We admire your dedication. I wanted to give you some special time because anybody who cares so much to come as a witness to our very important committee.... As you know, we're studying technological innovation and witnesses like you are very important to us. For you to be on vacation and take time away from your family to drive and get to a place where you can actually speak to us via video conference, we're very honoured to have you here, and I thank you very much for that.
We have Dr. Lear, ladies and gentlemen. You have the video conference from California in the background and what he has done to be here at committee today.
We have as an individual, Dr. David Price, chair of the department of family medicine at McMaster University. We're very pleased to have you here as well, Doctor.
We have a guest arriving, Paul Lepage, president of health and payment solutions at TELUS. He'll arrive at 4 o'clock.
We'll begin with you, Dr. Lear. You have 10 minutes.
Watch me a little because I'll gesture when you're just about a minute out. Thank you, sir.
Go ahead, Dr. Lear.
:
Thank you again for the invitation to speak at this committee. I'm quite excited about this topic.
As we all know, the use of e-health and telehealth has been met with substantial enthusiasm as a way to bridge gaps in health care and geographical inequities of care. This has been recognized by decision-makers throughout the country. It is reflected also by the proliferation of e-health provincial offices, and many health regions also have telehealth managers, as well as the creation of Infoway.
However, despite the enthusiasm for e-health and telehealth implementation, I would say the uptake has been quite modest. This is in part due to limited evidence to inform decision and policy-makers as to what programs may be beneficial and what ones aren't. In addition, most of the initiatives to date have been directed to supporting administrative duties such as electronic health records, and the storage and forwarding of medical images, and while these things are important, there has been relatively less attention given to improving direct patient care.
In British Columbia I lead a network of health researchers and health authority decision-makers called the BCATPR, the British Columbia Alliance on Telehealth Policy and Research. Our goal is to develop and evaluate patient-focused solutions for the delivery of health care services to patients with chronic diseases.
Our initial work has been directed toward bridging this geographical gap in health services. As we know, while most of our health care resources are centred around large urban centres, chronic diseases and other conditions are ubiquitous throughout Canada. Indeed, in rural areas, we actually find the prevalence of chronic diseases is increased due to higher rates of smoking and higher rates of obesity.
Conversely, access to health care services in these areas is commonly limited to the primary care physician and the local community hospital. They have little or no access to specialty care or specialty clinics, such as diabetes teaching centres, cardiac rehabilitation programs, and others that have proven effective for the prevention and management of chronic diseases.
What we find is that the per capita hospitalization for chronic diseases in rural areas is actually quite a bit higher than in urban areas, and it may be due to this missing gap in specialty care. So basically, if care for a patient gets too complex for the family physician, their next level of attention is to refer them to the local hospital, being unable to refer them to a specialist or specialty clinic.
Now our projects to date have made use of the Internet to bridge these gaps in care, as the Internet has the advantages of using existing infrastructure such as home computers, it's widespread, and it is growing in use, and models of care can be readily scalable through the Internet.
As an example of the utility of the Internet for health care delivery, in 2006 our team conducted a survey of nearly 300 hospitalized heart patients between St. Paul’s Hospital in Vancouver and what was then called Prince George Regional Hospital in Prince George. Two-thirds of these patients had home Internet access and about 80% of those had a high-speed connection. When we asked them about home Internet use, 70% actually said they used the Internet to access health information. This was third only behind general browsing and using the Internet for e-mail. What we do know is that as we move away from urban centres, Internet access diminishes. In our rural patients, we found about 50% had home Internet access, compared to over 70% in the urban centres.
At around the same time, we conducted a number of interviews with decision-makers, health professionals, physicians, and patients, and all indicated that using the Internet had great potential to coordinate care and also to communicate care and health information across the key players, including the patient.
We have subsequently developed and tested what we call a virtual cardiac rehabilitation program. Cardiac rehab programs are proven effective for preventing subsequent events for patients with heart disease, but only about 15% to 25% of eligible patients actually attend these programs with the greatest barrier being transportation and geographical access. Our virtual program consists of a website that mimics the hospital-based standard cardiac rehab program and allows patients to connect with the cardiac rehab staff we have in Vancouver.
One of the innovations is that patients are given a recordable heart rate monitor that they can wear while they exercise to record their heart rate. When they get home they can upload it to the web server so that the health staff in Vancouver can actually check on their exercise heart rate and provide any feedback as needed.
