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 really do not have an opinion on the subject.
Bloc
February 7th, 2008 / 12:05 p.m.
Conservative
Steven Fletcher Conservative Charleswood—St. James—Assiniboia, MB
Thank you, Madam Chair.
I'm interested in the integrity of the data. People will receive drugs either in an institution or in the community. Does CIHI have any data for people in the community?
President and Chief Executive Officer, Canadian Institute for Health Information
Yes, the NPDUIS database is in fact based on community claims from provincial drug plans. We don't actually have drug data for in-hospitals, but we would have drug data from public drug plans, which typically are drugs that are prescribed in the community.
Conservative
Steven Fletcher Conservative Charleswood—St. James—Assiniboia, MB
How are you tracking adverse events?
In the community—I'm just trying to figure this out on the ground—the doctor fills out a prescription on a little piece of paper. Generally, you can barely read it. I don't know what your handwriting is like, Dr. Benoit, but the handwriting I've seen from your profession is not something to write home about. That prescription goes to the pharmacist and they somehow decipher it. Right at that point, there seems to be lots of room for error. The pharmacist, then, fills the prescription. Who knows if the person is taking the medication as prescribed? If something bad happens, it's blamed, perhaps, on the medication, or perhaps it's due to something completely different. How can you tell? And how do you mine for accurate information?
Chairperson, Patented Medicine Prices Review Board
Mr. Fletcher, the questions you're posing are the obvious ones in the current context of what we're discussing here today.
It would be extremely difficult, because compliance with the prescription is one of the big problems the medical profession faces. In the context of a clinical trial, where everybody is being surveyed and you come to the clinic and the nurse checks you and they look in the pill bottles to see how many are left and so on, it's very easy to come to a conclusion that this dose or this medication is effective. But when you get out in the real world, where the patient says, “My headache was worse today, so I took four pills instead of the prescribed one pill”, I don't know how you'd ever be able to control that. Perhaps you'd have to ask the health professional, the nurse or the doctor, to code some kind of reaction to that. If we go to electronic medical records and so on, it may be easier, but right now it's very difficult.
Conservative
Steven Fletcher Conservative Charleswood—St. James—Assiniboia, MB
Is it even possible? You could code it and everything else, but even at that initial step, from the recommendation to the pharmacist, it could be garbage in, garbage out.
What do other jurisdictions do? Are there any examples of this working?
Chairperson, Patented Medicine Prices Review Board
I'm not sure I totally understand your question. Could you rephrase it?
Conservative
Steven Fletcher Conservative Charleswood—St. James—Assiniboia, MB
Okay. Is there any jurisdiction in the world where post-market surveillance of pharmaceutical products is conducted, in the institution or in the community, in a manner that has credible findings?
Chairperson, Patented Medicine Prices Review Board
I don't know the answer to that. Your point is why reinvent the wheel if some other country or organization has come to some kind of arrangement in terms of what we're thinking of doing.
Conservative
Chairperson, Patented Medicine Prices Review Board
I don't know the answer to that, Mr. Fletcher.
Conservative
President and Chief Executive Officer, Canadian Institute for Health Information
No, it's not a question we've looked at, I'm sorry.
Chairperson, Patented Medicine Prices Review Board
The issue of post-marketing surveillance and the reporting or evaluation of adverse reaction is something relatively new, at least to our organization. We're invited here today presumably to give our opinion from the point of view that we come from, but we've never been approached in any direct way to get involved with this.
Conservative
Steven Fletcher Conservative Charleswood—St. James—Assiniboia, MB
Well, if we're going to do something about it, it would seem to be a wise move to investigate what happens in other countries and what other countries are doing. I don't know who the committee could ask about that.
At CIHI do you guys meet your counterparts internationally, or do you have contacts internationally?
Chairperson, Patented Medicine Prices Review Board
Mr. Fletcher, as a matter of fact, our particular prices are compared with...I think somebody mentioned the European Union. We have seven countries that have similar health care systems to our own, with whom we compare the prices. It may be--
Conservative
Steven Fletcher Conservative Charleswood—St. James—Assiniboia, MB
Yes, I know that, but we're talking about surveillance--
Chairperson, Patented Medicine Prices Review Board
Somebody would have to ask them.
Conservative
The Chair Conservative Joy Smith
Mr. Benoit, our time is up for this particular question. Do you have anything else you would like to add to that?
Conservative
The Chair Conservative Joy Smith
Thank you so much.
The next in line would be the member from the NDP, but she's not available today. She's on another assignment.
I will go to Mr. Brown, please.
Conservative
Patrick Brown Conservative Barrie, ON
Thank you, Ms. Smith.
There's one part of the question that I didn't get to in my last round. Hospital reporting has been mentioned, and I wanted to touch on the manufacturing, on how a manufacturer would be made aware of adverse reactions as well. You mentioned that hospitals would have a vehicle through which they'd be able to report.
Can you think of a similar vehicle through which manufacturers would be able to report? And because they don't have the same direct monitoring of a patient that a hospital would, is it even possible, from your perspective, to keep accurate statistics on that?
President and Chief Executive Officer, Canadian Institute for Health Information
Well, we in a sense have prided ourselves on being able to work with people across the health sector in ways that make sense for the task. We have submissions directly from hospitals. In some cases, we have submissions from provinces. We'll have an entire province hand over data to us. In other cases, we work with individual medical practitioners. Orthopedic surgeons submit joint replacement data to us for that particular registry. Again, if there is the mandate, if there is the desire, if there is funding....
We work well with others in the health sector to support the health sector's data and information needs. Certainly that has involved working with the private sector in others of our databases. Again, if there is a will, if there is a desire, we can certainly accommodate submissions from others.
