Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue No. 23 - Evidence - May 11, 2017
OTTAWA, Thursday, May 11, 2017
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 10:31 a.m. to continue its study on the role of robotics, 3D printing and artificial intelligence in the healthcare system.
Senator Kelvin Kenneth Ogilvie (Chair) in the chair.
[Translation]
The Chair: Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
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I'm Kelvin Ogilvie from Nova Scotia, chair of the committee. I'm going to invite my colleagues to introduce themselves, starting on my right.
Senator Seidman: Judith Seidman from Montreal, Quebec.
Senator Stewart Olsen: Carolyn Stewart Olsen, New Brunswick.
Senator Unger: Betty Unger from Alberta.
Senator McIntyre: Paul McIntyre, New Brunswick.
[Translation]
Senator Petitclerc: Chantal Petitclerc from Quebec.
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Senator Hartling: Nancy Hartling, New Brunswick.
Senator Dean: Tony Dean, Ontario.
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Senator René Cormier: René Cormier from New Brunswick.
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Senator Eggleton: Art Eggleton, Toronto, and deputy chair of the committee.
The Chair: Thank you, colleagues. I want to remind us all that we are continuing our study of the role of robotics, 3D printing and artificial intelligence in the health care system.
We're delighted that we have three individuals before us, with two different representations. I'm going to identify them as I invite them to make their presentations. I'm going to go according to the order of the list, which I understand is acceptable.
I invite Dr. Ivar Mendez, Chair of Surgery, University of Saskatchewan, appearing as an individual. Dr. Mendez, we're delighted to have you. Please proceed with your presentation.
Dr. Ivar Mendez, Chair of Surgery, University of Saskatchewan, as an individual: Good morning, I thank the committee for the opportunity to present our work on the use of remote presence robotic technology in health care delivery. I'll be talking as well about our experience with 3D printing and virtual reality for surgical planning.
We have focused our work using robotic technologies to tackle the fundamental issue in health care in Canada of access to health care delivery. If you look, for example, at the map of Canada and you draw a line across Canada, the ability of individuals who live north of that line to access health care is very difficult, not only for primary care or emergencies but even for regular care.
If you live in Nunavut or in northern Saskatchewan and you have your knee operated on by a surgeon in Saskatoon, you may have to travel three days to see a surgeon to look at your knee. It may be a five-minute visit to see that your wound looks good.
This issue of access is a fundamental problem. There is clearly a gap of inequality in health care access in these remote communities, which are mainly First Nation communities that have poor health care indicators in relationship and in comparison to the rest of Canada. Some of the indicators are really atrocious in terms of the rate of tuberculosis, for example, that are comparable to rates of developing countries. We have been using sophisticated remote presence robotic technology to see if it can be used as a tool to provide access to communities that have the least and need the most.
What is this technology all about? If you look at the graph I have here, you will see one of the reasons I moved to Saskatchewan from Nova Scotia. The rural population of Saskatchewan is one of the greatest in terms of proportion to the urban population. If you look at the age group of Saskatchewan children from 0 to 4 years, you will see that about 37 per cent live in communities with fewer than 1,000 people. This means that they have difficult access to health care.
We have been using robotic systems that are called "remote presence''. The reason they are called "remote presence'' is because the physician can be remotely present in a remote location.
For example, this morning I activated one of the robots in Saskatoon from my hotel room and saw six of my patients I had operated on last week and decided that three should go home. I was able to talk to my resident and to the nurses to make decisions about the treatment and the disposition of these patients.
The issue of this remote presence technology is that it can be accessed through regular telecommunications infrastructure from the Wi-Fi of my hotel. If I get a call right away, I can actually use my iPhone and activate one of the robots in La Loche, in northern Saskatchewan.
The key of this technology is that not only does it use regular telecommunications infrastructure, but it is what we call HIPAA compliant. That means that the encryption of the signal as it leaves my phone and then reaches the robot is complete and assures confidentiality, which is different from using FaceTime. The sustainability of the signal is to the point that you can actually perform a medical manoeuvre at a distance.
I'm showing you here the ability to activate the robot with a laptop or with your iPhone. These are the robots in these different locations. They are plugged into a wall and they have chargers that are continually charging the robots. Without the need for human intervention, I can activate and drive the robot where I want to go, such as to the nursing station and then to the patient's room to see the patient.
Not only can I do that, but the most sophisticated systems now have the layout of the hospital. Let's say that I get a consultation from a hospital in Stony Rapids in northern Saskatchewan that I never visited. I can actually tell the robot the name of the patient and the room the patient is in. Then the robot will automatically and autonomously navigate the corridors where there are people, instruments and equipment. It will go to the patient's room and will identify the patient using face recognition. It will call me on my cellphone to tell me that the patient is ready for me to do the consultation. Technology has evolved to the point that I can do that.
You can do examinations and plug into these robots peripheral devices such as an otoscope, an electrocardiogram or an ultrasound. If somebody has chest pain, I can not only listen to the heart but I can do an electrocardiogram. I can also do lab work to determine the cardiac insight. Not only can I do that in a hospital, but if somebody in Nain, Labrador, with chest pain calls, I can send the nurse with one of the portable systems. Then I call the doctor in a box to be taken to their home to do all the manoeuvres to determine if the individual is having a cardiac problem and, if it is only indigestion, to actually triage the individual.
We have set up this remote presence program at the University of Saskatchewan. I'm proud to say it's probably one of the most sophisticated program in the world for remote presence. We can train a physician in half an hour to be able to utilize this system.
The next step has been the scientific study of whether it actually makes a difference. We started this project by looking at two of the main issues that concerned the communities. We went to the communities and asked them: "What is your first priority?'' They said two things. The first was small children that were acutely ill, for example, a baby that is blue comes to the emergency room with respiratory distress. The default was the doctors and nurses running to the phone and calling the transport team in Saskatoon to fly a plane in to pick up that baby. However, if the weather is bad or there are delays, that baby can die or have a permanent injury.
The second was prenatal care for young mothers. I refer to you some graphics. We did a study in a community of 2,700 people called Pelican Narrows, about seven hours from Saskatoon. We sent a robot there and then studied another community in the same remote location without a robot.
I want you to go to the bottom of this graph where it says: "Mean Ped-CTA score.'' This is a score of the acuity of the patient, how acutely ill that patient is. When we look at "control'' in the community with the robot, they were the same. The patients were as sick, both in the control community and the community with the robot. We were comparing apples with apples and oranges with oranges.
Then we can look at the transportation rate. In the controlled community that did not have the robot, 100 per cent of the patients needed to be transported because that is the default. They actually went to Saskatoon. In the community with the robot, only 37 per cent of the patients needed to be transported. That means 63 per cent of the patients were successfully treated in their own community.
When we look at the cost effectiveness, we see that one of these robots costs about $70,000 U.S. Every time we send a plane it costs about $10,000. Over a 13-month period in this small community we saved in transportation alone $240,000. If you get transported to Saskatoon, it takes you five days to come home. The length of stay is about five days. We also saved on the lengths of stay for these communities. The bottom line is that not only were we able to provide effective clinical care of these patients in their own communities, but that intervention was cost effective.
