Public Accounts Committee on June 3rd, 2010

[David Christopherson, NDP, Hamilton Centre, ON]

AG, can you help me? If I'm getting the answer, I'm not understanding it.

[Sheila Fraser]

Well, I think the answer is no, Infoway does not require a complete strategic plan for the whole EHR project in each province before funding individual projects.

[David Christopherson, NDP, Hamilton Centre, ON]

So who would be responsible for that, ultimately? I know Health Canada now has set up monitoring, but was there not something in the planning of this that would catch this somewhere if it's not Infoway?

[Sheila Fraser]

I think what Infoway does is make sure the projects that are being proposed are in accordance with the blueprint, and it would be an element of that blueprint, say diagnostic systems. But to say how this is going to be implemented across a province in particular, they have not put in that requirement, though you would certainly expect each province to have that.

That was the issue raised by my provincial colleagues. Some provinces had these strategic plans, but I think the majority of the ones we looked at actually did not. Or they had one, but it was never brought up to date or completed through. So there was a weakness at the provincial level.

[David Christopherson, NDP, Hamilton Centre, ON]

Have the provinces committed now to correct that?

[Sheila Fraser]

I believe that, yes, they have, and I believe they have even indicated they will do that in the response by the governments into the report.

[David Christopherson, NDP, Hamilton Centre, ON]

Still good?

[The Chair, Liberal, Shawn Murphy]

One minute.

[David Christopherson, NDP, Hamilton Centre, ON]

What am I going to do with one minute? It takes me that long to clear my throat.

Until the time runs out, Mr. Alvarez, would you speak to the doctors' office computerization? I understood what you said, that it was sort of a generational thing, ad it'll catch up eventually when the new one's ready. But that's a long term. We could go through quite a while. Is that what we're heading into, a period of hit and miss, in terms of the infrastructure within the doctors' offices?

[Richard Alvarez]

Sir, I don't think it's a period of hit and miss. I think it's a transformable period of basically change management. When you look at western countries across the world, Canada is somewhere dead last in terms of community physicians and automation, because there hasn't been this requirement to get them moving. That said, you've got 50% of the physicians in Alberta in the community using computers, you've got about 40% in Ontario who have moved, and in some cases the provinces have moved without any federal funds.

What we're going to see is an acceleration over the next little while, and a vast proportion of those new moneys from the government are going to be made available to move clinicians into the community settings. So I'm very hopeful that we're going to play catch-up with the western world. We certainly plan to have about 12,000 doctors, certainly in the first movement of the $500 million, moving with computerized systems in their offices.

[David Christopherson, NDP, Hamilton Centre, ON]

Very good. Thank you.

Thank you, Chair.

[The Chair, Liberal, Shawn Murphy]

Thank you, Mr. Christopherson.

We'll now go to Mr. Saxton for seven minutes.

[Andrew Saxton, Conservative, North Vancouver, BC]

Thank you, Mr. Chair.

I just want to note that I think this is the first time that my colleague, Mr. Christopherson, has run out of questions before his time was up. That's a good sign, I think.

My first question is for the Auditor General.

The report mentions that Infoway has taken solid steps towards maximizing the use of the funds for the projects. Can you explain what some of those steps are and how they're important?

[Sheila Fraser]

We do actually indicate that Infoway has accomplished a lot since its inception, such as the creation of the blueprint and working together with their partners and stakeholders. I would say one of the major elements to ensuring good use of funds is the gated funding approach, which was mentioned earlier. There has to be some indication of results or take-up of these systems before all of the funds are given. We saw that there was good analysis of the projects monitoring afterwards. So we really had no recommendations actually around the funding of specific projects by Infoway.

[Andrew Saxton, Conservative, North Vancouver, BC]

Thank you.

Your report also mentions the fact that Infoway has appropriate governance mechanisms in place. Can you share with us some of the board's activities that you reviewed as well as these governance mechanisms?

[Sheila Fraser]

We looked at the governance. This is something we would look at in most of our audits. We found that the board was very effective, very engaged, and that the information going to the board was appropriate, that they were getting comprehensive information. They had the appropriate codes in place: the code of business conduct, conflict of interest, and independence as regards Infoway. We looked as well at the activities they were carrying out. We saw that they were, for example, reviewing approving strategic plans; monitoring Infoway's performance; that they were reviewing a succession plan for senior management, ensuring that appointments to the board were staggered, which is an issue that we've come across in other organizations; and reviewing their own performance. These are all actually indications of best practices that we would expect to see.

[Andrew Saxton, Conservative, North Vancouver, BC]

Thank you very much.

My next question is for Infoway. This is a follow-up to Mr. Christopherson's question.

