Health Committee on Nov. 30th, 2009

[Some hon. members]

Oh, oh!

[Colin Carrie, Conservative, Oshawa, ON]

I certainly am.

[The Chair, Conservative, Joy Smith]

We'll have Dr. Carrie and Ms. Davidson, and we'll start with Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

I want to take this opportunity to thank our witnesses I think on behalf of all Canadians for your good work. Let's just say that I don't envy you working with all the provinces. I know there are certain challenges working among different jurisdictions. I like the results of the audit. Overall we are getting the job done, but it is very challenging. I can tell you from being on the ground that having these X-rays digitized is a wonderful communication tool. My background is that I'm a chiropractor, and it's just wonderful to have that.

Mr. Alvarez, you mentioned provincial-territorial collaboration, and the audit noted that Infoway's ability to achieve key outcomes in its funding agreements depends on the collaboration between the provinces and territories. I was wondering what Infoway is doing, or what it can do, to foster better collaboration with the jurisdictions.

[Richard Alvarez]

Madam Chair, thank you for that question.

I've been working at the national level now, having come from a province, for the last 15 to 20 years. I've never seen the kind of collaboration that is taking place between the federal government and the jurisdictions as I've seen around this particular project. Make no mistake about it, the jurisdictions are very keen to modernize the health care system. There are problems in sustaining our health care system and funding it. This is clearly an area where it could not only save lives but could actually save money. So they really want to get on with the job.

It is a complex job. If it were an easy job, incidentally, it would have been taken care of a long time ago. And it hasn't been taken care of in most parts of the world.

There is a high level of collaboration. Never before has the country agreed to a blueprint, an architectural diagram, of how these systems should work. Never before have they agreed to a set of standards, with federal leadership coming into play, so that every single province is not developing its own standards. After all, we have portability as part of our Canada Health Act. They've agreed to a set of standards. Now implementing the standards is always a challenge, depending on what they're starting with.

Never before have they agreed to a role wherein Canada Health Infoway does not fund provinces on a per capita basis. We fund them on the basis of results, and we fund them as a strategic investor in terms of take-up rates. As Madam Fraser has talked about, the use is going to be really important. We hold back 50% of those funds. The provinces have played by those rules. They realize that to leverage federal dollars, they need to get their own money as well. They need to get commitment from the highest level.

The level of collaboration from the provinces, I have to tell you, has been quite outstanding. For the last three or four years, I can tell you, the health ministers have made this the number one priority in health care, as they've written to the federal health minister and to others. We enjoy a very high level of collaboration in what is typically a fractious environment.

[Colin Carrie, Conservative, Oshawa, ON]

I appreciate hearing that, because often in various government initiatives you hear about what things are going wrong, but I think it's important to point out what is going right as well.

Am I about halfway?

[The Chair, Conservative, Joy Smith]

You're halfway now. Perhaps Ms. Davidson should continue.

Thank you, Dr. Carrie.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thanks, Madam Chair, and thanks very much to each of you for being here with us this afternoon.

I think Infoway is an issue that is perhaps a little misunderstood by the general public. Perhaps it's difficult for the general public to get a handle on it, when we're talking about electronic health records and also talking about electronic medical records. I think people become confused by the two.

Do you have a simple explanation, Mr. Alvarez?

[Richard Alvarez]

An electronic medical record is typically a record that is at a provider's location. Given that we all go to see our GPs, we want to build electronic medical records whereby a vast majority of your records will be there. Having said that, as individuals we seek services at times in emergency rooms, at clinics, in private labs, etc. At times, those records are locked away and don't actually make it back to the GP.

An electronic health record is ubiquitous around the patient. No matter where the patient moves, all of their records, all of their medication histories, lab results, and diagnostic imaging will be available. If the GP can download other points of care where care has been given into their medical record, it really becomes an electronic health record.

So one is ubiquitous around the patient—the health record—and the other is more location-specific.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you.

Do I have more time?

[The Chair, Conservative, Joy Smith]

You have one more minute.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Mr. Alvarez, what do you see as the biggest challenges and successes so far?

[Richard Alvarez]

I tried to point out some of the successes. I pointed out one success in British Columbia where, with a project like PharmaNet, pharmacists will have access to all dispensed prescriptions. They're picking up something like 2.5 million adverse events that could occur and are changing the prescription, typically in collaboration with the prescriber.

