Health Committee on July 6th, 2020

[The Chair, Liberal, Ron McKinnon]

Thank you.

We go now to Mapsted.

Mr. Nagpal, please go ahead for 10 minutes.

[Paramvir Nagpal, Founder and Chief Executive Officer, Mapsted]

Thank you, Mr. Chair and members of the committee.

I’d like to start off by giving you some background about our company, Mapsted. We have been in business since 2014. We’re an award-winning Canadian technology firm that provides highly scalable and accurate location-based solutions inside and outside any building without the use of additional external hardware such as Bluetooth beacons or Wi-Fi connectivity. Instead, our technology uses innovative, adaptive, data-fusion and self-learning algorithms to deliver an accurate and scalable positioning using any off-the-shelf smart phone. This means our technology can work anywhere, including in areas that are usually thought of as “dead zones”, like underground locations or skyscrapers.

We further expanded our core technology and developed an extensive location-based service platform, which includes seamless outdoor-indoor wayfinding, asset tracking, targeted alerts and notifications, analytics, location intelligence and secure contact tracing. We work with a wide variety of businesses and industries, including retail, health care and higher education. Our technology has been recognized as one of the most advanced location-based technologies in the world, with 62 patents granted to date. We have deployed our technology across 255 million square feet worldwide.

Over the last few months, we have seen an unprecedented response from the technology sector to the global spread of COVID-19 in our communities. Most countries have focused on developing technologies to help with contact tracing to try to flatten the curve and also prevent the health care system from becoming overwhelmed.

Singapore was an early adopter of a community-driven contact-tracing app, and now European member states are adopting a decentralized Bluetooth model for contact tracing. In this model, no data is stored centrally, ensuring that it's not possible to reconstruct an individual’s relationships or identity. They are planning an international “roaming” feature that could help revive travel and tourism across the area. Each country would have its own app, but the apps could “talk” to each other and help make travel across the region safer.

Other countries like China went beyond contact tracing and developed additional uses for location technology to help people access products and services during this challenging time by helping them check store levels for masks, sanitizer and gloves at nearby stores and also moving a significant portion of their everyday health care to online consultations.

In addition, they adopted the use of health QR codes to ensure that workplaces that had to remain open were safer. If an employee received a green QR code, they were able to work. A yellow or red code would require self-isolation. Population density maps have also been used to help pinpoint vulnerable populations, large gatherings and, along with some real-time data related to health and travel, to provide citizens with a visual representation of where potential hot spots are likely to occur, helping them to reduce their risk by avoiding those areas.

As we have seen recently, there have been some challenges and concerns with this type of technology, one of the main ones being privacy. Canada is looking to adopt a decentralized model of contact tracing moving forward, which will help address many of the privacy fears that currently exist, but right now, this concern has led to poor adoption rates of the apps, making them less effective. Alberta’s app, for example, has been downloaded by just 200,000 people out of a population of approximately 4.4 million. We need to have approximately 60% of the population using this type of app for it to be effective.

As the country moves to reopen in stages, we need a way to ensure that we can keep our population safe while allowing for Canada’s economic growth to move forward again. Essentially, we need to find a way to safely function in a society with the virus, as we wait for a vaccine to be developed. Location-based technology will play an important role in this process.

First, integrating the digital contact-tracing technology with traditional contact tracers can prove to be more effective in stamping out the virus hot spots and tracking the spread of the disease. Integrating these two approaches ensures that we address the issues inherent to each method. For example, traditional contact tracing has limitations of scalability, notification delays, and contact identification in public spaces. And even if we don’t have full adoption of the digital contact-tracing technology, many of the gaps could be filled by traditional methods, ensuring greater effectiveness overall.

As we get back to using many non-essential services, additional location-based technology can keep us safer. It’s not enough just to ensure that our health care system doesn’t get overwhelmed by COVID-19 cases. We need to work to accommodate patients who need diagnostics and care for other conditions and help them safely and securely access the services they need. Patients must have access to timely cancer screenings, and people with compromised immune systems need a way to safely plan their hospital or clinic visit for treatment so they don’t unnecessarily expose themselves to the virus by coming into prolonged contact with members of the public.