I know I'm running out of time, but I want to tell you that we have been using these systems to do prenatal ultrasound. One of the big problems in terms of maternal and infant mortality is with prenatal care. In northern communities there's no access to prenatal ultrasound. We have tested the first telerobotic ultrasound in the world, where the expert ultrasonographer in Saskatoon can do an ultrasound in a community that is 1,000 kilometres away.
On the other side, you don't need any expertise. You just need a person that will hold this frame, but the person actually moving the ultrasound probe is the expert. When we compare direct ultrasound to remote telerobotic ultrasound, there is really no difference.
I wrap this up by telling you that I feel this technology is potentially an answer to try to narrow the gap of inequality in health care delivery to underserviced communities.
The Chair: I will now turn to our visitors from the Humber River Hospital. We have Barbara Collins, President and CEO, and Peter Bak, Chief Information Officer.
Over to you. I understand you're sharing your presentation.
Barbara Collins, President and CEO, Humber River Hospital: Thank you, Mr. Chairman and honourable senators, for inviting us to speak. We are delighted that you share the interest we share in digital health care and the changes it can bring.
We had the distinct pleasure of building a new hospital, the Humber River Hospital in Toronto, that opened in October 2015. It has been accepted as North America's first fully digital hospital. You will see its many benefits, not so much from the conversation today, but from the video we have left leave about the hospital, some of its unique technology, and some information around how that has in fact decreased our costs.
We considered it a unique opportunity to be able to build a new hospital. Our leadership team saw that as an opportunity to perhaps disrupt the status quo in health care and begin to look at different ways of delivering care.
The drivers that really made us want to disrupt care are some interesting statistics like the public spend on health care in Canada is $149 billion a year. Hospitals account for about $62 billion across Canada. The average cost of a hospital bed per day is $7,000. It ranges really between $5,000 and $11,000. About 72 per cent of that is paid for staff and people walking around the hospital, providing care. Over 75 per cent of the hospitals are occupied with patients who are over 75 years of age. You all know the statistics that show that number is growing significantly.
Those were some of the factors, but another very important one to all of us is the fact that medical harm can occur in health care just by the speed and the requirement to do certain things. The latest evidence suggests that one in every 18 admissions in a hospital actually experienced some kind of harm during their hospital stay. That's a significant number. It is my experience, as a health care provider for many years, that it is often a communication breakdown, a failure in communication. We wanted to use this opportunity to perhaps change that.
We looked in many jurisdictions around the world at how health care is provided. A couple of things were very important to us: The hospital of the future is one where acute care and critical care are provided, but as much as possible we should keep people out of the hospital. We should have people being cared for at home, in their communities and in their long-term care facilities where they live. We had a goal to understand how we could do that and perhaps less expensively than health care has been to date.
We looked at other cultures and other jurisdictions where lots of different work is being done and learned from that, but clearly the aging population needs to stay out of hospital as much as possible. Countries such as Denmark and Hong Kong are building new hospitals with fewer beds because their goal is to drive this kind of process. That was very important to us at Humber.
Our digital journey carried on for a number of years and we did open. Our transformation in how we got there was a conscious effort at being sure that all information was electronic so we were able to have actionable data. If something was recorded or something occurred, we could observe that and the data could be actionable. We'll give you some examples of the mobile and connected.
We wanted to be sure that any time you had the correct information, the correct person at the correct time and in the right place, it was mobile or in a mode that was useful to the provider.
Patient empowerment is very important. Patients can participate in their care and they can actually help you with their care, but you need to engage them in that care and provide them with the information you have. Finally, we wanted to look at automation, which increases reliability, safety and efficiency in health care.
Peter Bak, Chief Information Officer, Humber River Hospital: We categorized our investment into a digital infrastructure in the hospital as a whole digital transformation. We're seeing this now happening around a number of hospitals in Ontario, as well as in the rest of the country. We're looking at how to leverage technology to drive safer, more efficient and higher quality care.
Ms. Collins mentioned key elements of our strategy, and I'm going to elaborate a bit on some of these things. First, we see the need for your information to be electronic. In health care, providers all talk about electronic patient records. Absolutely we see that as something beneficial, but it's not just the electronic chart that needs to be in digital form. It's actually a lot of information that's going on inside the facility itself.
We use technologies to track assets and to track people. We know where people are and we can leverage that kind of information to improve the work flow and the efficiencies of actions that are being taken. We actually track a lot of information around the building itself. In the world of buildings, we have the notion of smart buildings. Those things contribute to much better energy efficiency, but it also allows us to observe what's happening inside our facility, which all impacts the ability to deliver care more efficiently.
The mobile and connected piece is very critical. Being connected to the right data, the right person and the right team is a huge contributor to safety and quality. We've implemented all of these at our facility. We've integrated them all such that they address specific workflows and create automation in people activity and system activity.
I'll cite a very good example of this. We've implemented a lot of robotics, combined with all of the electronic software, to assist in our entire pharmacy and medication flow. We actually have an automated drug dispensing system in our pharmacy that packages all of the medications into little packages, or what we call unit dosing. They are all bar coded. When a physician place an order for medication, they do that electronically. They are verified by pharmacists and go straight into the machine that pumps out the meds that have been ordered. It puts them on what we call a ring. That goes into a canister or a container, and these then get delivered to the units using robots that are automated, guided vehicles. They move around autonomously. They pick up our supplies and meds, and then take them up to the floors.
Once they're up on the floors, the nurses now dispense them at the bedside using well-understood verification techniques to avoid giving patients the wrong medications. That's a very well-known issue in health care and a significant cause of error. There are many benefits that we see by combining all of this together.
I'll ask, Ms. Collins, to add something to that.
Ms. Collins: When you do laboratory work, you are looking for medications and patient information. Having the information entered in the chart, and then not having to deal with it but having it automatically make things work right actually helps.
In the case of our nurses at the bedside, you bar code the patient's name tag and then you bar code the drug. Then you know you have matched the right patient to the right medication. It automatically documents for you that you have administered the drug to the patient. These are important things in health care. We have many of these systems for laboratory, for blood, for chemotherapy drugs, a number of things. They save steps, they save time, and they are safer health care.
The second video we left you is about becoming a high-reliability hospital. We continue on our journey of digitization. We have taken our data and we are consolidating our operations into a command centre with a coordinated team that will leverage this real-time data on a series of 25 or 30 screens at a time using predictive analytics and monitoring to eliminate never-never events, to flow patients faster through the hospital, to understand who is delayed in a discharge, and to be able to speed this up and save days. Not only will it provide safer care, but it will increase capacity with fewer staff required and less stress on patients.
Our model for the command centre is that it will work to manage not only patient care issues that could occur, but clinical operations, delays in care or any issues that could occur.
Mr. Bak: What's interesting about the command centre is that it's a natural progression from our digital transformation initiative, which unto itself delivered a lot of benefit to the hospital. We saw efficiencies, quality benefits and cost-reduction benefits.
It has given us actionable data, and it's that actionable data that gives us visibility on what's going on in our organization. When we put that into this command centre setting, combined with a whole series of operational flows, it's what gives us the opportunity now to really change the game within our facility.
