This Episode

Diagnostics Beyond the Lab: episode 5

Janet: Hello, I’m Janet silver from Syntax Strategic 

Cameron: and I’m Cameron Groome for Microbix Biosystems. Thanks for joining us for diagnostics beyond the lab. On this podcast, we speak with industry leaders in the diagnostic testing and health community both discover challenges in their vision of the way forward in their fields, and cameras. 

Janet: Today we’re going to talk about current and emerging diagnostic technologies, how they’re viewed by the government, how they’re viewed by leaders, and how we can encourage their optimal use. 

Cameron: And to do that we have two very distinguished guests today. Christine Elliot, who served as the Deputy Premier of Ontario and Minister of Health from 2018 to 2022. And Ivy Parks president of Becton Dickinson Canada, one of the world’s largest companies focused on medtech discovery, diagnostics and delivery of care.

So, let’s kick off. Overall, health care spending in Canada is now approaching $350 billion a year, a staggering 200 billion of that is in Ontario, and yet only an elderly an estimated three to 5% Of that number, those health care budgets is actually spent on diagnostics. So I’d like to start by asking, Christine, when you were health minister for the province during COVID.

How did the relationship with the diagnostic system diagnostic sector change due to the pandemic, and has that impacted its funding and how it’s considered for testing in health budgets? 

Christine: Well, it changed significantly during the pandemic, we were in a situation where we needed to ramp up significantly in terms of volumes and spending. Because public health Ontario can only process about 5000 tests per day to determine whether people had COVID or not and  we needed to be able to test several 100,000 tests per day. So, we put together a more extensive lab network involving, of course, public health Ontario, but hospitals, universities, private labs, and so on, so that we were able to do those higher level volumes of tests. And that, of course, increased the financial value significantly. But we also had to allow for doing tests in places like fly in communities, where we could get the test results, first of all within a reasonable period of time, because they needed to know if it was circulating in their community, but also to make sure that we could get the just the tests themselves to a place where they could be tested before the sample went bad. So things that dramatically changed as a result of COVID. To my knowledge, the lab system is still in place. They don’t need to process that volume of tests anymore, but it needs to be there. Heaven help us if we should have anything else like this in the future, but we have to be ready for it.

Janet: And  just to pick up on what Christine was saying in terms of the increased awareness and the importance for the diagnostics sector during the pandemic. What are some of the challenges and lessons this provides for your industry, including relating to innovation?

Ivy: You’re right, Janet, the pandemic, and most certainly did increase the profile and the general awareness of the importance of diagnostics in our healthcare system. As someone who’s worked in the lab space for my entire career, this is the first time that I could actually go into a social setting and speak about something like PCR antigen tests, and have everybody know what I was talking about. I always say to my team, it is really our privilege to be part of the diagnostics community. But that privilege comes also with a really huge responsibility, when so many count on us for supply for innovation, for best practice, knowledge, all of those things. From an internal company perspective, BD really had to pivot in manufacturing, in our R&D projects, and just in our focus in general in order to prioritise production of products and services, which was going to help in that critical time and in those critical settings. It was one of my proudest moments in my career so far, to see industry really come together and to do what we knew it was incumbent on us as providers in the diagnostics space to do knowing that none of us would be able to do it alone. We truly collaborated to support government testing needs and to ensure that there was not only access to technology, but also an increased awareness and understanding of the tools that were available on the diagnostic side that could be used to inform important clinical decisions at the time. This collaboration was a common theme as supplies became constrained, as we especially as we came out of the pandemic. And we had to continue to work really hard across sectors to ensure supply for the healthcare system in Canada.

I really hope that overall, this increased awareness and knowledge about the critical role that diagnostics play in health care isn’t lost as we start to or continue to put that pandemic further behind us.