Seamless outdoor-indoor navigation technology, combined with location-based notifications and analytics, can help these patients plan optimized routes, from finding the closest hospital entrance to their appointments to planning the shortest route through the building to multiple appointments in different sections of the hospital. It can further help by sending notifications telling them when it’s safe to enter a waiting area, and giving them instructions detailing any safety precautions that must be followed. Heat maps could also be used to prevent bottlenecks and show the busy areas, so vulnerable patients could avoid walking into a situation that would increase the risk to their health.

This approach would also allow appointments to be spaced out, allow ample time for cleaning before and after patient visits, and help ease the anxiety of such visits significantly, helping to ensure that fewer people put off potentially life-saving tests and treatments because of the fear of getting infected.

Ontario’s upcoming cloud-based case management system, which will connect the lab system with the public health system, is another example of where location-based technology could complement a service to make going to appointments for tests and diagnostics safer. This technology would send patients to labs close to where they live, and use targeted notifications to let patients know when the doctors and technicians are ready for them, so they don’t need to wait with others in a room, potentially increasing their risk of exposure. To address any privacy concerns, all data should be stored locally on each device for a limited period of time, and would be anonymized.

Using location technology in this way would allow people to continue to practise effective social and physical distancing, while allowing them to access the needed services. This type of approach would also work well in malls and big box retail stores. This type of navigation technology would not only give customers the shortest or the most optimized route to the department they need, but it would also lead them directly to the product they are looking for, eliminating the need to wander around the store aisles in frustration trying to locate it. This would help reduce the time people spend inside around groups of other shoppers, reducing their exposure risk.

Many stores, including grocery chains, face problems with lineups as fewer shoppers are being admitted into the store at once. These lines put people in contact with others for longer periods of time as they wait outside. This is especially true ahead of holidays and long weekends. This is where the location-based solutions really shine, by ensuring that essential services like grocery stores can create a safe shopping environment for their customers, enforcing physical distancing measures and reducing the possibility of the spread of the virus. Stores can use this technology to set up a geofence around their location and control foot traffic into the store without any lineups, preventing crowding and bottlenecks.

This technology will continue to play a critical role as we move past the initial measures to help slow the spread of the virus and start to ease restrictions and open more businesses in the transition back to a new normal.

The uses of this technology go far beyond health care or retail applications. Contact-tracing apps can be a trade-off between privacy and effectiveness, but if we integrate this technology with traditional methods, and supplement it with additional location-based products and solutions such as indoor navigation, targeted notifications, geofencing and tagging, they could help more Canadians safely return to work, attend medical appointments, events or extracurricular activities, and much more, as we wait for a vaccine or an effective treatment for COVID-19 to be developed.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you.

Mr. Nagpal, I'm advised that the sound quality of your mike has degraded. Perhaps before you next have a chance to speak, you could unplug your mike and then plug it back in, and also select and reselect it. Thank you very much.

We will go now to Medtronic Canada.

Mr. Hupé, please go ahead for 10 minutes.

[Patrick Hupé, Senior Director, Health System Strategies, Medtronic Canada]

Thank you, Mr. Chair.

My thanks also to the members, the witnesses and the guests.

Thank you for giving us the opportunity to share with you our comments on the Government of Canada's reaction to the pandemic.

I would first like to congratulate the government for taking the following measures to date. It actively recognized the importance of maintaining international relations and the integrated global supply chain in order to make sure that infected patients have rapid access to medical technologies. That was critical. Canada played a key role in that regard, especially within the G20. It also established an action plan to mobilize industry in order to meet the challenges of the pandemic. It centralized the procurement of essential supplies and, lastly, created financial support for people who had lost their jobs in order to lighten the burden of the pandemic.

If I may, I would now like to give you a modest introduction to Medtronic Canada.

In fact, we are the largest medical technology and medical solutions company in the world. We have 90,000 employees globally, including 1,000 employees in Canada. We have a presence from coast to coast and our activities include marketing, research and development, production, education and training. The company focuses on five key areas: cardiac and vascular diseases, diabetes, minimally invasive therapies, neuroscience, and consulting services, which help healthcare systems to reduce wait times and improve the patient and caregiver experience.