After 12 weeks the patients increased their physical activity and fitness levels and reduced their cholesterol levels comparable to what we see in the standard hospital-based programs. One of the participants was quoted as saying at our interviews:
I can’t say enough about how helpful it was in changing some of my habits. The alternative would have been to go into Vancouver regularly, or to bring home a sheet of exercises and instructions...which I’ve done before and quickly given up on.
This patient lived about a two-hour drive from Vancouver.
We've since advanced to models that can be readily translated to a number of chronic diseases beyond heart disease, including diabetes, renal disease, and lung disease. In this program, patients log onto our website, which we call MyHealthConnect, and answer questions about their symptoms and how they feel. An alert may be generated if their answers indicate a worsening of symptoms.
The alert sends an e-mail to the nurse who will then phone the patient. Most commonly we find the nurses counselling a patient on supporting their self-management and behaviours. As well, the nurse, if it seemed fitting, would refer the patient to their family physician for additional medical management. Also there is the opportunity for the patient to converse with a dietician or an exercise professional.
The value of this model is that it acts as a type of early-warning system to direct patients in appropriate care and prevent downstream hospitalizations and complications. In addition, patients benefit from the nurse counselling, and as they do, the number of alerts they generate should decrease. Those patients who are stable actually don't generate alerts at all and spare the nurse's time.
This program also includes a patient action plan that is coordinated among the patient, the program nurse, and their family physician. We are currently studying this program throughout B.C. in smaller urban and rural areas, and we have right now over 70 family physicians and some of their patients participating in it.
One of the key aspects I want to stress about our work and research development regarding the downstream implementation is the inclusion of stakeholders or end-users in our design. Our team is constantly working with decision-makers, policy-makers, health care professionals, and patients to help guide our programs. For example, when designing the MyHealthConnect program, we had an advisory committee that consisted of specialist and family physicians, health care professionals, nurses, psychologists, and patients. This was extremely beneficial in ensuring that our program fit into and aligned with current primary care practices, in addition to addressing the needs of the patients.
The next step is working towards implementation. We already have one group in Whitehorse that is interested in looking at our virtual cardiac rehabilitation program in order to prevent having to send patients down to Vancouver for subsequent care or having specialists come from Vancouver to care for patients there.
Some of our future projects will look at translating these programs beyond the Internet to regular telephones and cellphones in order to increase access and use, as well as developing other solutions for patients and providers, such as an online specialist referral portal and programs to support the transition of patient care.
Just before I close, I would like to take the opportunity to suggest some recommendations as to how we might move forward in certain areas.
Number one, Infoway, which has provided extremely valuable support in electronic health records, should consider expanding its mandate to include support for models that incorporate direct patient care and also to go beyond funding health regions as innovation can come from other areas besides the health authorities.
Number two, a way should be found to promote interprovincial collaboration on telehealth strategies. We find that one of the virtues of telehealth is that it can cross jurisdictional boundaries, but sometimes these can become barriers to implementing and facilitating excellent programs.
Number three, the development and research of e-health and telehealth through the CIHR should be encouraged so that decision-makers have the evidence they need to make informed decisions for health care delivery. This can be done through the CIHR by taking a leadership role and conducting specific grant funding calls for research in technology-supported models of patient care. This may include examples of supporting patient care in the home, delivery of care at a distance, and mobile applications, as some ideas. This would also help put the data that's needed into the hands of decision-makers.
I'd like to close there. Thank you for your time and your attention.
:
Thank you very much for this opportunity.
As the father of three teenage girls, it's going to be an experience to have people listen politely and not interrupt for 10 minutes. I'm going to enjoy this.
My grandfather was born in Montreal and lived in a small town just outside Montreal called Chambly. One of his early chores was to harness the horses and hitch them to the wagon to take his father to the train station. He disliked horses very much so when the car came out he was one of the early adopters. Early adopters transformed the way transportation happened. We're at the same stage now in our development of electronic health records and e-technologies.
If you go to the States the CDC, the Centers for Disease Control and Prevention, this last year said that about 50% to 55% of physicians are now using electronic health records in the United States. In Canada the Canadian Medical Association estimated that somewhere around 39% of our physicians are using electronic health records.
