2nd-36th, Volume 27 - Committee of Supply

HEALTH

Mr. Chairperson (Marcel Laurendeau): Order, please. Would the Committee of Supply come to order. This section of the Committee of Supply has been dealing with the Estimates of the Department of Health. Would the minister's staff please enter the Chamber at this time.

We are on Resolution 21, item 2.(b)(1).

Chairperson's Rulings

Mr. Chairperson: At this time I would like to bring in a few of the rulings that I have before me on points of order.

Point of Order No. 1, April 18, 1996. On April 18, 1996, a point of order was raised by the honourable member for Kildonan (Mr. Chomiak) alleging that the honourable Minister of Health (Mr. McCrae) had imputed motives, was taken under advisement by the Acting Chairperson. I reviewed Hansard and note that the words spoken by the honourable minister were, “ . . . the member for Kildonan wants to stifle decent, hard-working people who want to provide service to their home-care clients.”

In my opinion, these words did impute motive and therefore are out of order. I am requesting the honourable Minister of Health to withdraw them unconditionally.

Hon. James McCrae (Minister of Health): Mr. Chairman, I withdraw those words.

Mr. Chairperson: I thank the honourable Minister of Health.

Point of Order No. 2 was on April 19. On April 19, 1996, I took under advisement a point of order raised by the honourable member for Kildonan in which he claimed that the honourable Minister of Health had imputed motives. The honourable minister's remarks as reported in Hansard were: “The NDP wants to abandon the clients of home care.”

It has been ruled on many previous occasions in this House that language which may be unparliamentary if applied to an individual member is not unparliamentary when applied to a group. I am therefore ruling the honourable member did not have a point of order.

However, I will conclude my ruling by again calling on all members, both in government and in the opposition, to choose their words with care in order to continue to maintain an appropriate and desirable level of decorum in this Chamber.

On Point of Order No. 3 on April 26, 1996, I took under advisement the point of order raised by the honourable member for Crescentwood alleging persistent repetition and irrelevance by the honourable Minister of Health. I have carefully reviewed Hansard and note that the honourable minister's responses to the questions, although related to the very general Estimates area this section of the committee was considering at the time, were often not strictly relevant to the specific question asked. I also note that prior to this point of order, the honourable minister had already made about 15 requests for a recess, all of which had been denied.

Rules 16 and 45 indicate that obstruction and persistent repetition or persistent irrelevance are infractions against the rules of this House. Our subrule 70(3) indicate that speeches in a Committee of Supply should be strictly relevant to the item under consideration. The honourable member for Crescentwood, in my opinion, did have a point of order. This committee is currently proceeding in a procedurally appropriate and correct manner, and I would urge all honourable members to continue to observe the letter and spirit of our rules as they are doing now.

On Point of Order No. 4, on April 26, 1996, I took under advisement a point of order raised by the honourable member for Kildonan, respecting words spoken by the honourable Minister of Health. The words questioned were: “somebody in the New Democratic Party will probably make that subject of some public information campaign where they can smear and have a little more fun.”

The honourable minister's remarks did not allege that any other specifically identified member of this House would undertake the action suggested. Also, I have reviewed the records of this House and the relevant portions of Beauchesne and find nothing to indicate that “smear campaign” has previously been ruled unparliamentary. Therefore, based on the precedent and context, I am ruling the honourable member for Kildonan did not have a point of order.

* * *

Mr. Dave Chomiak (Kildonan): Mr. Chairperson, the minister is just indicating that your very delicate balancing act has shown itself in the rulings, and I appreciate the difficult job and the fact that we are functioning quite effectively in this committee presently.

Mr. Chairperson, we are still at 21.2(b) and I believe we wanted to move on to 21.2(c). I just have one question that I posed to the minister when we last met. In the Supplementary Estimates book, it is indicated on page 36 that the branch administers and manages “collective contracts between Manitoba Health (or the funded facility) and these Associations.”

So my question to the minister was general, if the minister could give us an update with respect to collective bargaining in the various component parts of the Department of Health. I recognize the fact that the MHO carries out negotiations and then negotiations are conducted between the specific institutions. But it is fairly clear that the Department of Health has standards and guidelines that they provide, and I am wondering if the minister might give us an update as to the status of collective bargaining.

Mr. McCrae: Mr. Chairman, I think the status of the situation between the employers in the health system and the agents for the employees is such that, other than what is happening in the home care dispute, I believe things are--I suppose if there is no withdrawal of services one could argue nowadays that things are not going so badly. It is certainly not our wish that there should be any disruptions. We had a disruption at Thompson General Hospital and a potential one at St. Boniface, which was averted through some very cool heads, some very creative thinking on the part of the agents for the employees as well as the employers. It is our hope that kind of attitude and sense of reason will prevail in the future.

We were very heartened by the demonstration of that in the vote taken recently by the Manitoba Government Employees' Union where a large majority of Manitobans who work for the government voted not to resort to that sort of thing in the resolution of any future disputes. That bodes well, I suggest, for the discussions that are coming up. I think there will be reason that will prevail and that the citizens of Manitoba will be the beneficiaries.

* (1500)

I was going to say something else while I am on my feet, but I will wait until such time as the honourable member for Inkster (Mr. Lamoureux) can distinctly hear me.

Mr. Chomiak: Mr. Chairperson, is the minister in a position to outline for us what guidelines have been communicated from the Department of Health to the various bodies and institutions concerning collective bargaining and wage provisions and the boundaries and parameters of such?

Mr. McCrae: Mr. Chairman, the input of the government occurs when those negotiations come up, and it is very hard to speak on this in the way that I think the honourable member might like me to do. Certainly, everybody knows that it is the law in Manitoba that we have a balanced budget, and everybody knows, most people know, that the best way to ensure that we have quality health, education, and social services each and every year is by adhering to that. So it is within the framework of the budget and the fact that we cannot exceed revenues with the expenditures. In other words, we cannot go into the deficit situation. That is the fundamental guideline. It is felt that within that guideline we can deliver to the citizens of Manitoba quality services in health, education, social services and in all areas of government endeavour.

Mr. Chairperson: Item 2. Management and Program Support Services (b) Funded Accountability (1) Salaries and Employee Benefits $2,035,200--pass; (2) Other Expenditures $378,200--pass; (3) External Agencies $67,300--pass.