Cameron: Very much agree with all that Ivy.  And I’d like to expand a little bit on what you said, with regard to supply chain and access. And, you know, looking back on at that time, Christine, there were a lot of issues in accessing critical materials, whether ease, whether swabs, test reagents, tests themselves, the premier has said that the candidate needs to produce more, you’re at home. Yet, we still don’t do a lot of production and ramp up. It takes a lot of time. It takes money expertise, but it also takes ongoing support for those domestic producers from Ontario, you know, how do we balance all this? And how do you see us managing that during emergencies and outside of emergencies?

Christine: Well, you’re absolutely right, Cameron, we were literally chasing PPE around the world at the beginning of the pandemic. And that was really all aspects of PPE and Ontarians generally rose very well to the challenge. We had breweries that started producing hand sanitizer and, and local clothing companies making gowns, and so on. But there’s some things that they weren’t able to replicate. And one of those things was that some of the three agents were hard to find at the beginning. Also, vaccine production was something that we really wanted to have established in Ontario to make sure that we would have regular supplies, we were a little later with receiving some of our supplies, because we didn’t manufacture locally. But that’s not something that you can really have a serious conversation about. Just creating a vaccine facility out of nothing during a pandemic. But it is an ongoing conversation that I know premier Ford wants to continue. And there are some where there is a facility where they’re going to fill vaccines and so not create them in Ontario for COVID. Anyway, we have other vaccines that can be made, but not the COVID vaccine. So it’s something that I think you need to continue to have those conversations with industry as part of the government and keep your eye on innovation in terms of what’s going on with the diagnostics sector. Because you want to be able to provide the best care to patients. But it’s also relevant when you’re speaking about something like the worldwide lack of Health Human resources that we have right now. You want to create an environment where health professionals will want to come to Ontario to do their work, and to stay there. So diagnostics, I think, form an important part of creating that environment where people will want to come and will want to stay. 

Cameron: Well, that’s great. A great series of points to consider. One of the ones I’d like to draw on is some of the new technologies. Christine, Ivy mentioned earlier that, you know, first time she could talk about PCR, and people’s eyes maybe didn’t glaze over, I had that same experience. But you know, what, what, what are some of the new technologies that that Ontario mind started to consider coming out of the pandemic and some of the innovations that would bring better health care and, and motivate practitioners to want to stay here?

Christine: Sure, well, there are many examples. And that was one thing that I regret not being able to speak about during my time as health minister, because most of it was spent during the pandemic, but there are wonderful things going on in Ontario, amongst manufacturers, universities, hospitals, and so on. And I think one really good example is some of the work that’s being done on neuro modulation and some trials that they’re doing for Parkinson’s disease because they’re able to use low intensity MRI guided ultrasound in order to it actually can break the blood brain barrier and deliver enzyme replacement therapy which might be helpful in dealing with Parkinson’s. They’re still in trials. We don’t know yet. But this is state of the art work which when you look at it from the patient’s perspective

Instead of staying several weeks after having open brain surgery, this can be done with maybe a night at the hospital, and from a government perspective can save potentially millions of dollars if they’re able to treat many people that way. So it’s good in all respects. And there’s many other things of that nature that are happening that I think innovation is really key for forward progress and diagnostics. Again, play a key role

Janet: and Ivy from your perspective, you spoke earlier in terms of the pandemic and in the challenges that provided especially when it came to supply, but I’m wondering coming out of the pandemic in terms of technologies that you had to use, what has been prioritised going forward now for commercialization.