It's clear to me that with graduating 2,000 physicians per year we've passed the tipping point. Those graduating physicians are not going to start using paper charts and move backwards. They are moving forward quickly. I think we will see a massive shift to electronic health technologies in this country over the next three to five years. That's one of the key messages here; it's happening and we're there in terms of adoption.
One of the keys is that we haven't got toward meaningful use. What I mean by meaningful use is value added. If my grandfather only used his car to take his father to the train station and back, we wouldn't really have seen any development. If we're simply using our electronic health records to replace the paper chart, we're not getting anywhere. We're maybe slightly improving our efficiency but we're really not taking full advantage. That is really where we are now, that is, to drive the meaningful use. That's what I'd like to talk about a little: what we're trying to accomplish.
McMaster University is probably well known as being one of the innovators. We developed an electronic health record called OSCAR about 12 years ago. OSCAR is now one of the leading EMRs in the country. Approximately 2,000 family physicians are using it across the country with about three million Canadian citizens being registered with OSCAR and being supported on that. However, it's an electronic health record and that doesn't meet all the needs of our Canadian public. What we really need to see is the development of tools within the electronic health record that facilitate and promote care. We've been working with our colleagues and OSCAR has been developed across the country. It's now at McGill in the department of family medicine. It's at Queen's University, McMaster, and also at UBC.
This product is now starting to mature to the point where we're starting to see more and more, I will call them apps or add-ons to this product. For example, we are seeing an increasing number of patients with chronic kidney disease in this country who require renal dialysis. Renal dialysis, hemodialysis, and peritoneal dialysis are considered an onslaught and are extremely expensive. We know we can prevent large numbers of patients from moving down the slope to needing dialysis. Part of the challenge is identifying those patients early.
One of the things we've done is we've partnered with the Kidney Foundation of Canada and the Ontario Renal Network to start to develop what we would call an app that goes on to the electronic health record and identifies those patients early. As we start to see if they have an increase in blood pressure, if they have certain ethnic backgrounds, if they're aboriginal or South Asian, or if their glomerular filtration rate or their kidney function starts to deteriorate, it sends a signal to the clinician that says this is a patient whom you might need to pay more attention to.
As a result of that, we can now start to see changes in how we manage. One of the challenges with a paper record, frankly, is if it's sitting in the back of the paper record, nobody is triggering to the clinician that you need to pay more attention to that patient and perhaps intervene early to stop the progression.
This product is being trialled. It's now ready to go. I think one of the important aspects of one of the messages I'd like to give is that this is an open-source solution. Although it's been developed on our electronic health record, it will be made and is going to be made available to any electronic health record in the country. It would be something that would be an add-on, and we give it away. It's not a matter that there's a cost for it.
Another example is our BORN initiative, the Better Outcomes Registry and Network for perinatal and pregnant women. One of the keys here is that when you're a patient and you're receiving prenatal care from your obstetrician, your family doctor, or your midwife, that data resides on the clinician's chart. It doesn't necessarily get shared. In partnership with Ontario, as well as what was formerly called the B.C. reproductive care program—it has a new term, I'm sorry; it's in my speaking notes—the idea is to identify women and get their information onto a registry such that no matter what hospital they show up at, no matter which specialist takes care of them, their information is immediately accessible to the clinicians. That's going to lead to improved care, and less duplication of investigations.
We've also partnered with the Better Outcomes Registry to start doing prompts, again for the clinicians. When I was seeing patients this past Monday, up came a prompt that said to me the patient is 34 weeks pregnant, she has not received a certain investigation, she is already at risk because of her maternal age, because of her maternal weight, and it suggested that perhaps I should have done or should be doing a particular glucose screening. That fundamentally right there starts to change the whole dynamics of patient care because we're triggering early the information for how we're going to care for those patients.
We've also developed a program called MyDrugRef, which in a nutshell is a social networking site to try to improve how we provide care to our patients to stop the drug-to-drug interactions and to start to incorporate best practices. As a family doctor working in isolation in my office, I don't necessarily have access to a number of specialists and a number of other individuals. This is a way of having instant access to a whole variety of information. We think that's going to change how we practise over the next few years.
We've also been involved with the development of a personal health record. We've called it MyOSCAR for now, but really this is a personal health record that should be broadly available. I want to differentiate between a portal and a personal health record. A portal is a window into the physician's electronic health record. Our vision is that we develop a personal health record that you, the patient, own. It has a number of features.
