Public Accounts Committee on June 3rd, 2010

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

Okay. I know how complex it is. You're saying yes, you have incentives.

[Richard Alvarez]

Yes.

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

Has the strategic plan benchmarked engagement of the sectors? Is that part of the plan?

Can I look at your plan, if it's there, and while I've got the microphone, can you tell me about the process of engagement of local health care components? For example, a doctor's office gets 5,000 client files. Would the doctor start on day one to begin inputting the new data on electronic health records, or would you expect a doctor or clinic to go back and convert all the existing records into electronic health care records? What have you built into your plan, your benchmarking, your measurement mechanism, in relation to that? What expectation does your plan have for those medical practitioners, whether it's a new person or a 78-year-old practitioner somewhere who's working part time?

[Richard Alvarez]

Your earlier question was whether I could look at the strategic plan and whether it is there. If you look at my strategies, absolutely, it is there, and those strategies were just approved last week by my board.

In terms of how doctors go about the conversion, I talked earlier about the fact that we almost insist that governments and physician groups and nursing groups come together and form an office that will help work with the doctors to do a few things. First, they would select and qualify the vendors who provide these products, and then they would work with them in a change management perspective of how much data they need to convert, and, no, they're not converting all of their files.

This has been done before. It has been done very successfully in Alberta, it's been done in B.C., and it's been done in Ontario--to take from there those learnings of what they need to convert and how they need to convert it and make that available. By the way, it's not an organized process, so they don't just throw their papers away and start with the computer tomorrow. It does take a while.

[The Chair, Liberal, Shawn Murphy]

Now we go to Mr. Young for five minutes.

[Terence Young, Conservative, Oakville, ON]

I just want to congratulate you on the system and your management, which have obviously been truly first rate. I think you've underestimated the tremendous potential to improve health care for Canadians with electronic health records and underestimated savings. For example, the Canadian Pharmacists Association told the Commission on the Future of Health Care in Canada that Canadians waste $2.9 billion a year related to prescription drugs. As well, the Romanow commission reported that as much as $10 billion a year of our health care dollars is taken up with hospitalizations due to adverse drug reactions. One out of nine Canadians who enter a hospital suffer an adverse drug reaction. So if the e-health records can track adverse drug reactions and we act to address risky drugs, the reduction of human misery and the cost savings are massive.

My first question is, how much has been saved related to remote diagnostic imaging? The report mentions up to 17,000 patient transfers a year. What financial figure would that represent, roughly? If you don't have a figure but you can guesstimate, that would be helpful.

[Richard Alvarez]

I'll give you the figures, but if you don't mind I'll just do a little preamble to that first.

We are, as far as I know, the only country that systematically looked at what the benefits could be as we got into this. We talk today about the cost of $10 billion; the same studies pointed repeatedly to $6 billion to $7 billion being saved each and every year. Those savings actually come in two tranches. The major savings come through cost avoidance, through preventing adverse drug reactions and keeping people out of expensive acute care beds.

[Terence Young, Conservative, Oakville, ON]

I understand. I think you're actually a little bit low on that figure, but I do have a second question as well.

[Richard Alvarez]

I can give you the number. The number in the study that we did on diagnostic imaging is $1 billion annually, and we're just about to publish a number on drug information systems in the four provinces I mentioned, and that is in that region as well.

[Terence Young, Conservative, Oakville, ON]

I wanted to ask you about that as well. I wanted to ask you how much control you have over the blueprint of the records and how much the provinces have, because in just four provinces you identified 2.5 million dangerous drug reactions. They call it significant; I know it's dangerous. We know that doctors only report 1% of adverse drug reactions to Health Canada, so they're basically flying in the dark. Prescription drugs taken the right way, without error, are the fourth leading cause of death in Canada.

I wanted to ask you about a drug that's on the market right now that increases the risk of suicide for young people by eight times over placebo, which is Paxil. One out of fifty young people who take Paxil will think about killing themselves, and some of them will carry it out. On June 7, in Toronto, there will be an inquest into the death of Sara Carlin, who did exactly that. We know that GlaxoSmithKline paid a $2.4 million fine in New York state related to the cover-up of the risk of suicide with Paxil and underwent a four-year criminal investigation in the U.K. for the same reason.

So here's my question. Could you search the e-records and discover how many people who committed suicide in Canada were either on Paxil or withdrawing from Paxil at the time of their death?

[Richard Alvarez]

Certainly the jurisdictions that have the comprehensive drug information systems—that is all drugs for all people—can in fact do that.

[Terence Young, Conservative, Oakville, ON]

That is the four provinces that are doing it now.

[Richard Alvarez]

Yes, but there are other provinces—Ontario being one, for example, as well as British Columbia and Quebec—that have databases for the senior population because that's what the government basically funds. They can search those databases and give you that same sort of answer.

[Terence Young, Conservative, Oakville, ON]

But that's just seniors. Will they be able to do it for all the population?