Ivy: the pandemic really did act as a springboard for innovation across the board. We’re focusing on things like surveillance and screening on smart connected care technologies that allow for greater access, like point of care, diagnostics, and technologies that allow for self-collection of specimens, examples like that. At BD, we continue to stay focused on areas like automation, it was a priority before the pandemic and, and there are many organisations across the country who have already benefited from the adoption of systems like the BD keystroke total lab automation system in microbiology.But finding ways to automate certain repetitive processes allows for consistency and faster, more actionable results. But more importantly, in today’s current healthcare worker crisis, which was mentioned earlier, it helps to support resource challenges freeing up time for more value added care by the limited staff at lab staff that there that there are the introduction of technologies like this also produced data, which, with AI can act together as a predictor of future state issues and can help with some broader systemic challenges, like antimicrobial resistance as an example. Of course, the adoption of all this innovation requires changes in funding pathways and broader systemic change in order to realise their full potential for health care. Having an earlier test result would mean absolutely nothing, if nothing else changes in the system. Recently, the World Health Organisation issued a resolution on diagnostics that really underscores that timely, fair, and equitable access to health products is a global priority. And that availability, accessibility, acceptability and affordability of health products are fundamental.

Of course, keeping in mind that the intention of this was really around global access and tackling global public health emergencies. I think it’s really something that can act as a guide for us around where we focus our innovation, and how we focus on the adoption pathways of innovation as well in Canada.

Janet: So Christine, Ivy brings up a really good point. And Cameron briefly spoke about this earlier on, and that’s in terms of budgets, and help, right. And we know that the health budgets are very expensive. And I’m wondering when you were in government, and you were sitting around the Cabinet table, in terms of costs, were discussions about in your meeting with your other counterparts across the country? Is it diagnostics, test control? Is that all part of what’s being discussed and if I can add another element into this as we talked about the budget, because the federal government, as we know, boosted funding for health care earlier this year, but there were strings attached. Ivy spoke about data. That’s one of the strings attached to hating provinces. If you want more money from Ottawa, here’s what you need to do. And I’d like to get your thoughts on when we’re talking about those budgets, what’s considered and when the feds say they’ll give more money. But you need to do this. How is that viewed?

Christine: Well, I would say before the pandemic, it wasn’t an issue. Diagnostics wasn’t something that we would sit around and talk about on a regular basis. It did become a much bigger issue. Of course, once COVID came along, we needed to talk about getting tests, supplies, and then vaccines and so on. It was a much bigger topic of conversation when I became Health Minister, the Minister, the federal government, had recently granted some money for mental health and development for their mental health plan. So that was a priority for them at the time. So I spent a good part of the first year or so working on that, along with the many other things involved in health ministry. But of course that did change when COVID came along. And then with the federal government, they are requiring certain conditions be met in order to grant access funding, one is on data collection. And I think that is really, really important. I don’t disagree with them on that. Because you can’t really make good healthcare decisions unless you have that data. For example, during COVID, we were able to find out just through the data collection about where the biggest outbreaks of COVID were happening later on, where there was less take up of a vaccine. And so we were able to concentrate resources in those areas in those separate areas and to use other techniques of having people come out for tests or having people come out to get vaccinated that we didn’t necessarily use in other areas. So we had the Go Vax buses going to certain communities. We had community gatherings, we had people in different cultures speak, have their own communities come out and speak to them about the importance of being vaccinated, and so on. So I think the data is really important. And I think that the government does need to have that. And I really do think that there needs to be a closer relationship between the federal and the provincial and territorial governments on health, because we all play a role. And then we need to really look at what’s happening best practices in different provinces and territories. But what I’m worried about, frankly, because nothing seems to be moving with any great haste, is, how are they going to do this? And who was going to be responsible for setting up the requirements? When are they going to do it? And how long are we going to have to wait for it? So I think those are legitimate concerns that I would like to see answered, because right now, I think they’re looking at it at the 50,000 foot level, what we really need to do is go to ground and have a system that is going to be based on manageable conditions, everybody know what’s expected of them, with timelines to go along with it. And that’s really hard for ministers of health to do when they’re already managing their own portfolios. So I think that they need to take a look at a different strategy for dealing with all of those issues.