Initially, we have online booking for the patient. I booked my plane ticket to come here online. Why can't I book my doctor's appointment online? Why do I have to wait? We have now instituted that and it's up and running so that patients can actually book online easily.
There's secure messaging between the clinician and the patient. My patients can send me a message over the Internet, not e-mail but secure messaging, so that I can interact with them. That could be my nurse, or one of the nurses in the unit, a dietician, a social worker, whoever is the most appropriate person.
The other thing is document transfer. When I looked online today at my patient profiles, I received the cholesterol, the laboratory results, the sugar test, etc. I acknowledged that electronically. It gets filed into my electronic medical record, but it also was sent to my patient today so that they saw it online, in their own personal health record, along with a comment from me, “Great work. Keep it up, Joe. You'd better come in and see me. We need to talk about your exercise”, or whatever it is.
It's that starting to put the care of our patients in the patient's hands, which is where it probably belongs in the first place. Through Health Canada or the Federal Economic Development Agency for Southern Ontario, we've been part of a partnership with York University and NexJ and are starting to develop a series of apps so that patients can take care of their own health themselves. It generates that sort of care for themselves.
My next point is that telemedicine—
:
Thank you for this opportunity.
From TELUS's perspective, technology is going to be key to the transformation of health outcomes. We believe that to be successful we have to involve all of the players in the system—doctors, health practitioners, and patients.
As a company, we feel we have a corporate responsibility to step up and help health care professionals. A lot of our focus is on the tools and capabilities we can bring to market. We constantly ask ourselves whether to move the focus from illness to wellness.
From a Canadian perspective, health care is a service. It's a service-based industry and should be leveraging technology the same way as other major industries—banking, airlines, insurance—to get the benefits of IT to the patients. We focus on finding solutions that will help organize information, connecting the various health care professionals, moving information securely, and making information more meaningful.
In connecting professionals, one of the challenges we have in health care is that it's a very siloed industry. We need to connect all of the various providers along the continuum of care. As to moving information securely, this is where a large carrier has a role to play, because we move lots of information today over our broadband infrastructures and our wireless networks. Organizing information is also key. Applications have to be set up in such a way that health care providers can easily use the information provided to them. Finally, making information more meaningful has to do with taking the information we have and presenting it back to health care providers or patients so they can take action on it.
We have solutions that address the continuum of care, that go across that continuum. TELUS is active in most of these areas, whether it's providing electronic health records, clinical information systems in hospitals, or electronic medical records. For example, we have about 34,000 clinicians involved in our solutions. In our first line of care, we have about 3,500 physicians using our EMRs.
Then we move towards the other end of the gamut, which is home care and self-care. At the end of the presentation I want to show you a video where you'll see live Canadians actually using some of our solutions. One of the areas of focus is remote patient monitoring. It sits between the first line of care and self-care—
:
One of the areas that we have focused a lot on is remote patient monitoring. In the information that we supplied to you is a study that was done by HEC, École des Hautes Études Commerciales, on the benefits of remote patient monitoring and the implementation of e-solutions.
What you would have seen in the video is a patient using a terminal at home. This patient is discharged from the hospital, is assigned a care plan, and is asked to follow this care plan. In this case, we did a study on patients who were suffering from chronic obstructive pulmonary disease. The study from the HEC shows that by providing the terminals and the care plans, we've actually decreased the number of admissions to emergency by 34% and the total cost of hospitalizations by 66%. The study is there. I think the study is available in both official languages. It's a good example of how you can get the patient more involved in his treatment and drive lower costs in the system.
In the video we also have two different patients using a personal health record.
In one case, we are doing a project with the Lawson Health Research Institute relating to mental health. We started with 200 patients who are suffering from a form of mental illness, schizophrenia in most cases, and we supplied them with a personal health record. That personal health record is configured in such a way that the provider as well as the patient, obviously, have access to the record. The patient enters his symptoms during the day and exchanges information with a physician. The outcome has been one where in many cases the testimonies from the doctors have been around the fact that they've moved treatment forward. In some cases, having a patient on the system, after two or three weeks, they've gathered more information on that patient's mood and issues than they have had in six months of treatment. That's another example of how the personal health record comes into play.
The other example that we have on the video is where we've partnered with University Health Network to build an application called “bant”. We've enabled a personal record which sits behind bant. In this case the trial was with young adolescents with type I diabetes. What we've seen is that by supplying them with a personal health record, we've increased the amount of readings these adolescents are taking on a daily basis, how many times they're checking the blood glucose levels, by about 100% and their A1C levels have been reduced over time. That study is also available.
