Jeremy Patzer

“Madam Speaker, the minister’s enthusiasm for the bill is very well appreciated. The issue of health information technology is very near and dear to my heart, and not always in a happy way. Without naming any names of any particular institutions, one of the hospitals that I worked at for a long time foisted on physicians a health information technology solution without asking the physicians, the pharmacists or the nurses if they should do this or whether it was a good idea. They spent millions of dollars on it, and it frankly ruined our professional lives when it did not work at all. It is important to have good intentions. It is important to be enthusiastic about those intentions, but it is really important that the solutions that end up hitting the ground actually work for the people who use them and for the people those professionals serve. We have to be really careful about a bill like this. The possibility of causing more problems than it solves is a real and present danger. It is always a great honour to be in the chamber. It is always a great honour to speak on behalf of the people of Kitchener South—Hespeler. It is a great honour to give the Conservative response to the minister’s speech. This is, I believe, the first piece of legislation pertaining to health care in the 45th Parliament. It has been a long time coming. It has been a year and a half. I am a bit sad to say this is a bill that is warmed over from the last Parliament, when it somehow did not make it through. It has been years coming, and for that reason I would hold it to an even higher standard than if it were invented de novo. The bill before us today, Bill S-5, has the admittedly laudable goal of making it illegal for health information technology companies to engage in what the bill defines as data blocking, that is, stopping the exchange, or impeding the exchange, of personal health information between authorized health information technologies. In sharp contradistinction to many of the government bills that we have been debating over this past month, or even this past week, this is a very short bill. I commend it for that reason. It is perhaps only five pages long, in one language. Even though it is easy to read the bill, which I am grateful for, it is very difficult for me to understand how it could, in fact, work. I spent 95% of my clinical career in hospitals. There are three electronic medical record vendors that hospitals in Canada use very commonly: Epic, Cerner and Meditech. All three, I am sorry to say, are American companies. All three are subject to a 2016 law passed by the Obama administration called the Cures Act. My understanding is that the Cures Act is very similar, both in its intent and its operations, to the bill before us today, Bill S-5. Of course, it would be ideal, internationally, that all three of these systems be able to transmit patient health information between each other, obviously with the consent of the patient involved, but it is a really hard problem. This morning, for instance, my office printer was on the fritz. I was unable to send data, this speech, from my computer to the printer in my office. I had to get a friend in the lobby to print it for me, and that is a much simpler problem than all of the health information in all of Canada. Software vendors and Bill S-5 can have the best of intentions, but the problem of data interoperability is just a hard problem. Let us take, for instance, Meditech. Currently, Meditech has multiple products, multiple product families and different versions of each currently operating in the wild. There is Meditech 6.0, Meditech 6.1, Meditech Expanse, Meditech Expanse 2.1, Meditech Expanse 2.2. Different hospitals may choose to invest more or less money, or use one product family over another. They may choose to update whichever product family they are using often or not, depending on their own IT and human resources. I imagine it is a full-time job, nay several full-time jobs, at Meditech headquarters just to make sure that its own systems can communicate with each other in an interoperable fashion. That is not for a lack of trying. How much work, how many people and how much money will it take to make the Meditech system talk to the Epic system, to make both talk to Cerner and to make all three talk to the 10 to 15 major players in the European market? How much of a barrier of entry to one day starting a Canadian competitor would all of this entail? Let us drill down on a small part of the problem to understand the full scale of the problem. In my work as an ICU physician, any individual patient might have literally tens of thousands of data points stored in the EMR from just one day. Just their vital signs, such as heart rate, oxygen saturation, respiratory rate, body temperature and blood pressure, might be recorded and time-stamped continuously, providing thousands of data points before we even speak of medications, diagnostic imaging, clinical notes, blood work, etc. Each of these data points has to be filed or coded in some agreed upon, legible way in order to be interoperable. Even to zero in on just blood pressure, there are multiple numbers that go into a blood pressure reading and different numbers one might want to store, such as the systolic, the diastolic and the mean arterial pressure. There are different ways of measuring a blood pressure, namely a sphygmomanometer or a blood pressure cuff, or invasive arterial monitoring. Sometimes we are measuring both continuously throughout the day. One system might store, code and display the cuff systolic and the intra-arterial map every 15 minutes. My system might store, code and display only the cuff three times a day, or when an intra-arterial pressure is available, it might store that, superseding the other. It seems almost impossible to have a government regulatory