That was some seven years ago. Had this initiative not been started by the federal government and the provinces, I can tell you that today those systems would not be available in Alberta, Saskatchewan, P.E.I., or certainly in Ontario with all the emergency rooms.

There was a system that was producing great stuff, but there was no stimulus and no incentive to move it along. That has happened. Since we've been around, three-quarters of X-rays are now gone. We have the entire provinces of Newfoundland, Nova Scotia, and Alberta in which you won't handle an X-ray. No matter where you move, they can pull up your digitized images. Very important results have been produced.

I have to tell you that our 2010 goal really is a two-part goal. Part one says that by 2010 every single province and territory will benefit from some aspect of what we're funding. That, I can tell you, is happening. The other part says—the call to action—that 50% will have all of their meds, labs, and diagnostic imaging available through their practitioner. That's the one that is tough.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Alvarez.

We'll now go into our second round. There are five minutes for the question and the answer, so we're going to have to be sharp on it.

Ms. Murray.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Thanks for being here and helping us understand this. My questions are really about how this works.

When you say that two provinces are substantially there, Ms. Fraser, and that this is where most of the 17% comes from, which two provinces are they?

[Sheila Fraser]

Chair, they are Prince Edward Island and Alberta.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Does that mean that P.E.I. and Alberta would have had more than their per capita share of the funds and that this is what helped them get there, or were they already ahead of the pack, so will get less because they don't need as much help?

[Richard Alvarez]

I wouldn't say that they got a lot more than their per capita share; they've just completed their project.

I'll take one second to explain what we mean by this, because there's some confusion.

There are six fundamental elements that make up an electronic health record. There is one uniquely identifying Canadians, which we call a client registry. There is one uniquely identifying providers; we call it a provider registry. There's medication history, there's a drug database, there are lab results, and there is the diagnostic imaging. Those are the six components.

We're saying that Alberta and P.E.I. have switched on all six components, and they're working. The rest of the provinces are switching them on gradually, but they haven't switched all six on.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

How much of a barrier to your goals is a province that doesn't have broadband piped to its remote communities?

[Richard Alvarez]

The one part of the country we're struggling with is Nunavut. There certainly have been commitments that the broadband will be extended up to Nunavut by the time we're ready to roll out the systems. In Iqaluit, it's fine; we can get the systems there. But to get them down into the communities is going to take some work, I believe through Industry Canada.

In the rest of the country, we're pretty well served. In fact, we're very fortunate to be able to get what we need out there.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Last, we heard from a number of people recently in our health human resources study that multidisciplinary collaborative teams are the primary care of the future.

Do your standards and the direction you're setting include some of the other team members who should be part of a collaborative team, not necessarily just the doctors, but it may be naturopathic physicians or other complementary medicine primary care providers? How are you helping towards that goal of collaborative teams being able to work with electronic records?

[Richard Alvarez]

As I've said before, when you look at the six elements that we're talking about, it's building out those six elements. Once we've done that, it is a matter of access and authority to access those files.

Frankly, at the end of the day we want Canadians to have access to their own medication history, to their own lab results, and we want Canadians to allow whoever they want—a chiropractor, whoever they want—to have access to those files as well. There shouldn't be any reason that they shouldn't, once those files are available.

[The Chair, Conservative, Joy Smith]

You have some more time, Ms. Murray, if you want it.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

I do have another question.

Are provinces sharing best practices with other provinces, or are they each married to their own approach? I know that British Columbia changed from 53 to 6 health regions, with the goal of being able to integrate information technology in that province. Obviously, there may be similar challenges that other provinces can learn from.

How much are you helping them to share best practices and beg, borrow, and steal each other's successes?

[Richard Alvarez]

I have to tell you that one of the great successes, I believe, of an Infoway, which is no more than an instrument from a national perspective to bring the provinces together, has been aspects of commonality. Whether it is the architectural design adopted by the provinces, which is the standards, or whether it's entire applications, like the PharmaNet system, which we pick up from B.C. and implement and replicate in Alberta and in other provinces, or whether it's bringing three provinces together, as we did, and going out to tender for diagnostic imaging, saving something like $60 million because we had critical mass and putting it back into the system, there is a huge amount of collaboration.

Nobody wants to reinvent the wheel, which is a good thing, and we're a conduit, if you like, to best practice. We basically create toolkits and make them available to the country, not only to learn from lessons where there have been successes, but to learn from lessons where there have been failures as well.