[Richard Alvarez]

The four we talked about could, and there are about six provinces that track all drugs for all people. They could do that, but the challenge here.... The question you asked is a good one. It could be done on a retrospective basis. The kinds of systems that we have specified and got in place will have medication management at the time of prescribing and at the time of dispensing it. At this point, they mainly have the time of dispensing. They will have alert management systems, so they can look at a patient's medication history and, as the clinician prescribes another drug, they can tell at that time whether its a safe drug or not a safe drug and what the alternative should be.

[Terence Young, Conservative, Oakville, ON]

That's very helpful. Thank you.

I mentioned earlier that the fourth leading cause of death is drugs taken as prescribed. We know that of all the prescription drugs approved by Health Canada, and the FDA in the United States, one out of five will turn out to be far riskier than ever thought. In fact, they weren't safe and effective and either have to be taken off the market or, in the U.S., be given the highest level of warning, called a “black box warning”. So you really need that retrospective look. You need to be able to look back and go back, because the contraindications are not always on the record. In fact, they build up the list of contraindications over time.

Will you at some point be able to access, for the purposes of such research, all the provincial records to determine drug safety risks?

[Richard Alvarez]

The answer to your question is one that we're basically working on right now, and we're working on it together with the Canadian Institute for Health Information, which does this type of work.

The issue for us is privacy and the security of the records. Clearly, if we have these data in these databases, it would be absolutely asinine for us not to be able to do it from a research perspective and a safety perspective. That said, one has to be very careful about Canadians' privacy.

[Terence Young, Conservative, Oakville, ON]

Can't you just search a record without the patient's name and address?

[Richard Alvarez]

Yes, that's exactly the kind of system that's being looked at currently. At the same time, we have also done focus groups and talked to Canadians about whether we can look at their records in an unidentified way, where the numbers are scrambled, etc. Basically, there was a high response rate to that question that was very positive.

[Terence Young, Conservative, Oakville, ON]

Thank you.

Thank you, Chair.

[The Chair, Liberal, Shawn Murphy]

I just have an issue following up on that, and I think Mr. Young is quite right here, that the benefits here are tremendous for Canadian society. I believe Infoway, according to the audit, is doing a very good job. You are well managed and well governed, and you administer your contracts effectively and efficiently.

But when you look at it on a Canada-wide basis, it appears that we aren't really doing that well. We're slow off the mark when you compare us internationally with other western countries, where, as you said, we are dead last. I believe some of the records indicate that 9% of clinicians are using this, according to the 2007 numbers.

So my question is—and perhaps we'll get Dr. Dodds involved in this question—who is responsible for taking this right to the next level? Infoway is not a heavily funded organization. I think you are spending your money wisely. But we are in a country with 14 different jurisdictions, and it is complicated. It's not an easy process, and I don't think we're making the progress that other countries are making.

We're using federal money to drive change, but when you look back at the 2004 agreement signed between the provinces and the federal government, our federal government hasn't done a good job of monitoring these agreements. While this doesn't have to do with the electronic health records, but with other issues, they basically let the provinces take the money, who stated they would not comply with the agreements or give the federal government the information and they got the money anyway.

So I guess my question is a general one. Who is responsible for taking this to the next level, which is so important for Canadians? Is it the Department of Health or Infoway? Can you give us some direction?

Perhaps, Dr. Dodds, we'll hear from you first.

[Dr. Karen Dodds]

Thank you very much for the question.

As both the Auditor General and Mr. Alvarez have noted earlier today, the federal government has given significant sums of money to Infoway over a period of time. I think that does show the understanding of the federal government that this does have benefits. It has been both Liberal and Conservative governments that have given funds. The benefits that can accrue to the system are apparent to different people.

I did ask my colleagues at Infoway just the other week. Mr. Alvarez said if you look at what we call EMRs, electronic medical records—that's what the community doctor, the family doctor, has in her or his office—Canada is dead last. I asked him if you looked at the EHR, the components drug information system, diagnostic imaging lab results, where would Canada stand? And the answer was that you would turn that around and Canada would be at the top.

Other countries have focused first on EMRs and they haven't necessarily taken a national approach. It's been a local doctor, and it's been that doctor and that doctor's patients who have had the benefit. What Canada has done, largely through Infoway's blueprint, has been to develop what I'll call the unsexy components of electronic health records.

And I'm very pleased with the latest $500 million investment. There is a big focus on the electronic medical records, because that is when physicians and Canadians will really see the benefits of all the foundational work that Infoway has done with the partners in the provinces and jurisdictions.

As Mr. Young said, that drug information database is not really useful until a doctor is using it when he or she is prescribing to a patient. Right now it's good at the pharmacy, but you also would like the physician to have that information when the physician is prescribing. You would also like to have the patient, himself or herself, be able to access that information.

So as we're now really accelerating that implementation of EMRs, I think you'll see the benefits accruing and you'll see more physicians moving to EMRs.

[The Chair, Liberal, Shawn Murphy]

Have you anything to add, Mr. Alvarez?

[Richard Alvarez]

Mr. Chairman, I apologize if I've left this committee with any sense that we're not making progress.

[The Chair, Liberal, Shawn Murphy]

I didn't suggest that. I—