I want to start by saying that I disagree with Mr. Strauss's characterization of the meeting. From the beginning of the meeting, we've experienced nothing but obstruction to our amendments. The chair is being challenged every step of the way, when I think all of our amendments are in order and are relevant. I just want to put it on the record that the characterization of this meeting is something I disagree with Mr. Strauss on.
In terms of PrescribeIT, my understanding is that, first of all, Canada Health Infoway and Telus Health are the third party administrators of that. My understanding is that the uptake was low, which is why the program has ended and why I think it's also a crucial time for us to consider the legislation in the Senate right now, Bill S‑5, the connected care for Canadians act, which would create the federal framework for provinces and vendors to have interoperability on health data. This opens doors to connected care, connected medical records and connected health care, right across the province and across the country.
We've been hearing a lot of positive comments from various organizations that welcome this legislation. It's going through the Senate right now, so we're looking forward to it passing and to considering it at the House of Commons level as well.
In Canada, we are very proud of our single-payer system. We're proud of the diversity of our health data, and we're proud of the research sector that can utilize the wealth of data that we harness to boost and enable health care innovations. We've already seen a lot of that on the ground at the hospital level, and we have many doctors in this room who can speak to some of the innovations they see at the hospital level. I think Bill S‑5, the connected care for Canadians act, will enable that conversation even more and will also set the stage for a lot of great things coming out of hospitals and our tech sector.
With that, I would also like to speak to the report “The Expansion of Virtual Care in Canada: New Data and Information”. Just before we suspended to send in the wording of the motion, I was talking about virtual care. It reads:
Virtual care is showing its value across Canada's health care sectors, following its rapid escalation due to the COVID-19 pandemic. Health systems are recognizing how virtual care can address the diverse needs of patients and health care providers to deliver safe, timely and equitable care. In March 2022, about half of Canadians reported that they had been offered a virtual visit alongside other non-virtual modalities. Between January 2021 and March 2022, about one-third of all patient-reported visits were virtual, and 38% of family doctor visits, 27% of specialist visits and 16% of visits with other health care providers (e.g., dentists, physiotherapists) continued to be conducted virtually. Virtual care activity in this period remained above its pre-pandemic level, though the proportion of visits that were virtual decreased compared with 2020 [at the start of the pandemic], when many in-person health services were unavailable.
Virtual care is defined as “any interaction between patients and/or members of their circle of care, occurring remotely, using any forms of communication or information technologies, with the aim of facilitating or maximizing the quality and effectiveness of patient care.” It includes services carried out using a variety of digital technologies, both synchronously...and asynchronously....
Since the onset of the pandemic, health systems have leveraged existing infrastructure and programs to launch new or expand existing virtual care offerings. This report presents case studies from across Canada that show the diversity of these initiatives and highlights the common themes among the provincial and territorial approaches. Exploring how virtual care has evolved provides a valuable opportunity for provinces and territories to learn from each other to support continued improvements in delivering virtual care.
While virtual care has long been a part of the Canadian health care landscape, Canada has historically lagged behind its international peers in its adoption of information technologies.
Just from seeing many of the innovations at the hospital level or at the service level, I want to say that we're catching up really quickly. There is a lot of talent in Canada doing incredible work.
I also want to tip my hat to the hard-working researchers out there, who are so dedicated to their environment. They sometimes see Canada as a safe haven right now, given the geopolitical conflicts. We are going to deliver a lot of great environments for researchers and tech entrepreneurs.
It continues:
This report showcases new findings from the 2022 Commonwealth Fund (CMWF) International Health Policy Survey of Primary Care Physicians, which show that during the pandemic, Canadian physicians increased their adoption of certain information technologies—gains that now approach the CMWF country average. These findings highlight the health system gains resulting from a concerted focus on virtual service delivery.
I think a lot of us probably see that in care settings. We see information technology adoption across sectors. A lot of physicians are utilizing the tools that are currently available to them to expand capacity and deliver care faster. A lot of the innovation in diagnostics, in treatment and in personal medicine has been incredibly impressive.
On several fronts, we are close to breakthroughs in treatments, which is incredible to see, and a lot of them are Canadian innovations from Canadian researchers and Canadian technologies. In Toronto, I'm so proud that we have a few of the best children's and research hospitals and an entire network that supports our research sector and research environment.
I want to come back to some of the comparative figures and how Canada compares with its international peers. The international health policy survey of primary care physicians report in 2022:
...examines the similarities and differences in access to care between Canada and 9 peer countries. The latest responses from Canadian physicians reflect that recent efforts to increase uptake of virtual care technologies have been effective.