One area that we're extremely focused on going forward is the notion of collaboration. When we look at the health care ecosystem, one of the key elements is how you connect the various players in this health ecosystem so that we're sharing information along the health ecosystem, and how we put in place increased collaboration among the various players along the health ecosystem.
We introduced either personal health records, and in many cases, patient portal solutions, where the patient can go in, for example with various pharmacy chains, and sign up on a portal and get electronic refills of their prescriptions, monitor their medications, and set reminders for taking their medications. These solutions started out with two small regional pharmacy chains in Quebec and we're up to hundreds of thousands of people who have signed up for it. We've performed over 1.3 million electronic refills over those solutions, with only two pharmacy chains.
I guess one of the key messages to the committee is that not only do we have to connect the various players and providers in the health ecosystem, but we also have to enable the patient to play a more active role. Whenever we've provided solutions whereby the patient can play a more active role, patients are willing to embark on doing this because they're doing this in other walks of life.
:
Thank you very much, Chairperson.
Thank you to the witnesses for being here today, and to Dr. Lear for being here via video conference, far from home.
I must say that we're learning a tremendous amount about the new advances that are being made. I find it fascinating, but I also find that increasingly there's a sense of frustration. The stuff that we hear about is so incredible and, across the country, various projects, initiatives, or innovations are under way. What I'm beginning to wonder more and more is, is there a sense of national purpose about what we're doing? We have the Canada Health Act, which lays out the five principles of medicare, including universality. I hope it will be one element that we bring to this study. How do we take what you are doing, which appears to be working very well on the ground, and scale it up to a national level? I think it's a sort of frustration. It's a challenge.
On a personal note, I had an experience here in Ottawa. It was something very simple. I had to go to the ER, the one on Carling Avenue, and the ER doctor said, “Here's my e-mail. If you've got any questions, e-mail me”. I was just blown away. It was the first time I'd ever had a health care provider say, “Here's my e-mail, and if you have any questions when you go home e-mail me”. And I did. I wrote to the doctor and he replied within 20 minutes, instead of my having to go back. It was so simple. I mean, e-mail; what's e-mail? We all use e-mail, but even within the care system I had never had that happen, and it really blew me away.
In hearing about what's happening in B.C., Dr. Lear, with the B.C. alliance, I guess the question I have for you and I think it's also for Dr. Price, is, how can we respond to this in a more institutional way? How can we take what you are doing, find a way to scale it up, and replicate it? It's not necessarily one-size-fits-all. We want local innovation, as that's where the creativity is. How can we make sure that all of this stuff is accessible across the country?
For example, in B.C., I'm curious to know if you did it through the Ministry of Health, or did you have to go to each health authority and convince them to get on board with this or the various projects you've described? To me, that's where the challenge is. How do we put this into practice in a much bigger way so that we all get the benefits?
I know that's a big question. Whether it's the private sector.... I'm primarily interested in the public sector, but if you would care to answer that, I'd be very interested.
:
Thank you very much, Madam Chair.
I want to thank the witnesses. I find the sessions we're having here so exciting because, as you were saying, it seems we're right at the precipice of getting all these things implemented.
We've had witnesses in the past, Dr. Price, from Health Infoway. One of the things they did tell us is that they do have standards and they do have requirements for interoperability between the provinces. I think, though, there are a lot of really good products out there, especially what you're talking about with OSCAR and what you're doing on the ground. It makes common sense that we should be doing that across the entire country.
Some of the frustration we have is that I know the federal government invests in a lot of this. I think you've received money from CIHR and Infoway yourselves in the past, haven't you? Here we have people on the ground such as you and the people you work with, and you're doing really good work, but then suddenly there is an obstacle to getting the technology implemented. As I said, we've had witnesses in the past, and it seems that Ontario and Quebec are having a really hard time getting things implemented, whereas I think in P.E.I. and Alberta they do have some electronic health records implemented already province-wide.
What are the obstacles to getting this technology implemented?
Were you in discussions with the provincial governments when you were gearing up with this technology?
:
From my perspective, if we're asking what can be done, I see two areas, and I have some comments on the notion of standards.