Item 2.(c) Health Information Systems (1) Salaries and Employee Benefits $4,328,200.

Mr. Chomiak: Mr. Chairperson, I note that Mr. Alexander is now present in the committee, and I wonder if the minister could outline for me what role specifically Mr. Alexander occupies in terms of the various roles and activities he occupies.

Mr. McCrae: Mr. Glenn Alexander is the director of Health Information Services for the Department of Health for Manitoba. In that capacity it is his job to supervise and co-ordinate all information systems activity within the department, and, of course, a major initiative is the Health Information System that is in the course of being brought into being in the province of Manitoba.

Mr. Chomiak: Mr. Chairperson, within this area, would Mr. Alexander be the managerial position that is outlined in the appropriation in the Estimates which notes one staff year? Is that Mr. Alexander's position?

Mr. McCrae: No, Sir.

Mr. Chomiak: Can the minister indicate where Mr. Alexander is therefore located in terms of the process and in terms of the Estimates?

Mr. McCrae: If you look on page 39, as part of subappropriation No. 21-2C, you come down a quarter of the page, Contract l staff year, and that is the line.

Mr. Chomiak: Mr. Chairperson, so Mr. Alexander is on contract to the department for a sum of $85,400. Was he also on contract to the department last year for the sum of $53,500?

Mr. McCrae: Yes, and last year that line covered a portion of Mr. Alexander's contract because he was brought from another area of government, Economic Development Board.

Mr. Chomiak: Mr. Alexander's other duties, I believe he also sits as a director on the Crown corporation that has been established. Can the minister confirm that and outline other activities? Or he at one time sat as a director on that Crown corporation.

Mr. McCrae: Not anymore, Sir.

Mr. Chomiak: Could the minister please table a list of those individuals who are directors and employees of the Crown corporation that has been established that Mr. Alexander was formerly a director of?

Mr. McCrae: There are three directors: Mr. Julian Benson, Secretary to Treasury Board; Mr. Frank DeCock, Associate Deputy Minister of Health; and the Honourable Eric Stefanson, Minister of Finance. Oh, I have the wrong Eric. I am sorry, Mr. Chairman, Eric Rosenhek, Comptroller for the Department of Finance.

Mr. Chomiak: Can we have a list of the employees of that corporation?

Mr. McCrae: There are no employees. The president of the corporation is Mr. Alexander who is not paid for that function specifically. He is paid by the Department of Health.

Mr. Chomiak: So the corporation that was set up is--and this is not a derogatory term--basically a shell corporation to transact, I would assume, financial and related matters. Is that a correct characterization?

Mr. McCrae: It is an administrative vehicle.

* (1510)

Mr. Chomiak: What is the name of that corporation?

Mr. McCrae: Health Information Services of Manitoba.

Mr. Chairman, while I am on my feet, I would like to say that on April 30, the honourable member for Inkster (Mr. Lamoureux) requested a list of insured services. I am pleased to provide the honourable member with the following information which is currently in effect. The regulations are amended from time to time as required. I am turning over to the honourable member a copy of The Health Services Insurance Act, regulations under the act which include the physician's manual and regulations under The Prescription Drugs Cost Assistance Act, which is Pharmacare, which I myself will deliver to the honourable member.

Mr. Chomiak: Mr. Chairperson, the government has entered into a contract between the Province of Manitoba and SmartHealth Inc.to implement an HIN.

Can the minister outline for me what the structure of HIN is, whether it is a legal entity and what role Mr. Alexander has with respect to HIN?

Mr. McCrae: Last year I think we spent a fair amount of time describing the structure of the Health Information Network and what was being done at that time or what was being contemplated. Now those things are beginning to be done with the help of our Health Information committee, our Privacy committee and the various partners that are referred to in last year's Estimates. Basically, except that we have now signed the contract and moved forward actually to take some of the steps that we talked about, what we said last year applies this year as well.

Mr. Chomiak: Can the minister provide a specific update as to what has been done under the HIN project to date?

Mr. McCrae: We have signed the contract, released it to the public, incorporated the Health Information Services of Manitoba Corporation. There have been five work plans agreed to. The first is about the assessment of the DPIN; the second is about laboratories, the so-called Diagnostic Services Information Network; the third is dealing with the target architecture which is work related to the design of the total network; the fourth is the communications work that is agreed to; the fifth is a general facilitation function, which is all about building relationships between the government and all of the partners involved. There have been stakeholder meetings already. The two committees I referred to have had meetings, and there are more meetings scheduled.

Mr. Chomiak: Would the minister be prepared to table those agreements?

Mr. McCrae: The honourable member has a copy of that; we have released that all when we announced that agreement.

Mr. Chomiak: Can the minister indicate how this project integrates or relates to the DUMC project, the Drug Use Management Centre?

Mr. McCrae: At this time there is no link or relationship, but it is expected that there will be in the future.

Mr. Chomiak: Can the minister give us an outline of the DUMC project?

Mr. McCrae: At this point, the proposed Drug Use Management Centre is simply a concept.

Mr. Chomiak: Is there a concept paper or study that the minister can table?

Mr. McCrae: We will have a look at what documents the Manitoba Pharmaceutical Association has produced and consider tabling them for the honourable member.

Mr. Chomiak: Can the minister provide us with a list of employees of the SmartHealth corporation?

Mr. McCrae: SmartHealth is not a government corporation. The honourable member would have to ask the principals of SmartHealth for that information.

* (1520)

Mr. Chomiak: Is the minister indicating that since it is a nongovernment corporation and has no contact with government that individuals hired by that corporation have not been recommended, approved or dealt with in any way between the government of Manitoba and SmartHealth corporation?

Mr. McCrae: SmartHealth is a private company; they can hire whomever they want.

Mr. Chomiak: Can the minister indicate what contracts or subcontracts have been entered into, just a listing, as part of the HIN project?

Mr. McCrae: The only contracts are the ones the honourable member has been provided with.

Mr. Chomiak: The province entered into an arrangement to provide credit to the Crown corporation that was established. Can the minister indicate how much of that money has been expended at this point?

Mr. McCrae: None yet.

Mr. Chomiak: The contract between the government of Manitoba and SmartHealth indicates that SmartHealth can subcontract on section 4.(2)(0). The contract indicates that SmartHealth may contract the performance of any project services and deliverables to KPMG, InfoMagnetics Technologies Corporation and IDT, information training, without the prior approval of Manitoba. Does that, therefore, indicate that any other subcontracts entered into between SmartHealth and subcontractors require the approval of the government of Manitoba?

