Evidence of meeting #47 for Health in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was infoway.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Sheila Fraser  Auditor General of Canada, Office of the Auditor General of Canada
Richard Alvarez  President and Chief Executive Officer, Canada Health Infoway
Louise Dubé  Principal, Office of the Auditor General of Canada
Bernard Prigent  Member, Canadian Institutes of Health Research Governing Council, As an Individual
Alain Beaudet  President, Canadian Institutes of Health Research

3:30 p.m.

Conservative

The Chair Conservative Joy Smith

Welcome, everybody, to the Standing Committee on Health. We are delighted to have our witnesses here today, pursuant to Standing Order 108(2), a study of chapter 4 of the Auditor General's 2009 fall report on electronic health records. We have with us Sheila Fraser, Auditor General of Canada. Welcome. Everybody knows your face and your reports.

3:30 p.m.

Some hon. members

Oh, oh!

3:30 p.m.

Conservative

The Chair Conservative Joy Smith

So we have a celebrity with us today.

Neil Maxwell, assistant auditor general, we welcome you. Louise Dubé is the principal, and we welcome you as well. From Canada Health Infoway, we have Richard Alvarez, president and chief executive officer. Welcome, Mr. Alvarez. We also have Mike Sheridan, chief operating officer of Canada Health Infoway.

So we will begin. We'll start with Mrs. Sheila Fraser.

3:30 p.m.

Sheila Fraser Auditor General of Canada, Office of the Auditor General of Canada

Thank you, Madam Chair. We thank you for this opportunity to present the results of our audit on Canada Health Infoway Inc., which were included in our November 2009 report. As you mentioned, I'm accompanied today by Neil Maxwell, assistant auditor general, and Louise Dubé, principal, who were responsible for this audit.

Infoway was created in 2001 as a not-for-profit corporation at arm's length from the government. It describes its role as that of a strategic investor that works with the provinces and territories to foster and accelerate the development and adoption of electronic health records, EHRs, across Canada.

Electronic health records are intended to offer solutions to a number of persistent problems in Canada's health system, some of which can be attributed to the use of paper-based health records. With EHRs, it is expected that health care professionals would be better able to share patient information.

It is anticipated that this could result in reduced costs, improved quality of care, and lives saved. As of 31 March 2009, Infoway had spent close to $615 million and had committed another $615 million on electronic health records, for a total of $1.2 billion.

But it is still in its early days. Some experts have estimated the total cost of implementing EHRs Canada-wide at over $10 billion. We examined how Infoway manages the funds from the federal government to achieve its goal of making compatible electronic health records available across Canada.

Concurrent with our audit, six provincial audit offices audited how electronic health records funded by Infoway and/or provincial governments are being implemented in their respective provinces. The provincial audit offices are each reporting separately and we will table a summary of the federal and provincial audits next spring.

Overall, we found that Infoway has accomplished a lot since its inception and that it manages well the $1.2 billion in funds granted by the federal government to achieve its goal. There is good oversight of the corporation by the board of directors and Health Canada, the sponsoring department. Infoway has set the national direction for the implementation of electronic health records by developing an approach, as well as the key requirements and components of an electronic health record. It developed a blueprint, or architecture, for the design of the systems, and it developed strategic plans and a risk management strategy. Infoway worked collaboratively with, and obtained buy-in from, its partners and stakeholders, which is critical to the success of the initiative.

We also found that Infoway approves projects, which it cost shares with the provinces and territories, that are designed to comply with standards and align with the blueprint. We noted that Infoway adequately monitors the implementation of projects by provinces and territories.

We reported that Infoway needs to improve in certain areas. Infoway's 2010 goal is for 50% of Canadians to have electronic health records available to their health care professionals. We found that Infoway needs to report more information on results, in particular information on progress achieved toward its 2010 goal. To date, it only reports if systems are completed, not whether the systems are actually being used by health care professionals or whether completed systems meet the requirements for compatibility. This information on systems usage and compatibility would help Parliament and Canadians better understand progress to date.