body come in and say which one is correct. The sphygmomanometer, the intra-arterial blood pressure monitor, the EKG and the pulse oximeter all measure a patient’s heart rate, and three of the four measure it continuously. How do we impose a system that ensures that each health vendor will store those in mutually comprehensible ways? Let us consider a patient on continuous EKG monitoring. Literally every beat of their heart comes with multiple measurable waveforms depending on which EKG is looked at. Each monitoring system will come with different alarms and different ways of storing who responded to each alarm, how long the alarm went off, who turned it off and why they turned it off. I cannot imagine setting one standard for how all of this ought to be captured. This is not like saying all smart phones have to use a USB-C plug. There are so many more inputs and outputs to a human body that constitute health information. When I speak of monitoring vital signs, I am speaking of a fraction of a fraction of all the forms of data that go into health and health care. I have just now been speaking about electronic medical records, only one of the types of software we would find in a hospital. There are also prescription management systems, diagnostic imaging systems and scheduling systems, all of which contain personal health information. By the way, health care centres like hospitals are just one sort of organization that uses some classes of devices and some sorts of information technology on those devices. Bill S-5 seems to seek to regulate all sorts of other devices. For instance, I am wearing an Apple Watch. It went off, and the Speaker got mad at me. It also stores personal health information of mine on it, such as my heart rate. If someone has a CPAP machine at home or a blood sugar monitor, the bill would seem to make demands on those device manufacturers as well. This is just the present state of things. Health information technology is changing now at a faster and faster rate. A friend of mine runs an AI-powered ultrasound diagnostics start-up company for use by combat medics to see if a soldier in the field has a pneumothorax in real time. It is a pocket-sized device. It is an amazing invention. He worked so hard on it. He employs so many fantastic Canadian scientists who are designing it and making it better every day. I understand that he spends about 0% of his time making sure that whatever data is stored on that device in a battlefield somewhere can talk to Cerner, Epic and Meditech. He is trying to save lives by making something that has never existed before. How can he expect that whatever data his invention ends up outputting 10 years from now will be legible by these legacy systems? I am hoping that this House will take seriously the scale of the problem that Bill S-5 is trying to make go away. As I said earlier in my speech, the bill closely follows the approach that the Obama administration took in 2016, 10 years ago. Did this approach work in that milieu? If it pleases the House, I would love to table at some point a paper from November 2025 published in the Journal of the American Medical Association and written by Everson et al., entitled “EHR Interoperability Experiences Reported by Family Physicians”. The scientists surveyed more than 8,000 family doctors, asking them what their experience with health information interoperability has been like eight years after the Cures Act. I am sorry to say that despite the best of intentions, the results in this paper are dismal. Only 8% of the family doctors surveyed reported ideal interoperability. From my reading of the paper, it seemed that a majority of the doctors went so far as to give up on accessing outside clinical documentation. I hope we can talk more about this study at committee. Perhaps we could invite the authors of it to committee, should the bill succeed at second reading. If it is the case that the U.S. administration, after eight years of trying, largely failed to regulate the big American health information technology vendors I mentioned, Cerner, Meditech and Epic, how can we expect that the Canadian federal government would succeed in regulating those same American health information technology vendors into making their systems interoperable? As I said, most Canadian hospitals use information technology from these American providers. Many of the Canadian hospitals I have personally worked at, however, cannot afford to use the latest systems or subscribe to the most up-to-date features from each of these vendors. Is it really possible that Canadian regulators will be able to bully these gigantic corporations? Cerner is, in fact, by the way, the health information branch of Oracle, one of the largest tech companies in the world. Are we going to be able to demand that Oracle change what it is doing into solving what I fear may be an unsolvable problem when we are currently shopping in its bargain bin? Is it the case that the federal government has a good track record generally in the field of IT systems management? Who among us here could forget the $2.6-billion boondoggle that we now call the Phoenix pay system? Who could forget the $60-million arrive scam scandal? Who could forget the most recent scandal of all, the $300 million blown on the unworkable PrescribeIT program? I, for one, am not going to forget the PrescribeIT scandal. I think anyone who is familiar with my parliamentary work knows about PrescribeIT by now, because it has been the biggest part of what I have been working on over the last year. In brief, not to belabour the point, as I know the health minister is very familiar with it, it was a 10-year-long attempt by an organization called Canada Health Infoway, which receives funding both from provinces and from the federal government, to solve a simple problem. Ten years ago, when