Like many companies in the medical devices sector, we were significantly affected by the pandemic. First, there was an increased demand for our ventilators, pulse oxymeters, extracorporeal membrane oxygenation machines, and other devices used in respiratory care. That had two key consequences. First, we went into humanitarian mode, in the sense of delivering our devices that were in high demand to where the need was greatest. We were no longer in a conventional business mode, where we receive orders and process them on a first-come-first-served basis. In addition, we provided free access to our intellectual property in the case of a portable ventilator, so that other specialist partners, including Ventilators for Canadians, could manufacture more ventilators locally.

Lastly, our maintenance technicians and our clinical trainers had to work tirelessly to coordinate installation and maintenance and to train caregivers, particularly with regard to those ventilators. The cancellation of air routes made the task particularly difficult. Despite the crisis, our clinical teams continued to support essential surgeries all over the country.

Second, given that we provide technologies and services for more than 70 diseases, the cancellation and postponement of non-essential surgeries forced us to suspend our activities for a number of months. Despite the financial repercussions that ensued, we laid no one off because of the pandemic. Instead, we made preparations to support the resumption of surgeries by putting our experts and our products at the disposal of health care systems. We provided our expertise in clinical care pathways, in analysis, and in reducing wait times in order to redefine patient triage protocols, to optimize processes, and to shorten the time before discharge following a procedure.

Now we are at the point of considering the resumption of surgical procedures, we sincerely believe that Medtronic Canada and some members of the industry, given the international experience and the ingenuity of Canadian SMEs in our field, can be part of the solution rather than being simply restricted to the role of suppliers operating only in a purely transactional business relationship.

I would like therefore to focus my comments today on three areas. They are where we can provide tangible, proven and time-tested solutions so that procedures can be quickly resumed and the health and welfare of our fellow Canadians can be assured. These are the quickest possible transition from hospital to home, the procurement system, and the improvement of clinical care pathways. The pandemic has certainly highlighted the importance of keeping patients out of hospital once they have received appropriate care. Digital health care can certainly play a major role in that regard.

First, in a hospital setting, it allows physical distancing measures to be observed, thereby reducing the risk of infection. Moreover, this component of medical technology means that patients can be monitored at home, thereby reducing their number of hospital visits.

Clearly, health is essentially an area of provincial jurisdiction. However, the federal government has the opportunity to make better use of digital health care for the veterans and the indigenous population it serves, thereby becoming an example of health care innovation for the provinces of Canada.

Technologies that allow remote monitoring and virtual visits have been available for more than 10 years, but, because of the pandemic, we have seen those technologies adopted more quickly in the last three months than in the last 10 years. This is a tipping point and we cannot allow ourselves to turn back. Canadian companies are pioneers in this regard. According to Canada Health Infoway, before the COVID-19 pandemic, only between 10% and 20% of health care visits in Canada were done virtually. Today, that figure is closer to 60%. The federal government and each of the provincial governments have the opportunity to continue virtual visits, once the pandemic has been stamped out.

Let me illustrate all this with very specific examples. Digital health care does not just allow physical distancing, it is also an incredible tool for communicating with patients in remote locations. For example, a patient, a veteran or a member of a First Nation, who wears a pacemaker must have a check-up several times a year, with each appointment taking about 10 minutes. If that patient lives in the far north or in a remote region of our country, it can take him hours, even days, to get to the clinic. Using a form of digital technology that has existed for years and that involves an examination done remotely, reduces the risk of infection, reduces costs, and increases the efficiency of the services. Until now, that option was limited, because physicians could not bill for their services or because patients had no access to a stable Internet connection. Those two concerns can certainly be fixed with the support of the federal government.

Furthermore, in order to have access to the technologies and the solutions that help patients to obtain better care in a timely fashion, the government must focus on procurement. The pandemic actually proved beyond any doubt that procurement is not just a menial job that is simply about acquiring things. It requires men and women with a strategic vision, with a good understanding of the technologies that are needed, and with a solid foundation in new value-based procurement concepts. Those concepts, after all, have been adopted elsewhere in the world, particularly in Europe.