Mr. McCrae: With the exception of the three companies named by the honourable member, SmartHealth can contract with others, but with the approval of the government under the contract.

Mr. Chomiak: Insofar as it is a contractual obligation between the government of Manitoba and SmartHealth therefore for subcontracting, can we get a list of which contracts have been entered into that had been approved by the government of Manitoba between SmartHealth and third parties?

Mr. McCrae: There are none, Mr. Chairman.

Mr. Chomiak: Just for clarification, the minister is saying that there are no contracts entered into between the Crown corporation and outside agencies, and that with the possible exception of the three corporations confirmed in Section 4(20) of the contract, there are no contracts or subcontracts that have been entered into between SmartHealth and any entity?

Mr. McCrae: Outside the three companies the honourable member named, SmartHealth has not approached the department under the contract for approval for any other subcontracts to this point.

Mr. Chomiak: Has SmartHealth approached the government with respect to any personnel contracts in relation to their operation?

Mr. McCrae: No, that would not be something pursuant to the contract.

Mr. Chomiak: I wonder if we might get an update as to what projects or portions of projects these three identified corporations are working on.

Mr. McCrae: I am advised those companies are working to carry out the components of these five work plans that I referred to a little while ago. Their work would be related to parts of those, and it is those five work plans that those three companies are working on.

Mr. Chomiak: I have spoken with individuals who are working on these projects who are not part of those three entities and who are not employed by SmartHealth and who are not employed by the government of Manitoba, and I am trying to understand under what vehicle or agency these people are employed to undertake work with respect to this.

Mr. McCrae: Well, I do not know who they were working for; maybe the honourable member can tell us.

Mr. Chomiak: So again for clarification, Mr. Chairperson, with respect to the HIN project, we have the government department, we have the Crown corporation that is an agency for administrative purposes, and we have SmartHealth that has subcontracted to three contractors. Outside of those agencies and bodies, is there anyone else working on the HIN project, or the information project in general?

Mr. McCrae: There are a lot of people working on this: people in the department, the SmartHealth company, and the three that the honourable member has named. Who knows how many others working who are employed by the various stakeholders with whom we are consulting and with whom SmartHealth is consulting, so that we can make sure we have the appropriate public and stakeholder input that we require? I really do not know how many people, but I would assume that, as we develop this project, there will be literally hundreds of people involved, all wanting to accept our invitation for public input into the process.

* (1530)

Mr. Chomiak: Could the minister indicate who would be the stakeholders that would be hiring outside agencies to undertake work in this regard?

Mr. McCrae: I do not know what the stakeholders do. That is not part of my purview here. If I were in charge of, for example, the Manitoba College of Physicians and Surgeons, maybe I could answer the honourable member's question about who in the organization is involved with the process of consultation. I cannot answer for the all the stakeholders whom they hire or do not hire.

Mr. Chomiak: In the release that the minister put out in this regard on February 22, stages of a number of steps were outlined that dealt with the various projects and the various deliverables as they proceeded. Can the minister indicate what stages we are at and the various component parts with respect to the deliverables, and I am referring to Stage 0, Stage 1, Stage 2, Stage 3, Stage 4, Stage 5? Can the minister give me an update as to what the stage is for each of the component, earlier-indicated aspects of the project?

Mr. McCrae: On April 30 the honourable member for Kildonan requested information with respect to the Advisory Committee on Mental Health Reform, specifically the names of the committee members and the date of their last meeting and current recommendations or issues under discussion. The committee last met on February 19, 1996; their next meeting is scheduled for June 7, 1996. The last meeting of the committee, the issues discussed included urban health design team report and recommendations, rural health regional development, rural health associations.

These are the members of the Advisory Committee on Mental Health Reform: Dr. William Bebchuk of the Department of Psychiatry at the PsycHealth Centre, Dr. Jeff Ivey, medical director of the Eden Mental Health Centre, Sister Jean Ell, social work for Sara Riel Inc., Mr. Ed Ziesmann, occupational therapy consultant, Ms. Ellen Ledieu, registered psychiatric nursing for the Central Region.

Dr. Steven Feldgaier, psychology, Winnipeg, Dr. Garey Mazowita, family medicine, Winnipeg, Ms. Veryl Tipliski, registered nursing, Winnipeg, Mr. Bill Martin, Canadian Mental Health Association, Dr. Gary Altman, co-ordination of child and adolescent psychiatric services for St. Boniface Hospital, Mr. K.P. Aujlay, Vita and District Health Centre, Ms. Darlene Dreilich, Community Coalition on Mental Health, Winnipeg.

Mr. Bill Ashdown, consumer/family representative for the Society of Depression and Manic Depression, Mr. Jerry Marek, consumer/family representative from Swan River, Ms. Catherine Medernach, consumer/family representative from Winnipeg, Ms. Katherine Davis, consumer/family representative for the Schizophrenia Society of Manitoba from Winnipeg, Ms. Heidi Mortensen, consumer/family representative from Winnipeg, Mr. Ed Driedger, consumer/family representative from Roland.

Ms. Laurie Cenerini from the Anxiety Disorders Association of Manitoba, Mr. Jim Mair from the Thompson Region, Ms. B.J. Cooper from the Norman Region, Ms. Anna Pajdzierski from the Interlake Region, Ms. Lorraine Compton from the North Eastman Region, Mr. Del Epp from the South Eastman Region, Ms. Linda Lehmann from the Central Region.

Maureen Lennon-Borger, executive director of the Manitoba Schizophrenia Society, Winnipeg, Ms. Linda Earl from the Westman Region, Ms. Odette Wright from the Parkland Region, Ms. Sue Hicks, assistant deputy minister for Community and Mental Health Services and Dr. John Biberdorf, legislative and program analyst for Manitoba Health.

The honourable member asked about a progress report on the five work plans. The DPIN, that is an assessment, it is a one-time project and it will be followed by Stage 1 work plans. The DSIN, that is the Diagnostic Services Information Network, that is at Stage 0. The target architecture that I referred to is a one-time project, and with respect to communications, is not related to a specific network, so that will be an ongoing undertaking, and the same comment can be made with respect to general facilitation.

