Thank you very much.
I'm delighted to be here, and I'm really delighted that our government is taking this initiative to examine progressive licensing and pharmaco-surveillance. I think it is such a low-hanging fruit, a sure-win proposition, that I'm just thrilled to be here.
I don't think I need to convince anybody here that this is a good thing to do, because drugs are like surgery--they can cure you and they can kill you. Surgeons get controlled by hospitals. They have to have privileges. They do morbidity-mortality reviews, that kind of thing. But drugs...well, drugs get to be prescribed by everybody. Actually, there are 50,000 physicians--25,000 of them are primary care physicians--and they prescribe basically 80% of all the drugs. So there aren't the same natural controls here. So I think pharmaco-surveillance is definitely going to be an exciting initiative and one that's surely overdue.
Not only that, but what I would like to talk to you about is how you're going to do it, because we have some unique advantages in Canada that no one else in the world has. That has to do with the fact that we have a socialized health care system, that we actually provide services—come one, come all—for every Canadian. By virtue of having to administer a system like that across the board, we are like a series of health maintenance organizations--one in each province--that provide complete population coverage. If you get bankrupted by your health, you're not tossed out and no longer visible to the system. We count every one and all.
I would say that the only other countries that have the kinds of administrative systems that keep track of what everybody is doing are Denmark and Iceland. Those are the only other groups that have that kind of deep, detailed information on what's happening.
Now, what's exciting about this is that you're doing that anyway, so you can leverage that in. In fact, Canadian researchers have leveraged that. They have become leaders in the world in terms of how they actually assess the risks and benefits of drugs, using these detailed health services records that are maintained in each and every province.
What Mary referred to, and what Dr. Laupacis referred to earlier, is a proposition that was put together by a group of regulators, drug benefit managers, and researchers to say, “We can build a network across this country that will allow the timely observation and surveillance of who is using the drugs, how much they are using, and what the outcome is of that information on a daily basis”. That's possible, on a daily basis, with the information we have.
We haven't leveraged this opportunity. The data sit there in large servers and computers. Why don't we do that? I really don't know.
We've put together a proposition, during the first time that people such as myself have collaborated in such a broad scale with everyone, to actually link together these data repositories in each and every province. We will be the envy of the world.
Iceland actually sold its data. Saskatchewan has actually, I would say, more or less sold its data to the industry to have this kind of information.
We can have this information as Canadians. A proposition has been put forward; it's on the Health Canada website. I think we should be excited about that as Canadians, because I think we could become world leaders. This will be the place where people should come to actually assess the risks and benefits of drugs, using this data.
The second investment that we have made, which is also exciting and actually provides us with the complementary tools, is essentially the investment that we've started to make in the electronic health record in Canada. Some $1.4 billion has been put aside for upgrading the electronic health record in Canada. As part of that investment, about $34 million was put aside to create a repository of all drugs, all people, in each and every province. That information flows when the drug is dispensed into a repository. All electronic prescriptions would flow to those repositories.
Why is that information critical? The information is critical because in fact by putting in place essentially electronic prescribing, computerized, drug management systems for each and every provider in this country, we have certain huge assets. Number one, you have information on each drug dispensed for every Canadian. Number two, you have the potential to say, if you make this a mandatory requirement, “Why was that drug prescribed?” So you begin to be able to monitor why drugs are being prescribed. Are they being prescribed for people on whom the drug was tested or not?
I think that is a critical question, because in various studies I looked at, anywhere between 30% and 90% of some drugs are being used in people who have not been tested. That is a risk management thing we can actually address by essentially collecting that information through what we've already invested, which is an electronic drug repository, drug management system.
The second thing that is important about that is that should we achieve the objective of widespread adoption that is present, let's say, in Denmark, the United Kingdom, and Scotland, we would see almost 100% of physicians using electronic health records to deliver care. The advantage we have is that this would mean that with the repositories that have been built through Canada Health Infoway, that information on all labs, all diagnostic images, and all drugs would be available, irrespective of who prescribed them.
That means that for the first time ever a physician will have a complete drug history when they're prescribing. What drugs have you taken? What drugs have been stopped because you've had adverse effects from them or you've been allergic to them? What drugs should not be prescribed because there is another drug that another physician has prescribed that you don't remember, because you're calling it the purple pill? It actually is a magenta colour and is long and oblong, and there are 400 pills that shape and size that you'll have to figure out on your own, thank you very much.
We have this opportunity of leveraging this incredible investment that has been made to build these repositories, to say to each and every physician in this country and each and every pharmacist in this country that they shouldn't be prescribing or dispensing unless they have information on all of the drugs a person is currently taking or has taken in their medical history. We will have that information. That is the most exciting piece.
The second piece is when problems are identified. As Mary and Alan have pointed out, when problems are identified a piece of information is sent, essentially, to a physician to join the other 900 pieces of information that arrive daily on his or her desktop. That piece of information, instead of being sent by paper, essentially could be linked to the drug in the repository, and every time that drug is prescribed an alert fires to say that drug has just killed 300 people. An advisory is on this drug: “For this treatment, the indication that is this is not a good thing to do.”
This is possible in this day and age. We've already made this investment, and what it requires now is really a strategic decision about how we are actually going to leverage our investment so that we have the tools to actually do daily day-to-day monitoring for all Canadians through these two very exciting opportunities, where we've already made deep investments in Canada.
On a final note, while information technology is probably going to revolutionize the way we deliver care, one area where I'd have to say we're weak--in fact, we're at the bottom of the pile--is that we've built fabulous state-of-the-art resources where information resides and can be identified very effectively and accurately as being your information, but we have not addressed what other countries have done in terms of how to get the practitioners in our country to use that information.
We have some strategic decisions we need to make in order to actually have all 50,000 physicians, 150,000 nurses, and 60,000 pharmacists in this country using that information, so that we no longer have deaths because someone actually got three anti-coagulants because they didn't recall taking the first two, or an excessive dose of digoxin, which happened because two physicians were prescribing for them. This happens every day in our country, and it simply is not necessary.
Once we have this information, it can be a mandatory requirement that all stop orders on drugs get attached for a reason. Adverse effects and treatment ineffectiveness account for 66% of all stop orders in this country. Secondly, you can actually make it a mandatory field to have treatment indications so you know when people are getting drugs that are what I call the grand social experiment: they're getting drugs for which they weren't tested.
I would beg you to consider some of the strategic policies that were put in place in other countries, which have succeeded in achieving an almost 100% uptake of computerized prescribing electronic health records: a policy for paying for quality; support for training and transformation of practitioners in adopting electronic health records; and most importantly, the delivery of value-added benefits to those practitioners who work daily against all odds with a very archaic information system and need these value-added tools at the bedside.
Thank you very much.