Health committee  I can give you one example that has been undertaken. That is where the health care delivery mechanisms and social delivery mechanisms, which were taking place in isolated kinds of ways from different departments within health, have now been developed into an integrated structure, facilitating easier movement of individuals between the different types and levels of service that are available.

Health committee  Canada Health Infoway is going to be releasing their annual report in June of this year, so we will have that data available at that time. The numbers reflected in Jeanne's data to this point are for 2007. The others will be forthcoming.

Health committee  Right.

Health committee  I would be prepared to answer that. In my experience, there are some real jewels of success across the country. If we go to the Calgary Health Region, we probably see one of the pre-eminent programs for the delivery of hip and knee surgery in the country. The program that was developed there was done on the basis of very, very specific kinds of indications and included developing care plans with pre-admission activities that took place and made sure that when people were discharged from that program, they would be cared for appropriately in the home.

Health committee  If I were to think about the context in which that had been communicated, it would be an opportunity in which individuals came together to try to deal with a common problem. The result of that communication would simply have been put with the label of “communiqué”, just as one can have a letter of understanding, for example, or a memorandum of intention, or a social or health accord.

Health committee  Yes, it is, and we've been very fortunate to have been invited to participate in the conversation on Dr. Eldon Smith's initiative on cardiovascular disease across Canada. We've engaged in conversations with Dr. David Butler-Jones with respect to the Public Health Agency of Canada's initiative to address and advance efforts across the country.

Health committee  I'd like to point out that I became associated with the field of health informatics at the University of Victoria in the mid-eighties. It is an emerging area, and it is an absolutely essential area. Since the Hospital Insurance and Diagnostic Services Act was passed in 1958, and then the Medical Care Act in 1968, followed with the continuing care work during the 1970s, we've been very much institutionally focused, so we've been counting a lot of widgets, a lot of activity in that way.

Health committee  I can be very enthusiastic about the identification of the introduction of compassionate care. For those family members who may have a loved one, a friend, or relative who has become ill, we took the cause of promulgating and encouraging governments across Canada to look at introducing that, and through EI legislation it is now an option for people to actually take two weeks off work.

Health committee  There has been a significant increase, as Dr. Besner has indicated. One of the really important questions to ask as well is are all of those particular diagnostic procedures appropriate or necessary? Clinical guidelines around developing the indications for how to prioritize and how to actually undertake these in a much more efficient fashion is something the hospital you're probably speaking of is taking much more seriously as well, so things that are maybe not appropriate are not on that list.

Health committee  As to coming up with a national benchmark, there are hundreds of diagnostic procedures—MRIs, CT scans, PET scanning, X-rays, nuclear medicine. What's needed is to come together with the provinces and territories to talk about establishing benchmarks that can be used throughout the country, though some could perhaps be customized for particular areas.

Health committee  I might just add to Dr. Besner's comments. There have been some very successful initiatives across the country. The difficulty is we haven't had that conversation in a pan-Canadian context, so the Western Healthcare Improvement Network in British Columbia, or the Health Quality Council of Alberta, the Saskatchewan Health Quality Council, the new one announced in New Brunswick, the one in Quebec, all of these are gems of good efforts to try to advance the conversation within the regional context.

Health committee  Yes, this is an area of significant challenge. You think of the accord just starting in 2003, but it isn't a great length of time that's been associated with attempting to get these indicators in place. Despite the challenges, I think there have been some promising results. For example, there was an article in The Globe and Mail this morning that identified the initiatives that are taken on the pan-Canadian effort to try to better understand the issues around neonatal mortality within the aboriginal communities.

Health committee  Disinvestment is always a challenge, and it continues to be. However, the kinds of analyses and health technology assessments that have been conducted by CADTH, which are shared with the provincial jurisdictions, provide the jurisdictions with some effectiveness studies they can base their policy decisions on.

Health committee  In respect to access to pharmaceuticals, there are still challenges ahead of us, but significant progress has been made on a couple of fronts, which I think deserve mention. One is that the Common Drug Review, which was established to provide some form of coordination on behalf of the provinces to deal with those questions about pharmaceuticals that are emerging and that are to be introduced within the provincial context, has provided a valuable service to advance that particular effort.