Health Committee on April 25th, 2013

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much.

I may only have one question, so I'll ask Dr. Birtwhistle. You mentioned unwanted use of technology at the end of life, and it's very interesting. We've had this conversation in my family. You talked about low-tech options, something like an advance care plan. You talked about the possibility of smartphone apps. We've heard a lot about stuff like that in this study. You also mentioned an ethical framework.

What would you suggest that people have to make sure their wishes are followed? Could you suggest what kind of technological innovation could help with this situation for Canadians facing these big questions?

[The Chair, Conservative, Joy Smith]

Go ahead, Dr. Birtwhistle.

[Dr. Richard Birtwhistle]

Thank you.

There are opportunities for advance care planning, as an example, and to use technology to enhance that. We're not talking about doing it necessarily when people enter hospital but even before, as was suggested, as part of their routine care that advance care planning would be discussed.

Unfortunately, family doctors and others, we're not very good at it and we need to get better at it. One of the things that can help with this is electronic medical records both from the physician side, in which there may be prompts and then some sort of template that can be used for this for the patient, as well as patient portals, in which people can put in their own input into an electronic medical record about what their wishes are.

[The Chair, Conservative, Joy Smith]

Dr. Quint, would you like to make a comment on that?

[Dr. Saul Quint]

We recently launched a program, wisely instituted by the Alberta government, for complex care patients. One of the questions on the complex care plan that we helped develop for complex care patients, which physicians go through with their patients, is “Do you have an end-of-life plan?” It encourages the physician to actually help institute an end-of-life plan, which, to Dr. Birtwhistle's earlier point, is really important to create before a seriously ill patient arrives at hospital.

[The Chair, Conservative, Joy Smith]

Thank you very much.

We'll now go to Ms. Block.

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

Thank you very much, Madam Chair.

I'd like to welcome our guests here today.

Dr. Birtwhistle, in your opening comments you referenced the Canadian Primary Care Sentinel Surveillance Network. I understand you're the chair of that network. I know it's a national project funded by the Public Health Agency of Canada. I wonder if you would be willing to share with the committee how this network, this project, is generating health benefits for Canadians.

[Dr. Richard Birtwhistle]

I'd be pleased to give my answer.

This network has been funded by the Public Health Agency since 2008. Currently we have about 420 physicians contributing data on almost a half a million patients over every three months, so that we can now follow eight different chronic diseases over time and be able to report back around surveillance. These networks are in seven provinces so we're not quite coast to coast to coast, but pretty close.

This is a real opportunity to be able to track chronic disease in a way that we haven't been able to do before. We can collect information around medication. We have information on heights, weights, blood pressures—things that you cannot get from other types of administrative data.

With the opportunities for using this to look at chronic disease in Canada and to feed information back to physicians on how they're managing patients with chronic disease so that they can think about practice improvement and also as research opportunities, I'm perhaps a little biased, but it's a very powerful tool.

[The Chair, Conservative, Joy Smith]

Dr. Quint, do you have any comment on that particular question?

[Dr. Saul Quint]

It's only to say that those kinds of surveillance tools and databases, which track these results, are very helpful in proving which evidence-based tools and evidence-based treatments actually create positive health outcomes and a positive return on investment in terms of the expenditure on those treatments.

[The Chair, Conservative, Joy Smith]

Thank you.

Ms. Block, you still have another minute.

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

I could comment on what you focused on earlier in terms of end-of-life care. One can well imagine that the investment in technological innovation in health care results in a number of outcomes, not the least of which would be life saving, and thereby, perhaps life prolonging, when used in the case of treating an elderly person. I understand the dilemmas that are often faced when these technologies are there and are available. As citizens, as Canadians, we believe that research and that investment is being made on our behalf.

I was a member of a parliamentary committee that looked at palliative and compassionate care. We wrote a report. Maybe you could comment on hospice care and where that fits in terms of what you look at when it comes to end-of-life care.

[Dr. Richard Birtwhistle]

Thank you.

I think we have a dire need for hospice care in Canada. That isn't available. Many people end up in acute-care settings because there's no place for them to go. Home might be difficult for a whole lot of reasons. Some other sort of facility to provide care for people who do not need high-tech care is really important.

Let me add that technology is really good, but we need to do it in an efficient way and know when not to use it.

[The Chair, Conservative, Joy Smith]

Thank you so much.

Welcome to our committee, Ms. St-Denis. It's your turn now. You have seven minutes.

[Lise St-Denis, Liberal, Saint-Maurice—Champlain, QC]

Thank you.