Mr. Chomiak: Can the minister give us a description of the last three projects, that is, the target architecture, the communications projects and the general facility project?

Mr. McCrae: By target architecture, we mean the design of the whole network. By communications we mean an ongoing function for SmartHealth to communicate with the public and keep the public informed of developments in the project, and general facilitation refers to the ongoing job of building relationships, remembering to invite people to meetings, remembering to make sure that the right organizations are consulted and, I guess, generally manage the project, which is a multidimensional project.

Mr. Chomiak: Mr. Chairperson, can the minister indicate for me what staff or individuals are undertaking the communications function?

Mr. McCrae: On April 30, the honourable member for Inkster (Mr. Lamoureux) requested information with respect to the Health Links program. In 1994, the Misericordia General Hospital began operating a telephone information service known as Health Links. During the emergency physicians' work stoppage in September of last year, the Health Links service was expanded to a 24-hour operation to ensure that consumers had access as required, and that 24-hour-a-day coverage is continuing at this time.

I am just preparing to respond to the question put by the honourable member for Kildonan.

* (1540)

From the Department of Culture, Heritage and Citizenship, Therese Mickelson is involved in this part of the project. Mr. Glenn Alexander, who is with us today, and the communications subcommittee of our HIN stakeholder group, which is the group composed of all the nongovernmental agencies that we are consulting--they are involved in this. There is, of course, staff support from SmartHealth as well to carry out the recommendations of the communications subcommittee of the stakeholder committee.

Mr. Chomiak: Mr. Chairperson, are there any contracts or subcontracts that have been entered into between the communications subcommittee and any outside individuals or groups?

Mr. McCrae: The committee has no authority to contract with anybody.

Mr. Chomiak: Can the minister give us a brief description of the general facilities function? That is relatively new to me, and I wonder if the minister might elaborate as to what activities that body or group is involved in?

Mr. McCrae: General facilitation refers to the role that we know that SmartHealth is able to play in regard to reaching out to the various stakeholder organizations that are interested and supportive of the building of this public health information network. So that general facilitation includes things like, as I said before, working with the various stakeholder groups; keeping the stakeholder organizations informed of developments as we go along; making sure they get invited to meetings or get invited to consult in some way with us; approaching them to ask their advice perhaps on technical matters. That kind of facilitation is what I mean.

Mr. Chomiak: So is it a correct characterization or summation to state that the DPIN project and the Diagnostic Services Information project are the two tangible developments thus far, and they are at the stage--I will have to check Hansard, but I think it is one and zero respectively--and then together with the target architecture and the communications and the general facilitation, that is the status of the HIN project at present? Would that be a correct characterization?

Mr. McCrae: I would say that we have made some progress with respect to the Diagnostic Services Information Network. We have the people that we need to consult, ready to be consulted, or have been already consulted. Design has begun.

Mr. Chomiak: Can the minister just give an update of what roughly the design entails at this point, I mean, what direction the project is going?

Mr. McCrae: As you design a public health information system, you want to make sure that you are designing it to meet the needs of our collective vision of the future of our health system. It requires collaboration so that everybody can be using the same vision so that we are not designing a system that meets the needs of yesterday but designing a system that meets the needs of today and tomorrow. I think, in short, that is the best way I can put it for the honourable member.

* (1550)

Mr. Chomiak: Mr. Chairperson, in the last information put out by the minister, it was indicated that network charges would be $27.6 million; hardware and operating, $35.2; software development, $55.9; SmartHealth contribution, $25 million to $35 million; subcontractors, remainder.

Can the minister indicate whether or not those figures are still valid?

Mr. McCrae: Those numbers are believed by us still to be valid, yes.

Mr. Chomiak: Mr. Chairperson, can the minister indicate whether or not any funds have been forwarded from either the government of Manitoba or the Crown corporation by way of loan or expenditure for any of the projects or developments undertaken?

Mr. McCrae: For the work done prior to the end of the last fiscal year, the prefunding arrangement was in effect, so that will be paid out at a later date.

Mr. Chairman, the other day the honourable member was asking about waiting lists. In March 1995, interim funds were approved for the period of March 15 to June 15, 1995, as a short-term strategy for reducing waiting lists. These dollars were redirected institutional funds and were shared with seven hospitals to reduce the waiting lists for joint replacement surgery, open-heart surgery, MRI scans and radiation oncology.

The final statistics for 1995-96 are not yet available, but we do know that 58 additional joint replacement surgeries were funded the last fiscal year. We have also been advised that St. Boniface Hospital and the Health Sciences Centre expect to have performed approximately 1,000 open-heart surgical cases the last fiscal year, compared to 749 cases in the previous fiscal year. We also provided funding for an additional 450 MRI procedures and have continued to work with the Manitoba Cancer Treatment and Research Foundation to address waiting lists for radiation therapy.

Manitoba Health will continue to work with the physicians and hospitals this fiscal year to improve the system, to ensure that Manitobans receive surgery within appropriate time frames and specific issues will be addressed in this consultative process. I believe we have made some good progress in the area of the reduction of our waiting lists for important surgeries and services in Manitoba.

Mr. Chomiak: Mr. Chairperson, in the minister's preceding answer, he indicated that no money was expended in the last fiscal year because of the prepayment conditions that applied. Is the minister saying that no money been paid this fiscal year as well?

Mr. McCrae: Mr. Chairman, no money has yet flowed under the prefunding arrangement.

Mr. Chomiak: Mr. Chairperson, but the minister will agree that $26 million in the form of money placed in trust has flowed from the Province of Manitoba to its Crown corporation. Is that correct?

Mr. McCrae: No cash; borrowing authority.

Mr. Chomiak: Mr. Chairperson, so the Crown corporation has the authority, backed by the government of Manitoba, to borrow up to $26 million in order to meet the terms of payment of this agreement. Is that correct?

Mr. McCrae: Yes, Sir.

Mr. Chomiak: Mr. Chairperson, there is a provision in the contract that deals with the expenditure of the $26 million. The provision is that whichever comes first, an 18-month period from the signing of the contract or the aggregate expenditure of $26 million, will then see the authority utilized in the $26 million and the money expended. Is that a correct interpretation of the agreement?

Mr. McCrae: Yes, Sir.

