Health Committee on April 30th, 2013

[Dr. Feng Chang]

I'm wrapping up right now.

With INR testing at the point of care, that could potentially shave it down to one visit to the pharmacy, for a total of five or ten minutes to wrap up the process.

[The Chair, Conservative, Joy Smith]

Thank you so much.

Now, we'll go to Dr. Milne.

[Dr. Ken Milne]

My name is Dr. Ken Milne. I'm a full-time rural physician in Goderich, Ontario. I'm also chief of staff at South Huron Hospital. I'm also a professor at the University of Waterloo, McMaster University, and the University of Western Ontario. I've been doing research for 30 years now.

I'd like to leave the committee with only three things. There are just three things I want you guys to walk out of here with.

The first is, I want to bust up a myth. I know there are some other doctors in the room, but there's a myth out there that intelligence is inversely related to the distance you are from an academic centre. I'm sorry, but it's a myth. We have really smart people in the rural areas, and really smart physicians in the rural areas. That's the first thing. I'm glad I got that out of the way.

Second, rural centres can be academic centres of excellence. We are providing great care in rural areas. I'll use one example. I'm leaving the committee with 20 research papers that Gateway has done in the last three years to say that we can prove this. We have data that can prove that we are rural aces. We are rural academic centres of excellence. For example, you have a heart attack, you have the Ottawa Heart Institute here. The door-to-needle time is how fast you need to get that heart attack treated, to get that liquid Drano to open up that heart. No centre has ever published anything less than 60 minutes. The gold standard is 30. For the hospitals in our area, of 100 consecutive patients, it's 24 minutes.

If anybody is having chest pain right now, I suggest you go to a rural hospital. We will see you quickly, and we will treat you well, and we have the evidence to prove that.

Third is health innovation, which is why we're here today. One thing on health innovation, and Feng brought it up earlier, is hand-held technology. We have a validated tool using the iPhone, the smart phone, to assess people's health literacy. Health literacy equals health outcome. The more literate you are, the better your health is, especially in chronic disease management, such as diabetes, COPD, those things. if you are health literate, you have a better health outcome.

However, to assess somebody's health literacy, doctors use big words from time to time, and they can be confusing. How literate are our patients? We can assess your health literacy with an app in 10 seconds. I could go around this committee and peg people at less than grade 3 level—oh, sorry, nobody in this room—grades 3 to 6, grades 6 to 9, or greater than grade 9. I could do this in 10 seconds using a hand-held app with voice recognition. We can target these chronic diseases with the front-line health workers going out to the patients to say that they don't want to see Dr. Milne in the emergency department. That's bottom-of-the-cliff technology, bottom-of-the-cliff management. It's expensive for me to catch them falling off the cliff. What you want is me up there telling them to back away from the cliff, but we have to be able to talk English or French, not doctor. There's health literacy through an app.

That's only half the problem. The other half of the problem is the physicians. How do we get physicians to practise evidence-based medicine, with the highest quality of evidence, so that their patients, because that's whom we care about, get the best possible care? We want everyone in Saskatchewan to get the best possible care, don't we? Well, how do rural physicians give that care?

We can use social media as a disruptive technology. We're going to start podcasting the evidence that we're creating on a program called JOG, just out of the gate. We're going to take information just out of the gate, critically review it from an evidence-based standpoint, get it out to those front-line physicians, and turn medical education on its head. It's no longer going to be the grey hairs and no hairs trickling down; we're going to give it to the front-line workers and let it bubble up organically from the rural physicians, from the rural researchers. We're going to treat rural patients to keep them out of rural hospitals, so they're really healthy. That's what we're trying to do.

That's the end, other than to say that I hope I busted up a myth.

Are you going to remember those three things?

I'm counting on you, Dr. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

It's a test.

[Dr. Ken Milne]

I'm always teaching.

One, intelligence is not inversely proportional to how many kilometres you are from an academic centre. Two, we are rural centres of excellence. We are rural aces out there providing great care. Three, we have innovative technology not only to distribute it to patients, but to distribute it to the health care providers.

Thank you very much.