she introduced the legislation that gave the money for PrescribeIT, the minister of health at the time, Jane Philpott, called it the axe the fax program. Members are aware, of course, how much Liberals like rhyming three-word slogans such as axe the fax. Right now, in our country, physicians fax prescriptions to pharmacies. That was the case in 2016 when Jane Philpott introduced the legislation. Canada Health Infoway spent $300 million and took 10 years to make just this small class of health information transfer digitally between a doctor’s office or hospital and a pharmacy. We have investigated this matter at committee in some detail. To this day, I do not understand how it is that Canada Health Infoway invented something other than a digital fax, which has existed since 1998. Indeed, by its own admission, it invented nothing. It gave Telus $80 million to provide and manage the software platform, which already existed. That was a good deal for Telus. To this day, our study of this matter at committee having been truncated, I still have no idea what became of the other $220 million. It had a $300-million budget. It bought the software and had Telus managing it for $80 million. I do not know where the $220 million went. After all of that money and all of that time, physicians and pharmacists in our country, by and large, refused to use the solution. Canada Health Infoway seems to have spent a decade designing, or not designing but ordering, a software solution from Telus, without bothering to check in with frontline workers whether they liked the product or whether they would agree to use the product. The product was free, and still over 95% of physicians in our country declined to use the product. That is really bad and frankly activates my PTSD from my home hospital, which had foisted an information management system on us all those years ago. Of all the dogs that have never hunted, the PrescribeIT dog really did not hunt. It was a free solution that 95% of physicians and pharmacists declined to take up. With Phoenix, arrive scam and PrescribeIT, there is not a good track record. Maybe the federal government is about to turn over a new leaf and provide IT systems that work and that people want to use. I wish I could believe that, but do members know who it plans to put in charge of Bill S-5? Can anyone in the House guess? It is Canada Health Infoway, the totally corrupt organization that just blew $300 million on a failed solution. I know this is the Liberals’ plan by word of mouth, but I also know it from Senate testimony. This bill is called Bill S-5 because it came from the Senate. It has already gone through Senate committee hearings, and that has been the clear message. They had the now interim CEO of Canada Health Infoway give testimony. It is their intention to oversee the regulation of this perhaps unsolvable problem. For those who have not heard, Canada Health Infoway just fired its CEO because he came to the health committee to answer questions about PrescribeIT. He refused to answer the most basic questions about what he accomplished with his nearly $1-million salary. He would not even answer what his salary was. We had to get that information by other means. Its current CEO is the former vice-president, whom he hired. The $300-million PrescribeIT boondoggle is not even Canada Health Infoway’s total spend over the last decade. I believe the organization was in receipt of $1 billion of public money over this time, yet when we had the chair of the board at the health committee and I asked him what it accomplished with the other $700 million, he was unable to describe a single tangible achievement. This is a big problem. Even acknowledging that PrescribeIT did not work, acknowledging that the CEO of Canada Health Infoway was a big problem and acknowledging the extent to which the health minister took credit or did not for his dismissal, even after all that occurred, she planned to reward Canada Health Infoway with another $50 million of funding this year. I came to question period week after week and asked why she would give it this money. To her credit, the minister halted that funding, acknowledging that this organization is in a serious state of disrepair. This is a big problem when we talk about Bill S-5. It is, to my understanding, still the Liberals’ intention to have Canada Health Infoway lead the charge on regulating into existence a solution that is maybe not even possible when they have not accounted for the last $1 billion they spent. Do I support Bill S-5 in principle? Of course I do. Of course health information technology should be interoperable. Of course no patient should ever have their care suffer because data transfer between institutions is hard. Do I believe that the government, with its track record of IT boondoggles and its track record with Canada Health Infoway, will succeed in getting this job done with this piece of very short legislation? I fear I do not. I want to hear more about it at committee. I certainly want to hear more from Canada Health Infoway on what its plan was, but I cannot say that I have great faith that it will work out. Solving a problem like the one I have described is not a matter of intention. For instance, I do not want anyone in this country to be sad. If we were to make a law that no one is allowed to be sad anymore, it would not work. That was the question I asked the minister. She said it seemed to be the case that Bill S-5 would not even apply to Ontario because Ontario already has legislation with this intention. However, the reality in Ontario, as I described in my question, is not that health information technologies are interoperable. In the discussion and debate we have in this House, I would love for the government to explain why it will succeed where Ontario has failed if it already has similar legislation.”