(Mr. Mike Radcliffe, Acting Chairperson, in the Chair)

Mr. Chomiak: Mr. Chairperson, how can the public be guaranteed that the cost benefits, as outlined by the government in the establishment of this project, will be met when we have expended an aggregate sum of $26 million?

Mr. McCrae: The modular approach constantly monitored and evaluated by the stakeholders.

Mr. Chomiak: Mr. Chairperson, yes, I understand that, but there were very optimistic projections of savings as a result of this project, and yet within the agreement the only protection basically that I could see is that--well, there is none effectively insofar as when they submit their bills and once $26 million is expended and ultimately $100 million is expended, the government is required to pay to contractor of SmartHealth.

Mr. McCrae: The work plans have dollar values. Each work plan is subject to approval by us as we go through, and we do not work alone. We work with many, many stakeholders who are all part of the process. The beauty about going into an important new endeavour like this is that we are not going in alone, we are going in with the support of Manitoba.

Mr. Chomiak: Mr. Chairperson, is the minister saying that there are specific dollar figures and savings that must be achieved on each work plan before the money will be expended? Is that what the minister is saying?

Mr. McCrae: I think the honourable member will remember last year we made reference to go and no-go decisions and, obviously, the department and the stakeholders with whom we are working will ensure that there is a commensurate benefit for the people of Manitoba before they expend taxpayers' dollars on something that does not show evidence that we can achieve what it is we are setting out to achieve.

* (1600)

Mr. Chomiak: Mr. Chairperson, that is not quite what I asked, and I may have not made my question clear. Are there specific dollar figures attached to the work plans that must be achieved prior to the expenditure of the funds?

Mr. McCrae: I can only repeat what I said, Mr. Chairman. If savings are not achievable--I think cost efficiency or cost benefit is probably the better language to use. This will be what the stakeholders will be looking at as they make their decisions along the way. If there is not a level of satisfaction amongst the stakeholders that we ought to move on a particular dimension or a particular module of this network, then no doubt they will make the decision not to proceed. That is allowed for under the contract.

Mr. Chomiak: Last year, or perhaps the year earlier, the department made available computer hardware for pharmacists and outlets, et cetera, to deal with the DPIN project. In regard to this overall HIN plan, has there been offered to agencies or institutions or facilities any type of hardware in order to effectively integrate this system?

Mr. McCrae: I do not think we are advanced far enough in the project that we would have been brought to a conclusion of that discussion. I know it has been informally discussed with various stakeholders.

Mr. Chomiak: Have those discussions generated a policy paper or an outline or anything that the minister could share?

Mr. McCrae: No, Sir.

Mr. Chomiak: I recently visited a hospital in Winnipeg that was considering new software and hardware with respect to the operations in the hospital. How have various institutions been integrated in order to participate in the whole project? In other words, have they been integrated? Have they been alerted? Are they plugged in? Or is it too early in the process?

Mr. McCrae: Mr. Alexander has regular contact with the information technology people in the various facilities in Manitoba.

Mr. Chomiak: What is the exact relationship between ISM and HIN and/or the Crown corporation and/or SmartHealth?

Mr. McCrae: There is not one.

Mr. Chomiak: Is a relationship contemplated?

Mr. McCrae: No.

Mr. Chomiak: Mr. Chairperson, one of my concerns about the SmartHealth contract is that certain provisions and terms in the contract have not been included--[interjection] The minister is asking where? On page 16, subsection (c)(i)(ii), Clause 3.28, and in addition, 3.39 of the contract, just for a start. Page 16 of the contract (c)(i)(ii), the management fee in subsection 3.28, and the rate of interest on the $26 million on the borrowing authority between the Royal Bank and SmartHealth, which is 3.39.

Mr. McCrae: When we released the contract, that part was blacked out, and that was done for proprietary reasons.

Mr. Chomiak: Well, I am not going to dispute the proprietary reasons, although I question them. I am not going to get into a long argument. I do not see why the interest rate on the loan could not be provided as well as the costs that Manitoba will be paying to SmartHealth for work under the work plan. I do not see how that is proprietary, but I am not going to get into a long dispute with the minister on that.

My comment, or whether we just move on.

Mr. McCrae: I guess a politician never wants to give up an opportunity to make a comment. We think it is a good deal. It was worked out very, very carefully. It took a long time to work out the contract, but it was, at every step, worked out with the best interests of Manitobans and the taxpayers at heart.

Mr. Chomiak: Mr. Chairperson, can we get a rough estimation of where we expect to be in the process at year's end?

Mr. McCrae: That depends upon our stakeholders, and how much work they see fit to approve that we move forward with.

Mr. Chomiak: Mr. Chairperson, we are behind schedule, but I am not posing that as a criticism. It is obvious that we are not within the time lines of the original schedule, but, given the undertaking, that is not a surprise. [interjection] I would not say we are behind where you set out to do in the contracts. Certainly, in the feasibility plan that was put together it was expected that the project would be much further ahead at this point than it is right now, and that is on page 22 of the feasibility schedule, the strategic assessment that was originally--

* (1610)

Mr. McCrae: I remember, if we are behind, I know why. It is because last year around this time we were being told, oh, do not sign anything because the NDP is going to win the election, and they will not. So we said, well, let us just relax. We will not sign anything. We will be very, very careful just what it is we are signing. Well, the rest is history, of course.

Mr. Chomiak: Mr. Chairperson, so the minister is saying that the contract was delayed in terms of signing because of the provincial election and specifically and only because of the provincial election. Is that what the minister is saying?

Mr. McCrae: I certainly am saying that the election intervened and did give us cause for pause, and that was taken very seriously. I recall the Premier (Mr. Filmon) saying during the election that there will not be any contracts like this signed during the election and after that time any delays that were occasioned were occasioned because of the extreme care with which we approach our work here. We listen to the honourable member and his colleagues when they raise warnings about different things that are going on in the government, including Health, and when they make an allegation or a suggestion that something might be wrong with this, that or the other, we check it out very, very carefully and only after we have made sure that members' concerns have been properly addressed, then we proceed.

So, yes, I think the writing up of the contract took longer than probably we expected because it is a very complicated and important contract, and it is important that we bring the best possible legal considerations to the construction of a contract like this. That all having been said, the honourable member has me at a significant disadvantage with the legal training that he has. I am not very good at reading a contract and interpreting what it all means. That is why we have smart people like the honourable member for Kildonan, and others working sometimes with us to make sure that we do a good job on getting our contracts written properly.