Ms. Collins: The command centre can be thought of as an air traffic control centre. Many industries use them. health care has not. Planes fly around and everybody knows what's going on with them: the temperature in the plane and if they will hit any turbulence. Yet we have many people in hospital beds with the issues I've told you about that we have not been doing this for.
Humber is moving in that direction, not only for flow and smooth transport of patients around the hospital and envisioning what's going on in departments, but particularly for the second phase of our projects. Where a never-never event may occur because a certain protocol has not been followed or a certain type of care has not been provided in a timely manner, the control centre will know this through our data and be able to intervene and help the staff get it done by shining a light on where the issue occurs.
The third component of our centre is complementary to what Dr. Mendez spoke about. Many people who could be cared for at home with wearable devices or ways of monitoring themselves, but sometimes they don't know what they need to do. Sometimes they don't follow through. They're not aware that they're feeling less well. We can monitor that kind of patient in the command centre and be in touch with them if there's a problem or send the home care worker to check on them. We can bring the patient back to the hospital for an elective clinic visit, not wait until they have deteriorated, or not know their device wasn't working or they weren't paying attention to it, and actually end up in the emergency department more ill.
We are embarking on opening our command centre by the end of this year. We have done much of the work for it, developed the systems that are in place for it, and we will introduce it in three phases.
The Chair: I will open the floor to questions from my colleagues.
Senator Eggleton: Thank you for your fascinating presentations. It's good to catch up on what the hospital community is now capable of doing in terms of using new and advanced technologies.
I want to ask you about three concerns that have been raised at these hearings with respect to new technologies. The first is job loss and a concern that while there may be new opportunities in high tech, a lot of low-tech jobs may disappear as a result. I'd be interested in your experience.
Second is the comfort level of the patients, particularly when they are facing robots and using robots. A lot of patients are older patients, of course.
Third is patient data. Artificial intelligence involves a wealth of data about patients to fully function. There are ethical and privacy considerations in all that.
What are your comments on those three areas?
Dr. Mendez: These are very pertinent questions. It's important to relate to you our experience over the past three years with the deployment of remote presence robots in the province of Saskatchewan. We have 17 systems in various Saskatchewan communities.
The first issue has to do with: Do you lose jobs? Does the robot replace the human? The robot is only a tool. It would never replace the human being, but it facilitates the support of the expert, for example to a nurse working in a remote location.
When we have observed it being the other way around, it is very difficult to attract nurses or physicians to very remote places because sometimes they deal with difficult problems that go beyond their training, which results in a lot of stress on the job. We've observed that wherever we deploy the robotic systems and there is constant communication with experts, two things happen. There's increased retention. People want to stay there because they have the support. More importantly, there is an increased recruitment. Everybody wants to go to the centres where they have robots because they have the communication and support from the experts in the tertiary care centre. At least from our experience in the past three years it has been the other way around.
The second issue you raise is how a patient interacts with a robot. Would they rather have a physician of bone and flesh? This is very interesting, especially in our experience with First Nations communities. The interaction is natural for someone that has never seen a robot and for the first time is sick in the emergency room and sees a robot with the face of a physician in Saskatoon coming into the room. The physician is not a regular physician. It is actually the neurosurgeon that is doing a consult on a patient who would have never had a surgeon see them in their own remote community. The interaction is very natural and the patients forget about the medium, which is the robot, and interact directly with the physician.
We have done surveys of people in those locations. I want to tell you an important anecdote. When I was in Halifax the first robot we ever deployed was in the northern community of Nain, Labrador where we did a study for a year. After that, I sent a plane with the technicians to pick up the robot. They went to the nursing station and there was no robot. The robot was actually kidnapped by the citizens of Nain and it was hidden in one of their houses because they didn't want to give it up. The elderly patients that would never fly to Happy Valley-Goose Bay to have an electrocardiogram or people who needed mental health care could go to the nursing station to have all that done through the robot. That is very interesting.
Ms. Collins has mentioned the issue of artificial intelligence. We need some intelligence in terms of monitoring our patients. Our cars have 100 sensors. When you are close to something, you know you will hit it. We don't have that in health care. These intelligence solutions could assist in monitoring in real time the blood sugars of patients to know they are going down and to get them a clinical visit before they actually get sick.
Ms. Collins: I want to add to patients and their acceptance of it. We do have elderly patients in the hospital and we are always surprised. They require some education around technology, so our patients don't interact with the robot but they interact with the technology. The data show that patient empowerment, knowing what is going on and having some control over your environment, will make patients and their families more satisfied and move involved in their care.
In the year we have been open, patient satisfaction has increased almost 20 per cent. We truly believe in their ability to have access to some of their information, some control over their environment and be able to understand what is happening. The staff we may not have needed to hire has allowed us to have more staff at the bedside to be able to communicate with patients and to help them through this learning process. That has been beneficial as well.
Senator Eggleton: The one thing both of you did not respond to were the ethical and privacy considerations of all the data. How do you keep that under control?
Mr. Bak: On the topic of privacy and security around the data, being a digital hospital that is a significant topic for us. The issue I see when you move into this level of digital environment is with your privacy. That is surpassed by the potential disruption to all your systems when you get attacked. Putting in strong security measures is an absolute must, but it's doable. However, you need people that understand the business very well. You need skills. There is plenty of technology you can deploy to protect yourself against an attack and the exposure and leaking of information inappropriately. It needs a lot of attention.
Ms. Collins: And a lot of commitment. An important part of developing digital is that you have to commit to it.
Senator Seidman: Thank you for your presentations. Dr. Mendez, in the materials that you gave us you said you should look above the red line for your solutions in remote presence technology.
I am looking at the entire map and I'm thinking. I buy in wholly to Ms. Collins' statement at the outset that her concept for hospitals is for acute care and trauma care. I buy that completely. Then we ask: "What do we do with the rest?'' This study and your presentations to us are convincing me more and more that there is a bright future for community care.
I imagine the presence technology that you use in remote areas only, Dr. Mendez, could help us solve this often- heard refrain these days about the impact of an aging society on our health system and on community care. Unfortunately, hospitals become the first port of call and the last port of call for care these days. This is a bright new vision of aging, as I am sure you are aware. We used to have travelling libraries and ice-cream carts and all kinds of things in communities.
With this type of remote presence technology, diagnostic systems, treatment, triage and monitoring, could you envision some sort of mobile system in communities, caring for seniors who want to stay in their communities as long as possible?
Dr. Mendez: I envision the shift in a model of centralized health care to a point of health care. We are behind the ball with other industries such as banking and airlines. For health care it is crucial that timely access needs to happen. You want to get the patient when the symptoms come, not when they are so sick that a lot of things could happen.
We have focused on the service communities because even simple things are life or death for them. It has been a priority for our program. However, we have started two programs in Saskatoon. I am a neurosurgeon and every day the hospital is full because our emergency rooms are chock full and all of the beds are taken. We have to cancel surgeries because there is not a bed for my patients after I operate on them. When you look at the population in the emergency rooms, a lot of those people are elderly people that have not been taken care of by their family physicians or are left in long-term facilities where the first point of entry is the emergency room.
