Health Committee on Nov. 30th, 2009

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Alvarez.

We'll now go to Monsieur Dufour.

[Nicolas Dufour, Bloc, Repentigny, QC]

Thank you very much, Madam Chair.

I want to thank the witnesses for being here today. I mainly want to thank Ms. Fraser because I know her time is extremely important.

Thank you very much.

In your statement, you talked about Infoway's goals. I'm going to read a quotation:

By 2010, every province and territory and the populations they serve will benefit from new health information systems that will help transform their health care system. By 2010, 50% of Canadians and, by 2016, 100% will have their electronic health records available to their authorized health care professionals.

This leads me to ask you the following question. In your opinion, have the provinces received enough money to date to achieve the goals set out for Infoway by 2010?

[Sheila Fraser]

Madam Chair, that's perhaps a question that Mr. Alvarez could answer. We don't audit the provinces. I don't believe our auditor colleagues in the provinces look at that issue in their audits. We can simply look at management of the funds that have been allocated to Infoway.

[The Chair, Conservative, Joy Smith]

Again, we'll go to Mr. Alvarez.

[Richard Alvarez]

Bonjour.

Let me give my response in two parts.

I said this is very similar to building a house. You have to have the house built and available and then you can sell it and it can be used. So in terms of having the house available and the systems for 50% available, the answer is yes. The provinces have enough money.

Do they have enough money for the use? The answer is no. To incent use, which involves a lot of training and change management, we are going to need more money. And that was part of the $500 million.

One of the incentives for provinces is not just building it but making sure that people come and use it. So use goes hand in hand with construction.

[Nicolas Dufour, Bloc, Repentigny, QC]

Thank you very much.

The following passage in the Auditor General's report is interesting. It reads as follows: Some experts have estimated the total cost of implementing EHRs Canada-wide at over $10 billion, and Infoway concurs.

To date, the federal government has invested $1.2 billion in Health Infoway. If it didn't invest the amount the experts have estimated by 2016, would the project risk being compromised?

[The Chair, Conservative, Joy Smith]

Go ahead, Mr. Alvarez.

[Richard Alvarez]

The answer to that would be no. In the federal government, part of the model of Infoway is that for every dollar the federal government invests, we leverage that dollar with a provincial dollar; if $1.2 billion is invested by the federal government, then rest assured that about $2.4 billion is being spent, because that's been leveraged.

Part of the use of these systems is the electronic medical records in physicians' offices in primary care, and that's a big part that is missing. Part of the use would be Canadians having access to their own information, their own medical data, as well. That's very much part of the $10 billion that we're talking about.

[Nicolas Dufour, Bloc, Repentigny, QC]

According to Health Infoway, as of March 31, 2009, only 17% of Canadians lived in a province or territory where a complete electronic health records system was accessible.

Health Infoway intends to achieve its goal of covering 50% of the population by December 31, 2010 at the latest. We noted that, based on Health Infoway's own assessment, the risk of not achieving that was high.

What do you at Health Infoway intend to do to achieve that goal?

[Richard Alvarez]

Thank you.

The goals, first, are a call to action. They are premised on the goals put forward by the provinces and the territories. As Madam Fraser has said, at Infoway we can only move as quickly as the provinces and territories move, so based on the plans put forward, we felt that by the end of 2010 we should be able to get to 50%.

These are complex projects. Today we're at 17%. Remember that the larger the province you are--meaning Ontario, Quebec, and British Columbia in particular--the more you will contribute to that 50% goal. With the best evidence we have today, we're still fairly confident that we're going to get close to the 50%, on the understanding that the provinces keep their commitments and keep driving the projects forward.

[Nicolas Dufour, Bloc, Repentigny, QC]

Do you believe you have the necessary resources at your disposal to achieve your goals, both financial and administrative?

[Richard Alvarez]

Certainly from an administrative perspective we do, and at this stage also from a financial perspective. Again, if the provinces saw that we would incent use with the building of electronic medical records, etc., it would incent the provinces to move faster, because they'll be pushed along by the clinicians in the field as well. That would really help.

I believe that if they stick to their plans, they should be able to get close. If you take the 2016 goal, that is a goal, a call to action, but we certainly don't have the dollars to get there.

[The Chair, Conservative, Joy Smith]

Thank you very much, Mr. Alvarez.

We'll now go to Ms. Wasylycia-Leis.

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

Thank you very much.

And thanks to all of you. This is an issue of particular urgency for our committee, as we grapple with health human resources and the renewal of our health care system. Electronic health records have been seen as key to this whole area of renewal. The government made a commitment in the last budget to advance the agenda for that reason and other reasons. But this issue goes back to 2001, and progress, by all accounts, has been very, very slow.