Mr. Chomiak: Mr. Chairperson, I am not at all clear on the relationship between DPIN and HIN and the way DPIN is presently operating and functioning and the way it is to be integrated with HIN. I wonder if the minister might outline for me precisely what that relationship is and where it is going.

Mr. McCrae: I think the honourable member has heard me describe the DPIN as the first spoke of a wheel, and that is about the best way I can describe it. It was put together as a result of a tendering process. The Systemhouse company got the deal and helped us build the Drug Program Information Network. I recall saying then that this will be the first spoke in a larger wheel. That must be nearly three years ago now I guess we got that going. It has really been of significant benefit, is very popular with Manitobans.

I have given some statistics already about how many additional consults have happened between physicians and pharmacists as a result of the Drug Program Information system, how many prescriptions have been changed or cancelled because of the information contained in that system for the protection of the consumer, the convenience that is has brought for people with respect to their deductibles and all those things. Once you add these other components to our health information system, appropriate information shared with appropriate health professionals can really inure to the benefit of the consumer of health care services in Manitoba. Simply, it is that one first spoke in a much larger wheel.

Mr. Chomiak: Has that spoke been integrated with any other aspect of that wheel at this time?

Mr. McCrae: That is the work that is going on nearing completion, I understand. That is the work going on in that first work plan that I referred to earlier on in the assessment of the DPIN.

Mr. Chomiak: Is Systemhouse still undertaking the project?

Mr. McCrae: No.

Mr. Chomiak: Can the minister indicate who is undertaking that project?

Mr. McCrae: The department runs the DPIN.

Mr. Chomiak: Are there any subcontracts that have been entered into between the department and any other outside agency concerning the DPIN project?

Mr. McCrae: No, Sir.

Mr. Chomiak: If an individual establishes a pharmacy and requires the software and the hardware to plug into the network, how can they integrate their system into the department? In other words, what is the connection between the department and that particular outlet? What is the relationship?

Mr. McCrae: They have to register with the department, and we have to approve the software.

Mr. Chomiak: Outside of the department and the outlet, who has access to the information that is contained within the network or that system? That is, outside of the direct people in the pharmacy, who deal with it and the department? Does anyone else, any other agency or body, have any access to that information?

Mr. McCrae: The department has that information, the pharmacist has that information, and only on proper application to the department can a regulating agency like the College of Physicians and Surgeons or the pharmacy association might they be able to access that information.

Mr. Chomiak: Mr. Chairperson, so outside of regulatory agencies, nobody has access to that information. Is that correct?

Mr. McCrae: The department and the pharmacist.

Mr. Chomiak: The department and the pharmacist. Would that information be available, for example, to the Centre for Health Policy and Evaluation upon proper application?

Mr. McCrae: We have not given out any information to organizations like the centre to this point. They can access blinded information which blots out the name of the consumer or the patient, and that can only be done through the privacy with the approval of the access and confidentiality committee.

* (1620)

Mr. Chomiak: I thank the minister for that response. Is the minister indicating that that has not happened? It potentially can happen, but it has not happened. Is that correct?

Mr. McCrae: Yes, Sir.

Mr. Chomiak: Mr. Chairperson, at the end use, that is the pharmacy, there is also a fair amount of information, which from the minister's comments, I take it, is protected other than by application. Is the minister aware of any outside organizations or agencies having access to that information?

Mr. McCrae: This information will not be made available to anybody except under the circumstances we have described.

Mr. Chomiak: Mr. Chairperson, the minister is aware that there have been concerns expressed about information relating to pharmaceutical use and data, and I am pleased to see that the minister is indicating that that data will not be made available. Can I take it that it is Manitoba policy that this information is not available to any outside organization or body or group or individuals other than those that we have already earlier identified?

Mr. McCrae: I would just like to remind the honourable member that there is a law in this province called The Drug Cost Assistance Act and prohibits what the honourable member is talking about. We have no intention of changing that.

Mr. Chomiak: Mr. Chairperson, I actually would like to pursue the whole question of confidentiality and go down that line; but we traditionally take a break at this time, so perhaps we should at this point. I know the member for Inkster (Mr. Lamoureux) wants to ask some questions, and then I will come back so that I can do it in a more systematic basis. So maybe if it is agreeable we will take a five-minute break for the benefit of the staff involved and ourselves, too.

The Acting Chairperson (Mr. Radcliffe): Is it the will of the committee to recess for five minutes?

Some Honourable Members: Agreed.

The Acting Chairperson (Mr. Radcliffe): The committee will recess for five minutes.

The committee recessed at 4:22 p.m.

________

After Recess

The committee resumed at 4:34 p.m.

The Acting Chairperson (Mr. Radcliffe): The committee will come to order, and I believe the honourable member from Inkster has a question. Is that correct?

Mr. Kevin Lamoureux (Inkster): That is correct. Mr. Chairperson, this is in fact an area I alluded to earlier in my response to the budget where I had given the government sound criticism, I like to believe, in different areas. But this, quite frankly, is one of the areas in which we think that the government is moving in a very positive direction. The agreement that has been entered into allows for the province, I believe, ultimately to have an opportunity to be a leading force in this whole area, not only in the province of Manitoba but, in fact, Canada.

Even though I have not read through the detailed contract that was made available to me through the department in trying to get a bit better of an understanding of it, I acknowledge right up front that this is an area in which we support the government in its agreement with the subsidiary, SmartHealth, which is a subsidiary of the Royal Bank, acknowledging that, yes, there is going to be some profit going towards the subsidiary but, given the potential of return that Manitoba could see in the future, I think it is just overwhelming where the potential is there.

I know at times when you come up with the programs you might be criticized, and part of the concern--actually, we did meet with Royal Bank representatives and expressed first-hand some of the concerns that we had in terms of making sure that Manitobans in particular are better informed of exactly what is happening here, along with some of the departmental officials. I know I have had opportunity to comment on this particular program, because there is always the opportunity to spread misinformation. It is not a hundred million dollars going to the Royal Bank, as an excellent example, as some have indicated.

What I really like about it is that it is going to be multifaceted in the sense that there are many different ways, whether it is going to be patient oriented, policy oriented in another form. This data bank, as I said, has wonderful potential.

