Public Accounts Committee on June 3rd, 2010

[Dr. Karen Dodds]

Yes, thank you.

Your question came back as a basis to where did we start. I want to come back to one of the points that my colleagues made. Within Canada we started across the country in very different positions. Even within provinces, you start from different positions, with some hospitals having their own well-developed systems, maybe two decades old, and some provinces having none. When Infoway began, there was a vision and there was a goal. One of Canada's opportunities is that from the beginning the goal was national—to have information that moved nationally, which was identified with the patient and not with just the hospital or the physician. I think it is a significant goal, but it takes time to achieve.

Look at Denmark and New Zealand—they are examples of the time required in small countries. New Zealand has only two million people, and think of the geography. With a very federal system, it took them 17 years. It took Denmark 16 years. It took Veterans Affairs in the United States 16 years. So good progress is being made. There are areas of difficulty, but there are significant benefits. The audits have been extremely helpful in pointing out where things need to be strengthened; they have called attention to this issue.

[Daryl Kramp, Conservative, Prince Edward—Hastings, ON]

Granted, there have been a number of successes. We're pleased. With health care demands rising dramatically, e-health is critical and crucial. We understand that reality. Still, there appears to be a situation. Does our confederation serve us to the best of its ability? Well, we have what we have, so it's a bit of a problem. In a perfect world, a benevolent dictator would give you the perfect solution, but we're not there. We have other people now in other sectors, private sectors, coming up with solutions, embracing technology in a different way.

There is the Telus proposal. I wonder, Mr. Alvarez, if you could discuss briefly the potential implementation or collaboration. Is there a conflicting proposal? Where do you see this working within health care assessment?

[Richard Alvarez]

There's a whole host of safeguards and principles that we've operated on from the get-go. One of them was that information systems of this nature should be coming out of the private sector. We are not funding governments to build huge bureaucracies to develop these systems.

The other issue is, we wanted to make sure of two things. We wanted to make sure we had a strong and vibrant software industry in Canada that could sell globally, given that some of the issues would be clearly on the leading edge. We also wanted to make sure that we could replicate these systems across the country, and that's exactly what we're doing. You can't take government systems and try to replicate them. Who maintains the system at the end? So the private sector has a role to play.

One of the differences that differentiated us from the efforts in England and other places was that we worked closely with the private sector, telling them where the puck was going to be: what the requirements are, what the standards are, what the availabilities are, when the provinces are going to be ready to start to tender out, to start to get their RFPs. This way they can bring their resources and their intellects to bear.

There's a major report by an international group, which reports on IT systems, that gives us high praise for the blueprint and how it's been orchestrated. The vendors have been working with that blueprint as they develop the system.

[The Chair, Liberal, Shawn Murphy]

Thank you, Mr. Kramp.

Mr. Dion.

[Stéphane Dion, Liberal, Saint-Laurent—Cartierville, QC]

Thank you very much, Mr. Chair.

I would like to revisit the three main points that have been raised here, especially by Madame Beaudin and Mr. Shipley. The first one is the target. The second one is pan-Canadian interoperability. The third is confidentiality.

Let's look at the target. You said, Mr. Alvarez, that we are now at 22%, and that you are confident that next year at this time we will be at 50%. First question: is it a robust 22%? Are we able to say that a fifth of Canadians, when they go to see their doctor, will be able to use an electronic file on their health?

[Richard Alvarez]

Sir, this is the way the target is measured. We have six core systems: drugs, diagnostic imaging, lab results, a provider registry, a client registry, and some clinical reports. As we look at a province, if they have 100% of their database completed in five areas but zero in one area, we count them as a zero. So we set a very high standard. They could be getting tremendous benefits out of the drugs, out of the diagnostic imaging, but maybe they haven't as yet got their clinical reports available. Where we're at today is looking to Ontario, in terms of the provider registry, to bring that on board, and we're looking at Quebec in terms of the drug information system they need to get on board before we can get to that 50% of data.

Now, I will caution and be quite clear on this. We're talking about the availability of these systems; we are not talking—and Madam Fraser pointed it out very astutely—about the use of these systems. The only analogy I can give is a situation where you have all these paper files. If you look at a building, you have to make the building available first before you can move the tenants in. You have to have the utilities in that building, etc. The statistic we're quoting here is basically having that building available. If you don't have the stuff in electronic form, you can't have use of it. So we have to move with availability, and from there we will see use.

I'll just add that in Alberta they have availability and they have 20,000 users using the file. So that will come over time.

[Stéphane Dion, Liberal, Saint-Laurent—Cartierville, QC]

But you don't know if it's actually used.

[Richard Alvarez]

No. We're absolutely going to be reporting on absolute usage of those available files.

[Stéphane Dion, Liberal, Saint-Laurent—Cartierville, QC]

What percentage is actually used today?

