Health Committee on Feb. 24th, 2009

[Dr. Karen Dodds]

Thanks for the question.

We have regular meetings with our provincial and territorial colleagues and we work at the federal level on those issues that the provinces agree warrant a national and a federal presence. One of the issues that have been undertaken in collaboration with provincial and territorial colleagues is health human resources, which obviously has a direct impact on capacity in hospitals. The federal government has provided significant funding over the last number of years to support a pan-Canadian strategy on health human resources.

[Patrick Brown, Conservative, Barrie, ON]

I am interested in health human resources, but in terms of capacity, I'm thinking about the lack of beds available. For example, if we look at wait times, is the fact taken into account that frequently patients are sent away from the hospital because there is no capacity to handle any other patients? I know on numerous occasions patients at RVH in Barrie are sent to a different hospital; they're told they're no longer able to go there.

Is that added into the indicators on the time periods involved, when people are not able to be served at their local hospital?

[Dr. Karen Dodds]

Certainly we collect, as others do, information about wait times. Part of the focus on wait times has helped to elaborate these different sorts of process parts in the different steps between somebody thinking they have a serious problem that needs to be addressed by a specialist, seeing their family physician, being referred, going to emergency, and all of those different things.

What we do from the federal level is align what we're doing with federal roles and responsibilities. So to support provinces in their responsibility, because it's a provincial responsibility to deliver health care and hospital services, we have worked with them very much on health human resources, which should help issues such as wait times.

This most recent budget announced another $500 million for Canada Health Infoway to support a number of things, including the goal of having 50% of Canadians with an electronic health record by the end of 2010, I believe it is, which really should also help the issue with wait times across the system.

[Patrick Brown, Conservative, Barrie, ON]

By 2010, did you say? Is that the date?

[Dr. Karen Dodds]

I'm pretty sure that's the goal.

[Patrick Brown, Conservative, Barrie, ON]

On that note in terms of electronic health records, I'm also very curious about that. Are there any monitoring abilities for how that's trickling down? Does the federal government have any means by which we can track where we are in that process?

[Dr. Karen Dodds]

Again, those moneys go to Canada Health Infoway, which is an independent organization funded by the federal government.

[Patrick Brown, Conservative, Barrie, ON]

Does Health Canada get a report from Canada Health Infoway?

[Dr. Karen Dodds]

We do. Their goal is to have 50% of Canadians with an electronic health record by 2010. I believe it's 100% by 2016.

The budget this year also included funds to work on electronic medical records, which are specific, then, to physicians' offices instead of being patient specific and doctor specific.

[Patrick Brown, Conservative, Barrie, ON]

If I recall, in 2006 there was $400 million for electronic health records as well, wasn't there, in the budget?

[Dr. Karen Dodds]

The total investment is now $2.1 billion, I believe, to Canada Health Infoway.

[Patrick Brown, Conservative, Barrie, ON]

So if 2010 is a year away with a goal of 50%, do we have any idea of where we are, being so close to 2010?

[Dr. Karen Dodds]

Yes. Canada Health Infoway publishes annual reports and periodic reports. They believe they're on target for meeting those targets of 50% coverage by 2010.

[Patrick Brown, Conservative, Barrie, ON]

The reason I ask is that the CEO at the hospital in Barrie told me they've never seen a nickel from the provincial government or Canada Health Infoway for electronic health records. I asked them if there were any electronic records, and they said there's no immediate timeline where they'd be looking at that. I obviously find that disconcerting when I see all this money allocated.

[The Chair, Conservative, Joy Smith]

Mr. Maxwell, I think you also want to comment on some of these things.

[Neil Maxwell]

Yes. Thank you, Madam Chair. This is such a great opportunity that I can't let it pass by.

As we speak, we're in the midst of doing an audit on electronic health records for this fall. It's an interesting one too, because we're working in collaboration jointly with six of the provincial auditors general who are looking at how electronic health records are being rolled out in their respective provinces. Stay tuned.

[Patrick Brown, Conservative, Barrie, ON]

Is Ontario one of them?

[Neil Maxwell]

Yes, Ontario is one of the provincial auditors general working with us.

[The Chair, Conservative, Joy Smith]

We'll now go to Dr. Bennett.

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

There's a little frustration in that if it's measured, it gets noticed. If it gets noticed, it gets done. It's a frustration that we all feel. There's a cottage industry of people looking at data and indicators and steering away from ranking. The whole objective of Canadians being able to understand whether we're winning or losing, with all this money that's going into it, is really not happening.

From the Public Health Agency, the chief public health officers report annually to the CIHI, the Health Council of Canada, and the OECD. The OECD data seem to be better than what we get from any Canadian government department. I'm not sure where the OECD gets theirs from.

But it's frustrating that the goal of being able to tell a Canadian who lives in B.C. whether or not he or she is really doing better on cancer outcomes than somebody who lives somewhere else seems to be not possible. As our colleagues have said, it needs to be put into a grid somewhere to let people figure out that certain provinces are doing better at some things and other provinces are doing better at other things. In the way they have actually reported, interesting provinces, such as Saskatchewan, have said these are the things they're doing really well, these are the things that they've improved on, and these are things where they still need work.

Can we not find a way to get everybody together around a table to say this is the way we would like everybody to report and step up to the table? I would like to know whether or not it's been tried. Have all these groups ever sat in a room together and had a little chat about indicators or data? Whether it's hepatitis C in prisons, or aboriginals on and off reserves, or any of these things, we really need to know if we're winning or losing in terms of our policies. How do Canadians find out how we're doing on post-traumatic stress for the military?

In order for us to fight for more funds for these things, we really need to know that we're funding what works and we've stopped funding what doesn't work. The most exciting thing in the report is to see that tobacco has gone down. We spent $100 million on that. When I was elected, the rate was 31%. It is now 19%. That's a success. Those are the kinds of things that Canadians would hope we're doing.

But maybe I should ask this of the Auditor General's office. You could study anything that you wanted to and you chose to study this. But you chose to do a study instead of an audit, and there are no recommendations. As a group, what are we supposed to do with all this? There are five or more different groups doing the same thing, and not one report speaks to Canadians about what we're doing or how we're doing across the country.

[Neil Maxwell]

Madam Chair, to clarify, we're really talking about two different chapters that we are presenting here. One is a study, which is the description of how the federal transfers work in general. The second part, which is very much an audit, is the piece where we have the comments about the health indicator reports.

That's what I took the question to be.

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

It was mainly a rant.

[Neil Maxwell]

I got that part of it too.

[The Chair, Conservative, Joy Smith]

We only have one more minute.

[Neil Maxwell]

Thank you, Madam Chair. I'll be brief.

There are really two levels, I would say, where activity has to go on. First of all, Health Canada really needs to get together with all of the other players here. You mentioned the CIHI, the PHAC, and Statistics Canada. When you look at what's been published, there's clearly an opportunity to make some low-hanging fruit, as I would characterize it. There are clearly a lot of things they could be doing, the least of which is simply interpreting the data that they already have.

In the report, there are many examples both provincially and within the federal family, including the chief public health officer's own report, where very insightful interpretation is provided, sometimes with quite limited data. A lot more could be done. But in the longer term are the opportunities that come from improving the indicator set and the data sources. Again, we were quite disappointed to see that four editions into this--eight years--things have been relatively stable, with very little improvement. Again, we're encouraged to see some of the steps that are being taken.