From my perspective, we have to continue to focus on primary care reform in Canada. We're at 40% penetration, 39% depending on the numbers, of EMRs within clinicians using EMRs. Many countries are sitting at 90% or a percentage in the high eighties. So we have a huge gap just in terms of moving information into an electronic fashion and then making it accessible.
I think primary care reform.... The focus on putting EMRs with physicians is going to help us drive a lot of the other programs that we're trying to put in place around chronic disease management, medication management, etc.
The second comment I would make is that as Canadians we have spent the better part of 10 years focusing on standards, from 2000 to 2010. From my perspective, what we need to focus on is what we are trying to achieve in terms of health outcomes. Let's not fund on meeting a certain standard; let's fund on getting to certain meaningful uses. So let's fund outcomes. Let the market sort out, frankly, the notion of standards. We've spent so much time, a good part of 10 years, on a blueprint and on standards, and we haven't moved the bar.
One of the things we need to do is.... I would say the latest funding that was done with Infoway was funding that was more around projects and innovation and bringing solutions to market. For example, our Lawson project with the Lawson Health Research Institute was partially funded by Canada Health Infoway, but it was not funded on meeting a certain standard; it was funded on meeting a certain outcome.
From our perspective, we need to shift our funding from standards-based to funding that's outcomes-based. The U.S. is doing a pretty good job on that right now.
:
Thank you very much for that comment. It makes a lot of sense to me.
I wanted to talk to Dr. Lear as well.
You have probably heard of a doctor down there in California, or you may not have. I think his name is Eric Topol. He's doing a lot of things with cardiac. He's doing a lot with self-care. He's doing a lot with apps and cellphones.
We've had some witnesses here in front of us who are talking about the wonderful things that could be done with these apps, and the work that you're doing for remote communities, things along those lines.
We see these apps that could be used for diabetes, where people will put a sensor on their skin and they can read their blood sugar levels. We see where you can do an EKG that used to be a 12 lead when I was in school, and now it's just two fingers and you've got an EKG. You can do these things cheaply with a $199 app in remote communities, so the technology is there.
I wanted to ask you the same question. I know you've received federal funding, CIHR grants, things like that, but what do you find? Now that you've got the model, are you having trouble with the B.C. government? Are they prepared to start supporting you and financing these in your initiatives?
It seems that as the federal government we can do the role on the research side of things, but to actually get this implemented we have to have the provinces to buy in and it seems that there's a real stopgap there. What do you see being the obstacles?
:
Thank you very much, gentlemen, for coming today. My questions will be directed to all three of you. Basically, I have one.
Certainly, Dr. Lear, I wanted to extend my understanding. I come from British Columbia in the southeast corner near Cranbrook. We deal with IHA there, the Interior Health Authority, and to me it would appear, and this is just a statement, Chair, that the health authorities are there as a buffer for the province, and it becomes difficult at times to try to administer something as it moves forward. That's just a statement, Chair.
I live in a small community of 3,000 and we work under the primary health care model. Our hospital was closed some years ago and it worked quite well. But part of the problem, and I want to understand what we can do federally, from you three gentlemen, is how do we convince the general public that either e-health or telehealth is something they can believe in?
The other thing is, what I hear from a lot of people is, “Why do I have to be the doctor? You're the doctor, so why am I doing all this stuff for you?” How do we get them to the point where they're confident with the system, that they understand that this is the next generation and that this is where we have to go, especially in smaller, rural communities?
I'll start with you, Dr. Lear.
:
Yes. Thank you, Mr. Wilks.
What we're looking at here is basically trying to change behaviours. What you're asking is no different from how we get people, regardless of where they are, to be physically active. How we do that is to make these solutions the easy solutions, so there's easy access. However that patient is interacting with the system, whether it's through the Internet, telemedicine, through their phone, it's easy. Also, we must build their confidence in it. There are some barriers around health literacy, or e-health literacy, as well, with patients, and comfort levels. Now what we'll see as time goes on is that more and more older people will be using these devices more so, mainly because it's a cohort age thing. As we all age, we'll be still using these systems. So there are these challenges. I don't have, off the top of my head, the single answer that we can do here, but making sure that people have access to that information would be the first thing, and then engaging it and ensuring that the providers....
The other thing that you talked about is whether patients should be their own doctors. We talk a lot about the self-management, proactive patient in primary care. But a lot of patients don't want to be proactive. There are a lot of patients, who you've described, who want to go in and be told what to do and then go and do it.
