Madam Speaker, I am pleased to have the opportunity to speak to the motion by the hon. member for Medicine Hat.
I am also pleased to have the opportunity to speak today on Canada Health Infoway Inc., also referred to as Infoway, and its accountability framework.
Canada Health Infoway Inc. is an independent, not for profit corporation that was created in 2001 with a mandate to accelerate the adoption of electronic health information systems such as electronic health records and telehealth.
Infoway's members are the 14 federal, provincial and territorial deputy ministers of health. Infoway is equally accountable to all 14 members.
Infoway operates as a collaborative federal, provincial and territorial mechanism in which all jurisdictions are equal partners.Infoway’s members all have a stake in its performance given that electronic health information systems are, and will continue to be, funded jointly by all jurisdictions.
All jurisdictions, federal, provincial and territorial, face similar challenges in funding the development and deployment of electronic health information systems, such as electronic health records and telehealth applications.
The funding provided to Infoway is for the purpose of easing the fixed costs of the initial development and the cost to replicate and deploy the system across Canada. This collaborative approach yields both cost and time savings.
The Government of Canada made its first investment in Infoway in March 2001 as a direct result of the agreement by first ministers in September 2000. The purpose of the investment was to accelerate the development and adoption of modern systems of information technology with a focus on the electronic health record.
Since then, additional funding has been provided on two occasions. In 2003, $600 million was provided for electronic health records and telehealth applications in support of the first ministers accord on health care renewal of February 2003 and again in 2004, $100 million went to support the development and implementation of a national public health surveillance system with a focus on infectious disease monitoring.
This upfront funding gives Infoway financial stability and allows it to develop and support multi-year partnerships and projects.
Infoway’s accountability is addressed through funding agreements governing the use of funds. There are two funding agreements, one governing the electronic health record and telehealth area and the other the health surveillance area.
Health Canada followed the guidance and direction of central agencies during the development of these agreements.
These arrangements were developed taking into consideration many factors. Especially important to the discussion today are the accountability provisions of budget 2003 and Infoway's unique structure making it accountable to all its members.
The agreements balance these factors and contribute to ensuring that Infoway can operate as a collaborative, federal, provincial and territorial mechanism in which all jurisdictions are equal partners.
Health Canada believes that the reporting and accountability requirements for Infoway are sound. Health Canada reports on Infoway's plans and progress in its reports on plans and priorities and departmental performance report.
As mentioned earlier, the federal, provincial and territorial deputy ministers of health are the members of Infoway. The members set the strategic direction for Infoway and ensure that these align with those of the provinces and territories.
Infoway works with its members targeting its investments toward the priority needs of individual provinces and territories. Infoway’s members have unanimously endorsed all of its business plans.Infoway regularly provides progress reports and plans to members and all of these may be shared with ministers.
In this way, all federal, provincial and territorial ministers are kept informed of Infoway’s progress and issues.
Infoway has a board of directors consisting of 13 directors. Seven of the directors are appointed by the members and the remaining six independent directors are elected by all members.
The measures of accountability reflect the unique, multi-jurisdictional structure of Infoway and are consistent with good corporate governance.
They include, first, an annual audit of its financial statements by an independent auditor. Infoway's financial statements must be prepared in accordance with generally accepted accounting principles. The financial statements and the auditor's report must be made available to the members and to the public.
Second, an annual report to include performance results relative to the business plan, which was mentioned earlier, and an overview of expected results are also made available to the members and to the public.
Third, an annual business plan for the upcoming year is presented to members and a summary is made available to the public.
There is an annual compliance audit specific to the terms and conditions of the funding agreement with the Government of Canada. This report is made available to all 14 members. At least every five years there is an independent third party evaluation to measure overall performance in achieving the outcomes identified in the funding agreement, the first of which must be completed by March of next year.
Infoway has initiated additional detailed reporting and governance practices and has also adopted a phased and gated funding approach, requiring that funds only be disbursed once pre-set milestones are met.
Health Canada is committed to the effective oversight of Infoway. In 2003, the department worked closely with Infoway to include the accountability provisions of budget 2003 in a new funding agreement which was required because of the $600 million additional investment and made significant improvements to the reporting and accountability measures. Health Canada also reached an agreement with Infoway to apply the new accountability and reporting requirements to the previous grant, the $500 million provided in 2001 to Infoway.
