Health Committee on Nov. 30th, 2009

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Alvarez.

We'll now go to Ms. McLeod.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you, Madam Chair.

I appreciate the review of this very important issue and the enthusiasm that Mr. Alvarez brings to the work he's doing.

This is near and dear to my heart, and within our region we've just made incredible progress, from the X-rays, by which you can clear people in a rural emergency and they don't have to transfer to larger communities, to chronic disease toolkits.

In Williams Lake right now, they have a nurse. The thoracic surgeon in Kelowna is reviewing.... Through telemedicine, the thoracic surgeons are seeing them, doing consultations. In another community, again funded by Health Infoway, the congestive heart failure patients are being sent home and are being monitored through some home devices. They're having a huge impact upon stays.

I have a few questions, and my first one is this. I understand that public health is looking at a Canadian-wide system—Panorama, is it? What is Health Infoway's role in that? How, with this current H1N1, would it have made a difference—how, and what difference?

Mr. Alvarez, could you respond?

[Richard Alvarez]

Panorama is a system that is being built for the country. It's a system where B.C. took the leadership role on behalf of the country. It's the only system I know of where every single public health officer and chief information officer came to the table over several months, probably 18 months, with a common specification and design. It is a system that will cover alert management, outbreak management, case management, immunization, etc. Unfortunately, it wasn't ready to roll out in time for the H1N1. It will make a huge difference, as further pandemics—unfortunately—come to our shores, in terms of an alert perspective, an outbreak perspective, an inventory control perspective, just controlling how many vaccines we have and who's getting what vaccines.

In this country, for example, public health physicians have never had access to lab results, and that's going to happen. With the Panorama system and the EHR as we're building it, with the lab results, they will have access to those.

There is no system of its nature anywhere in the world that is being rolled out like that, including in the U.S. Unfortunately, I say, really, we didn't have enough time to roll it out for H1N1, but it will make a substantial difference. It's being rolled out in B.C., Ontario, and Quebec at this stage.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

So right now it's designed. Is it being cost-shared? Is it money you've committed out of the $1.6 billion?

[Richard Alvarez]

We received $100 million from the federal government. When we went to market to look at the specifications, the bill was something like $300 million. We obviously couldn't afford the $300 million, so we had to sit the country down and say we have to make some concessions somewhere in terms of the specifications, and we cut it back I believe to $130 million, $150 million. A lot of those costs are actually in the implementation of the system, so we have spent a part of that, but as we roll it out we'd be spending time in terms of training and the testing of these systems across the country.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

You talked about the difference between an electronic health record and an electronic medical record, and I'll again use British Columbia as an example, where I know they've finally gone through the process of creating five that meet the standards for the electronic medical record. We now have large groups of physicians implementing that in their practices.

I understand that's part of your future phases. Has the work that's going on in terms of the electronic medical record within British Columbia been picked up by the provinces solely, or again, is there some support from Health Infoway?

[Richard Alvarez]

Madam Chair, this was part of the $500 million, where we needed to accelerate the medical record at the community level. So far the heavy lifting has been done by the provinces, but it's moving up too slowly. We are really at the back of the bus when it comes to the rest of the world. We were there, and were probably quite content to be there because our southern cousins, in the U.S., were sitting in the seat next to us. That's all changing, with the $20 billion Obama has put into accelerating their electronic medical record. I can tell you there are going to be huge advances in the next two years in the U.S., and we're working very closely with Washington on that.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Alvarez.

We'll now go to Monsieur Malo.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you very much, Madam Chair.

Good afternoon to everyone.

Ms. Fraser, I can't help but ask you a question since you are here before us. If you can't answer it, I'll understand. Please feel comfortable. This is not a trap. I simply want to know what the situation is.

Health Canada has had difficulty planning the human and financial resources and the necessary time to approve natural health products.

I simply wonder whether your office was asked to look into this matter to determine in greater detail why all that had happened. If not, would it be possible for you to do that?

[Sheila Fraser]

To date, we haven't examined that issue, and I don't believe that's planned for the next two or three years.

Perhaps Ms. Dubé could give us more details on that subject. I believe that drugs are the next issue we will try to address.

[Louise Dubé, Principal, Office of the Auditor General of Canada]

We're conducting a follow-up on medical instruments. That's scheduled for spring 2011. We're currently developing a long-term plan for future audits. We should be finalizing it in the next few months.

[Sheila Fraser]

That will have to be consolidated.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Very good. Thank you very much.

Thank you, Madam Chair.

[The Chair, Conservative, Joy Smith]

Thank you very much, Monsieur Malo.

I want to say a special thank you to our guests today. I know we have about three more minutes. Would anyone else like to ask questions?

You're completely finished, Monsieur Malo? Okay?

Now we go to the Conservative side. Would anybody there like to ask a question?

Ms. McLeod, I know you were right in the middle of something when I had to go to Monsieur Malo.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

No, other than congratulations. I know my colleague from the NDP was concerned, but it's been identified that this is a huge task and it's huge change management. I think we're making some good progress on some really important work. Again, I appreciate the enthusiasm and the passion. And I am really appreciative of an audit report that reflects the good management.

[The Chair, Conservative, Joy Smith]

We do have a couple more minutes.

Ms. Wasylycia-Leis, did you have a quick question?

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Back to eHealth Ontario compared to Infoway--and I know there is a big difference--eHealth Ontario got started when people didn't practise proper oversight and contracts were untendered and there were single-source contracts. You've said there are some, in the case of Infoway. Do we not need to be cognizant of where that can lead and how we can watch for that and make sure we're not going down that path, leading toward a similar scandal at the federal level?