We also found that Infoway approves projects, which it cost shares with the provinces and territories, that are designed to comply with standards and align with the Blueprint. We noted that Infoway adequately monitors the implementation of projects by provinces and territories. We noted that Infoway's controls over executive pay, travel, and hospitality are basically sound, although it could improve its contracting policy. Infoway has made a significant contribution to the development and implementation of EHRs, but important challenges remain. Reaching the goal of 50% of Canadians having an EHR available to their health care professionals by 2010 will be very challenging because they are only at 17% now.

Other challenges include upgrading legacy systems to ensure compatibility, ensuring that electronic medical records are used by primary care doctors, ensuring the compatibility of systems designed to allow patients direct access and control over their personal health information, and ensuring the privacy and security of personal health information. These challenges also need to be addressed by the provinces and territories.

Madam Chair, we are pleased that Infoway agreed with our recommendations and that it is developing an action plan. It has committed to clarifying its goal, to reporting additional information on progress achieved, and to revising its contracting policy. Because significant funds are spent on this initiative to implement electronic health records across Canada, and because the potential benefits offered by electronic health records are important to Canadians, this committee may wish to devote continued attention to the initiative by following up on progress achieved against the goal and against Infoway's action plan.

Madam Chair, this concludes my opening statement. My colleagues and I would be pleased to answer any questions that committee members may have.

3:35 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you, Mrs. Fraser.

We'll now go to Richard Alvarez from Canada Health Infoway.

Please go ahead, sir.

3:35 p.m.

Richard Alvarez President and Chief Executive Officer, Canada Health Infoway

Madam Chair, thank you for this opportunity to be invited here today for the presentation of the results of our recent audit by the Auditor General of Canada. With me today is Mr. Mike Sheridan, our chief operating officer.

I want to start by complimenting the Auditor General and her staff for what we believe is a thorough, balanced, and transparent audit conducted on Canada Health Infoway. Being an organization that strives for continuous improvement, we believe the implementation of the auditor's recommendations will strengthen Infoway.

The Auditor General pointed out in her November 3 news release that Canada Health Infoway has accomplished a lot since its creation. Needless to say, as its CEO I'm quick to agree with that, but I'm also quick to state that a lot more needs to be done.

Across Canada today, every province and territory and the populations they serve are benefiting from a share of the federal government's investments through Infoway in new information systems that will help transform health care. For example, our investments have helped eliminate three-quarters of X-ray films and replaced them with digitized images. The images are cheaper to produce, easier to store, and can be accessed by health professionals in various locations. Most importantly, they can be used to diagnose and help patients thousands of miles away in the remote and rural communities of our country. Today, as many as 40% of radiologists are now reporting on providing services in new or remote sites, eliminating anywhere between 10,000 and 17,000 patient transfers each year.

Leveraging Infoway's investments, drug information systems are now in place in B.C., Alberta, P.E.I., and Saskatchewan. Today, PharmaNet in B.C. captures every prescription dispensed in pharmacies and provides alerts to pharmacists and some physicians. For example, in 2008 more than 55 million prescriptions were processed via PharmaNet in British Columbia. Of those, 2.5 million significant drug interactions were identified. When you project that across Canada, this suggests that drug information systems could reduce about 55 million inappropriate prescriptions and identify more than 20 million significant drug interactions each year. In terms of lives saved and injuries prevented, that is hugely significant.

In Alberta, 20,000 authorized health care providers are active users of the electronic health record. Having the EHR in place has enabled Alberta to begin essential chronic disease management systems, like the management of diabetes.

The investment Infoway is making in the area of telemedicine is making a substantial impact in Canada, especially in the north, where all communities north of 60 are telehealth-enabled or are getting there. We're also on track to get 40% of first nations communities telehealth-enabled, with a focus on mental health and drug addiction services.