[The Chair, Conservative, Joy Smith]

Thank you very much. You're very inspiring to listen to.

[Dr. Ken Milne]

Well, I didn't bring my slides. I had to make up for it with enthusiasm, because I am passionate about rural health, and I'm passionate about research and what we're doing out there. I want this committee to remember that we're doing great stuff.

[The Chair, Conservative, Joy Smith]

I would very much like a copy of your slides. Could you send it to my office? I'll give a copy to the clerk for anybody else who wants it. I know we have several people.

[Dr. Ken Milne]

I'd be happy to share my passion with anybody.

[The Chair, Conservative, Joy Smith]

If you send it to the clerk, I'll get it translated, and then everyone will get a copy, which I think is the best strategy here.

[Dr. Ken Milne]

That's wonderful. Thank you very much.

[The Chair, Conservative, Joy Smith]

Thank you very much.

Now we'll go to Mr. Dale Friesen of Beagle Productions.

[Dale Friesen, Chief Executive Officer, Beagle Productions]

Thank you as well for letting me be here today to present to you guys. Similar to some of the other witnesses here, I have a unique combination of a passion for software and technology and a passion to help people and make them healthier.

I started a software company 16 years ago, which was pretty close to the infancy of the Internet. I think a 28.8 modem came out at the time. Since then we've really been focusing on how we can engage users and make a good end-user experience.

Over the last 10 years we've done that through helping athletes get better and connecting trainers with athletes. We also moved that into the health and fitness world about six years ago where we started to move with just general health and wellness. That has led us to corporate wellness and to helping youth engage in health and wellness as well.

I do have a brief that is going to come to you at a later time in more detail. It's being translated, so you'll receive that later this week I'm told. For now we'll get started with my slides.

First of all there is a health crisis in our country. In 2010 well over half of our population 35 years of age or older was considered to be overweight or obese. You guys have heard lots of stats, and the panel members all know lots of stats here as well, so I'm not going to focus on that. I'm going to take my time here to focus on how technology can help us move in the right direction in this fight.

Technology will be a part of the solution to this crisis. It's continuing to play a greater part in all aspects of our lives and is our most cost-effective way to help prevent and manage chronic disease on any kind of scale given the number of people it can touch and the number of locations it can service.

I'm going to touch briefly on how technology can manage chronic disease, but I'm going to focus on the prevention side, because if we don't fix the growing problem, we'll run out of resources to manage it.

I want to start by talking about some of the obstacles we face here.

The health and wellness industry regularly cites the lack of motivation, education, convenience, and funding as roadblocks to success. While each of these items does play an important role, the key factor for behavioural change is motivation: why am I in my current state and what would motivate me to change?

To support motivation and ultimately behavioural change, there is a requirement for knowledge. We've heard a few times now about the lack of knowledge out there. We need to educate people on the overall importance of health and wellness, on the reasons they became unhealthy in the first place, and on how we can direct them back onto a path of health.

We have created a convenient medium for people to engage in, which allows easier integration in their busy schedules and increases the chance of their success.

Funding is also a barrier to success. Having low-cost or no-cost options available allows for maximum participation, as does educating people that healthy living doesn't need to mean expensive living.

Using technology to make health education available, convenient, and fun in an interactive way will motivate users to continue with the program. With the right motivation there can be behavioural change, and that is the ultimate goal to spawn an effective health and wellness initiative.

Let's turn now to technology and how trends and technology are changing. I have an example here of stats that came out a couple of months ago from Facebook. One of the interesting things you can see—and in the brief that's coming, you'll see the full graph, but I wanted to put it on one page—is that the age groups of 55 to 64 and 65-plus are the only two age demographics that are actually increasing their participation in Facebook as of three months ago. So the older demographic is no longer untouchable in the technology world. They're all moving there and they're accepting the tool. The younger generation accepted it long ago. It is an easy way to reach youth.

Using a digital medium such as the Internet, which allows users to have access to private information virtually anywhere via their mobile devices or their computers, is the first step.

Second, we need to ensure that the content richness and the information are relevant, applicable, vetted, and personalized.