We have started this program called "remote community paramedics'' where the paramedics go to the long-term facilities and the houses of the elderly and they take the doctor in a box with them. They do the first assessment. If they need a doctor to make the decision about the triage or the treatment of that patient, they can then communicate with the physicians in the hospital, who are on call for that. Those individuals can then examine the patient and make a decision if they can be treated at home or come to the hospital.
The preliminary results of that study have shown that we can avoid over 75 per cent of the referrals to the emergency room. Yes, this is a natural extension of the technology.
Mr. Bak: We see very much the same. Part of our objective is to move to a world, as Ms. Collins said in our presentation, where patients are looked at or treated before they even come to the hospital, the hospital being the most expensive place for them to come.
We see lots of technology for wearable. Dr. Mendez's robot is one example of where you can do a lot of diagnostics, but who is at the other end of that wire to look at it and take action on it? This is where we see that the skills of the staff in your hospital can start to serve as a hub in that community. In order for data to flow and for those physicians and nurses to actually make decisions, they need to be made available to do that work.
This is where we see the command centre stepping in. It will be staffed 24-7 by capable people, so now you have the ability to monitor so much more than just your own hospital. You can monitor everyone who is out there. Here is a key piece: You are not spending your time monitoring things that are working well. You want to see things that are not going well. This is where automation, artificial intelligence and cognitive computing come in, because that is going to give you the analytics to say, "Here, pay attention to this. Don't worry about all of that.''
That is what we see happening over the next few years when our command centre becomes that hub. Then we need to develop programs with the community providers so we can call on them and say, "Go visit that person there and help out.''
[Translation]
Senator Mégie: I am very pleased to see that all health institutions are facing this serious problem of drug-related errors and are doing everything they can to address it. I'm glad that we'll finally be able to find a solution with the help of robotics and software. That being said, do you have any comparative data on the decrease in the rate of drug-related errors in smart hospitals compared to other so-called traditional hospitals? Have you noticed any errors related to the use of robots for the administration of drugs? Are there no other causes of error?
If there is a control centre, there are people who oversee it all; is there really a decrease in costs? You have to hire staff to control it all. You are hiring people to do this, so are there any costs associated with it? Yes, there are, but compared to other hospitals, have you seen a decrease or an increase in costs?
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Ms. Collins: We have been looking at our data for one year and have seen two elements. First, missed doses of drugs have dropped 50 per cent in our hospital, which means the patient got the drug at the right time. Second, we have also seen specimen labelling errors decrease by a significant amount.
In terms of cost it is about repurposing staff. We can continue to grow our emergency departments and the number of hospital beds, or we can look at using that staff to intervene earlier so the patient actually doesn't have to come to the emergency department. We have monitored in their homes that there is a problem. We might send Dr. Mendez's robot. We might send a nurse or a neighbour to check on the patient, but preventing them from coming to the hospital and requiring an admission will always save us money. What it will do is allow our population to live healthier, to have more control over their environment, and quite likely live in their own homes for a longer period of time.
It isn't for every patient. It's not for everyone. In our community 80 per cent of our patients over age 80 live alone. Who is helping them? Who is monitoring them? Not all of those people will need monitoring, but those who do and avoid hospital admission and an emergency department visit will save us lots of money.
Mr. Bak: The technology is very instrumental in achieving the reduction in errors. I don't have the stats in front of me, but I would say that without the technology you will not achieve that reduction.The second part of the question is: How much money do you spend on that and is it worth it? The "worth it'' question is always a tricky one to answer. It is always worth it.
The cost of the technology, in our case, has actually been quite affordable. That's not an objective statement. It is amortized across many benefits that you get. We would claim that our investment in this technology has paid for itself from the point of view of our ability to see more patients and get patients out more safely, which leads to cost reduction. We haven't measured all of that explicitly yet, but the anecdotal evidence is that it has absolutely paid for itself very well.
Dr. Mendez: About the issue of costs, it is critical because we have data from the cost of transportation. I came back from Manitoba yesterday where I gave a lecture. The federal government spends $100 million in Manitoba alone on transportation and in Saskatchewan the provincial government spends about $70 million on transportation.
When you look at the types of people transported, about 70 per cent of them would not need to be transported if you could take care of them in their own communities. Our study of the small community of Pelican Narrows, which has 2,700 people, shows that it saved $260,000 in one year, or enough to buy five robots.
This is the issue. We need to do the studies that look at the cost effectiveness and invest the money that we invested in transportation into true health care.
Senator McIntyre: Thank you for your presentations and for the good work you are putting into some of these innovations.
In doing some reading, I note that Humber River Hospital has been reported to be the first fully digital hospital in North America. As noted by Mr. Bak, among the innovations currently in use at the hospital is a fully automated pharmacy. You even have a robot tasked with preparing chemotherapy drug mixtures, which is quite impressive.
In a sense, you are a pioneer in the adoption of some of these new technologies. Is this the reason why you became a pioneer by bringing in these new technologies?
Mr. Bak: That is actually an interesting question. A lot of the technologies have been around for a while and are deployed in hospitals around the world. If you take all of the componentry and treat them as all individual components, there is nothing particularly innovative about them.We have integrated all of them together with a strong focus on work flows and outcomes. It's that integration that really sets us apart and is where the innovation has occurred.
We have had visitors from all around the world and every one of them has commented on how they have never seen a hospital operate in the way that Humber does. We may go so far as to say we are the first global digital hospital, if you define the digital hospital by what it is that we have done. This is quite surprising because we have seen many hospitals that have all of the same technology but haven't created the efficiencies and work flows we have managed to achieve. That is what sets us apart.
Senator McIntyre: Is there a certain overlap between artificial intelligence and robotics? How interconnected are those fields?
Dr. Mendez: I want to make a comment on your first question. This is not about technology, because technology is advancing and it will continue to advance. It is about how we provide the best care to our patients wherever they are. That is what will shift this model to hospitals providing care where the patients by using technology.
This is where artificial intelligence comes into the picture. You want to monitor individuals by a system that can have foolproof algorithms that allow you to determine the time of the intervention. The time of an intervention is basically prevention: prevention of a complication or prevention of an emergency. With artificial intelligence in health care we will be able to monitor what we do.
In the future when two or three patients beep in a hospital within a community like the Humber River Hospital, with a control centre that is controlling 100,000 patients in an automatic fashion, the nurse or doctor will analyze the data before action is taken. In my mind hospitals will become smaller because we will all be doing only the specific things that hospitals can do. The rest of the health care will be where the patient is.
Mr. Bak: Artificial intelligence is very much a part of what we need to deliver our care more safely and efficiently. Everything that Dr. Mendez said is correct. What I would add to that is we are seeing concepts or what they call early warning systems that are now emerging. These are algorithms that take a variety of data and can start to anticipate an outcome that is about to happen. A good example of this is in cardiac situations. We can predict that someone will go into cardiac arrest well in advance of that happening.
In order for algorithms and AI technologies to work you need data in electronic form. In my mind this is a key piece. We need to shift everyone into digital transformation so that the information is there to assist them in leveraging the AI and all of the automation that comes with it.