Cameron:  It’s a lot to bite off. Christine, I’m pleased to that you’re saying, you know, there was some greater thought given to the diagnostic sector, you always seem to be a bit of the neglected stepchild, and I’m reminded of the trope Q & A, you know, what do you think of me and the resupply? You know, as a matter of fact, I don’t. So, you know, for those of us in industry, I think, for us doing a better job to justify the value propositions of our products and services has been key. So maybe I can ask Ivy for some concrete examples of really where diagnostic shine is showing leadership to get to better and of course, more cost effective patients.

Ivy: Thanks, Cameron. There are many examples of diagnostics leading to better and more cost effective patient outcomes. Unfortunately, labs aren’t always considered those direct patient care providers. But in my opinion, this viewpoint really needs to be changed or more broadly changed. As it wasn’t a pandemic, everyone knows the importance of a test result, then, that is absolutely for sure. Some technologies that come to mind that lead to better and more cost effective care that I might highlight here today might be things like cancer screening, HPV, cervical cancer screening, early detection leads to less cost for the system. But even more importantly, leads to better outcomes for patients at the end of the day. We talked a lot about data a few minutes ago, as well, but data processing and artificial intelligence, we generate a tonne of data in the health system, and finding ways to use this information, as Christine mentioned, but for trending out and predicting, for example, infections in certain patient populations. That can lead to proactive care, which does save money and improve outcomes. And it has the side benefit of reducing the unnecessary use of antibiotics in some cases, as an example, harnessing the power of molecular tests with the use of PCR tests during COVID many labs across Canada have lots of instrumentation in their labs that now can be used for many other tests outside of COVID. Molecular diagnostics is a really great way to generate faster and more reliable test results, and leads to earlier treatment plans for patients. So diagnostic technologies, in my view, are really key infrastructure for a sustainable and functional health system as we go forward. Definitely, it would be amazing for us to be a lot more open and assessing new technologies. And in looking at the broader systemic value that they can create, versus just the cost of the technology itself. If we’re open to changing the way we think about costs, and shift more to that creation of value, we’re going to see that there are many ways to introduce the newest and most effective technologies, while at the exact same time reducing the systemic cost of care, and most importantly, providing a better outcome for Canadians.

Janet: So Ivy just talked about how you can use those technologies right to help HPV in some areas. Right, the diagnostics, I’m wondering, and I’ll put this to both of you. Are there other? Are there any specific health challenges that diagnostics could help resolve? And I and what should we be doing now that we’re not or I know, Christine, you talked about, you know, delays in terms of things like data collection, but what could we be doing now that really, maybe not necessarily needs to be funded? It’s just willpower. And, Christina, I’ll start with you.

Christine: Sure, well, one of the things that we saw come out of the peak of the pandemic is the waitlist for other procedures. And so we’ve got a huge volume of people, a number of people waiting for cataract surgeries for orthopaedic surgeries, hips and knees primarily, but also for diagnostic procedures for MRIs, and CT scans, and so on. And so we did open up hospitals and so on to work extra hours and on weekends to be able to provide these procedures, but it still wasn’t enough. And so that’s why the government came forward with Bill 60. Their Health Act, which is now asking for private providers to come forward with proposals to operate to set up and operate. More MRI and CT scanners, especially for Mr. He also have to have the physical infrastructure in order to be able to house it properly. So I think that is a way that it is an urgent health challenge right now to be able to provide this service, they’re moving forward with it and by the end of this year, early next year, they should be able to do that. So I think that’s an area where diagnostics can do a lot of work. In this case, it will not be at the usual cost for the government because individual providers will be building and operating and they’ll receive payment for the services that people receive. So people don’t have to pay out of pocket. But it is a way that more services can be provided at a lesser cost.