[Sheila Fraser]

I think, Madam Chair, that organizations always have to be vigilant and always require good governance and oversight. And we did see that the board of directors, in the case of Infoway, was providing that governance and oversight and was being rigorous in the kinds of information.

The issues we raised in contracting out say there were only five out of over 500 contracts that we saw that had been sole-sourced. The issue we had with contracting related to Infoway's own policy about how they reported amendments to contracts, and this is something they had indicated. So we certainly saw nothing at all similar to what was happening at eHealth.

[The Chair, Conservative, Joy Smith]

Thank you very much, Ms. Fraser and all our witnesses today. It was very insightful and very useful having you come. We appreciate the time you have taken.

Now I will suspend the meeting for two minutes, and we'll ask our other guests to please take their chairs.

[The Chair, Conservative, Joy Smith]

Good afternoon.

Welcome to the committee. We're very pleased to have you here today.

We have before us, pursuant to Standing Orders 110 and 111, the order in council appointment of Bernard Michel Prigent to the position of member of the governing council of the Canadian Institutes of Health Research, referred to the committee on October 21, 2009.

Welcome, Dr. Prigent.

We also have here today, from the Canadian Institutes of Health Research, Dr. Alain Beaudet. We're very pleased to have you here.

We ask that you make your presentations, but prior to that, Ms. Wasylycia-Leis has asked for a point of order to be addressed.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Thank you, Madam Chair. I won't take too much time.

I originally brought this motion to the committee, so I have a real concern with making sure it is followed through appropriately.

I want you to know, Madam Chair, that I did speak to Dr. Beaudet and indicated to him that I would have no trouble with his appearance here today. I thought it was only appropriate. However, I certainly didn't assume it would mean no other witnesses would be permitted, so I want to do a couple of things right now.

First I want to table my letter to you, Madam Chairperson, as of this past Friday, indicating my concern for the refusal on your part to entertain any other witnesses who were willing and able to come. They include Dr. Patricia Baird, Dr. Noralou Roos, Dr. Joel Lexchin, Dr. Abby Lippman, Dr. Steve Morgan, and Dr. Trudo Lemmens.

In the letter I'm tabling, Madam Chair, I indicated that I certainly didn't expect all of these witnesses to come. I knew we were limited in time. I suggested that one voice bringing an alternative perspective to this debate would have been very useful. I'm disappointed that you disregarded the recommendation and did not bring it to either the steering committee or this committee as a whole before you made that decision. I will table the letter and seek the advice of other committee members as to appropriate action.

Let me also table a petition of some 2,085 names of concerned citizens around the appointment of Dr. Prigent to CIHR.

Finally, let me reference the considerable correspondence that we've all received from numerous scientists, researchers, and health care specialists around the country. If it is appropriate, I would be happy to table all of those as well.

I don't want to take up the time of the committee. We have two courses of action. One is to schedule another meeting to hear from other witnesses, which would be my preference. However, it would have to be done, and a report sent back to Parliament, before December 9. It would mean we would have to make this decision rather quickly and have it happen by no later than next week.

The other option for us would be to just swallow what has happened, to grin and bear it, and to bring a motion later on for how we as a committee will deal with this kind of situation in the future. I'm certainly prepared to do that.

[The Chair, Conservative, Joy Smith]

I'll just speak to that for a moment, and I thank you for your presentation.

Your motion is there, and the cut-off is December 9. This is November 30.

A lot of witnesses were brought forward. The decision was made in the best interests of the committee, because when we calculated the time, Ms. Wasylycia-Leis, we discovered that it came to 48 minutes, plus another question. We would have run out of time. I thought the committee was very clear that it wanted to be able to hear from Mr. Prigent and Mr. Beaudet, and one of your witnesses--Mr. Beaudet--is a request you had, so we brought Mr. Beaudet forward. That request came from your office, so you did get your one witness.

Go ahead, Dr. Bennett.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Madam Chair, with due respect, my understanding of the people who are objecting to this appointment...they are very well known to one another, and I'm sure they would have been able to select somebody to speak on their behalf in terms of being able to have one witness who was opposed to this appointment and who would speak. Certainly, in the e-mails that I have received, from some of the most prominent health ethicists, professors, and health law professors, it has been quite a tsunami of objections. I will go along with my colleague as to whether or not we would table the e-mails we've received to date, as well as the petitions, in that these are very eloquent and persuasive arguments that they've brought to us.

As we unfortunately know, this committee can only express our concerns to the House. I think you will find that there are concerns. Because we are up against the time limit of the parliamentary break, I would take from my colleagues as to whether we need to hear these people in person or whether by the end of today's hearings we'd be able to make a decision based on what they've written to us already.

[The Chair, Conservative, Joy Smith]

Ms. Wasylycia-Leis.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

First of all, it is true that we had submitted the name of Dr. Beaudet. I certainly wanted him before the committee, but under no circumstances did I suspect that would be the limit. In fact, the list of the names I gave you were checked out, and we knew there was at least one person who would have been able to make it today, if not two. Certainly, Dr. Noralou Roos, who is in Ottawa for an important award, was prepared to come, and so was Dr. Trudo Lemmens, from Toronto. I think that would have ended this matter today and we would have been able to deal with it. But since we did not get a chance to hear another side, I think we should actually meet on Monday, December 7, have one more hour of discussion, and put our report in before the deadline of the 9th.

I also move that.