The Auditor General has quite correctly defined some of the challenges in making electronic health records available for 50% of Canadians by December 2010, and of course their subsequent use by health care professionals. I want to be clear that without the availability of these systems, use cannot and will not happen. It really is a two-stage process. Our jurisdictional partners are building and implementing the core system solutions for the electronic health records.

Developing such health information systems is very similar to constructing a home or a building. The building has to be available before tenants can actually move into the space, occupy it, and use it as it was designed and intended. In this joint initiative, as the Auditor General has so astutely noted, Infoway can move only as quickly as our jurisdictional partners are able. The jurisdictional deputy ministers of health have told me they are committed to making their best efforts to meet the December 2010 target of 50%. Again, I need to be clear: I believe it will be a challenge.

Infoway has accepted the Auditor General' s eight recommendations. We have completed an action plan for each of the recommendations, have shared the plan with the Auditor General's office, and have received extremely useful comments. It's our intention to file the action plan with this committee and with the public accounts committee by mid December, following a review of that action plan by my board this week. We intend to have the Auditor General's recommendations fully implemented during the next year.

In closing, I would like to say that while we remain committed to our ambitious call to action target of 50%, I do believe that we have a bigger challenge emerging, especially if we need to start equipping our community clinicians with electronic medical records to increase the use of the investment to date.

The time, Madam Chair, doesn't allow me to explain the difference between electronic medical records and electronic health records. However, the auditor's office has done a wonderful job in chapter 4, paragraph 4.4, which explains the difference.

Let me say that in a recent Commonwealth study of primary care in 11 countries, Canada had a deplorably poor showing. In an example from the study, Canada is last of 11 countries on doctors in communities using EMRs. We're second to last of 11 countries on routinely sending patients reminders for preventative or follow-up care. And we're second to last of countries where the practice routinely receives and reviews data on patient clinical outcomes.

These basically add up to one conclusion, as the Auditor General has said in her report:

Unless the percentage of primary care doctors using electronic medical records (EMRs) increases significantly, the potential benefits offered by electronic health records (EHRs) will not be fully realized.

As a country, we really do need to take the next logical step and focus on the implementation and broad adoption of the use of EMRs.

Madam Chair, that concludes my remarks.

Both myself and Mr. Sheridan would be delighted to take questions.

3:40 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you, Mr. Alvarez. I appreciate that.

Before we go into questions, I want to introduce a new analyst, Marie Chia. She will be joining our health committee, and we do welcome her here today and look forward to having her work with us.

We'll now go into our first round of seven minutes, questions and answers, beginning with Dr. Bennett.

3:40 p.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

Thanks very much.

Can you let me know the dates of the audit, the period of time you were in the field for this?

3:40 p.m.

Auditor General of Canada, Office of the Auditor General of Canada

Sheila Fraser

Madam Chair, our audit focused on the 2006-07 and 2007-08 fiscal years, and the audit work was substantially completed on April 30 of this year, 2009.

3:40 p.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

In this last budget, Infoway was given $500 million. It is noted in paragraph 4.105 in your report that there is no funding agreement yet for this amount. Is that the case as we sit here today?

3:40 p.m.

Auditor General of Canada, Office of the Auditor General of Canada

Sheila Fraser

I'm not aware of that, but Mr. Alvarez would probably be able to answer.

3:40 p.m.

President and Chief Executive Officer, Canada Health Infoway

Richard Alvarez

Yes, that is the case. At this stage, the money hasn't flowed.

3:40 p.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

Maybe from the Auditor General's point of view, do you think that is normal, that from a January budget, 10 or 11 months later there would be no funding arrangement put in place for something that clearly saves lives?

3:45 p.m.

Auditor General of Canada, Office of the Auditor General of Canada

Sheila Fraser

I really don't know the reasons why that has not flowed out to Infoway. Perhaps Mr. Alvarez knows. But no, it would not be unusual to see very long delays between a budget announcement and the actual issuance of funding. This has occurred in other situations.

