Health Committee on April 23rd, 2013

[Dr. Robyn Tamblyn]

On that one part of your question, the knife and the gun, I'm going to let Peter talk about that, but I do want to talk about the science.

What was recognized in this area, which is not uncommon with many areas as new technologies are developing, is that the science was scant relative to the promise. Most of the science, 80% of the science, comes out of five centres in the United States.

What's going on in those five centres in the United States? They have the magic triad. They have researchers linked with clinical people who are linked with a large test bed where they can actually try this out in big populations. We don't have that. We think we should go down that pathway. Other countries in the world think they need to go down that pathway.

[Dr. Peter Selby]

Do you want me to answer?

[The Chair, Conservative, Joy Smith]

Yes, please.

[Dr. Peter Selby]

I think you're right: it is a knife at a gunfight, but I think it's within the context. At the bottom line, for behaviour change to occur, we have to change hearts and minds. With that comes the change in skill to counteract. We all like to believe that we are the masters of our own domain and we make decisions, but that's the issue: the decision-making does get clouded by all of these other things that happen. Life happens.

You're right, the app in and of itself is not going to do it. There's nothing magical about sitting in front of a computer or playing with an app that's going to make you do it. But if it can touch your heart, it can give you some knowledge, and it can help you keep track of it; that's the science that is shown to make a difference.

[The Chair, Conservative, Joy Smith]

Thank you.

Now we'll go to Ms. Block.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Thank you very much, Madam Chair.

I join my colleagues in welcoming you here today.

I have a lot of questions. Usually when we're at the end of the questioning we've run out of questions because everyone has asked them, but your answers have served to create more questions.

Ms. Elmslie, you said at the beginning of your presentation that three out of five Canadians today live with one or more chronic diseases and that eight out of ten Canadians have at least one risk factor. You talked about the impact on the economy as a result of that. Then you said that with such a profound impact on the quality of life for Canadians, it is important that we make use of innovative technology to support the prevention of chronic diseases.

I would like you to tell us how PHAC's Centre for Chronic Disease Prevention and Control program is continuing to benefit Canadians who are suffering from chronic disease, but also whether there is anything you're doing in terms of prevention. I'm sure there is.

I'm sure there's a whole lot you're doing, but could you share that with us?

[Kim Elmslie]

I'd be glad to, and I'll keep this brief.

As the federal public health agency, a big part of our role is surveillance of chronic disease. That means we're working across the country with the provinces and territories, with StatsCan, and CIHI, the Canadian Institute for Health Information, to provide good information on how chronic disease rates are changing in our country and where there are pockets of problems.

The reason we do surveillance is not so that we can talk about a lot of statistics; it's about targeting interventions where they can do the most good. It's also about helping our stakeholders—because we work with partners all the time—to know where their interventions can be best placed to make a difference. That's a foundation of public health, as you know, and that's one of the things we do at the agency and the centre.

The other really important thing is around identifying best practices and working with our partners to scale those up. That's an important federal role. You can imagine that if every jurisdiction across the country were trying to identify best practices there would be so much duplication; everybody would be doing the same thing. We have one place where we can devote our expertise and resources to pulling together what is known about what works in chronic disease prevention.

That's not an easy question to answer. That comes back to what colleagues have said about intervention science and research, and investing in that. That's the only way we're ever really going to know what works in communities. We're all different, and our communities are all different, in chronic disease prevention.

Those are the two areas where, as a federal agency, we're adding value to prevention. We're identifying best practices and working with partners to scale those up in a way that prevents us from being inefficient in the use of our resources to do the right things that are working to prevent chronic disease for Canadians.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Thank you.

One thing this study has done is to highlight not only the opportunities that are out there when it comes to technological innovation, but also the challenges we face, perhaps on a daily basis, when it comes to innovation in the health care system.

I want to ask Dr. Tamblyn a question.

You talked about the need to build capacity. You talked about having a high-functioning alignment between researchers, industry, and providers...or maybe I didn't hear that correctly. You also talked about what they are doing in Israel.