Some of the specific enhancements in 2003 were annual compliance audits, annual business plans and default and recovery provisions, all of which were mentioned today during debate.
On behalf of the government, the Treasury Board Secretariat has indicated a willingness to explore the Auditor General's recommendations that will further improve the accountability framework while at the same time respecting the independence of foundations and enabling the effective pursuit of policy objectives.
The bylaws of Infoway specify that the members appoint the external auditor of the corporation. Therefore, their concurrence would be required for the Auditor General of Canada to be appointed as external auditor.
I do not know whether all the provinces will agree that Canada should be responsible for the independent audit of an entity such as Infoway. However, the rules in place will allow for discussions with all members, based on recognized practices, on an external audit.
It may be that Infoway would be one of the few exceptions noted in the Auditor General's report, given Infoway's federal, provincial and territorial membership.
Health Canada will work closely with federal counterparts and will follow the accountability framework for foundations established by central agencies.
Implementation of an interoperable electronic health record is an immensely complex endeavour that will not happen overnight, but there is evidence that Infoway is achieving progress toward its goal of having the basic elements of an interoperable electronic health record in place across 50% of Canada, by population, by the end of 2009.
Infoway's efforts to date have focused on the start-up phase of the organization, the need to plan carefully so as to make the best use of funds, and the implementation of the basic components of the electronic health record. Infoway has now committed a total of more than $180 million in over 90 specific projects in all provinces and territories across Canada.
Infoway has made progress on the electronic health record components, including electronic health record architecture and standards, registries for clients, providers and locations, diagnostic imaging systems, drug systems and laboratory information systems.
An electronic health record solution architecture for Canada has been developed and accepted by all jurisdictions to ensure a pan-Canadian, interoperable electronic health record. This architecture will guide electronic health record development and implementation in all provinces and territories.
Infoway has developed investment plans with each jurisdiction covering three years, thus, ensuring the Infoway’s priorities and investment plans are aligned with the priorities of each jurisdiction.
Infoway work was supported by the first ministers in September 2004 in their 10-year plan to strengthen health care.As well, the recent Health Council report recommended increasedcommitment to the rapid adoption of electronic health records andtelehealth technologies.
There is recognition that the pace of implementation needs to be faster so that the health system can reap the benefits of modern electronic health information systems. Infoway is working with the jurisdictions to see what can be done.
Progress toward an electronic health record is being made and Infoway is playing a vital role in achieving this progress.
Funding agreements are in place governing the use of the transferred funds and these agreements meet the accountability requirements set by central agencies. Key provisions include annual reports, annual business plans and annual financial and compliance audits. The first program evaluation will be reported by March 2006. Health Canada will work with Infoway and central agencies to include any new accountability requirements identified by government.
I do want to point something out for the record. There has been mention in the debates from across the way about the question of the integrity, I suppose that would be the proper term, of the use of these funds by these organizations and the characterization of the comments of the Auditor General.
I would like to point out that I do not want to put words in the Auditor General's mouth, but the Auditor General was at the health committee yesterday, as she had been at the public accounts committee, speaking about this point and about her report to Parliament and taking questions from members.
When the question was asked about how these funds were used within government and if there were any abuses, this was her response from the record of yesterday:
Madam Chair, the concerns we have about foundations are not related to any concerns about abuse within the foundations. We have tried to make it very clear that any remarks in our audit findings related to foundations shouldn't be viewed as criticisms of the foundations, nor the people that work there. It's really about the accountability to Parliament over public funds and the amount of information that is available to Parliament. It's not driven by a concern that there may be something untoward going on in foundations, not at all.
Those are the words of the Auditor General.
As I said in discussion earlier, members can have differing views. They can support 100% the auditor's findings. Others might not support 100% of the recommendations of the Auditor General. That is a matter for debate. Reasonable people can disagree, but I would hope that reasonable people would not improperly misuse the words of the Auditor General to cast aspersions on the fine men and women working within the foundations to try to achieve goals that are to the value and the benefit of all Canadians.