Last, it needs to be fun, motivating, and rewarding so that they continue to stay involved. Then we can improve efficiencies at all levels from users to advisers to health coaches to doctors to specialists.

In order to prevent chronic disease, we need to use technology to educate and empower our youth. This can be done directly through the school system. It can empower teachers and parents. It can be done indirectly by creating healthy workplaces and communities so that the example is set for the youth.

I'm going to show you some examples of this technology in action. I'm going to go through a bit of a process of how a company is using it to help fight chronic disease in the workplace.

The goal of this health campaign is a healthy weight for everyone in their company.

It all starts with a personal wellness account, and in that personal wellness account is an online community. All their information is private and secure, but they can connect with others in their company.

They can engage in fitness and weight loss challenges. They can have their own personalized nutrition tracking. They can take their mobile phone to a restaurant and take a look at what the nutritional value is before they order.

There are weight management plans. There are fitness plans. There are programs for how to deal with stress and how to deal with high blood pressure. They can choose what works for them, or they can take a health risk assessment and get recommended programs for where they are. They can connect with a coach. This could be connected to physicians and doctors as well.

There's a reward system. As they engage in health, they earn health reward points that they can use in a health store, to help incent them for their healthy behaviour.

Then, of course, finally, it's all available on mobiles.

How does it work? A company will direct their employees to their wellness account. They'll get their health evaluated with a questionnaire, a health risk assessment. If they are doing biometric health screenings, those can also be imported into the system so that their health score is verified. Then they set their goals, access guidance based on their score, engage in challenges, connect with others, track their progress, and re-evaluate their health. Then they can get rewarded.

Personalized health guidance can come in various forms. Here, it is important that it be customized and personalized to the user. This isn't a one-size-fits-all type of solution to get healthier. This can come about in a variety of ways. I have an example of meal plans and exercise plans, but this can also include testimonials, success stories, and goal-setting, all delivered on your smart phone and to your computer.

Motivation is key to engagement and keeping you going in the long term, so we have various forms of motivation. We ask, “What is the reason that you're getting healthy?” Maybe it's because you want to look good for your son's wedding. Maybe it's because you want to play with your grandkids. Maybe it's because you want to beat your brother in next year's race. Whatever your motivation is, we want to identify it and help you realize it. We give that to you readily, so that you always remember why you're doing this.

We always engage in fun challenges. Dynamic leaderboards and comment walls are ways in which people can compete, whether that's individual versus individual, team versus team, or location versus location. It's a great way to have a school versus another school, say, or a community versus another community. It's a great way to motivate and engage people in healthy activity.

What kinds of interactive health tools are in there? There's nutrition tracking, as I mentioned. There, you can sync hardware, so you can have heart rate monitors, pedometers, glucose meters. Whatever you want from a hardware standpoint, if they have an API, it can be integrated, and then you can track that result without actually logging in, which is an obstacle, obviously, in regard to people taking the time. Those results are also there if you have a coach or a specialist who's looking at your data.

We also provide thousands of examples of recipes, of how to create meals, and of how to do exercises. All that information is readily available, so the obstacle with regard to knowledge isn't there.

We provide rewards and incentives. As you interact with the site, you earn rewards and you gain points, and then you can redeem those for products, programs, and services through the health store.

Finally, it has to be available on mobiles. That way you always have it at your fingertips, and you have no reason to not be engaging in health. We push notifications to you, so that if you haven't been logging in or if you haven't been journalling, we ask you to come back. There are different ways in which we can help to engage users throughout the course of their health journey.

From a management standpoint, there are online health coaching tools. This is where we can start managing disease, whether it's identifying that you have a disease or connecting you with coaches and specialists who can help keep you accountable and motivated by assigning meal plans to you, assigning fitness plans, and assigning whatever kind of programming is best for you in our post-care, but also by monitoring you and making sure you're keeping track of what you're supposed to be doing.

Today, by using innovative technologies, we can start working with and educating our youth, whether that's in our schools, from elementary to post-secondary. We can empower our teachers. We can empower our parents with knowledge so that the smart choices don't have to be expensive and can still be convenient, because there are smart choices out there.

