Health Committee on Feb. 7th, 2008

[Patrick Brown, Conservative, Barrie, ON]

So you also work with individual practitioners. You mentioned orthopedic surgeons, but what about family physicians? When you think of the physicians outside of hospital settings, are there vehicles similar to the one you mentioned for hospitals that would enable those physicians to report on an active level?

[Glenda Yeates]

At the current time I think the reporting mechanisms are better for institutions than for individual practitioners. But there are two initiatives there that I will speak to.

We are all hopeful that electronic medical record development in the country will enable data flow and feed back information that primary care practitioners will find useful. We are also working with the College of Family Physicians of Canada on certain things right now to understand whether we can have a partnership with them that would meet the needs of some of their members for data, and comparable and standardized information.

So where there is a will to collect data in a standardized way, we certainly work well with a variety of health stakeholders across the country.

[Patrick Brown, Conservative, Barrie, ON]

Are there any comments on that?

[Dr. Brien Benoit]

Not really. At the family doctor level there are probably many adverse reactions. At the moment, if a serious adverse reaction occurs the physician is obliged to inform the Ministry of Health or the medical officer of health of his municipality. That's an ethical obligation, but it's not mandated by law.

[Patrick Brown, Conservative, Barrie, ON]

Because we've heard that 10% figure, it makes you ponder what ways there are to find out if there's a much greater percentage of adverse reactions. I'm curious about what potential vehicles exist to enhance that reporting so we can have a greater effective knowledge of the reactions out there.

This may not fall within your ability to comment, but I've asked folks previously at this committee about Health Canada and whether they should have the authority to recall pharmaceutical products, either prescription or non-prescription. Do you think it would help this overall issue if Health Canada could recall products?

[Dr. Brien Benoit]

I really have no comment on that.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Brown.

Mr. Dhaliwal.

[Sukh Dhaliwal, Liberal, Newton—North Delta, BC]

Thank you very much, Chair.

I welcome the panel. I'm probably the newest person on this committee today.

I will pick up where Mr. Brown left off. I was at the Surrey Memorial Hospital and ran into one patient who was the victim of adverse effects as a result of a physician prescribing that medicine. Instead of it being simply professionally ethical to report these to the Ministry of Health, should we make it mandatory for health professionals and institutions to report these adverse effects?

[Dr. Brien Benoit]

That's the only way you're going to get a high level of compliance.

[Sukh Dhaliwal, Liberal, Newton—North Delta, BC]

Ms. Yeates, do you have something to add?

[Glenda Yeates]

We have a number of databases that are voluntary, and it really depends on whether the practitioners are interested in reporting. For example, in our orthopedic joint replacement registry database, upwards of 70% of the orthopods across the country are submitting data.

[Sukh Dhaliwal, Liberal, Newton—North Delta, BC]

Do you agree with Dr. Benoit that it should be made compulsory, to improve on this 10%?

[Glenda Yeates]

Given our history and what I've heard people say, voluntary reporting has not led to very high percentages. It may well be that a different approach is appropriate. On whether that needs to be mandatory or whether there should be some other series of possible options, I haven't studied that matter and don't have a view.

[Dr. Brien Benoit]

It is mandated in Ontario that a physician must report to the Ministry of Transport if a certain individual is not able to drive a motor vehicle. Then the ministry asks the patient what their problem is. If we have somebody with unstable diabetes, angina, seizures, or whatever, we are obliged to tell the Ministry of Health that person has a condition that would preclude their driving a motor vehicle. That is mandated by law, and every physician automatically does it if that circumstance arises.

[Sukh Dhaliwal, Liberal, Newton—North Delta, BC]

My question is to Glenda Yeates.

Because I am pretty new to this, what is your relationship with the health care providers and the professionals? How do you fit with those fellows?

[Glenda Yeates]

We are essentially a vehicle for the collection of data, so we don't have a mandate to make recommendations, to make policy prescriptions, to regulate anything. But we know that many people who do have those mandates to regulate, to make major decisions, whether that's within a regional health authority or a hospital, or at a provincial or a federal government level, need data to make those decisions, and they need it standardized and collected. So that essentially is where we fit in.

Our expertise is to work with the stakeholders across the country. We are not a federal nor a provincial body, so we can work well with most stakeholders in the health system to understand what data they would need, what would be feasible to collect, and we operate in that way and then provide the data to our stakeholders for their use. Those uses sometimes are regulatory, sometimes they're decision-making needs, sometimes they're just an individual hospital wanting to know how they're doing.

We then also make reports to Canadians. For example, we put out indicators that would give the Canadian public some sense of comparability in terms of indicators.

[Sukh Dhaliwal, Liberal, Newton—North Delta, BC]

My understanding is that you don't get involved in the post-market surveillance, then. Is that true?

[Glenda Yeates]

That's right, at the current moment we are not involved.

[Sukh Dhaliwal, Liberal, Newton—North Delta, BC]

And how would you, if you need to?

[Glenda Yeates]

Well, we are a data provider. I think the relationship with PMPRB is probably a good example of where we have data. Again, all of the legal arrangements, all of the arrangements allow us to pass that data on in a very appropriate way, under appropriate conditions, to someone else to do another function in the health system. I think we would have the ability to do that. In fact, the drug database that we are currently building, that's been spoken of this morning, wouldn't be able to do everything, but, again, I think it would have some power to assist in that process.

Given how expensive it is to collect data and given it's expensive to standardize it, it does make sense to understand what exists now and how that might feed into or support post-market surveillance or any other number of health activities.

[Sukh Dhaliwal, Liberal, Newton—North Delta, BC]

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you very much, Mrs. Yeates, and thank you, Mr. Dhaliwal.

We are now going into a third round, which is quite unusual, but because of the lack of our third witness group we're allowed to do that.

We also have, committee members, two issues on business that we need to discuss after we have questioned all the witnesses.

We have Mr. Fletcher, Ms. Gagnon, Mr. Brown, Mr. Fletcher again, and Mr. Temelkovski.

I would ask that we start now. It's still a five-minute round, but you don't need to use all that five minutes if you don't choose to.

Mr. Fletcher.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

Going back to the real world and data integrity, a doctor in an institution or in the community prescribes a drug, an adverse reaction occurs, he or she is obligated to report it. What incentive is there for the doctor to report it? I can think of a lot of disincentives, not the least of which could be possibly legal issues or paperwork or just not accepting that there was an adverse reaction. How do you deal with those types of situations or how do you account for those types of situations when you're examining data?

I guess that goes to CIHI.

[Glenda Yeates]

I think your point is very well taken. There are many times when we will receive data because someone has mandated it, so either the hospital says it must happen or.... In the case of the hospital databases that we have, for example, it's usually the province that requires that their hospitals all submit data to us so that they can have an overall standardized picture of what's happening.

In some instances there is an incentive that drives enough data submission, but in general, I would say, there has to be someone who decides it's important to collect it. Because, as you say, it takes time, it takes money, it may be inconvenient, people may perceive risk to collecting it, often they need to have that mandated in some cases. For the databases for which we have the most complete coverage, those have been, generally speaking, mandated, often in our case at a provincial level.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

To go back to my previous line of questioning, which you didn't have an opportunity to respond to, have you been in discussions with other jurisdictions in regard to post-market surveillance, or even looking at post-market surveillance?