3:45 p.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

But within a government department to an arm's-length agency, surely that.... This money didn't have any particular designation. It was a free $500 million to Infoway. What kind of trouble could one have in negotiating that?

3:45 p.m.

Auditor General of Canada, Office of the Auditor General of Canada

Sheila Fraser

I could only say there was a budget announcement, but after that, of course, it has to go through all the process of funding submissions, of approvals by the Treasury Board, and on and on. And it depends, obviously, on the speed with which departments move this through.

Mr. Alvarez may know some of the reasons that--

3:45 p.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

The trouble for those of us on the committee is that everything we've said is accelerate, accelerate, accelerate. And certainly, from the Conference Board study that showed we would save $6 billion in the health care system in Canada, to the people who had wanted to testify today from the medical association, to the health care associations, pharmacists, nurses.... Even on H1N1, the Canadian Nurses Association cited the lack of the transfer of the $500 million as being problematic in terms of moving the system.

I guess I am concerned as to what could be the hold-up when that's as important as it seems to be to everybody we talk to.

3:45 p.m.

Conservative

The Chair Conservative Joy Smith

Who would like to comment on that?

Mr. Alvarez.

3:45 p.m.

President and Chief Executive Officer, Canada Health Infoway

Richard Alvarez

Madam Chair, I should say that the specific reasons are still unclear. Having said that, in the government's third report on the economy to Canadians, the $500 million was marked with an asterisk, which basically indicated “due diligence”.

To be perfectly honest, given some of the scrutiny that has been placed on eHealth Ontario, it's hardly surprising that any government would want to do further due diligence on an organization like Canada Health Infoway, although we're not in the same business as eHealth Ontario. That said, the auditor's report basically speaks for itself. It came out early this month, and I hope the government will take that into great consideration as part of their due diligence.

3:45 p.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

What does the asterisk usually mean in terms of due diligence?

Just to make it clear to everybody, did Infoway give any money to eHealth Ontario?

3:45 p.m.

President and Chief Executive Officer, Canada Health Infoway

Richard Alvarez

Let me answer your last question first. The answer is no. We didn't give any money to eHealth Ontario. We don't even have a contract with them. We have a contract with the ministry.

The funding model that Infoway employs is a funding model that basically pays for results. If you don't get results, you don't get the federal funds.

We've had some terrific results in Ontario, such as the diagnostic imaging systems I've talked about, and certainly such things as having the drug systems for seniors available in emergency centres, as well as many good telehealth systems. We did fund those systems and we did get results.

In terms of the asterisk, we read the report, which said due diligence was being conducted. I would hope that part of that due diligence is what the Auditor General of Canada was doing, and I hope the government will take that into consideration.

3:45 p.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

So to get the clean bill of health to say that you've accepted the recommendations of the Auditor General and will put in place an action plan, what are you now in negotiations with to get that asterisk removed and the money to flow?

3:45 p.m.

President and Chief Executive Officer, Canada Health Infoway

Richard Alvarez

We're really not in any negotiations, so to speak. The government did allocate this money in their budget. Based on some of the goings on, certainly in Ontario, we suspect we were put under due diligence. For the last 18 months, the Auditor General has been conducting a major report. As I've said before, we certainly hope the government takes the findings into consideration, and the fact that--

3:50 p.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

Can you maybe go even further to explain what kind of stimulus an investment in eHealth can be in terms of an economy? I think you gave a very impressive presentation in the pre-budget consultations, as substantiated by the Conference Board. Can you explain?

3:50 p.m.

President and Chief Executive Officer, Canada Health Infoway

Richard Alvarez

As part of our submission, we brought forward a report that was done by the Conference Board of Canada, which says for every $100 million, 1,500 knowledge worker jobs are created in this country; that for every dollar spent, the GDP is increased by $1.34. These are knowledge worker jobs that are dedicated to the digital economy, which Canada hopes to become. And there are many other economic numbers in that report that are exceedingly positive.