Having said that, there is one area of concern that we do have, and that area is in regard to privacy and confidentiality of files. I would ask the minister what he could indicate is or has been done in order to ensure that the confidentiality element is going to be there for the privacy for the citizens.

Mr. McCrae: I certainly appreciate hearing those words from the honourable member. I remember the early days of my career in this place, watching the Liberal Party as it moved into the world of information technology in the carrying out of its function as a political party, and I sometimes wonder if that is part of the reason why we see a recognition on the part of the Liberal Party that the world is indeed changing, that there is technology available to us that we have not used to the extent that we could. Maybe that accounts to some extent for the understanding that is displayed today by the honourable member for Inkster for what we are trying to do.

But, indeed, he is right to focus on the issue of privacy. As we enter a world which has turned from an industrial type of world to an information type of world, that information can be misused if appropriate safeguards are not put into place. It is for that reason that we have enlisted the help of the privacy or the confidentiality committee component of our Health Information Network initiative. They represent a number of interested organizations from society, from the community, and we say that privacy, security and confidentiality of health records is of paramount importance to us, too, and the government will ensure that this information technology will be used in such a way as to enhance the right to privacy that people are entitled to. That includes security and confidentiality measures being taken that should be integral components of a project like this, and to ensure that the necessary security is there, we plan to follow some pretty important paths and take very important steps to ensure that.

We want to clearly identify and understand just what information must be protected and from whom it must be protected, and we are going to do that by consulting extensively with consumers, health care providers and regulatory bodies, all of which people and organizations share that very same concern the honourable member is raising. We have already set up that Privacy and Confidentiality committee and the members include regulatory bodies like the Manitoba Association of Registered Nurses, the College of Physicians and Surgeons, the Manitoba Association of Health Care Professionals and consumers groups like the seniors organization and Consumers' Association and the Association for Rights and Liberties, and as required for the appropriate input, others might as well be added.

* (1640)

We need to look at the broad alternatives that are available to us, and it is quite probable that action will be taken in any area where that is available to us because of the strict emphasis that we want to put on this aspect of this project. Among the initiatives and actions that can and will be taken will be legislative and regulatory action. We want to amend existing legislation to tighten access rights and provide for stiffer penalties should there be breaches of security. We need to know what new legislation might be required in terms of this, and we are doing research on a world-wide basis to see what regulation or legislation are in effect with respect to this. So we do not really miss out on opportunities to find whatever ways there are to protect people's privacy.

Of course, the technology part of this very significantly allows for enhanced privacy of health records. We have heard too many horror stories about breaches in the past and we do not want that to happen. Things like encryption and card technology and dedicated lines and passwords and system security, all of which are not exactly my forte in terms of my knowledge of the way the computer world works, but to people that like SmartHealth and people like Mr. Alexander and his staff, those words do have very much meaning, and they know exactly how to design a system that will use these technologies to ensure that our rights to privacy and confidentiality are indeed respected.

Management practices will include the signing of nondisclosures and oaths of confidentiality, and there will be the opportunity for punitive action, including firing people who abuse other people's rights to privacy and confidentiality.

We know that there are experts with respect to this, and through the vehicle that we have with this contract, we can access those people. Manitoba Health and our vendors have the expertise to deal with the technology required to ensure that the necessary security for health records is indeed in place.

All of the things that I have been talking about thus far in this answer have been guided by the consumers, by the health care providers and regulators with whom we have been consulting thus far, so it is not something that I made up or that Mr. Alexander made up or something that the honourable member might even bring forward. These things have come forward from our extensive consultations with consumers, providers and regulators.

We have now completed a preliminary review of the need for legislation, and we have announced that there will be legislation to enhance the rights of the public to the privacy and confidentiality of their health records.

Mr. Lamoureux: That, in essence, was leading to the next area of questioning that I was wanting to get from the minister; that is, if the minister was looking at legislative means in order to enforce privacy that would enhance the assurance to Manitobans that the government takes this issue quite seriously in terms of privacy.

The question I would ask the minister is: Does he have any indication on when we would see some legislation brought forward, keeping in mind, of course, the new rules of the Chamber which, in essence, allow for--the minister would have to bring in first reading prior to the summer breakup, or would we anticipate that any legislative requirements would be met in the spring of 1997?

Mr. McCrae: Yes, and we have announced our intentions in that regard. We expect to be able to introduce legislation in the spring of 1997 after a further period of consultation, which will include things like discussion papers and meetings and that sort of thing.

Mr. Lamoureux: Can the minister indicate if--I believe they call it the Confidentiality committee, or there is a Confidentiality committee. Has that committee met already? Is it something that meets on a monthly basis? What sort of a process is put into place to ensure that those different stakeholders are having some input into the framing of the legislation?

Mr. McCrae: There is a Confidentiality committee that has been in existence for decades, but there is one specific to SmartHealth and it is the one I referred to, which is a subcommittee of the stakeholder committee and has the representation to which I referred. It met three weeks ago, for example, and will meet again in a couple of weeks and certainly on an as-required basis as we move through the various modules of this project.

Mr. Lamoureux: Before I move on to another area here, just to confirm from the minister. This committee will then have direct input into the framing of the legislation?

Mr. McCrae: I should perhaps correct myself to this extent. It is not a committee associated with SmartHealth. SmartHealth is the vendor here. It is a committee associated with us as the government. The question was, will they have direct input? Yes, of course, they will have direct input into the legislation, they and others as well.

Mr. Lamoureux: Mr. Chairperson, just on a note of high-tech technology that is out there, the other day I received some correspondence, and I believe it was the federal government now has a health online service so people can actually tap in and find out all sorts of things that are happening on the national scene with respect to health. I am wondering if the minister could give some sort of indication, does the Department of Health have something that is, whether it is on the info-highway, is there any development that is consumer oriented dealing with computer technology.

Mr. McCrae: We have had material, Mr .Chairman, on the government's home page on the Internet, for example. I got word from somebody I know that they saw my picture on there, and I thought, well, my, are they not lucky. Anyway, there are opportunities in that regard for the Health department to use that government home page more than we are already, and we fully intend to do that since the access to that is free, as I understand it. That being the case, we can utilize that as a communications resource as well.