We are seeing these algorithms emerge. In our facility, as part of our command centre, we are now developing some new algorithms to assist us in the monitoring of all these events and patients. We are innovating on this particular point. It is possible to do because we have data available.
Senator McIntyre: You mentioned data. Does AI necessitate a large amount of data?
Mr. Bak: It doesn't necessitate a large amount of data in all cases. Humber is an example of where it is not the amount of data; it is the type of data.
Senator Stewart Olsen: My first question is probably more an affirmation but I think it is important that we get this on the record. I don't say facetiously but meant it when I say that in order to move into this wonderful new world, we need to improve Internet access Canada-wide. The government would be behooved to support this kind of initiative. It would save provinces incredible amounts of money because then they could move into these fields.
Would be supportive of that kind of statement?
Dr. Mendez: One of the reasons I moved to Saskatchewan to test this system and to scale it up to a province of one million people was that Saskatchewan had invested in telecommunications technology. In Pelican Narrows there is a tower that provides cell data to 2,700 people. You have a better cell reception in Pelican Narrows than you have in Saskatoon.
I have also travelled to Nunavut. In Iqaluit there is only one technologist that does ultrasound. It happened that when I went there that person was on holiday. They needed five or six ultrasounds, so the patients were put on a plane and sent to Ottawa to have an ultrasound. The issue with Nunavut is that they spent $120 million on transportation for 69,000 patients and they don't have the telecommunications infrastructure. I truly believe that access to the Internet goes beyond communication. I think it's a right.
Ms. Collins: I would add availability and accessibility to it as well. When you are dealing with a population that has income issues, or an elderly population, affordability of that Internet plays a key role and it would be a shame for it not to be available to them.
Senator Stewart Olsen: I was pleased to hear you say, Ms. Collins, that with the savings of staff in the pharmacy area you have managed to increase your bedside staff. I am hoping that this will be everywhere. I wouldn't want to see technology take over in hospitals and care centres so that they could reduce the staff in bedside nursing or bedside care.
Could you comment on that a bit?
Ms. Collins: I will comment on that. There are two sides to that story. The cost of health care is largely driven by staffing. About 72 per cent to 76 per cent of that $69 billion a year is paid to staff.
I don't think we are talking about decreasing it; perhaps we are not increasing it. There is a shortage of health care workers and people that are able to do health care. It is more about providing it more efficiently and using the resources we have more effectively.
All hospitals will tell you that more people helping out at the bedside is important, but perhaps we are also talking about the people that can go and visit somebody in the home when you have a decrease in some of those levels, or perhaps focusing that care more to home.
The Chair: Dr. Mendez, your example of access to the high-speed Internet in the province in which you have landed would be quite different from the villages around the province that you left. The point the senator was making is that it is a myth that Internet, let alone high-speed Internet, is available to Canadians outside of major areas.
In fact, there have been rumours that even in the southern part of Ontario there are areas around one of the great universities that are not served by high-speed Internet, but I will leave that as a rumour.
[Translation]
Senator René Cormier: Thank you very much for your presentation. I am very impressed with the research you are doing on the use of robotics in medical services. I have two questions for you. The first is about labour relations, and the other about the role and responsibilities of the federal government.
As this new technology is introduced in hospitals, the culture of work is likely to change. In your opinion, what are the issues affecting labour relations? Robotics is certainly bringing about changes in terms of job descriptions and relationships between the medical professionals and patients. What are the current key issues in labour relations?
Second, the federal government has recently made health transfers. The priorities that the federal government has passed on to the provinces have dealt mostly with improving home care and mental health initiatives. When we look at the positive impact of new technology in the health care system, what role should the federal government play today to promote the integration of the new technology? Has the federal government set the right priorities by focusing its actions on those agreements in this way, and how can we get a better distribution of the technology across the country to make it more equitable? Those are two big questions for you. Thank you.
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Ms. Collins: I will speak on the issues of labour relations. It's very important that people spend a great deal of time working with their staff to determine what did waste their time and what were their frustrations?Whenever you create and implement technology either for the physician, the staff or the patient that will decrease their frustration, you do get excellent adoption.
We moved into a facility that our staff had never seen before, except on brief tours, with lots of technology and terrific adoption. There's an educational component to it, but if you're fixing somebody's problem you're allowing them to communicate better or to have a bit of control over their own environment, they are willing to adopt that. I think that's an important piece of it to understand.
We do work through it and find our staff don't have difficulty with adoption and if in fact a piece of equipment isn't working, we hear pretty quickly about it. That has been very beneficial for us.
Mr. Bak: I'm glad you asked this question about what the federal government can do about this. There's a lot. If I may, I'll cite some history with Canada Health Infoway and the initiative of the federal government to drive the pan- Canadian electronic health record. I was very involved in that. We need to shift all of our health care institutions into a digital transformation for all of the reasons that we're experiencing and advocating and that this panel is talking about.
The challenge I've experienced as part of the Infoway initiatives and as a consultant in work I've done with many hospitals is that it's very challenging for people to take the leap of faith to initiate such a large transformation. There are change management issues. There are cost issues. There are many things that have to be done. People shy away from wanting to take that initiative. We at Humber took that initiative. We took that leap of faith and I think we're demonstrating that it pays off. It's of value and it's actually a must for every hospital to engage in.
The question then is: How can hospitals have confidence in being given the tools and skills to be able to engage in such a transformation and in doing it quickly? Now I come back to the history of Canada Health Infoway, which had that same challenge: How do we drive the country to be able to achieve a pan-Canadian electronic health record? My role in Infoway was to actually drive the DI program, the medical imaging program. Back in 2003, we looked at the country and found 35 per cent filmlessness. That means we were still doing everything with film and not electronically.
The whole initiative for Infoway was to convert the country to a fully filmless electronic state for medical imaging and wire everybody together. That was done in nine years. Infoway's budget allocation for that was $320 million. I think it was a tremendous success for the country, but it took Infoway to take that initiative and then work with the provinces to give them guidance on how to get it done.
This is what is needed now. We have demonstrated it at Humber, and there are other places around the world that have done similar digital transformations. There is evidence. Now, how do you drive it and repeat the exercise in a cost-effective way and rapidly across our entire country?
The Chair: We have dealt with for some while the issue of the electronic record. As you know from your own experience we still don't have an electronic record system in the country, even though billions of dollars have been spent in the effort.
The example you gave is one of only a few successes I'm aware of with regard to electronic data cooperation across provinces. The radiologists seem to be advanced in their eagerness to get engaged.
Would that have been your experience? Did you have a group of people much like Dr. Mendez who were anxious for access to the digitalization, quick access to data, and were often dealing with patients across some distance as opposed to the local situation?
Mr. Bak: In the case of radiology, many elements were aligned to allow the DI program to be successful. There was a shortage of radiologists, so getting the data to them, rather than them to the data, was very attractive and the climate was absolutely there.
The benefits of doing that were well understood. Moving to digital radiology is something that has been going on since 1992. This was a mature, well understood business. Dr. Mendez has been describing rural communities needing access. In our world there were many strong business cases for getting people connected for radiology images and moving them from remote areas into the centres, and even within centres to radiologists. The business cases around this were extremely strong.
