Health committee  As it stands now, for something as serious as renal failure, it's estimated that only about 25% of patients are eligible, largely because of cognitive limitations, physical dexterity, and vision issues. Some end-stage renal disease patients have other serious comorbidities. Yvonne was young and relatively healthy otherwise.

Health committee  We actually did do a pilot in Chapleau, Ontario, a couple of hours out of Timmins. Again, with the significant type 2 diabetes population, some of the challenges we faced at the time were infrastructure problems. The use of the mobile phone in some of those rural areas was difficult.

Health committee  We're somewhat agnostic at this, but we used some personal health record tools such as Google Health, which is now defunct. There are others, like Microsoft HealthVault, and the Canadianized version of that is TELUS health space. There are others that FedDev have invested in called the Connected Health and Wellness Project out of York University.

Health committee  That's right. Absolutely.

Health committee  That's a great question. In the case of home hemodialysis, the cost savings are essentially the fact that the patient is taking over the role of the nurse, which is significant. Nursing ratios went from 2:1 to 20:1 as a result. Quite honestly, with the increasing prevalence of diabetes and end-stage renal disease, there's plenty of work for nurses to do.

Health committee  The mechanisms in terms of how home hemodialysis improves these health outcomes are that...normally when a patient with end-stage renal disease uses conventional hemodialysis three times a week in a hospital setting, the renal replacement therapy they get brings back about 15% of their renal functions.

Health committee  The behavioural mechanism around that is—what we believe happened—because this application prompted them to take their blood pressure measurements on a more regular basis, these patients became more aware of their blood pressure. They took their medications more frequently, and the follow-up was closer.

Health committee  Thank you very much. Thank you for the opportunity. I'm Dr. Cafazzo from the Centre for Global eHealth Innovation at Toronto General Hospital. We have a mandate, as an academic research facility based at Toronto General, to look at the design and evaluation of future e-health innovations that will transform the health system.