Health Committee on April 30th, 2013

[Matthew Kellway, NDP, Beaches—East York, ON]

Thank you, Madam Chair, and thanks everybody for coming today and sharing your thoughts and experiences with us.

Ms. Collins, you mentioned at the beginning that the application of technology for management seems to be ahead of the application for prevention. You went on to express a bit of skepticism about how useful it is, or at least you said it's not the answer to everything.

On the prevention side, how much of the problem is this the answer to?

[Mary Collins]

I'm not sure I can give you a percentage, but I think we do have to remember that people are social beings and we still need to interact with other people. One of the most effective things I have seen in workplace health is that somebody decides that they're going to go for a walk at noon, and they get other people to go out for a walk, but people wouldn't necessarily do it on their own.

You have to get people to work together on some of these issues. It's not only the smart phones that are going to be the answer to all of our potential ills.

[Matthew Kellway, NDP, Beaches—East York, ON]

Right, because I just get the sense, and I hope this doesn't cause offence to anybody, that with respect to technology for prevention, we're still at the days where computers came into our homes and when we asked what we would do with them, we were told, “Well, put your recipes on them.” It really didn't make a lot sense to be typing your recipes out onto a computer. I just get the feeling that this is where we are on the prevention, which isn't to suggest that maybe there's not a great future for it, but it seems we just haven't found it yet.

You mentioned walking, and that seems like a sensible thing to do that doesn't require a phone.

[Mary Collins]

I think there's a lot of potential that we have not yet explored.

Certainly there's the example we're hearing today and I've heard of others in terms of workplace health. In terms of helping to inform people and to engage them in new ways, and particularly with younger generations, I think there is a lot of potential, but I wouldn't say it's going to be the answer to everything.

Hopefully, families still sit down and eat together and talk about having healthy food and doing things in a healthy way. It is not just all going to be because it comes on an app.

[Matthew Kellway, NDP, Beaches—East York, ON]

This question is for Mr. Friesen. I'm a bit concerned about this information coming in to workplaces for a couple of reasons. One is that when you look at labour markets these days—and others have commented on them—the vast majority of work in an urban setting, at least, is precarious work. It's people stitching part-time jobs together, it's self-employment, etc. These aren't the kind of jobs where you're sitting at a desk and having stuff pushed at you.

Where it is those kinds of jobs and these kinds of programs make some sense, I worry about what it does to people in terms of increasing their stress levels at work. You start suggesting meal plans, but the big question is whether you are even going to be home for dinner that night, whether you are going to have time to go shopping for fresh vegetables.

It's like employers building a new gym for the employees, but they're requiring overtime of everybody, so no one.... You're stressed out because you see you're supposed to be on the bicycle over there, but you can't get away from your desk.

Maybe the answer is what the Americans are doing with this affordable care act. If you could tell us a bit about that, that might be useful, but could you also respond to my concerns about putting this on people in their workplaces.

[Dale Friesen]

Just to piggyback on what was being said before, nothing is all things to all people. I think we've seen a lot of examples in the workplace where what the tool has done is it has actually empowered people to start walking and they use the tool to set dates to go walking together at lunch, because they're earning points for the challenge. The online actually facilitates what they should be doing off-line.

All of the evidence we've had in all of the companies, the universities, and with the students who have done it, shows it actually reduces stress. The studies indicate that exercise and thinking healthy thoughts actually do reduce stress at the workplace.

Unfortunately, in this day and age there's a lot of overtime everywhere and I'm not sure how we can stop that. There might be something you guys could mandate about that, but as an employer, I probably wouldn't want you to.

[The Chair, Conservative, Joy Smith]

As interesting as your questions are, your time is up.

Thank you so much.

Mr. Lobb.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Thank you, Madam Chair.

Thank you to everybody for coming today.

My first question is for Dr. Chang.

I wonder if you could tell us if you have any projects or studies that are just about complete. In the mid to near future, what would you like to look at in regard to technology and better health outcomes?

[Dr. Feng Chang]

I'll mention a few examples very quickly.