Madam Auditor General, I know people are interpreting your report as a clean bill of health for Health Infoway, and on that basis they are urging us to urge the government to flow the $500 million. I'm not sure we're ready to do that yet. Beyond the straight accounting practices, I'm not sure whether this program has met its mandate. I'm wondering if you can help us figure out what questions to ask and where to take it.

For example, if they've already spent $1.6 billion and only covered 17% of the population, is that getting the job done? Is that a clean bill of health? Reports that go back to May, June, July, August, and September all show there are big concerns with the whole Infoway program. We had the health council before us in May, and they had big concerns.

There have been news reports suggesting that Health Infoway could be headed toward the same problems that eHealth in Ontario faced...without accountability, according to news reports—and I'm asking whether this is true or not—without oversight by federal watchdogs, without accountability with respect to contracts, with the use of outside consultants but no requirement to proactively disclose contracts, whether sole-source or otherwise.

I think we need some of those questions answered. Maybe it's not in the context of this report, but I would certainly like to hear your advice, Madam Fraser, so we'll know what advice to give to government.

[Sheila Fraser]

I think it's important to note at the very beginning that the role of Infoway is very different from eHealth or provincial organizations that are putting electronic health records in place. Infoway is a funder, so it is about how well they assess the projects being brought to them. Are they in line with the strategies that have been developed—the blueprint? The actual development of the electronic health records is a responsibility of the provinces and the territories. Our audit looked at how well Infoway was managing in that role of strategic investor.

To compare the 17% to the $1.2 billion that has been spent is a false comparison, because much of the money—and Mr. Alvarez may have the numbers—has gone to provinces that have not completed an electronic health record. The 17% is for two provinces at this point, but much funding has gone to other provinces to help them develop the electronic health record. Getting to that goal of 50% is very dependent upon the provinces putting in the necessary funding and having the necessary management in place to be able to deliver on electronic health records.

As I mentioned, there are six auditors general looking at doing audits of electronic health records within their jurisdictions. I'm hopeful that when we come in the spring we can give the committee a better idea of the actual state of affairs. To date the reports have not been particularly positive on the management within the provinces.

I think we have to separate the roles and responsibilities of the various players. While Infoway has a very important role to play, the success of these projects is not its alone.

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

I appreciate that. But I'm wondering if this agency, which is arm's length from the federal government, has played the appropriate role in terms of coordination and encouragement at the provincial level. If we see that kind of slow progress, shouldn't we question whether we wouldn't see more progress and it being a higher priority if this were taken seriously at the federal level?

Even if what you're saying is true—and I believe what you're saying—when Infoway says we'll achieve 50% by the end of 2010 and we're only at 17%, it seems a bit hard to accept. There might be a bit of smoke and mirrors happening on a critical issue.

[Sheila Fraser]

I can't really respond to that. Perhaps Mr. Alvarez can. We don't know. Where the provinces are and what stage they're at is not something we looked at in our audit. We certainly note that Infoway played a very important role in starting that strategic direction, developing the blueprint, and trying to ensure that there was compatibility of systems across the provinces and territories. These are very complex. Just to have done that would require....

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

Isn't there a problem when you have promises made at the federal level, as we have also had with the national pharmaceutical strategy, and people hold out great hope, and then nothing is really done at the federal level to push the envelope and make it happen? How do we, in fact, recommend that the government flow another $500 million when we haven't really seen this made a high priority at the federal level?

Just before I go to Mr. Alvarez, could I just ask you, Madam Fraser--

[The Chair, Conservative, Joy Smith]

Your time is running out, Ms. Wasylycia-Leis.

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

--if there's any truth to the fact that it is an agency that hires outside consultants, and they're not required to--

[The Chair, Conservative, Joy Smith]

Your time is running out.

[Sheila Fraser]

We looked at the contracting practices, and we found that there were some modifications needed to contracting policies, in particular as regards amendments to policies that were made. We did not see, I would say, any significant problems with sole sourcing of undue numbers of consultants, quite frankly. It was certainly nothing that was comparable to what was in eHealth.

[The Chair, Conservative, Joy Smith]

Thank you very much, Mrs. Fraser.

Now we'll go to Dr. Carrie and Ms. McLeod, who will share their time, I believe.

[Colin Carrie, Conservative, Oshawa, ON]

It will actually be Madam Davidson. We switched around. I'm sorry about that.

[The Chair, Conservative, Joy Smith]

Okay, that's fine. You're playing games behind me here.