In the time you have, perhaps you want to highlight a couple of things you saw in Israel that you think should be transported to Canada, and also the barriers that are keeping us from being able to get to where Israel is.

[Dr. Robyn Tamblyn]

It would be hard to summarize this in as short a time as we need to make it, but I want to highlight two or three things.

One thing that's key is the collaboration at the intersectoral interfaces, where the innovation is. You need the provider and consumer, and they're going to come out with the best ideas and where the inefficiencies are.

The next thing you need are the researchers. You don't know whether the stupid thing works or not. You need the person who's going to co-innovate with you: the industry. You need to partner these three folks together so that you get the right answer. You do the co-innovation together, and you actually evaluate it, initially on a small scale, and then if it looks promising, on a bigger scale. You need those three things to come together.

When you have something really cool and successful and you've already shown it's cost-effective, then you say “You need to push it out in whatever policy-relevant approach you can”.

I've talked about procurement. It isn't Canada first; it's, let's say, a multinational first or another company that is lower risk, because this is a baby Canadian company kind of thing. I think that needs to be addressed. It needs to be the right thing to do, to actually adopt Canadian innovation that works. We'll make sure the science is good behind it, and that's going to be better than even what an international could do at this point.

[The Chair, Conservative, Joy Smith]

Thank you so much.

[Dr. Robyn Tamblyn]

Oh, and capitalize on our space agency, yes.

[The Chair, Conservative, Joy Smith]

Thank you, Doctor.

Thank you, Ms. Block. It's a very good question.

Dr. Sellah.

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

Thank you, Madam Chair.

We know that certain patients, who have a physical disability in addition to a chronic disease and even some other diseases, can suffer from a loss of dexterity or of their cognitive faculties owing to pain or other factors. In what way does technological innovation change the approaches used to manage chronic diseases in the health care system for those kinds of patients? In addition, do the innovative technologies designed to manage chronic diseases often present physical or cognitive obstacles for patients? We would gladly hear any examples you may have regarding those technologies.

I have another question for you. Could you give us an example of a concept or change that was created to facilitate the use of an application for patients with a specific disability?

[The Chair, Conservative, Joy Smith]

Who'd like to take that?

Dr. Selby.

[Dr. Peter Selby]

Currently, we're exploring a very interesting innovation. The intervention is done using the video camera, but it's all virtual, and it guides the person through the whole assessment. The screen is very simple. It's not a lot of big check boxes, so it helps the person who might have a disability to go at their own pace and fill it up online, either in the presence of a health care practitioner or not.

This is very interesting for me particularly because it speaks to the issues of people with pain disorders, which are chronic. It also helps them do that and be able to do this. We can do this remotely as well as in the clinic.

That's one example with people who might have head injuries and some of these cognitive problems. You can slow it down without necessarily slowing down the clinician, who is often very pressed for time, very pressed to get things done. It becomes an enabler for helping that kind of assessment happen.

The good thing about those kinds of systems is at the back end you can start collecting those data and real-time decision-making is possible to see what kinds of trends.... For example, in my hospital we just did a quick survey, and we found that 30% of people coming in for addiction treatment have a history of a head injury. If you're trying to get that population into care, and you talk to them in high language and expect them to grab concepts, they're not going to do well.

So technology can help us. We need these systems, not only at the interface, but also at the back end, to rapidly tell us what's going on.

[The Chair, Conservative, Joy Smith]

Ms. Sherrard, do you have one?

[Heather Sherrard]

I was just going to mention that there are two pieces. One is technology that helps you look after those patients. The other one is to make sure whatever technology you use does not become a barrier. Part of it is looking at the technology you're using and making sure that people can actually work it. For example, when we did our initial look at the equipment, there was some equipment that people with arthritis couldn't actually use. They didn't have the dexterity to use it and it was too painful.

So that's the other part I would add: as we buy technology and we implement it, you have to go through the disability, who can use it, and how it works. For example, in our calling systems, we can change the pace of the question for the people who have a bit of dementia. We slow the question down; we give them more time to answer. That's the other half of trying to make the technology work.