It wasn't so much that the radiologists themselves were the impetus. It was all of the other elements and climate at the time that made that successful.
I cite it as a good example of sharing electronic records. Whereas Infoway has spent a lot of money on that and seen some success, as you point out it hasn't fully happened yet. I have lots of strong opinion on why and what can be done, but a key thing was missed. The hospitals are not electronic. If they are the source of the data, you can wire everybody together but there's no data to put into the wire.
Here we are as a hospital. We've gone fully electronic. We've done that. Now it's time for everybody else to get there.
The Chair: That's partly why we're so delighted to have you here today.
On that last one we had testimony in one of our studies in this area where a surgeon from Toronto sat down there and pounded his fist on the table saying, "Frankly, I don't give a damn if I can't get the data from Calgary. I can't even get it from down the hall in my own hospital.''
We'll leave it at that, but your example is an excellent one. I sense that you share some of our own observations with regard to the challenge that Senator Cormier raised for us in this very important area.
Senator Dean: I'm local to the Humber hospital, so I know somewhat of the terrific work you've done.These are two examples of what we might refer to as place-based transformation. We have remote north. We have highly urbanized, concentrated, diverse urban south. Both are lighthouse examples. As we've just been talking about, one of the big challenges we have is how do we take those lighthouse examples and diffuse them across the country.
I noticed common denominators that are commendable. You both started by talking to users about the priorities in Pelican Narrows, what staff needs to help them do their jobs better, and likely what the community needs, if I'm familiar with your project.
We also learn, as we did from other digital transformation initiatives, that once we have data it produces dividends we might not have expected when we went into the process. This has been discovered in the application of computer assisted policing. We found it in health wait times reform.
My colleague Senator Cormier talked a bit about the role of government. First, from a provincial or territorial perspective, how did your respective provincial/territorial partners help? What key things did they do that helped you along this journey?
Second, what could they have done better? If you could go back and have the conversation with them, what would you ask for them if you were doing this over again?
Third and related to that, what worked with government provincially and not? How did procurement work? You each had to go out and find technological and digital solutions, and in some cases robotic solutions. To what extent was that customized? To what extent did you reach out to the community? If staff told you they had an issue, an opportunity or a problem they were trying to solve or a remote problem, did you ask, "How can you do it for us?'' To what extent were those things available in the form of existing robots that were easily customizable?
I ask these questions because we have had innovators in front of us who have said, "We have talent. We have skills. We have know-how, and we had a challenge in trying to get it in front of those who could benefit from it.'' I read into that, particularly yesterday, that procurement rules in the public sector may be an inhibitor, based on our concerns about conflict of interest, privacy and things of that nature.
I've asked a lot of you, but I think you get it. Could you deal with what helped and what didn't with government, and then tell us a bit about your approach to procurement, how that worked, and what might be necessary to make that work better?
The Chair: We'll go to the Humber situation first. I may not have time to get to every aspect of them and I'd like Humber to focus on the key elements of those questions.
Ms. Collins: I will do that and I'll ask Mr. Bak to speak about the role of technology and how to work with your partners.
It's very variable across all of Canada as to how much digital and how much of hospital build is paid for. It is one of the deterrents because you must raise local share money to pay for technology if government does not pay.
It is difficult to do that in the country because people believe that our health care system is paid for. That is one of the things that slows down many hospitals from doing that. The cost of purchasing, developing, installing and creating the technology is what is slowing us down.
We worked with our provincial government, and there were pieces of it that they picked up. They did not stand in our way of wanting to introduce things. That is something I thank them for. They could have said, "Whoa, we're a bit worried about it.'' They worked with us on it. It is the funding that will move us forward, and I understand the problems with that. That combined digital record and the funding of the technology will move us forward.
I will ask Mr. Bak to speak on how to work with the industry, but the RFP process that we established, which again was maybe more provincial than federal, was extremely costly to companies that may be trying to bring forward an idea to market. There are ways, but they have become much more limited in the 40 years I've been in the business than they used to be, where you could sit down with somebody and partner on a product. They're afraid to do that because then they may not be able to bid on it. That is harmful and it delays a lot of the work.
Hundreds of RFPs were put out by us. First you put out to have somebody come to the table to play with you to see if you even have a decent idea. Then you have to put out the RFP to see who else has the product. There are significant challenges with that piece of it.
Mr. Bak: Innovation is a key element of moving this digital transformation forward. Whereas there are many technologies already available and fairly mature, we need plenty more and we need innovation to come from industry. Hospitals like ours are not ones that can invest in doing the innovation ourselves. We need industry partners to be at the table.
We look at two things. One is that you need to have a culture of change. Our organization, by virtue of going through this transformation, has now become comfortable with change. That, by the way, is another topic of how we get everybody to do that. In order to drive that culture, you need to be able to react. To your comment where you asked if we went out and asked people and they said, "Here's a good idea,'' that's exactly how this works. It's our front-line staff that will come up with good ideas. If we can't react to those ideas, the whole process comes to a grinding halt.
How do we solve the problem of continual innovation? We need to have companies at the table that are bringing their own ideas and can rapidly develop technologies to support the requests that are coming to us. Two things get in the way with that. Who's paying for it and how can smaller players come into our organization without the whole procurement process getting in the way?
For us, we're somewhat relegated to having to leverage larger corporations that are more well established and have the deeper pockets to engage with us and reap the benefit in a longer time period. There are many companies. I say "many'' but there are certainly a number in Toronto that we've uncovered and worked with. They're small start-ups and they have very innovative staff. In order for them to come play with us, the risk for us is that we either have to pay them lots of money or it doesn't happen, and most of the time it doesn't happen.
We are interested in exploring how we can facilitate this so that those innovators can come to us and benefit from the brand of being in a hospital like us, without our having to take all the risk and same for them. We might have an answer yet.
The Chair: Senator Dean has asked a really important question about something that has arisen. I'm going to pick up on what you just said.
Obviously the answer isn't there yet, but things are in the way that you have identified from your side of the equation. I wonder if I could ask you to give that more thought after you leave here, to see if you can get back through the clerk with even a list of the obstacles that are in the way. You've mentioned the nature of the procurement process, the issues around somebody having been involved with you prior to the RFP and then subsequently going out with an RFP.
Could you give those things some thought and get back to us? That has arisen as a very important issue in Canadian technology starting up and getting support in Canada. We had an example yesterday of where technology has been in use in the Netherlands for seven years and is not yet even available through a procurement process in a Canadian hospital. We would really appreciate your following up with us on that point.
Dr. Mendez, you wanted to come in on this briefly.
Dr. Mendez: I wanted to make an important comment about what the provinces can do to promote this type of innovation. What happened in Saskatchewan was not only that they provided some resources but, more importantly, they took away the barriers to allowing these types of remote presence robotics to be used.
What are the barriers? One of the barriers is remuneration. The remuneration for telemedicine is different from the remuneration for face to face. Now the province has agreed that physicians will be paid the same rate if they use remote presence as if they were seeing a patient face to face. There is also the issue of jurisdiction. Can somebody who is a physician in Regina take care of a patient in Saskatoon?
