TECHNOLOGICAL INNOVATION IN HEALTH CARE Report of the Standing Committee on Health Joy Smith Chair JUNE 2013 41st PARLIAMENT, FIRST SESSION Published under the authority of the Speaker of the House of Commons SPEAKER’S PERMISSION Reproduction of the proceedings of the House of Commons and its Committees, in whole or in part and in any medium, is hereby permitted provided that the reproduction is accurate and is not presented as official. This permission does not extend to reproduction, distribution or use for commercial purpose of financial gain. Reproduction or use outside this permission or without authorization may be treated as copyright infringement in accordance with the Copyright Act. Authorization may be obtained on written application to the Office of the Speaker of the House of Commons. Reproduction in accordance with this permission does not constitute publication under the authority of the House of Commons. The absolute privilege that applies to the proceedings of the House of Commons does not extend to these permitted reproductions. Where a reproduction includes briefs to a Standing Committee of the House of Commons, authorization for reproduction may be required from the authors in accordance with the Copyright Act. Nothing in this permission abrogates or derogates from the privileges, powers, immunities and rights of the House of Commons and its Committees. For greater certainty, this permission does not affect the prohibition against impeaching or questioning the proceedings of the House of Commons in courts or otherwise. The House of Commons retains the right and privilege to find users in contempt of Parliament if a reproduction or use is not in accordance with this permission. Also available on the Parliament of Canada Web Site at the following address: http://www.parl.gc.ca TECHNOLOGICAL INNOVATION IN HEALTH CARE Report of the Standing Committee on Health Joy Smith Chair JUNE 2013 41st PARLIAMENT, FIRST SESSION STANDING COMMITTEE ON HEALTH CHAIR Joy Smith VICE-CHAIRS Libby Davies Hon. Hedy Fry MEMBERS Kelly Block Ben Lobb Patrick Brown Dany Morin Colin Carrie Djaouida Sellah Matthew Kellway David Wilks Wladyslaw, Lizon OTHER MEMBER OF PARLIAMENT WHO PARTICIPATED Mark Strahl CLERK OF THE COMMITTEE Julie Pelletier LIBRARY OF PARLIAMENT Parliamentary Information and Research Service Martha Butler Raphaëlle Deraspe Karin Phillips iii THE STANDING COMMITTEE ON HEALTH has the honour to present its FOURTEENTH REPORT Pursuant to its mandate under Standing Order 108(2) the Committee has studied technological innovation in health care and has agreed to report the following: v TABLE OF CONTENTS TECHNOLOGICAL INNOVATION IN HEALTH CARE .................................................... 1 Introduction ................................................................................................................ 1 PART ONE: TECHNOLOGICAL INNOVATION IN HEALTH CARE................................ 3 CHAPTER 1: OVERVIEW OF THE FEDERAL GOVERNMENT’S ROLE AND INITIATIVES .................................................................................................................... 3 A. Regulation of Pharmaceuticals and Medical Devices ............................................ 3 B. Supporting Research and Commercialization of Emerging Health Care Technologies and Innovations in Health Care Delivery ...................................... 4 C. Evaluation of the Clinical and Cost-Effectiveness of Pharmaceuticals, Medical Devices, and Clinical Procedures ...................................................................... 7 D. Promoting the Adoption of E-Health and Telehealth Across Canada through Canada Health Infoway Inc. ............................................................................... 9 E. Promoting the Adoption of E-health and Telehealth in First Nations and Inuit Communities .................................................................................................... 11 CHAPTER 2: E-HEALTH, TELEHEALTH AND TELEROBOTICS ............................... 13 A. Technological Innovation in E-Health, Telehealth and Telerobotics .................... 13 1. The Role of Mobile Health Devices and Web-based Applications in the Promotion of Self-Care among Patients .................................................... 13 2. The Implementation of Electronic Health Record Systems Across Canada ..................................................................................................... 16 3. The Role of Telehealth and Telerobotics in Improving Access to Health Care in Rural and Remote Settings ........................................................... 19 i. Telehealth ................................................................................................ 19 ii. Telerobotics ............................................................................................ 20 4. The Implementation of E-Health and Telehealth in First Nations Communities ............................................................................................. 22 B. Committee Observations and Recommendations ............................................... 24 CHAPTER 3: PHARMACEUTICAL DRUGS AND MEDICAL DEVICES ...................... 27 A. Medical Devices .................................................................................................. 27 B. Pharmaceutical Drugs ......................................................................................... 29 C. Genomics ............................................................................................................ 31 D. Nanotechnology .................................................................................................. 34 E. Committee Observations and Recommendations ............................................... 35 vii CHAPTER 4: THE TREATMENT OF RARE DISEASES .............................................. 37 A. Rare Diseases in Canada .................................................................................... 37 B. Canada’s Proposed Orphan Drug Framework .................................................... 38 C. Innovations in the Treatment of Rare Diseases................................................... 38 D. Strengths of and Challenges Facing Rare Disease Research and Treatment in Canada ........................................................................................................ 40 E. Committee Observations and Recommendations ............................................... 40 CHAPTER 5: THE PREVENTION AND MANAGEMENT OF CHRONIC DISEASES .................................................................................................................... 43 A. Chronic Diseases in Canada and the Role Technology Can Play in their Prevention and Management ........................................................................... 43 B. Innovative Technologies to Prevent or Manage Chronic Diseases ...................... 44 C. Some Advantages and Challenges of Using Technological Innovations to Prevent and Manage Chronic Diseases ........................................................... 46 1. Reducing Geographic Barriers ....................................................................... 46 2. Financial Barriers to Accessing Health Technologies ..................................... 47 3. Physical and Cognitive Barriers to Accessing Health Technologies ............... 48 4. Scientific Validation for Self-Management Tools ............................................ 48 5. When to Refrain from Using Technology ........................................................ 49 D. Committee Observations and Recommendations ............................................... 49 CHAPTER 6: MANAGING THE COSTS ASSOCIATED WITH THE ADOPTION OF TECHNOLOGICAL INNOVATIONS IN HEALTH CARE ............................................... 51 A. Overview of the Costs Associated with the Adoption of Technological Innovations in Health Care ............................................................................... 51 B. How to Manage the Costs Associated with the Adoption of Health Technologies ................................................................................................... 52 1. Determining Value for Money ......................................................................... 52 2. Managing the Costs of Pharmaceutical Drugs ................................................ 53 3. Using Patient Modelling to Implement Technological Innovations .................. 54 C. Committee Observations and Recommendations ............................................... 54 CHAPTER 7: PROMOTING TECHNOLOGICAL INNOVATION IN HEALTH CARE IN CANADA ................................................................................................................... 57 A. Research and Development ................................................................................ 57 B. Commercialization and Venture Capital .............................................................. 59 1. Access to Venture Capital and Business Expertise ........................................ 60 viii 2. Public-Private Partnerships ............................................................................ 63 C. Committee Observations and Recommendations ............................................... 64 PART TWO: OTHER INNOVATIONS IN HEALTH CARE ............................................. 65 A. INNOVATIONS IN HEALTH CARE DELIVERY ........................................................ 65 1. Innovation in the Delivery of Primary Care. .........................................................