Evidence of meeting #11 for Health in the 39th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was data.
A recording is available from Parliament.
President and Chief Executive Officer, Canadian Institute for Health Information
I certainly think the problem is not unique to Canada. I think cooperating internationally, wherever we can, makes a lot of sense for us. In many of the databases we hold, for example, we work with international standards.
Ultimately we hope to be able to compare Canada to some other countries. If we work on the same standards, I think that makes it much more possible in the future to do so.
Conservative
David Tilson Conservative Dufferin—Caledon, ON
Are we there now? Do we have the same standards as the European Union and the United States?
President and Chief Executive Officer, Canadian Institute for Health Information
I can't speak for our standards on adverse drug reporting; I'm not familiar with those. The example I'm most familiar with is hospital data collection. There are international classifications of hospital data that we at CIHI are the representatives of for Canada. We work very hard to make sure that data is collected in the same way across the country, and according to international standards.
Conservative
David Tilson Conservative Dufferin—Caledon, ON
How do you determine that there has been human error?
President and Chief Executive Officer, Canadian Institute for Health Information
The system we're building now looks to submission on the basis of individual practitioners, and there are thresholds that people have. I could ask my colleague Michael Hunt to speak to some of the specifics of that threshold.
Michael Hunt Manager, Pharmaceuticals, Canadian Institute for Health Information
As a statistical organization we actually don't make that determination or judgment as to when an error occurred, or if an error occurred. We rely on the institutions who supply us with data to make that determination prior to giving us the data.
Certainly we want to look at contributing factors. The goal with those is to look at things within the system that we can modify to make the system safer. We don't make the determination of when an error occurred; we collect the data around that error to be able to inform on preventative strategies.
Conservative
David Tilson Conservative Dufferin—Caledon, ON
Someone has to do that, though, to determine whether the problem is with the drug or whether there has been an over- or under-prescription.
Conservative
The Chair Conservative Joy Smith
Your time has run out.
Mr. Hunt, if you could summarize very quickly, I'd appreciate that.
Manager, Pharmaceuticals, Canadian Institute for Health Information
Within the data we collect we look at whether it is a product-related issue. Was it a naming, packaging, or labelling issue? Was it a systems issue? For example, is there a way to deliver drugs within institutions in a safer way? Was it a patient identification issue that contributed to the error?
There's a fairly large piece of data that needs to be collected around contributing factors to the error. Then you can apply that information to put forward better quality standards, so we deliver safer heath care.
Conservative
The Chair Conservative Joy Smith
Thank you, Mr. Hunt.
We're now going to to our second round. I'll remind members that our second round is five minutes for question and answer.
We'll start with Mr. Thibault.
Liberal
Robert Thibault Liberal West Nova, NS
Thank you very much.
It's regrettable that Susan Paetkau, if I'm pronouncing her name right, was unable to come.
I notice that she's co-chair, and I understand she co-chairs that with the representative of the federal government. I think we probably could have sent a dog team to Tunney's Pasture to get the federal representatives to come. I certainly hope they will accompany Madam Paetkau when she can come.
Conservative
Liberal
Carolyn Bennett Liberal St. Paul's, ON
We want them both here. We want the federal co-chair as well, because it seems--
Conservative
The Chair Conservative Joy Smith
Madam Bennett, you can submit your suggestions to the clerk. We'll certainly be--
Liberal
Carolyn Bennett Liberal St. Paul's, ON
No, no. They were part of the original ones. We need the federal co-chair.
Liberal
Robert Thibault Liberal West Nova, NS
Thank you.
When I look at the documentation provided in your presentation and past presentations, I see that on this question of data collection we have the MedEffect of Health Canada, we have NPDUIS that is shared between both your organizations, CMIRPS with CIHI, and COMPUS with the Canadian Agency for Drugs and Technologies in Health.
We have these four parallel organizations. Then we also have everything happening under Infoway, which hopefully is within these, but there might be some other silos or some other organizations. Yet at the end of the day, we hear from our witnesses, and I think it was confirmed, not statistically but in principle, by Dr. Benoit, that we know about only 10% of serious adverse effects or events, and we know very little about what we wouldn't consider serious--serious being something that requires hospitalization or further treatment that you can't necessarily solve by just discontinuing treatment--but what could be relevant.
It would seem to me that we should have 100% of those. Hopefully we'll be able to resolve that and get hospitals and clinicians to report on those.
In the case of those that are not life-threatening or that we don't consider serious--and I put this to Dr. Benoit as a practitioner--how do you know about them through your system? I know it would apply, especially in the case of off-label use of drugs, but even with regular use of pharmaceutical products for which there can be some adverse events that are not life-threatening, how do you know about events in the past or elevated risks involving them, under other practitioners?
Is there a good way out there? Is there a good exchange of information?
Chairperson, Patented Medicine Prices Review Board
Mr. Thibault, I work primarily in a hospital. I'm in a tertiary care hospital, so we have a quality assurance program that is quite intrusive. Even a minor medication error creates what we call an incident report. The incident report is then reviewed by the unit manager, and, if it is minor, dealt with. For example, the nurse gave—
Liberal
Robert Thibault Liberal West Nova, NS
Seeing that I only have five minutes, perhaps I'd like to ask the question this way. I take it that you have a good system within your hospital. Do we have a good system of sharing that with other hospitals and with sole practitioners working in a clinical situation?
Chairperson, Patented Medicine Prices Review Board
The answer, regrettably, is not as far as I know.
Liberal
Robert Thibault Liberal West Nova, NS
Perhaps I'll go to Madame Yeates on this one. You indicated that your organization is very good at standardizing the data we're receiving. In the coming years, with the systems that we are now working on or that we have in place, do you see this matter being resolved, given the way we are going? Are we heading to the point at which that information will be available?
President and Chief Executive Officer, Canadian Institute for Health Information
I think there's tremendous potential with things like the development of electronic health records and electronic medical records, but I also think that we, as a country, need to take specific steps and be clear about what we want. Standardization of data fields and definitions is not the stuff of headlines, but in fact it is very important for the data to be useful.
Unless we focus and are clear about what data we want to be collected in the same way and reported centrally, my sense is that there will be local solutions built, and we simply won't necessarily build in the capacity to share it centrally.
My own view is there's much opportunity in the future, but I think we will have to take specific steps and actions to ensure that we're clear about what data we think is useful.
Liberal
Robert Thibault Liberal West Nova, NS
Do you currently, in your systems, collect any data on adverse events related to off-label use? Do you have that as a separate category in your data?
President and Chief Executive Officer, Canadian Institute for Health Information
No, we don't.