We have some barriers to deal with there, but I'll stop there to let the other people respond as well.
:
Thank you very much, Madam Chair.
My first question is for Dr. Price.
My colleague Colin Carrie asked a very good question about the standardization of electronic medical records. At first, your answer was not what I expected, but as you answered more questions, you provided more details. You said that you would like to see the federal government do something about how data is entered into that software.
In terms of applications such as OSCAR and MyHealth, which are developed in Canada, I think it is healthy for the companies to compete in the marketplace. All those applications can export data, but the problem is that they are not compatible with each other.
A number of years ago in my riding, when we started to develop electronic records, I was working in a clinic that wanted to implement a system like that. Since buying a program requires private clinics to make a large financial investment, the clinics want value for their money. They want to be able to read their patients' data and that of patients who were referred to them. The problem is that the data are not compatible, although they can be exported.
You mentioned
[English]
that the federal government should look at how we enter our data.
[Translation]
Since you know more about electronic records than I do, could you tell me how you think the federal government could contribute to make the data compatible from one software to another?
:
Thank you, Madam Chair.
Let me go back to the question that Dr. Price did not have time to answer. It had to do with the concerns of health care providers in relation to the OSCAR system that you implemented.
As a general practitioner, I have some questions about this whole technology. I am not saying that it is bad, on the contrary. It is very useful. It enables us to save a lot of time and to have access to our patients' records. But I am wondering what place the industry is giving to the doctor-patient relationship.
I am probably old-fashioned, but I see that some patients who go to the doctor's office do not have an organic disease. Instead, they need someone to listen to them. Sometimes, it takes a number of appointments to realize that the patient has a psychological problem rather than an organic one. If doctors relied on what patients say, they would be tempted to order a series of tests.
How can we work with this situation? My colleague Dr. Carrie talked about a physician who was using a BlackBerry to measure patients' heart rates, to monitor their hearts, and so on. In this industry, I still think that the role of physicians, particularly general practitioners, is based on trust and on the relationships they have with their patients.
How do you see this in the future?
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I can give you a personal case.
Both of my kids are type 1 diabetics so they are insulin-dependent. They use the bant application, which allows you to take your readings and monitor your readings over time. My kids are a little older now, but when they were adolescents, often they would take their readings and fill out the booklet the night before meeting the doctor; whereas here with this application, you time-stamp it. You know exactly what the reading is, and you have that information. That gives the doctor more information when it comes time to either adjust the insulin doses or make changes to their diet. It allows you to get more information, and it makes it easier for the patient to enter that information at any point during the day.
So it's true for type 1 diabetics, and it's true for mental illness. In this application we're asking the patients at any point in the day to enter how they feel, to enter information, and that information is fed back to the provider. If they are not feeling well, or their mood is poor, it triggers an alert, and that information is sent to the provider, and it triggers a reaction.
So you're creating this ability to support that patient, not quite 24-7, but much more than what my kids would have had seeing their doctor, let's say once a quarter, as diabetics. The use of technology has increased the possibility of that exchange.
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In this particular project, we started with 200 patients and we're going to grow this to 400. There's a first control group. The first group of 200 patients had the first version of the technology. There's going to be a third group that is going to get the new and improved version of the technology.
What the patients did is sign up via the Internet on a PC to a personal health record application. In conjunction with their physician, they set certain goals for themselves and they set certain parameters they wanted to monitor. This would be true for mental illness, for somebody who's a diabetic, or someone who has congestive heart failure. It would be true for any patient who has a chronic disease that has to be tracked over time. We created a version of that application to make the user interface more compatible with use on a smart phone. You can't do on a smart phone exactly what you can do on a PC.
Reminders are sent to the patient. If in his care plan he was supposed to exercise, he was supposed to do certain things, those reminders are pushed to the patient, and then the patient will do the assigned task. That information will flow from the smart phone to the personal health record and is stored somewhere.
What we're doing, basically, is creating an interaction between the patient and the physician, but you're also creating a sense where the patient is taking charge of his chronic disease. If we're going to be successful in doing that today, we have to do it on technology that people are carrying with them. If you're creating a third or fourth piece of technology that you're going to have to carry with you, people won't adopt the technology.
A lot of our thinking is we have to push our applications to smart phones, to tablets, because more and more doctors are using tablets. The idea is to make it accessible to individuals.