During the pandemic, the federal government took two steps in procurement. First, it centralized procurement, especially for ventilators and personal protective equipment. Once free from a part of that burden, hospitals and industries were therefore able to concentrate on what they do best, which is taking care of patients. Then, the government began to implement innovation policies focused on demand.

Historically, the federal government has focused on the supply of innovation rather than on the demand. For more information on this subject, you can read the article by Neil Fraser, the president of Medtronic Canada, in Longwoods. Right now, I can tell you that innovation policies focused on demand involve asking for and obtaining solutions, not just products. That is exactly what the federal government did when it launched Canada's Plan to mobilize industry to fight COVID-19.

By implementing innovation policies focused on demand, the government was beginning to follow the recommendations of the Economic Strategy Table for health and bio-sciences that the government established in 2017, with the Department of Innovation, Science and Economic Development collaborating with Health Canada. This crisis has shown us all the importance of having a more advanced manufacturing sector in Canada. I would say that the government can achieve that by re-examining the recommendations of the Economic Strategy Table for health and bio-sciences.

I would like to end with integrated health solutions.

In our search for solutions to improve our health care system, one of the greatest challenges facing the federal and provincial governments is to find a solution to eliminate the incredible delay in surgeries and diagnostic procedures, and to avoid other deaths because of those delays.

Before the virus emerged in Canada, hospitals were already operating in a complex environment. The way forward will be increasingly difficult if we do not act quickly. Hospitals also have to adapt to the new expectations of patients who have seen the advantages of virtual care, as opposed to being afraid to stay too long in a waiting room.

Despite everything, there is hope and a huge amount of optimism. Let me give you some specific examples. One is the Fraser Health Centre in British Columbia, which now conducts patient evaluations virtually, before they are admitted. In Ontario, virtual care is used for more than 50% of the patients at the Peter Munk Cardiac Centre. In New Brunswick, the Vitalité Health Network has established a specialized drive-through clinic for pacemakers, in order to reduce the growing number of patients waiting to have their cardiac devices checked.

Medtronic Canada has the expertise and the tools needed to help the government to develop those kinds of new protocols and thereby to create patient-centred health care pathways. These will help health care systems meet the new challenges and the new expectations. We are determined to deliver the results that we have promised.

On behalf of Medtronic Canada, I would like to thank you once more for making it possible for me to share my comments. I hope that this session today is just the beginning of a concerted initiative that will call on the leadership and the courage of our governments, the expertise of our academia, and the resilience, experience and ingenuity of Canadian companies and their international affiliates that have chosen to invest here in Canada. The benefits will be seen in the health of all Canadians.

[The Chair, Liberal, Ron McKinnon]

Thank you.

We will start our questioning now. We will undertake two rounds of questions. We will start the first round with Dr. Kitchen.

Dr. Kitchen, please go ahead for six minutes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair.

Thank you, everybody, for your presentations. They are greatly appreciated.

Dr. Possamai, I really appreciate your being here and the work you did with the SARS Commission, because that facilitated the start of PHAC, as you mentioned a little earlier today, and the setting up of protocols and policies to deal with pandemics. We've seen that not only has Canada done that, but other parts of the world did that at that time.

Taiwan did exactly the same thing, and they implemented those policies and procedures from day one, right from the very start. My colleagues and I brought forward, a number of times, with the minister as well as the government, the issues of shutting down the borders, using face masks, testing, etc. As I said, Taiwan closed its borders and utilized masks and temperature screening from day one, and they've done a tremendous job in reducing the impact of COVID-19 and the number of deaths.

I have a question on the issue of temperature screening. Last month, the committee questioned officials from Transport Canada regarding the effectiveness of temperature screening for travellers during the COVID-19 pandemic, specifically at airports. Dr. Tam herself has said that when it comes to SARS, temperature screening was ineffective. My colleagues and I asked the Transport Canada officials to provide us with new, scientific evidence that would support the effectiveness of temperature screening. However, they've only provided what seems to be an opinion piece, without any scientific paper. They state, “The greater number of COVID-19 cases increases the likelihood of temperature screening effectiveness”.

