Hon. Art Eggleton:
Colleagues, let’s talk robots. It is my pleasure today to move the adoption of the report entitled Challenge Ahead: Integrating Robotics, Artificial Intelligence and 3D Printing Technologies into Canada’s Health Care Systems.
It’s the latest report from the Standing Senate Committee on Social Affairs, Science and Technology and a study on the future role of automation in Canada’s healthcare systems. The study was conducted under the leadership of our chair, retired senator Dr. Kelvin Ogilvie, and the report recommendations were adopted unanimously by the committee.
We undertook this study within the context of the committee’s history of searching for solutions to help to build a healthier Canada. Most recently, the committee has reported on the needs for Canada’s healthcare systems to adapt and innovate in order to maintain viability, the complexities of caring for individuals with chronic disease, which can, in part, be prevented by lifestyle choices, and the increasing needs of an aging population, particularly of those individuals with dementia.
It was within this context that the committee undertook this latest study into the role of automation in the health care system. We held 12 meetings between February 1 and May 15 of this year and heard from witnesses, including researchers, research funders, ethicists, entrepreneurs and healthcare providers and futurists, who have studied deeply this technology and understand its potential.
In addition to formal hearings, we visited two Ottawa-area facilities where these new technologies are being developed. In recent years, we have seen the rapid rise of automated innovations that can be applied throughout the medical field for the benefit of all Canadians and for the benefit of the systems themselves. By automation, we mean a myriad of high-technology innovations with the potential to cut costs; make treatment and diagnosis quicker, easier and more accurate; and create a system that routinely goes to the patient rather than the other way around.
These technologies will help with hospital workflows and management. In home care, wearable devices and sensors will assess and predict patient needs, while personal robots will relieve home care helpers of many menial tasks.
How do we ensure that advanced technology and the health care system grow together in harmony, while keeping Canadians healthy and successfully treating those who need care in a timely manner? This was the starting point for the committee when we began our study on the use of robotics, artificial intelligence and 3-D printing in health care.
While experts come to the subject of automation from many different perspectives, there is one fundamental aspect they agree on. Our health care systems are on the edge of revolutionary change, and, in order to meet the inevitable challenges ahead, we must prepare, prepare soon and prepare well. The onus rests on the federal government to make sure that we take the fullest possible advantage of the opportunities that will come our way. I will come back to the crucial conclusion of our study shortly.
The most recent report by the Canadian Institute for Health Information, released on November 7, estimates that health spending will grow by almost 4 per cent by the end of this year, to $242 billion. That’s roughly $6,604 per Canadian, an increase of $200 over last year. Costs per Canadian vary from province to province, from $7,378 in Newfoundland and Labrador, $7,329 in Alberta, $6,367 in Ontario and $6,321 in British Columbia, just to give you some examples. Spending on health care now represents about 11.5 per cent of Canada’s gross domestic product. The unavoidable truth is that health spending is rising, and it will continue to rise. Despite these constantly increasing costs, Canada is not keeping pace with inflation and population growth. This should make us all concerned about the sustainability of Canada’s health care systems that are so treasured by Canadians. To put it bluntly, they are ailing.
Our committee emerged from this study convinced that automation has the potential to revitalize health care, while simultaneously boosting the fortunes of Canadian automation researchers and manufacturers, who have done brilliant work in getting us to the stage we are at. Nurturing the work of these Canadian innovators, encouraging them, supporting them and keeping them ahead of the pack in an increasingly competitive international environment offers great potential for our economy. Of course, the nurturing of innovation offers great promise for the good health of Canadians.
It is not science fiction to suggest that robotics, artificial intelligence and 3-D printing will eventually take us to a place where the average person will be able to anticipate his or her own heart attack, get immediate notice of an insulin deficiency and, in time, see vital organs and limbs regenerated and, who knows, completely artificially built.
The transition won’t always be simple or easy, but the potential benefits for patients in provincial and territorial health care systems will be huge. It could mean a leaner, more efficient delivery of health care, more accurate and quicker diagnosis, less invasive surgery, easier access to distant health care and remotely controlled surgeries for indigenous populations and others in remote and rural parts of Canada, personal robots to perform mundane tasks for home care patients and their caregivers and shorter hospital wait times.