As I am getting older, I am very concerned about these issues.

I am in no way questioning the quality of your research; it is very interesting.

You spoke about seven provinces. Which three are not taking part?

Do people, even researchers, have different attitudes toward these problems? It's a question of attitude. The programs are perfect, intellectually, but are we really trying to respect the wishes of patients? There is also what the family wants, but what the patients want is a priority.

I'm from Quebec. Contrary to what Mrs. Sellah said, when my father was sick, his doctor, who was a woman, asked him what his wishes were should he have a heart attack. The next morning, he warned me that she had written in his report that he wanted nothing done. That was because my father, who was all there mentally at 90 years of age, had made that decision. No one even consulted me. I greatly appreciated that attitude. I think it is important.

In your programs, do you place importance on respecting people's freedom?

Also, why are three provinces not participating in your program, which is federal?

[Dr. Richard Birtwhistle]

Thank you.

The Canadian Primary Care Sentinel Surveillance Network is slightly different from the Technology Evaluation in the Elderly Network. They're two separate things. The only provinces it's not in are P.E.I., New Brunswick, and Saskatchewan at the moment, and the territories.

As far as your other question, I think it is really important for us to respect individual choice, particularly in aging people. Their choices should be respected and there are some....

I have a 97-year-old patient in my practice and up until very recently she was gung-ho. She wanted all the technology she could have if she could continue to live. So as much as I've been speaking about the downsides of technology, perhaps. But there are some really good sides and we need to be able to find the right technology for the right person.

[The Chair, Conservative, Joy Smith]

Dr. Quint, did you have any comments that you wanted to make for Ms. St-Denis?

[Dr. Saul Quint]

Not at this point.

[The Chair, Conservative, Joy Smith]

Okay, thank you.

Continue, Ms. St-Denis.

[Lise St-Denis, Liberal, Saint-Maurice—Champlain, QC]

Dr. Quint, is your organization, INTERxVENT, public or private?

[Dr. Saul Quint]

It's a private organization originally founded in the United States and now global.

[Lise St-Denis, Liberal, Saint-Maurice—Champlain, QC]

Your programs are interesting, but how do people communicate with you? Do you advertise?

[Dr. Saul Quint]

There are essentially two different ways that people enter the program. One is through employer-sponsored programs. Ninety per cent of organizations in the United States with more than 1,000 employees offer their employees a formal wellness and disease management program. The reason for that is there is a great return on investment in terms of improvements in direct and indirect health care expenditures.

In Canada it's a little bit more of a challenge. Employers only benefit from the indirect health care expenditures, and by that I mean from absenteeism, presenteeism, and improved productivity. The actual cost of direct health care is borne by the government in Canada versus by the employer in the United States.

That being said, a lot of research has been done. A gentleman by the name of Chapman published in the 2012 American Journal of Health Promotion 62 workplace wellness studies, in which he showed a return on investment of 5.5:1, just on the productivity. Productivity is very important to employers. Obviously the Canadian governments, both federal and provincial, could be seeing themselves as, if you will, giant corporations that in their own right would benefit from both the direct health care expenditure—because the government foots the bill for hospital visits, emergency visits, etc.—as well as improved productivity.

Also the other channel, if you will, by which INTERxVENT is offered to patients is through physicians. Again in the United States under Obamacare, recent changes have allowed for the offering of wellness and disease management programs with in-office coaching by nurses.

The easiest way I explain this to patients who consider going on this program is, Weight Watchers. There's nothing magical about Weight Watchers other than that behaviour change is difficult. You need support. You pop into your Weight Watchers or you go online. You speak to your coach to keep yourself motivated. It's much the same with Alcoholics Anonymous.

In any lifestyle behaviour change where you have to change your diet, increase your exercise, drop or reduce your weight, it's very important to have that support that a coach brings. These are formalized programs that are offered very recently in the United States. Some studies have been done. They're very positive in terms of extending that health coaching to telephone-based coaching.

INTERxVENT's programs are scalable because the telephone-based coaching is delivered out of call centres. We offer employee programs, for instance to Sykes, which is a private company, for their own employees. They do Telehealth Ontario.

As a family physician, when we work with THAS, the telehealth advisory service, they take inbound calls. In my view, they have an unused capacity to place outbound calls to encourage people to lose weight, increase exercise, have their blood done, have their physicals done, improve their cholesterol, glucose, etc.—

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Quint. I know it's very hard because you can't see me giving you those secret signals. I just have to blast into the microphone.

[Dr. Saul Quint]

Interrupt me any time. Thank you.