]

Yes. In the briefing, we submitted a range of apps for various health behaviours, and we've also put in some of the ones that we've developed, studied, and written about. But again, when we look at it, when we take a step back, there needs to be a better evaluation. Right now, it's a buyer beware kind of problem, because you don't know what is snake oil versus the real McCoy. I think we do need to come to a way of helping consumers make an informed choice in what they use.

About 10 years ago we did a review internationally of all the websites—at that time, there were no apps—and there was a methodology developing to start rating websites around content and usability and whether they were science-based or not. I think that work still needs to be done. The issue is that it gets out of date as soon as it's put out there, so there's a bit of a challenge in getting our heads around how to do that and keep it up to date.

[Colin Carrie, Conservative, Oshawa, ON]

Is anyone around the world doing that?

[Dr. Peter Selby]

One way in which people are beginning to do that—and I think the big one—is crowdsourcing. The more people are using something, the more it tends to rise. Search engine optimization is one way in which this is being done.

The Internet is much flatter, and the authority of health individuals is not respected as much as are the individuals. We've got to pay attention to that. Sometimes just having a stamp of approval from an agency doesn't necessarily lead to the adoption of it. It really is dependent on what the crowd is saying right now.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you.

Ms. Elmslie, go ahead.

[Kim Elmslie]

I'd like to reinforce what Peter said about ensuring that there's a scientific base underneath whatever application the public is choosing. For example, the Public Health Agency, of course, recommends CANRISK because we developed it and we know what science is behind it. We're not recommending other apps for just the reason Peter talked about. I think there is a lot more research to be done on what is underlying these applications that folks are using. We have to be sure that we're doing more good than harm.

[Colin Carrie, Conservative, Oshawa, ON]

Dr. Selby, you mentioned these electronic cigarettes. I've heard about those and I've seen kids with them. They think they're cool and safe. You mentioned the importance of research.

[Dr. Peter Selby]

Right now, it's just out there, but we have no framework to study them and say, yea or nay, whether they're harmful or not. But that's an example of technology coming in without a framework and taking over.

It requires research. We don't know what's in them. We don't know the product-to-product variability. We don't know whether there are heavy metals going into people's lungs or not. But we see them sold in convenience stores, so we need to get our head around them. That's technology grabbing people.

It might have some benefit, but we need to study it. Right now, it's a bit of a concern to me that we aren't in a position to be able to study it.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much.

You mentioned CANRISK is in different languages. Do we have CANRISK in any first nations languages?

[Kim Elmslie]

At this point we don't, but we're in the process of modifying CANRISK to ensure that's it's scientifically valid for first nations populations. Once we've done that, we will have it in those languages.

[Colin Carrie, Conservative, Oshawa, ON]

Okay.

You mentioned the importance of partnerships as well. Can you comment on the partnership of the federal and provincial governments on the obesity initiative?

[Kim Elmslie]

Yes, I'd be delighted to do so. That's a really exciting partnership.

[Colin Carrie, Conservative, Oshawa, ON]

Are there opportunities to use technology in that?

[Kim Elmslie]

Absolutely. As governments have come together around the childhood obesity challenge, we're looking at ways we can support families in providing healthy choices to their children and reinforcing that message in schools and of course in workplaces. Even if you're fighting childhood obesity, you want the whole family to be involved. The moms and dads are doing the shopping; they have to be part of this as well.

Applications that we're looking at and talking about with others include the Dietitians of Canada, for instance, and working with them to provide information based on good science, using technology to get that information out there, and to make it fun for kids to learn about healthy eating so that they can do that in the schools and take those messages home.

We're facing, as all of you around this table know, a very serious problem with childhood overweight and obesity. The creative solutions that will come to us from partnerships with sectors beyond the health field—the technology sector, the telecommunications sector, and many others—will need to be part of our innovation agenda going forward. We've got a great partnership with provinces and territories to do that.

[Colin Carrie, Conservative, Oshawa, ON]

Dr. Sherrard, you mentioned that sometimes you get the best savings out of the least expensive...that when you implemented what you were moving forward with, you saved $340,000 in the first year.

Have you ever done any extrapolations on that? If we applied that across the table or if we did it with other diseases, how much potential money could be saved? Has anybody done that work?

[Heather Sherrard]

That work is done in different jurisdictions. The methodology is always slightly different, so the ability to say that this is the exact way of doing it is not really out there. When you go into the literature, you'll see a variety of numbers.

For us, that was done with heart failure patients, and that number represents a catchment of $1.5 million. That number represents real savings annually when you do these programs. That would be how I would start.

[The Chair, Conservative, Joy Smith]

Thank you very much.

We'll now go to Mr. Pacetti.

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

Thank you, Madam Chair.

Thank you, witnesses. This is very interesting.

My question is going to be directed more to Ms. Sherrard.

You were speaking about patients and using monitors and devices. It might not be the group, but I'm just wondering.... I'm going to make this very basic. I'm not trying to insult you in any way, but are we replacing a nurse with a technician or a telephone operator? I guess that's what I'm asking. If I'm going to be self-diagnosing through a monitor by having myself clicked into a telephone or by a mobile app, as somebody else mentioned, what happens to my practitioner? What happens to the specialist? What happens to the surgeon? How does this make me healthier?

[Heather Sherrard]

If you look at the data, you see that about 80% of the patients who you send home with chronic disease don't actually have a problem. They manage quite well. It's the 20% who do, so you need to have an economical way of getting to the 20%. This absolutely does not replace a practitioner at any level. It helps the patient self-screen themselves to know if they're okay or not. Immediately that you see.... You're not diagnosing yourself; you're just answering a question like you would do on a phone call. Then a practitioner is in contact with the 20% who really need them, because the other 80% are fine.

The problem is that in health care you don't know who the 20% are if you don't have, for example, a mechanism to call them. It's very cost-effective to deal effectively with the 80% who are fine and to identify those who need help. Then we leverage the nurse and/or their family physician, because they work in partnership—or a specialist if they need one.

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

Before you determine that 80% don't need medical intervention or access, don't they have to come in?

[Heather Sherrard]

Well, these are patients who we would actually see, but in our data that we see as we follow up on patients, if you take a cohort of 100 patients, about 80% of them are fine. We don't actually have to—

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

After you've seen them one time?

[Heather Sherrard]

Yes, after we've seen them. This program is designed for patients who have actually had a medical incident or had a need to be hospitalized for some reason.

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

The next question would be, once you determine who are the 80% who don't need a follow-up or who need a small amount of follow-up, do they turn around and say, “I think I'm having a heart attack today”? You tell them they're not having a heart attack, but do they turn around the next day and say that maybe they have cancer, and then the next day maybe something else? Does this lead them to keep going back? Is this something else you're seeing?

[Heather Sherrard]

No, because we teach them how to live with their chronic disease. Everybody has to learn how to do that. It's a step process that you take people through: understanding what is your condition, what you can do to help make yourself better, and when to know when to engage back into the health care system.

For example, there are people on home monitoring. That's a very step-wise program that we take them through for three months. At the end of three months, we are confident they know the symptoms to watch for, they know who to call, and they've had enough experience in trying to manage themselves so they can actually get through it better. Otherwise, without these systems, you just toss them out and say “good luck”, right?

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

I have one other question for you. You were saying that you call to verify that people are taking medication. How can you determine through a phone call that the person is taking his or her medication?