Ivy: I totally agree. I think diagnostics can help to resolve a lot of challenges. I think, again, it’s been mentioned at least once today already, but human health resource challenges. You know, there is a real crisis with healthcare workers. I think technology can help with this. As I mentioned before, things like automation, things like putting devices in other care providers hands to help with the diagnosis, access to care technologies like point of care, we saw that in the pandemic, if there’s an openness to increase the utilisation of technologies like this in Canada, I think we could really help improve access to important diagnostic testing that could inform patient treatment plans, and even in rural and remote areas and places where it where patients might not have access to big labs nearby in their communities, big system thinking and big system change. I think that’s a real challenge for us. That concept of shifting to this value procuring on value, looking at that full system when assessing technologies, I think is a challenge. But I know that diagnostics can impact whole systems. And so I think if we can get around that challenge, diagnostics can really help and, and of course, I think, continued collaboration we saw in the pandemic, that collaboration was the way that everything kind of happened. When you look at vaccine delivery as an example, when you look at diagnostics. It was a lot of stakeholders coming together to make those things happen. And I think keeping proactive, that proactive collaboration happening is going to be really important across industry, government procurement, you know, all the sectors to support the health system.

Cameron: Great, great point. So thank you. We’ll start to move towards takeaways, as we don’t have, you know, unlimited time or attention from our audience. But some of the questions we’ve heard about pinch points and health systems, whether it’s lack of family doctors, you know, HR and lab techs closing emergency rooms, you know, what are some of the pinch points with respect to diagnostic diagnostics could help to address it? Maybe I can ask Christine, off with that question. 

Christine: Well, I think that there’s diagnostics can really helped both in terms of it with innovation to in terms of increasing supply increase, making better care available to people collaboration, as Ivy has indicated, especially with the local Ontario health teams now in effect, to really take a patient centred look at care. And I think that we really need to always bear that in mind with anything that we do . How is the patient at the centre of this? How is this going to improve their care? And as I said, diagnostics really sort of start the process and determine what the issue is. And then it’s up to everyone else to make sure that they continue with that collaboration in order to make sure that the person doesn’t fall between the gaps because we see that happen time and time again, and health. And I think that’s something that we do need everybody to participate in order to make sure that the patient receives the best care possible and exactly what they need. 

Cameron: That’s great. Ivy, BD is involved in so many different areas in the sector, where we’re some of the points that excite you and depend on innovations that can relieve some of the strain on the system. 

Ivy: Yeah, I think I mean, I’ve mentioned a lot of those today, I think, technologies that can be used for testing outside the traditional care setting. So maybe at the point of care at home, in settings closer to the patient, including, you know, self-collection of diagnostic specimens, these types of things that can improve access to care, I think are really key. There are also technologies that allow a remote reading of results so that you can have a specialist in one part of the country and with the aid of really high resolution imaging, have that specialist interpret results for a patient who may be in a lab across multiple provinces. So again, providing that access to the same type of, of high level care, through specialists too, and making it more available for everybody. And then finally, with the expansion of, of scope of practice, within healthcare, for example, in pharmacies, certain diagnostics, also some treatments can be prescribed outside of that traditional critical care setting, helping to eliminate some maybe or ease some of those, those pinch points where we’ve got some of those backlogs as well.

Janet: I guess for viewers, finally, who may you be watching this, or listening to this in the car. What’s the key takeaway, and I’ll get both of you to respond to this. What is The key takeaway for someone maybe driving in their car, who doesn’t have a doctor and is wondering, oh, my gosh, I think I may have a problem. And I may need a test, like, is this something what we’re talking about? How hopeful are you that We’ll get there soon? What would you say to them? Christine?

Christine: Well, I am very hopeful, I think that that degree of collaboration that was built up during the pandemic hasn’t gone away, and that everyone, all providers in the healthcare system, including diagnostics sector, really want to be able to work together to make sure that the patient receives the information, their physicians received the information that they need, in order to provide them with better care. But I think that collaboration needs to continue. And I would really like to see that continue between the federal government and the provincial and territorial governments too, because you can’t have one strong area without the other area being strong too. So I really hope that they will find a way to be able to formally collaborate to make sure that every person across our country gets the care they need when they need it.  