Those are crucial elements in the ability of this technology to be scaled up and applied.
Senator Unger: My first question is for the Humber facility. I'm wondering if you had federal money or if it was provincial. Where did the funds come from to develop this new digital hospital? It seems like a success, so what needs to happen before there are these types of facilities? I live in Edmonton, and I don't think we have anything like that in our city.
With regard to automated cars, Dr. Mendez, the manufacturers of those things have had several accidents. In one that I know of there was a fatality. I'm wondering if you've had a similar experience with using robotics, not that there was a fatality but if there were serious problems.
Ms. Collins: I'll answer on the hospital piece. We were an alternative funded project or a PPP model, as it's known. Certainly the Ministry of Health in Ontario helped to build the building and funded large parts of it, as they do in their cost sharing. On the digital component of it, not much of it was paid at all and it was over to the hospital to raise its local share. We actually have a $250 million local share to be paid back over time.
Our concern with fundraising is the concern that stops other hospitals, that is, you offset your debt through fundraising and perhaps some retail that you can sell. That may prevent you from going forward and being able to develop even more because of the cost. Having to raise that kind of money is always a barrier.
You can generate interest from certain industries in terms of people who have an interest in seeing that go, and they will donate to you, but that's a lot of work to get done and it does take a lot of our time.
Mr. Bak: An interesting observation I would make is that the cost of the technology and the rollout of everything that we did is actually not that significant. The word "significant'' needs to be put in context, but when we set out to do this Infrastructure Ontario were looking at it and saying, "You want all this technology. This is going to balloon the cost of this facility by orders of magnitude, hundreds of millions of dollars.'' We said, "Absolutely not, nowhere close to it.'' In fact, the total cost of our investment was $26 million, and when you look at that in context it's not very much.
This is something that people misunderstand. They think it's a very expensive proposition to do, and it really isn't. You still need to raise that money and you have to operate it. Another key point is that once you put it in, your operating cost does go up. Overall, the cost of doing it is very reasonable, but we need assistance from ministries to chip in.
Senator Unger: Should they be chipping in?
Mr. Bak: It would be very nice.
Senator Unger: So they have not.
Mr. Bak: The federal government in our case did not chip in. No, absolutely not.
The Chair: This isn't where we can go. We know the distinction between the federal role and so on, if an infrastructure project qualifies under a federal program and so on. We understand all of that part. We don't go down this road very far. Dr. Mendez, did you want to come in on this?
Dr. Mendez: Yes. I want to answer the specific question about failure of equipment. This is an important question because in medicine, especially in surgery, we are surrounded by equipment. When I'm in the operating room, I rely on the computers to navigate the brain. I rely on the systems that are breathing for the patient. Where there's an electronic or mechanical system of course there's a potential of failure.
However, there's a huge distinction between dedicated medical equipment and consumer equipment. To enter the skull in neurosurgery, I may use a Black & Decker drill, which actually will do the job, but it is not a dedicated medical device. There are clear regulations and restrictions around medical devices that allow the reliability of the system as it is being used for the patient.
All robotic technologies classify as Class II medical devices specifically dedicated for acute patient care. Therefore, the telecommunications devices, which are very different from Skype or FaceTime, allow this secure channel to be used to treat a patient. Although things can fail, I believe the use of technology, specifically robotic technology, will have to be done within the framework of approved, dedicated medical devices.
Senator Petitclerc: Thank you so much for these very interesting presentations and answers. I want to talk about data because to me it's very clear how prevention works right now and how effective it can be. I can't help thinking that maybe it's very valuable not only for the one individual or one patient that's going to take advantage of it, but for future research.
It seems to me that health data can be collected in a more efficient way than it may be traditionally done, whether it's via robotic or something that you can wear. If data collected for provincial research in some medical field is shared, I'm wondering whether in the future you could even understand some medical conditions better. I don't know if it's clear. To me, it seems like it would be valuable. We don't want to use it only for one patient, but we want to save it.
Mr. Bak: The short answer is absolutely. We actually break this down into three themes. One is the daily operational dashboarding or analytics to tell you what's going on. That's at a very micro level. Second, we look at all this information at the hospital-wide level and optimize our operations from a cost and performance perspective. Third is the macro level, which is where you're really wanting to look at the clinical outcome. If I use these procedures, am I getting the right outcome I want? If I use these medications, are they really helping? Can I use another? The health care industry asks itself these types of questions all the time.
Artificial intelligence is going to play a very strong role in helping to answer those questions far more effectively and rapidly than we can do today. In order for that to happen, we need the data. You're absolutely right that the data needs to be collected, stored and made available. It should be done at the micro, macro, provincial and national levels.
I come back to Infoway because this is one area where the notion was that data should be stored from cradle to grave. That would be of value, and beyond that they would anonymize data and keep it forever for research. There is a challenge with that, which is that the cost of keeping the data around is extremely expensive. We generate so much more than the cost of storage going down that it gets cheaper but we just consume more.
Again, there needs to be the use of cognitive technologies to filter out so that you're keeping useful data. That's a key element to throw in because history has shown us that just keeping everything is not affordable.
Senator Petitclerc: How about privacy?
Dr. Mendez: You have raised two issues. Can that data be shared? It's extremely important, specifically with new technology, to be able to systematically and scientifically evaluate and assess the value of that technology, not only clinically but also its cost-effectiveness. Our approach is that all our projects are research projects that actually not only evaluate but get published and are shared with everybody for people to learn. That is crucial in terms of everything we do.
On the issue of privacy, it is extremely important. We touched on that before. Again, registered and approved medical devices that are compliant with privacy issues such as these things called hyper compliant, have to do with sharing and encryption of data. They are the basics in terms of everything that we do.
The Chair: Senator Petitclerc, did you have another question?
Senator Petitclerc: No. I just wanted to balance the value of collecting data. The person needs to agree to share that data, I assume.
Senator Hartling: I can see your passion in your field. It is exciting. I am very fortunate to be here and learn all of the things we have learned in the robotic presentations.I want to thank you for mentioning accessibility and availability, especially for First Nations. That is a challenge and something we are looking at in Canada.
You mentioned the culture of change is shifting and moving. We are here learning about all of this, but I'm thinking in the general population that is probably more difficult. Also, I am wondering if learning institutions are keeping up. When someone goes into the medical field or the learning field, can they learn about the interface between technology and their field?
Do you know anything about that, if that is happening or not?
Dr. Mendez: Maybe I can start. I work in an academic institution. We train medical students and residents. Our responsibility is to train the surgeons and physicians of the future who will be using this technology. This technology is unstoppable. It will actually happen, and everything else will accommodate that.
We train and encourage all our students and learners to use the technology. It is not only in terms of using the technology, but at the end of the day in terms of remote presence robotic technology it is not about the robots but about relationships. One of the big issues we confront is when a physician in a small community wants to send a patient to a bigger centre and there are no beds in the hospital. That individual has to refer that patient. There are difficult relationships between physicians working in small communities and tertiary centres. They feel abandoned. They don't feel supported.
We've encountered using remote presence technology that relationships are built. We are able to take care of our patients in a better way. It is easier for the patient to be taken care of because there is trust that there will be support. When the patient actually needs to go, there is that trust and the promptness of the physician to accept that patient.