As our committee chair, Kelvin Ogilvie, noted:
People will come to expect the same service on their bodies as they now get for their cars. Whatever the ailment, they will want it fixed today— not months or even years from now.
In short, people will not want to wait for treatment, and that’s going to take significant planning and significant change in corporate culture if the systems are going to cope with these new demands and expectations that patients will have because of the emergence of robotics and artificial intelligence in medicine.
Work on artificial intelligence began in the early 1960s, but rapid developments in computer capacity and the advent of both the home computer and the Internet led to a surge of interest during the 1990s. It can all sound quite overwhelming for the layperson, but, as one leading expert told us:
. . . artificial intelligence is only artificial intelligence until some critical mass understands how it works. Then it’s just a computer program. It’s nothing more.
Robotics and artificial intelligence are interconnected to a great degree. AI — I’ll call it that for short — is the brain; the robot is the body. Of course, AI is already used in speech therapy, diagnostics and blood tests, and we see robots becoming more useful in laboratory and pharmacy automation, surgery, exoskeletons, rehabilitation needing physical therapy, and the daily well-being of the elderly and the disabled. But Canadians are a long way from the full integration that our committee’s study envisions.
3-D printing involves producing several successive layers atop each other, ultimately producing a 3-D object. Another term that could be used is “additive manufacturing,” adding the different layers, which may be a more accurate way of describing the process. It uses a range of materials, including various plastics and metals, as well as biological material, namely, cells.
The technology for 3-D printing has evolved since its invention in the 1980s to the point that it is now economical to use in small-scale production and for customized purposes.
While the technology was initially used in engineering for the production of prototypes, there are several applications for 3-D printing in medicine, including the fabrication of prototypes for surgical planning, designing implants, producing prosthetics and orthotics, regenerating tissues and organs, manufacturing surgical and medical tools and enhancing medical research training and education. In fact, hearing aids are manufactured by the millions with 3-D printing nowadays.
Indeed, we committee members witnessed the 3-D production of a brace for a broken knuckle. It took 15 minutes. It’s anyone’s guess where this technology will be in 10 or 20 years, but the prospects are, to say the least, exciting.
Our report contains 14 recommendations. Most of them are predicated on support from the federal government, which has enormous influence and spending power in multiple areas of health care through the federal research granting agencies — the Canadian Institutes of Health Research, the Natural Sciences and Engineering Research Council of Canada and the Social Science and Humanities Research Council — as well as directly for research conducted at the National Research Council of Canada. They are all engaged in this matter.
So we are proposing a federally sponsored national conference that will be a launchpad for initiatives that will lead to dynamic and organic change. Our recommendation is for a coming together of all stakeholders who would emerge from the conference and expert groups with mandates to monitor progress in their own areas of expertise. The groups would be supported and coordinated by a permanent secretariat led by chairs of the expert working groups and in turn would report regularly to the federal government.
For this integration to work efficiently in the longterm, we need to be prepared. We need to keep abreast of developments in the technology, in the use of the technology and in all other aspects those expert working groups would monitor.
Technological developments will be rapid, and if this integration is to work, the partners have to be well informed and develop a mutual understanding, respect and trust. The medical community and the people they serve must have confidence in these new systems.
For example, if the robot disagrees with the doctor’s diagnosis, who does the patient, and indeed the doctor, believe?
These are fundamental ethical considerations, the most fundamental being the need to keep the robotics under human control, however smart they may become.
We will be dealing with massive amounts of data, and, in turn, that raises privacy issues. If we don’t protect patients’ privacy, we cannot expect them to have confidence in the system.
Then there are jobs. Training and retraining must also be high on the to-do list. As with any technological revolution, jobs will be lost. But jobs will also be gained in some areas, and others will change. Properly educating, training and, where necessary, retraining our health care workforce will be vital to the efficient integration of this technology.
So regulatory oversight will be essential, and we look to Health Canada to provide that guidance and to monitor developments emerging internationally in all related areas.
So the challenge ahead, as the report is called, casts us into the future, but a future with a strong enough connection to the here and now to convince us that our hospitals — indeed, all our health care components — need to prepare for significant change.
With the will and support of the federal government and the ongoing productive partnerships among stakeholders, which very importantly includes the provinces, territories and local governments, we can find a way to make this integration work for the well-being of Canadians. We are indeed on the edge of a health care revolution, , one that Canada, with preparation and organization, can and should lead.