Canadian primary care physicians (84%) were more satisfied with practising virtual care compared with international peers (68%). They generally did not find the implementation of a virtual care platform in their practice to be challenging, compared with their CMWF peers. They also noted that it has had a positive impact on certain aspects such as the timeliness of care, and effective assessment of mental and behavioural health needs of their patients.
Increases were seen in the proportion of Canadian physicians whose practices offer patients options to communicate electronically. More practices offered options to schedule appointments online, to communicate via email or secure website about a medical concern, and to view patient visit summaries online in 2022 compared with 2019, but all of these areas remained below the CMWF average....
Similarly, improvements were seen in the proportion of Canadian primary care physicians who can electronically exchange information with any doctors outside their practice. Exchange of patient clinical summaries with other doctors increased to 38% in 2022 (25% in 2019), exchange of laboratory and diagnostic test results increased to 55% (36% in 2019) and patient medication lists increased to 51% (33% in 2019). However, all of these areas continue to be below the CMWF average, which ranged between 67% and 72%, despite most Canadian physicians (76%) having access to regional, provincial or territorial information systems.
Demonstrating the impact of focused efforts on technology adoption, uptake of electronic medical records (EMRs) and remote monitoring devices has increased to approach or exceed the CMWF average. EMRs are important tools that facilitate the flow of information and communication between health care providers, and between providers and patients. Some EMRs include integrated virtual care tools, such as secure messaging capabilities. More Canadian primary care physicians were using EMRs in 2022 (93%) than in 2015 (73%), similar to the CMWF average (93%). About 1 in 4 Canadian primary care physicians (27%) use remote monitoring or connected medical devices to monitor patients with chronic conditions, which is higher than the CMWF average of about 1 in 5 physicians (19%).
I must say a lot of the technologies that are evolving very quickly really offer physicians the ability to monitor from a distance. Some are enabled by AI, and the devices have evolved to a point where they're so portable and so seamless that people can wear them without impeding their everyday lives.
Again, we're very proud that Canada is home to many of those technological developments. We're seeing a lot of great entrepreneurs partnering with researchers to make sure that what we deliver passes the highest standards, can be the pride of our country and can go on to compete on the world stage.
I'll get back to the findings:
These findings reflect the positive impact of focused efforts to increase technology adoption and virtual care during the pandemic, and bring Canada more in line with its international peers. Given the growth trends demonstrated through the CMWF survey and supported by high physician satisfaction with practising virtual care, there are likely further gains to be made.
I want to get into the approach of some of the case studies for virtual care. The report says:
Federal, provincial and territorial governments have been investing in digital health for many years, supported by funding from multiple sources including Canada Health Infoway.... In 2020–2021, the Government of Canada provided new funding to provinces and territories to advance virtual care in response to COVID-19. This funding could be used to enhance technology and infrastructure that would facilitate virtual care, to evaluate the impacts of virtual care or to establish policy supports for virtual care. As a result, provinces and territories implemented a wide range of initiatives....
We'll talk about it in the next couple of minutes as well. The report continues:
To share the successes and challenges of these initiatives and to inform future virtual care policy and delivery, the Canadian Institute for Health Information (CIHI) asked each province and territory to highlight 1 newly funded initiative during a semi-structured interview.... The case studies resulting from these interviews do not cover all the initiatives outlined in each jurisdiction’s action plan, nor longer-standing initiatives. Where available, complementary quantitative data was used to support the case studies.
The case studies are grouped according to their focus: strategy, governance and direction-setting; and programs and initiatives. They reflect that jurisdictions had different starting points and priorities, and showcase examples of progress, share learnings and reveal commonalities across the different approaches.
We'll talk about the case studies in the next few minutes, and we'll talk about the common themes across these initiatives.
One of the case studies provided in the report that's focused on strategy, governance and direction-setting is from the Northwest Territories. As stated, its “EHR strategy paves the way to improved health care delivery and outcomes”. To offer a bit of background:
The Northwest Territories uses a variety of information systems to deliver health care in primary and specialty care, diagnostic imaging and pharmacy services, and many of these systems are approaching retirement. Some areas, such as acute care, record almost entirely on paper.
The Northwest Territories recognizes the need to approach the replacement of its information system as a foundational step toward a more comprehensive patient record and to meet the future information needs to support the delivery of virtual care. To prepare for this transition, an overarching electronic health record (EHR) strategy will support efforts to ensure that new technologies will work successfully toward creating a comprehensive patient record, address technical shortcomings and enable providers with the right information at the right time to enhance patient services.