Gateway was involved in a study called Artemis. The other name for it is basically “10,000 steps a day”. It looks at using the BlackBerry as the hand-held device that connects into a hub of your weight scale, blood pressure monitoring, blood glucose monitoring, and a pedometer. It uses that app to feed all that information into the user's hand-held device to see if that helps with motivation. We talked about patient engagement earlier on. It's very important.

That was shown to have pretty positive results in terms of increasing the number of steps taken daily and also over time. They tracked this for a year and they were able to show a decrease in blood sugar and blood pressure. There is some positive data on that.

We talked about how to get people engaged. There is documentation that rural residents have a bit of a stronger cultural influence, in that they tend to be more independent-minded and less likely to actively seek out preventive health services on their own. We looked at who they trust and where they usually go to have a regular chat. We targeted community-based pharmacists as that group in almost every smaller community who know each other and know the patients intimately well. They have usually been there for decades and they see the patients on a regular basis, even though it may be for something completely unrelated.

We're looking, for example, at whether we can embed cognitive impairment screening, which is a short three-to-five minute test, into a visit like that, which could spot signals that could be an issue down the road. We know early detection leads to earlier diagnosis, which leads to better outcomes when it comes to management of the condition as well.

Those are some examples.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Dr. Milne, when we're looking at technology, as Dale was talking about, you enter your information about what you're eating in a day. Whether it's on your hand-held device or your laptop, or whatever, it goes into a database somewhere.

For instance, say I'm your patient, and I am a borderline diabetic. I've got high blood pressure and I'm overweight. I have a problem and I come into your office. You tell me to enter everything I eat, everything I do, into my iPhone and to come back in a month and you'll see what I'm really doing. Then you can work with the patient.

Are we at that point where the patient can punch it in on his hand-held device and then it comes out on your records?

[Dr. Ken Milne]

Some medical records will allow you to do that.

If you were my patient, I would have to tell you that sometimes I am not the best person to manage this. I would then have you see the diabetic educator who can take the time and sit down with you for an hour. I would have you see the diabetic nurse. As a team approach, we would tell you to keep an electronic diary that we could plug into our EMR and share among all of your health care providers.

[Ben Lobb, Conservative, Huron—Bruce, ON]

As far as being a doctor yourself, when you are implementing technology, what kind of decisions do you have to make?

How do you verify the piece of technology before you bring it into your office?

[Dr. Ken Milne]

It would depend on whether it is a diagnostic technology. If we're using it to diagnose things or it's a treatment type of thing, there are evidence-based methods to do it that way. I look at what evidence there is for implementing it. If it improves patient care, that's great. If it doesn't improve patient care, then I won't implement it.

It's just a tool. You have to evaluate each tool independently.

[The Chair, Conservative, Joy Smith]

You have about 20 seconds.

[Ben Lobb, Conservative, Huron—Bruce, ON]

That's all? Then I will just thank everybody for coming.

[The Chair, Conservative, Joy Smith]

It was very interesting, Dr. Chang and Dr. Milne. You made some amazing points there.

We'll go to Ms. Block.

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

Thank you very much, Madam Chair.

I would like to join my colleagues in welcoming all of you here today.

It has been an amazing panel. This whole study has been amazing in terms of all the different ways we've been challenged to understand technology. And obviously, there are competing dollars. Whether you're looking at life-saving and life-prolonging measures or you're looking at managing health issues, or disease prevention and health promotion, there is a competition for those dollars.

I am from Saskatchewan. I mentioned that earlier. It has a relatively small population, just over one million people in a very large geographic area. That forces us to be innovative and to do what we should do long before we have to.

I was the chair of the third smallest health district in Saskatchewan, so I know full well all the challenges that rural communities face when it comes to the provision of health care.

I believe all of you are obviously champions of empowering individuals and of health promotion and disease prevention, and you obviously appear to be leaders in embracing innovation and technology.

My question for you is whether you can identify some barriers to moving forward with innovation and technology that you are facing in all of your different fields.

We've talked about incentives and the value of incentives, but what are some of the disincentives you see that exist in moving forward?

Anyone can start.

[Mary Collins]

Sure, I'll start.

We mentioned earlier that one of the challenges is the plethora of stuff out there and not knowing whether it's worthwhile or not. I know lots of people who've used certain apps for physical fitness. They use them for a few weeks and then get bored with them. That doesn't really work.

