Thank you for the question. I will start, but I may turn to Glenda, only because in her previous job as the president of the Canadian Institute for Health Information she was very involved in some ongoing work that I'll mention.
Privacy is an issue, obviously, with respect to any electronic system, especially a system dealing with the nature of the personal information you'd find on the electronic health record. It's important to manage the evolution of this in a way that will achieve a number of goals in equilibrium. Obviously we want to have the most efficient health record possible. We want to do it in a way that's going to be respectful of privacy. We also want to do it in a way--and it's in this area that the work is really important--that gives us access to aggregate information. There is huge value in having that aggregate information so that the management of the health system can understand outcomes on a regional or population basis.
I'll give you one example of how aggregate information might have been helpful had we had an electronic health record. You'll remember the situation around COX-2 inhibitors and Vioxx back a few years ago. What I've heard in the United States... Vioxx killed thousands and thousands of people. It killed a lot of middle-aged men with strokes and heart attacks. It took lengthy detective work to associate those conditions, because, frankly, a lot of middle-aged or elderly people might come into hospital with those kinds of conditions. If you could have linked the drug interaction--in other words, what they were taking--with the fact that they were presenting with these symptoms and you did a search that determined there was a pattern, it might have been possible for regulators in the world to have moved much more expeditiously with respect to dealing with that situation. To have that capability, you're going to need individual patient information. You don't necessarily need everybody's specific identifiers right down to the name, etc., but you need to have enough information to enable you to draw those conclusions.
That's one illustration, one example, of the kinds of issues we're dealing with. On the one hand, we don't want to have rules that would just expose everybody's information; obviously that has huge implications with respect to insurability, and there is no question that there are issues about that. On the other hand, you don't want to do it in such a way that it's going to prevent us from having better interventions through the power of that aggregate data.
That work is going on now. There is a working group that involves the provinces and territories, the federal government, and the Canadian Institute for Health Information, because as the premier national health information organization, CIHI obviously has an interest in making sure that we're not going to have the perverse effect of electronic health records causing less information to be available to them. Obviously Infoway itself is also involved, and discussions would take place with privacy commissioners across the country as well.