From your experience and your review of the SARS epidemic, I'm wondering what scientific data proved the effectiveness of temperature screening.

[Mario Possamai]

That's a very good question. During SARS, there was some work on temperature screening, but it was inconclusive, and the information was that it appeared to be ineffective. This occurred over a short period of time. The equipment at the time was not as effective as it is today, so I think that it warrants, in a very speedy fashion, an examination of what the best technology is and whether it works.

One of the things I've noticed with PHAC is a lack of urgency to look at new technologies, to examine the best way to address this, and I think this may be an example.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

You indicated the fact that temperature screening can produce inaccurate results for a variety of reasons. They could include improper calibration of the machine, user error and environmental variations—the technology has changed, obviously—which could lead to false positives and false negatives that create incorrect data for scientists, as well as a potential risk to public health in general. Do you have concerns, not just about the effectiveness of temperature screening overall, but also about the integrity of the data collected?

[Mario Possamai]

You know, I'm not an expert in this area, so I don't want to speak on it. I do think the whole issue of border control is one that needs to be controlled in depth. What's the best way to do that? What's the best way to monitor movement? Is it the technology, as mentioned by the witness from Mapsted? I think we need a really holistic approach to examining the best way to do this.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

You did talk a little bit about masks. We're aware of the issue of droplets versus airborne transmission and the fact that certain masks meet certain standards. There's the standard mask that we see people walking around with today, which is just a cloth that basically keeps the droplets in but doesn't necessarily protect you from what's out there. We also talk about the N95. Obviously, the reason it's called N95 is that that's the percentage it reduces. We even talk about N99.9 masks that are out there.

These masks that are there, should we be using them today? Should it be something on the issue of...? Yes, N95s are of value in certain areas where there is a much greater risk, but is that a value that we see in the public?

[Mario Possamai]

That's a really great question. Dr. Osterholm of the University of Minnesota has raised this issue. He is in fact working on a plan to be able to create, for the public, masks that are as protective as N95s. I think that should be our goal. I think everyone should be protected, if the equipment is available, to the same level as health care workers.

This darn COVID-19 is extremely infectious. I think airborne infection is a real risk. I think our goal should be to protect everyone to the N95 level. I think Dr. Osterholm's project is a great way forward in that direction.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

In the CFNU press release, you're quoted as saying the following:

The SARS Commission provided clear recommendations on worker safety and infection containment, lessons that have been overlooked in this pandemic. It is our hope that this investigation, prompted by the CFNU, will yield unequivocal, evidence-based recommendations that are urgently needed to prepare Canada and frontline workers for the next wave of COVID-19.

What are the barriers when it comes to knowledge transfer on the lessons learned from the previous pandemics and epidemics?

[Mario Possamai]

That's a great question. I think one of the problems is that PHAC and other public health agencies in Canada, and the WHO as well, don't have the kind of diverse knowledge and expertise that we need. They have very good knowledge in terms of epidemiology, but they really need to have broader knowledge on worker safety expertise, and also expertise on aerosols and aerosol transmission. For example, two of the top people in the world on aerosol transmission are Canadians. They are Dr. Raymond Tellier in Montreal and Dr. Lydia Bourouiba at MIT. They should be at the table. They should be involved with PHAC in developing the kinds of policies and procedures that could protect our workers.

I would recommend that there be a real review to ensure that PHAC's expertise is expanded and really reflects the latest science. A lot of the science that PHAC and WHO are relying on when it comes to disease transmission dates back to the 1930s and 1940s, when instruments were not good enough, sensitive enough, to measure aerosol transmission. The science has made incredible progress in looking at small aerosol transmission, but that expertise is not at the table at either PHAC or WHO. I would recommend that they really expand their knowledge base.

My last point is that we should look at the CDC. The CDC has two components. One is NIOSH. NIOSH is dedicated to worker safety. PHAC should have the same type of independent, very strong, very well-resourced and well-staffed expertise to look at this. We have Canadians who can do that, and we should bring them on board.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Kitchen.