The Auditor General in her opening remarks stated:

These challenges include the need to increase the number of primary care doctors using computerized record systems....

What actions can you take to encourage more widespread use amongst doctors?

[Richard Alvarez]

The actions that we are taking, again, thanks to the new money from the federal government, will be actions to accelerate the adoption of automation at community settings in primary care, so both with physicians and with nurse practitioners.

Right now about six provinces have already moved ahead with this agenda, but the rest haven't. The provinces that have been particularly successful have set up offices between the ministry and physician associations to help doctors get computerized. We will be helping those provinces that haven't got those offices set up to do so by looking at best practices and making the best practices available. Provinces like Quebec and Newfoundland would be good examples. We will be encouraging them to sign up their doctors and nurse practitioners as soon as possible. We will be carrying half of those costs for the first two years. Again, we will be getting our funding.

We want to make sure that these systems, as they go in, are not used as doorstoppers or desk ornaments but that they are used in a meaningful way. So we will be putting in requirements that they have, for example, alerts and reminders in their system about contraindications around medication; adverse or negative lab results; the ability to provide reminders for chronic disease patients; the ability to receive the lab tests into their systems; and then the ability to move on to things such as e-prescribing. That's all very much part and parcel of our program.

We're also very keen about our blueprint, which Ms. Fraser mentioned several times. The blueprint is very simple. As we're building the system, we're building it around the individual, around the Canadian. We're not building it around the doctor or around the hospital. Those systems are of the past, and those have been closed systems. As patients moved around from one place to another they could never get hold of their tests, and therefore they had to repeat their medical histories. So it's very important for us now to build on all the investments we've made in the past and to make sure that these electronic medical systems in community settings are interoperable with drug databases, lab databases, and diagnostic databases so they can refresh the patient's history and get a full history of the patient.

I have just completed a tour across the country, meeting with the provinces and the territories, and the strategies and processes are being extraordinarily well received.

[Andrew Saxton, Conservative, North Vancouver, BC]

Thank you.

It also says in the report that not all completed EHR projects have implemented the standards required for national compatibility. How does Infoway intend to ensure that these completed EHR systems are compatible across the country?

[Richard Alvarez]

As I said, one of our core businesses is standards development, standards implementation. If you're putting in a new system and you're getting any of our money, you have to put in the standards. It's as simple as that.

For the standards, there are slight variations from province to province at times because of the business requirements. That said, they have to interoperate at a jurisdictional level. Those systems have to be built up, and then as we do the joins across the country, in some cases there will have to be translation engines that do those joins.

I'll also say that we're now in an era of consumer space and consumer products and consumer health records. Earlier this week, there was a major announcement by one of our Canadian vendors allowing this to happen. There is a product that we will certify for privacy and security considerations by Infoway. Consumers will have access to those records. Those records will be portable wherever they go.

[The Chair, Liberal, Shawn Murphy]

Thank you, Mr. Saxton.

We'll now start the second round, for five minutes each.

Mr. Lee, five minutes.

[Derek Lee, Liberal, Scarborough—Rouge River, ON]

Thank you.

One of the Auditor General's focuses here is to ensure that there are some kinds of benchmarking standards, measurements, to see how we're doing as we move along. This is a multi-year project; it could be multi-generational.

I'm wondering about the business of incenting the various components of the health care sector to be involved in, to comply with, to engage in--the whole engagement on electronic health records. You've talked about incenting practitioners. Does the system incent components of the health care field, such as medical laboratories, pharmacists and pharmaceutical companies? Are they in any way incented to be partners in the engagement of local practitioners, of clinics, in this whole system?

[Richard Alvarez]

Thank you for your question.

One of the major challenges of this job, by the way, is the number of stakeholders that we have to interact with, that we have to, if you like, jolly along and incent. Clearly, we're not only talking about clinicians here. We're talking about ministries, administrators in RHAs and regional health centres, clinicians, and the private sector as well, whether they be labs, whether they be—

[Derek Lee, Liberal, Scarborough—Rouge River, ON]

I know there are a lot of sectors and components.

[Richard Alvarez]

We have the world's only standards collaborative. When we talk about the building of standards, into that group we bring in the private sector, we bring in clinicians, nurses, pharmacists, and we bring in governments, and they basically work on what the standard should be.

Again, with the new moneys, when I talked about interoperability, I basically want these systems to interoperate with the lab systems, with pharmacy systems, so we're going to be working with the vendors of these systems that sell to Canada to incent them to change their products. In a lot of cases, they're pretty small vendors. In a lot of cases, if they don't get this sort of incentive—and remember, a lot of this money came as part of the stimulus—