How do you get things that really work, and what do you need to go along with that? I think we've heard lots of good suggestions on that as well.

Some of the barriers have also been mentioned this morning, that it's very hard to drill down and really get some of this knowledge and support and technology to those who are most at risk of chronic disease, because they're living in poverty or other things. I think that's another big challenge, how to share this knowledge and capacity more equitably among all Canadians.

[Dr. Ken Milne]

From the provider side, in the package you guys will get later, when it's translated, there is one nice picture that shows the leaky pipe model. It's the various different leaks in the system that cause physicians to not adapt new information, whether it be information technology...but new information.

We're trying to address that by using social media to turn it on its head so it doesn't have to trickle down from above. We give the high-quality information to the front-line providers using social media, especially when you're talking about distributive learning.

[Dr. Cameron Norman]

I would say that one of the barriers, as has been mentioned, is the fact that there is not a lot of evidence for a lot of the stuff. It's partly because the research models out there are somewhat inadequate to be able to address some of that.

There are oodles of apps and they're by well-intentioned people, but they have very little evidence. Some of them may actually work quite well, but we don't have a lot of that.

I would also say that another big thing is organizational support. We've heard some great examples about how it has been used. In most of the organizations I work with, people are interested in it, but they don't feel they have the support to be able to implement it, at an individual level and a management level. They still think they need to be on social media, but they don't actually know how to do it tactically. I think the ability to create a bit of a culture around where it's possible to do that is a good one.

One of the other disincentives—just to turn it a little bit on its head—is that particularly those of us who are health professionals often are shocked when people aren't obsessed with health all the time. They're not. Most people just want to go home and have fun with their kids. They want to have fun with their grandkids. They want to go out for a run just because it's fun, not just because it's healthful. I think we get very fixated on creating interventions to try to get people to do stuff, rather than trying to maximize the enjoyment.

There was a good point made about whether people have the time to create healthy meals. Often people love to have mealtime. It's a great opportunity. So how do you have fun with it? Gamification was an idea. Turn these things into something enjoyable, rather than another thing on people's plates, which I think is probably one of the biggest barriers because very few people out there are lacking something to do. If we can actually turn it into their fun time, we can do a lot of good with that.

[The Chair, Conservative, Joy Smith]

Thank you very much.

We'll go to Dr. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much, Madam Chair.

I just wanted to say that the idea, when we last left off, of finding games for people to play, and then Norman—or is it Cameron?

[Dr. Cameron Norman]

It's Cameron.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Cameron, you came up with the idea that this could make for fun. It could be a teaching tool for the whole family to play this thing that talks about healthier eating and a healthier lifestyle, and all that kind of stuff. I think that's kind of fun.

I'd like you to give me an example of a game that would intrigue young men, for instance. Earlier Mary talked about a place in California where they were working with social media to get involved with obese lower-income kids, who are really outside the loop. You could see games being a part of that.

I'd like to hear of a game. That's the first thing.

The other thing I wanted to say is that you mentioned over and over, Dr. Milne, that there is a place where, if somebody sent you the information about what was going on, you might say, “You don't need to come to see me. You can go to the nutritionist.” That would be very helpful, if we had the comprehensive, integrated community care systems of delivery that we need to actually be cost effective, to move us to getting real results.

I would like to know what you see as the barriers to our getting those done. It was one of the major objectives of the 2004 health accord. It's moved well in some areas, and it's stalled like heck in other areas. I'd like to hear what you think are the barriers.

[Dale Friesen]

A few examples of games.... Actually, Dr. Chang mentioned one.

Just tracking your steps made people walk more. People are educated if they do a step game or a step challenge that tells them they need to have 10,000 steps today. When you get to 9,500, instead of turning into your house, you walk around the block one more time until you get to 10,000. I've heard stories of people, once they got home, going up and down their stairs until they got to their goal of the day. From a male standpoint, men are competitive, and a good part of the game is just pitting one person against another. It can be as simple as getting points for general nutrition, getting points for doing activities, getting points for answering a health question. We're giving them knowledge, but it's the points that drive them, and the desire to stay ahead of their friend.