Ms. Collins: In our case we are affiliated with the University of Toronto and we are the Toronto campus for Queen's University medical students. Everyone applies to come for the opportunity to work with the new technology. Other hospitals will come along that will have that, but the young people coming out of med school now grew up with this technology. I have an interesting piece of equipment that I tell them is really their GameBoy, which is one of our vascular tables. They love playing with that. Graduates now are used to that, but it is more challenging to find the opportunity to go somewhere and work with the equipment. Over time they will be able to see that change.
Mr. Bak: Everyone has made the comment about the younger generation expecting this, and that is absolutely the case. On the question of education around this, I think there is a need to improve the education. I haven't seen it all. I have taught a McMaster's eHealth course in technology in health care. What I see is that those courses are not really as far along as where we are actually going with what is going on. There is a need for some improvement there.
The second point you talked about was about the population and how it will change. I think our population is rapidly changing because consumer life is very digital. They have an expectation to engage with their health in a digital fashion. We know the elderly population is not quite the same, but the younger generation that supports their family through that process is absolutely wanting to be online and be educated and engaged in understanding what goes on. There is a lot of need for us to get far more digital with the community itself.
The Chair: Thank you very much. This has been a tremendous contribution to our study. I want to go over a few things and put them in an overall perspective.
Mr. Bak, in response to one of the early questions you described how you move forward with regard to invention versus application. You pointed out that many novel technologies were available. What is truly novel in what you are doing is bringing them together in a delivery system. I want to come back to that a bit.
As a country viewed from outside, we are not known for our innovation in the delivery of health care. Within the health care system we bring in innovative medicines, new ball joints for hips and so on, but in the actual delivery we are not known as being innovative on the international scale, with some clear exceptions of individual examples.
The critical thing in moving to that next level is understanding how to use the innovative potentials that are out there in the actual delivery of health care, which is what you have been describing this morning. Your ability to take and develop a new centre to bring that together gave you some advantages. It gave you the disadvantage of cost, which you described and we certainly understand. However, it is a wonderful example of innovation in the delivery of health care within a context where the demands on the system are bursting at the seams. The hospital, as big as it is, can no longer contain all the people who want to go there, and we know we have to develop new, innovative ways of delivering health care.
The great model that you have developed is that very issue. You need a mindset to develop change in your delivery overall. You probably already have examples, but my guess is that now you are operating people who have never thought innovatively before will be seeing new things. They are probably already saying to you, "Look, if we had only had this.'' The reality is, as is known across all industrial and business activities, that an organization with no culture of innovation can't even adapt or adopt new innovation. Even if it is just next door, it can't do that. The medical system is one of the most resistant to bringing in new developments or innovative solutions.
I want to say right up front that your example in a hospital setting is incredibly important to us, not just in your province but as a country, because we have to learn how to do the next step.
I am sure you have used this term yourselves. We are known in the health care system as a country of pilot projects. Often provinces have money to fund a pilot project. Then it works, but it brings about a change, doesn't it, in how you deliver? That change, as I think Dr. Mendez mentioned in terms of how you pay for these systems, is not on the funding formula. The pilot projects studies, the report is written and the evidence was clear. You reduced the number of people going to emergency by 1,000 people a day over the three- to five-year period of this pilot study, but now it can't continue because there is no way to pay the people who are delivering this outside the pilot project funding.
The hope is that your example, where you have managed to take a whole hospital concept and bring it into a new delivery system, will bring pressure to force changes that will make the provinces recognize that they need the ability to pay for service when that service is innovative and doesn't fit but brings about tremendous advantage to the health care system.
I wanted to make that comment. We have identified in our other studies where really good ideas have terminated because there has been no way to continue to pay for them down the road.
Dr. Mendez, I want to get your comment on something that is slightly outside of what could occur within the kind of process you have described today, where you are operating from a central location and dealing with remote communities.
I want to come to the ultrasound model that you referred to. About three years ago, I attended a presentation here in Ottawa by a leading medical practitioner of technology who did an ultrasound on stage. He had a remarkable amount of electronic data of his own. He stood on the stage and showed how the device. It was really just his cellphone that was adapted to do a number of things, including an ultrasound. We had the example that was widely broadcast a week or so ago of a doctor who did an ultrasound through his cellphone of a kidney stone he had and was able to project that forward.
Dr. Mendez, I'd like you to take the example you used of the community where they had one ultrasound person who was not there, and they had five or so people needing ultrasounds. How far are we from the possibility of taking your model and having someone who in this case is not an expert in ultrasound technology but perhaps a nurse practitioner administer an electronic device of that nature in a centre?
In this case it doesn't have to be 1,000 kilometres away because this is an issue that could be important in a city and either avoid a person coming to the hospital or have them go directly to the right location in a hospital.
Dr. Mendez: The way we have approached the issue of the ultrasound was first to validate the system. Is the system as accurate as you would do it in the standard direct fashion? We have demonstrated that it is.
Not only is it as accurate as you would do it in the standard fashion, but we did a survey of three types of individuals involved in the project. The first one was the patient. We asked the patient: "If you were in a community that was far away and you needed an ultrasound, would it bother you that the ultrasonographer was not there with you?'' In response 90 per cent said it wouldn't be a problem as long as they got the ultrasound.
Then we surveyed the ultrasonographer technician who is actually moving the probe and asked: "How easy is it to do ultrasound at a distance?'' For 80 per cent of them, their answer was it was as good as doing it directly.
The third survey was to the radiologists who interpreted the ultrasound and would look at the quality. The radiologists can be anywhere because they are looking at the images. They felt it was accurate enough.
After we did that we had two systems that will be deployed within the next two months in two different communities in northern Saskatchewan. During these next few months we will understand the issue of logistics. Who orders the ultrasound in the remote community? Once the ultrasound is done, how is it reported? What is the next step if the patient needs to be triaged? I think those are the critical issues.
The technology will continue to evolve and we will have even better systems in the future. However, what prevents a successful pilot from being implemented is how you scale these up to a routine procedure that can work in everyday fashion. This is the next step. I hope that within the next six months or so we will have an early answer to your question.
The Chair: After you folks leave, because you are both remarkable innovators in our system and in delivery, if there are thoughts that occur to you and examples that you think we should be additionally aware of, please communicate those to us through the clerk.
Going back, Ms. Collins and Mr. Bak, to the issue of spontaneous innovation arising within your hospital, if some examples occur to you beyond what you have described today, could you communicate them to us? That is something, with all due respect, Senator Dean, the bureaucracy doesn't always understand. The development of these kinds of things often leads to innovations which are spontaneous but arise because there is an innovative culture being captured within that environment. If there are any particular examples that occur to you, please forward those to us through the clerk.
Ms. Collins: I will do so.
The Chair: I thank you folks for being here. I am particularly delighted to see Dr. Mendez, again. I am quite annoyed with him for having decamped from Nova Scotia, but Canadian society will still continue to benefit from him.
Again, I thank you, Ms. Collins and Mr. Bak for the remarkable example you have there.
(The committee adjourned.)