Employees at any workplace in any industry can start to use the same technology by simply using content that is built for them and unique to them. At home, families can engage with others in the community and participate in the same challenges, and they can engage in challenges to live healthier, more fulfilling lives.

The same tools can also connect doctors and specialists with their patients, removing geographical borders—I'm from a rural community—and limiting the time they need to spend with each patient, while at the same time keeping the patient motivated and accountable.

Thank you for your time.

[The Chair, Conservative, Joy Smith]

That was very interesting. Thank you so much.

By the way, I'm from a rural community, just to let you know.

We will begin with Ms. Davies. Welcome back. We missed you.

[Libby Davies, NDP, Vancouver East, BC]

Thank you very much. Thank you to the witnesses for being here today.

We've had a very interesting discussion about this issue over a number of months now. I have to say that I'm beginning to sense more and more that the issue isn't the array of technological innovation. It's mind-blowing to know what's out there. It's overwhelming.

The issue is who is responsible for ensuring some level access for people. I don't want to use the word “uniformity”. I represent a community where I see people in food lineups a lot. Many of those folks suffer from chronic diseases. These are the folks who probably need some of these innovations the most, but they probably have the least amount of opportunity or access.

How do we get these technologies to people? Is the individual responsible? Is it somebody who is already motivated and into apps and they'll try out a new app? Is it the individual physician, the hospital, the health authority, the province? What is the federal role?

I feel we have to address that if we're to take advantage of these amazing technologies, particularly when it comes to the prevention of chronic diseases that you've all spoken about so well. How will this happen?

It strikes me that one way might be some kind of agreement between the feds and the provinces. The health accords are coming due in 2014. We don't know what's going to happen, but is this an area that should be addressed in terms of technological innovation? It's not the development of it. It seems this is happening pretty well, and I could be wrong on that, but it's how people use it.

Would any of you like to address that? It will help us figure out what we need to do in producing this report, particularly in terms of the federal role.

[The Chair, Conservative, Joy Smith]

Who would like to address that question? Honourable Mary Collins.

[Mary Collins]

I will start, and I'm sure others will want to chime in because it has been an interesting array of good examples.

We touched on that in our presentation. We think there is a need for a mechanism, I guess you could say for quality control verification, so people have a way of knowing what works and what doesn't.

I'm not sure that we necessarily think the government has to do that, but government could support that through funding mechanisms. We've got a wonderful array of different institutes like CIHR and different groups that work in health along with NGOs to put together some of the appropriate people to form a group and set out a plan for this and how this might be developed. I think that would be our preference. Ideally it could be done at a national level so each province isn't having to replicate the same kind of thing because these kinds of apps go across the country.

Challenges would be involved. That's where we would like to see you get started. Perhaps the committee could recommend a framework for something like that.

[The Chair, Conservative, Joy Smith]

Dr. Milne.

[Dr. Ken Milne]

Being a physician I'm going to say that I think it's all about the patient. In this case I don't want them to be a patient. I want them to be a person and not sick, so it should centre around the individual, not around the institutions, not around the professions, but around the person.

All this innovative technology and stuff are just tools. I could diagnose your heart murmur with my stethoscope or I could strangle you with it, but it's a tool to be used for great good. We've got to make sure the content is good and the systems are set up and that the research has been done to prove that these tools work in the appropriate way, but the person ultimately needs to be the centre of this. They need their health dossier. They need all their information to go with them, no matter what provider they're working with.

[Libby Davies, NDP, Vancouver East, BC]

Are you saying that what really underlies this is the whole notion of patient empowerment?

[Dr. Ken Milne]

Empowering the patient into shared decision-making.

[Libby Davies, NDP, Vancouver East, BC]

That's if people even know what the information is about them, which most people don't. It's a very secretive thing.

[Dr. Ken Milne]

It's their information. They should have it, and they should have me or Feng, or any other health professional, helping them.

[Libby Davies, NDP, Vancouver East, BC]

Do you think that's changing though?

[Dr. Ken Milne]

Yes.