[Richard Alvarez]

I couldn't tell you those numbers. Those are the numbers we're still gathering in terms of the provinces. They measure in a different way, but we certainly will have those numbers to report on.

[Stéphane Dion, Liberal, Saint-Laurent—Cartierville, QC]

This committee will be very pleased to see them.

[Richard Alvarez]

I'll be delighted to share it with you, sir.

[Stéphane Dion, Liberal, Saint-Laurent—Cartierville, QC]

How come we will catch up so spectacularly in a year, from 22% to 50%? Between 2001 and 2010, we went up only to 22%.

[Richard Alvarez]

Sir, the two that I'm hoping will play catch-up are our two largest provinces. As part of that methodology and equation, we look at the population distribution. When you look at the population distribution, if I can get Ontario with the provider registry, say, and Quebec with the drug registry, that's a huge population base we're covering, which will get those numbers up.

[Stéphane Dion, Liberal, Saint-Laurent—Cartierville, QC]

How come we are lagging behind other countries, then?

[Richard Alvarez]

Again, I want to be clear. We're lagging in the electronic medical space, which is in clinicians' offices. Those numbers are at about 37% today. But we're not lagging in some of the drug information systems, the diagnostic information systems, the lab information systems that we have. It is in clinicians' offices, and we'll be using the new moneys from the federal government to basically accelerate that agenda.

[Stéphane Dion, Liberal, Saint-Laurent—Cartierville, QC]

How would you assess the risk that at the end of the day we will have a patchwork of systems, instead of a system that Canadians may use from coast to coast to coast?

[Richard Alvarez]

If we have a patchwork of systems, then we've failed in our job. Our job is basically to make sure we have a coherent, interoperable basic system, and I can assure you, sir, that we're working at that very, very diligently.

[Stéphane Dion, Liberal, Saint-Laurent—Cartierville, QC]

Thank you.

[The Chair, Liberal, Shawn Murphy]

Thank you, Mr. Dion.

Mr. Dreeshen, five minutes.

[Earl Dreeshen, Conservative, Red Deer, AB]

Thank you very much, Mr. Chair. Thank you, everyone, for being here today.

I spent a number of years as a hospital board chairman in Alberta. We worked closely with our surrounding hospitals and tried to make sure.... Even though we were one organization, there were a number around us. This is the type of thing we've been doing for perhaps 15 or 20 years, so I'm certainly well aware of the challenges there are in the delivery of the health care system.

Again, I'm very pleased to hear some of the things that everyone now is hearing about the Alberta system, and some of the things that out of necessity we were forced to do. Yet, when we look at the type of training that doctors have, I'm just hoping.... I guess my first question is to ask if you're aware of any types of courses that are being given in universities where doctors are being trained about the business aspect of it, and also this type of clinical training. Perhaps you could start with that.

[Dr. Karen Dodds]

I can perhaps start.

Health Canada actually funded faculties of medicine to do a review of the educational requirements to receive an MD degree. It was the first such review in quite some time.

One of the things we've been doing, which I think my colleagues at Infoway and other places are doing too, is to encourage the use of electronic technology for information in the curriculum. It's not part of the training now. They may use the specialty aspects of it. A radiologist is used to special equipment, but in terms of the recording of clinical notes, etc., it is not an aspect they currently receive. It is different from many other professions, where you can't imagine graduating from university and not having that background.

[Earl Dreeshen, Conservative, Red Deer, AB]

Thank you.

I must admit that we're talking about younger doctors, but my doctor has been out of university as long as I have, and he was one of the first ones to be able to use this. There are people who recognize the significance of it. I'm glad it was brought up.

We talked about the cost of the system, but we then recognized the $6 billion of annual savings that was spoken of. There were some discussions you had earlier on the great amount of savings there are.

Mr. Alvarez, are there any other key components of savings that you might want to put on the record for us to consider?

[Richard Alvarez]

As I said, we've done a couple of studies.

On one of the things we did, again, as far as I know—and I've now been in this job for the last six years and I have a pretty good handle on it internationally—we're one of the only countries that has had a benefit measurement framework.

Not only have we taken these reports and said it's $6 billion and $7 billion—and we've heard it could be higher—but we wanted to put in place a benefit mechanism that asks whether we are getting those benefits.

We brought in some of the brightest minds from the research community, some of the international guys, and a lot of our guys in Canada. They designed a framework for us that has a variety of indicators. As we fund projects and these projects come on line, we then go back and systematically measure whether those benefits have been achieved.

I've talked about diagnostic imaging. We're about to publish one on drugs. For even the few provinces that we have, we're looking at benefits in the region of about $450 million a year. When you extrapolate that, it's well over $1 billion a year for Canadians. There are big benefits.

Again, as some of the other systems come on board, we'll be doing the same type of measurement work.

[Earl Dreeshen, Conservative, Red Deer, AB]

Madam Fraser, in future audits, would you look into that type of breakdown of the benefits as well?