[The Chair, Conservative, Joy Smith]

Very good. Thank you so much.

Mr. Weston, welcome to our health committee today. I'm sure you'll find it extremely interesting.

[Rodney Weston, Conservative, Saint John, NB]

Thank you very much.

Actually, Madam Chair, I have found it very interesting. I'm not a regular member of the health committee, but I will say that when you talked about the app, you probably noticed I went online. I downloaded your app and I went through the series of questions you ask, and I found that I'm at moderate risk. Now I'm very concerned.

[Kim Elmslie]

You know what to change.

[Rodney Weston, Conservative, Saint John, NB]

That's where I was going with that, actually. It provided advice on what I should do to reduce my risk.

Mr. Kellway, you made a comment about showing up with a knife at a gunfight. I guess it's better to show up with a weapon of some sort, because then at least you stand a chance of drawing some blood.

Knowing that this is an audience you are trying to reach out to, and knowing that information is key to getting people to the position you talked about, Ms. Sherrard, of being ready to make the necessary changes, what other technologies are you looking at to move that thought process forward, to get people into that position?

Dr. Selby, you talked about people driving to the gym. Just get people thinking about how ironic it is that we actually drive to the gym, get on a treadmill, get back in the car, and drive back home. It's to get people thinking about these factors that can lower our risk levels, and I am wondering if you have something else.

I was thinking about the tools we had before. All too often what we had in the past was probably a pamphlet at the doctor's office to read while we were sitting in the waiting room or something of that nature. This is something more innovative. It gets people moving to where we are today with technology, people of my age who use an iPad or whatever, and my parents. I jokingly talked about my mom and dad. On the weekend, I helped my mom try to do something on her computer, and that's weird because I'm not technologically advanced. So many people have gone in that direction. Elderly people are intrigued now as well.

Do you have any thoughts or ideas on how to leverage that tool?

[Kim Elmslie]

We started out with pharmacies and the pharmacists because they were ready and they wanted to join up with us. They felt their role in the community would put them in a good place to help clients understand their risk. Now we're starting to talk to other parts of the private sector. We want to tell them that we have this tool, and find out how we can leverage people in workplaces, where it would be very easy. It doesn't take long to fill out that risk assessment and get your score, but that is only one part of what we need to be doing.

Working with partners, we're trying to create a change in the social norm regarding what it means to take control of your health and what it means to do things that support healthier choices in communities. There are many researchers and many organizations and communities working on things that use technology, but also very basic things, like how to change the built environment so that you allow people to walk more. You do the simple things. It doesn't have to be high tech and it doesn't have to be complex, but some of these technological innovations, as part of a bigger package, become very compelling tools for Canadians to use.

We've taken the first baby step with CANRISK. Now we think we have a platform on which we can start connecting up those other sectors that want to work with us on health. The Heart and Stroke Foundation's TV ad tells us that the last 10 years are spent in poor health. The Heart and Stroke Foundation is one of our key partners, and they are sending out a message to Canadians that is very compelling. That allows us with our tools to hook onto that message and take Canadians to the next step of understanding one's risk, understanding how to prevent, understanding what can be done for one's family, in our workplaces, in our schools, in our communities. It is putting the pieces of the puzzle together that moves us as a society.

[Rodney Weston, Conservative, Saint John, NB]

Do you use Twitter?

[Kim Elmslie]

I've just started using Twitter.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Weston.

I thank the committee for generously giving me a slot so that I can ask questions.

Dr. Tamblyn, you have talked about research, the consumer, and industry. I'm going to direct this question to you, if I may. I'm very interested in what you had to say about how we need to go forward in terms of developing the research and about the practicalities of modifying the health care delivery in such a way that we can reach more people faster, so that people can be empowered, basically, to help themselves. That's what we're doing.

I was wondering if in your research you have coordinated or collaborated with other countries, such as Israel and Sweden. I've had quite a bit of dialogue from those two countries recently, and smatterings of some of the things you've said today have had that kind of delivery in those countries. Could you elaborate a bit on that?