We'll go now to Mr. Longfield.

Mr. Longfield, please go ahead for six minutes.

[Lloyd Longfield, Liberal, Guelph, ON]

Thanks, Mr. Chair.

Thank you to all of the witnesses. I wish we had more time, but that's always the struggle we have.

I'm going to start with Medtronic, then go to Mapsted and then, time permitting, finish up with Mr. Possamai.

Mr. Hupé, it's great to have you here. You mentioned Ventilators for Canadians. We have a couple of Guelphites who are helping out on that project: Jim Estill from Danby and Rick Jamieson from ABS Friction. I had early discussions during the pandemic with Jim Estill about the war approach to treating industrial problems and sharing information in order to work together on problems.

However, one of the issues we studied on the industry committee is intellectual property. I wonder how you see intellectual property being managed and shared in the health sector as we go through the COVID crisis.

[Patrick Hupé]

Thank you for your question, Mr. Longfield.

Actually, as far as we're concerned, we haven't really had any intellectual property issues.

There are different types of ventilators. There are portable ventilators, which are mainly used by the military in case of emergency and allow evacuation of people in the field. If more advanced care is needed, there are much more sophisticated devices, with thousands of parts and very advanced technology.

There really is a whole spectrum of devices from the simplest to the most elaborate. So that needs to be taken into account. So it may be wrong to believe you can convert factories very quickly for the type of device that is at the extreme end of the spectrum in terms of complexity.

However, I won't go into detail, but devices with what could be described as fairly average technology, which aren't overly elaborate or as simple as the technology found in the armed forces and used in the field, are readily available to people. We've released this type of device around the world, and I think it's been a win for Canada, as we've seen Ventilators for Canadians take up this opportunity.

[Lloyd Longfield, Liberal, Guelph, ON]

Thank you.

I come from a pneumatics background. I know that when you're operating under low pressure and low flow, which is what the lungs do, it makes for some challenges. You also need a fail-safe to make sure that if the unit doesn't work properly, there are ways to continue without starving the patient for air.

When working with universities and academics, developing and innovating, we've had challenges in the past in Canada to transfer intellectual property without other countries buying our intellectual property and then selling it back to us so that we have to manufacture under licence. Are you manufacturing under licence at your place, or are you working within the ideas from Canadians?

[Patrick Hupé]

You're referring to ventilators that are currently completely free.

However, academically, there is currently a trend that intellectual property is increasingly being freed up. I'm no expert, but I think McGill University's Montreal Neurological Institute and Hospital has moved in that direction. We may see this elsewhere in Canada.

[Lloyd Longfield, Liberal, Guelph, ON]

Terrific. We have seen that in Germany, too, at Fraunhofer, with its institutes sharing information. Thank you very much.

Mr. Nagpal, the 62 patents that you mentioned always get my attention. I love ideas being patented in Canada, but then there is a time and a place where you have to operate openly.

Anonymizing and aggregating data is another thing we talked about, Mr. Nagpal. You also talked about location-based data. Are you able to still use the data for a limited amount of time? Could we use the data, and have protections on that data, so that the Government of Canada could aggregate and anonymize it, or does it just fade away once it's been used one time?

[Paramvir Nagpal]

We are an innovative technology company, and that's why we pride ourselves on having 62 patents in six years, from the company's formation.

Back to your question, any authentication and credentials can be done to control the data. First, the data is stored on your personal device. If you want to share that information with your local government authorities, you can do that by giving them a password that disappears automatically within seven to 14 days, depending on how the system is configured. At the end of the day, we want to give the control to Canadians so they can make their own choices.

[Lloyd Longfield, Liberal, Guelph, ON]

That's great. Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Longfield.

[Lloyd Longfield, Liberal, Guelph, ON]

That's too bad. I knew I'd run out of time. Thanks so much.

[The Chair, Liberal, Ron McKinnon]

It's your turn now, Mr. Desilets. You have six minutes.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

Thank you, Mr. Chair.

My first question is for Mr. Nagpal.

Mr. Nagpal, what percentage of the population would be able to access this application, including of course those who don't have a cell phone?