Ivy: I think I would, I would really say, you know, this, again, I’d echo what Christine said around collaboration. I think it’s so important for us to keep collaborating, learn and learn from those lessons that we learned during the pandemic. And that collaboration along with the implementation of new innovation. It just to me will lead to that more timely treatment and better outcome in general for patients. I think there certainly is reason to be hopeful that through the implementation of new innovations, and in this collaborative fashion, I think, data and information from test results Will, you know, truly enable patients to get the right treatment as early as possible. And I think that’s all that we can hope for, for the system. So, yes, I’m very, very helpful.

Cameron: I think that’s great. I mean, when we look at collaboration, effective collaboration, implement these innovations between industry and government, whether that’s self-collection, point of care, better, better dissemination of data, it’d be great to see faxes no longer be relied on in the in the so much in the health system.

All of those give me reason for optimism to win. It’s a pleasure to get your perspectives today. So I think that’s pretty much all our time. So I’d like to thank you, Christine. And I’d like to thank you, Ivy, for joining us today. It’s great to have you with Janet and I on this and discuss the importance of the industry for optimising health for Canadians in a cost effective way. 

Cameron: Thank you both. Thank you.

It’s been a pleasure.

Cameron:  I’m Cameron Groom. 

Janet: And I’m Janet silver. Till next time

Meet the Guests

 Christine Elliott

Christine Elliott, former Ontario Minister of Health and Deputy Premier, is Counsel with the Fasken Health Law group in our Toronto office. With over 15 years of experience in public service, she is ideally positioned to assist clients with navigating existing and emerging complexities in the healthcare space.

During her tenure as Ontario’s Minister of Health from 2018 to 2022, Christine played an integral part in overseeing the province’s response to the COVID-19 pandemic. In this role, she also sponsored The People’s Health Care Act and enacted the Connecting Care Act. The Connecting Care Act gave rise to Ontario Health, a Crown agency that merged the 14 Local Health Integration Network and other agencies including Cancer Care Ontario, Gift of Life Network, eHealth Ontario and HealthForce Ontario in order to facilitate integrated care delivery systems also known as local Ontario Health teams. Christine also served as Ontario’s Deputy Premier (2018 to 2022) and as Ontario’s first Patient Ombudsman (2016 to 2018).

Christine, along with her husband James Flaherty (Jim) was a founding partner of Flaherty, Dow, Elliott & McCarthy. Later, Christine and Jim co-founded Abilities Centre in Whitby, Ontario, which supports and celebrates the abilities of all people and is a place where everyone belongs, regardless of their challenges. In addition, she has held positions on a range of boards in the health care sector since becoming involved as a volunteer with several charities including the Lakeridge Health Whitby Foundation, Durham Mental Health Services, and Grandview Children’s Centre.

Christine graduated from the University of Western Ontario law school and was admitted to the Ontario Bar in 1980.

Ivy Parks

Corporate Photography by Mark Skalny 1-888-658-3686 www.markskalnyphotography.com

Ivy Parks serves as the President of BD-Canada (Becton, Dickinson and Company), a leading global medical technology company with the Canadian office in Mississauga, Ontario. 

Ivy brings extensive market experience to this position, having been with BD in Canada since 2000. Throughout her career, Ivy has taken on new challenges and roles that have provided her with a deep understanding of the Canadian landscape, specifically within acute care, alternate care, pharmacy and the laboratory, while working in collaboration with medical associations and partners.

Prior to her current role, Ivy served as the Vice President for the Integrated Diagnostic Solutions (IDS) business, Ivy collaborated with the federal and provincial governments and led the team responsible for successfully delivering millions of PCR tests, and rapid, point-of-care tests using the BD Veritor™ Plus System to Canadians, in response to the COVID-19 pandemic.

Ivy is currently a member of the Board of Directors for Medtech Canada and is an active member of the Corporate Advisory Council with the Canadian College of Health Leaders (CCHL).

Ivy holds an honour Bachelor of Science degree from Western University in London, Ontario.