* (1650)

Mr. Lamoureux: I am somewhat familiar, I am still trying to get an understanding, in fact, our caucus just got on to the Internet in a significant way, and we are hoping to develop that. I would not want to see, for example, the governments--and I am sure the government will go ahead either way. I am very familiar that the government caucus, and I believe even the Premier's office has a cover page on the Internet which you can click, and you can find out all sorts of things the government is up to.

That is not necessarily what I am looking for. What I am looking for is more of a service to individuals who want to know what is up with health. Maybe they want to find out the types of clinics that are available or the types of services offered through the Department of Health, this sort of an informational type of service being provided. Is that being considered?

Mr. McCrae: Well sure, Mr. Chairman, and any suggestions the honourable member might have that he thinks might be helpful to the population and to the world for that matter with respect to health issues that consumers might be interested in or might be educational or instructive, we would be interested in knowing. If the honourable member has suggestions, we would be happy to look at them.

Mr. Lamoureux: I do have one suggestion in terms of an area in which we think that the Internet would be a good place to provide this, and that is more so with health prevention, you know, prevention with dealing with health care. This is an area in which there is always a need for establishing more communication links, different sorts of programs that are made available, whether maybe it is the new wellness centre that is being set up by the Seven Oaks Hospital or the Reh-Fit Centre which complements the St. Boniface Hospital and other facilities.

It might be programs that are provided through our different health community clinics, this sort of thing, whether it is a foot care, whether it is other type of prevention-type programs being made available through a network, might be somewhat beneficial, which would be sponsored in essence through the Department of Health.

I know the other day I had received, and I think it was from the Department of Industry and Trade, a CD-ROM or disk which had all this wonderful promotion about tendering, and it is fairly impressive. The minister nods his head; I think he might have seen the disk. It is in fact fairly impressive. This is the type of [interjection]--OBS, the Minister of Labour calls that particular disk. The idea is that this is something that can be circulated virtually en masse. I do not think there was any cost for the department or for the consumer that wanted this particular disk, and I think that those are the types of things--like you open up the white pages and it shows, you know, if you are choking, here is what you should be doing. It has all sorts of illustrations, if you like. I think to a certain degree that sort of information, because you can do so much more on the computers today, would be somewhat beneficial.

I would leave that with the minister. I would be interested in getting some sort of a response back. Maybe the minister can have someone from within the department at least look into the possibility, potential for cost of establishing something that would be made available to the population as a whole. I think that what we are seeing is more and more of the population gaining access to computers and the Internet and so forth. There is always some concern that there are those who do not have access, but that is maybe for another debate.

I do not know if the minister was going to respond to that. Otherwise, I know the member for Kildonan (Mr. Chomiak) had some more questions that he was wanting to ask at this time.

Mr. McCrae: I appreciate what the honourable member said. I have already asked the department to do that, but the department is going to be delighted to know that the honourable member feels the same way. I think that we ought to use whatever technologies there are available, and just in case not everybody in the province has a computer to access this type of information, as the honourable member already knows, we have other efforts underway as well through direct public information spots in the newspaper or on television to make sure that the public is aware of the things the honourable member is talking about.

We will do what we need to do, but certainly the specific suggestion is very helpful, and I will make sure that it is understood by the department.

Mr. Chomiak: Just before I start, just on administrative matters, I anticipate I will have a fair amount of questions yet that will probably take us into tomorrow, so I wonder if--[interjection] No home care calls.

Mr. McCrae: Mr. Chairman, I think that what the honourable member says is something we can accommodate. However, does he have any general idea how long he might be on Information Systems, so that we can be ready for Home Care later in the afternoon?

Mr. Chomiak: I anticipate probably no more than--although I must admit, sometimes questions lead to other questions, but my guess would be no more than probably an hour tomorrow.

Mr. Chairperson, there is a Privacy and Confidentiality committee that has been up and running, as the minister indicated, for decades. The minister also mentioned a specific privacy committee in relationship to SmartHealth. Can the minister outline for us who comprises that committee and what its mandate is?

Mr. McCrae: It is not in relation to SmartHealth. It is in relation to the Health Information Network, as I corrected myself a little earlier, and it has representation from, among others, the Manitoba Association of Rights and Liberties, the Consumers' Association, the Manitoba Society of Seniors, the Manitoba Association of Health Care Professionals, the Manitoba College of Physicians and Surgeons, the Manitoba Association of Registered Nurses, and others may be added as their expertise is required, and we do appreciate the willingness of all these organizations to take part.

* (1700)

Mr. Chomiak: Mr. Chairperson, I am going to ask some questions with respect to confidentiality just so that I can clarify in my own mind how procedures work at present.

I will start with the issue that we discussed yesterday, and that is the income tax information, the authorization. I sign and authorize the release of that information to an appropriate Department of Health employee who then has the right to access that information from Revenue Canada, that being line 150, I believe, of my income tax form--[interjection] My assessment form.

Now, that particular piece of information is confined where, and to what extent can that information be disseminated throughout the system? Is it only Department of Health employees who have access to that, or will that information be on-line with the pharmacist?

Mr. McCrae: That information is restricted to Manitoba Health staff whose function it is to administer the program.

Mr. Chomiak: So that information is restricted to the employees who receive the application form and verify or not verify the information. Is that correct?

Mr. McCrae: Yes.

Mr. Chomiak: What is the policy with respect to the Department of Health and that information? Will it all be verified or is there a policy or policies that apply to the use of that particular information?

Mr. McCrae: We are just going to check on that one and answer it tomorrow.

Mr. Chomiak: Has that issue been dealt with or reviewed by either of the Privacy and Confidentiality committees and, secondly, will that area be looked at in terms of proposed legislation?

Mr. McCrae: No, Sir.

Mr. Chomiak: Is that no to both questions?

Mr. McCrae: As I recall, the questions were, was the access and confidentiality committee involved, and, no, and then the next part was, is there a future role, I think, for the access and confidentiality committee. This is an administrative matter and not a matter relating to people's health records, and so that is why the no encompassed both parts of the question.

Mr. Chomiak: I understand that and I thank the minister for that response, but it will mean still at the computer end, at the computer terminal, there will be a figure that will come up that will indicate to the pharmacist whether or not that person has to pay. There is a trip-in point where that will happen. Is that correct?

Mr. McCrae: What the pharmacist will know is the dollar value of the prescription. That will be there. The pharmacist will know how much to charge the patient, and the pharmacist will know how much has been charged within a given year.

Mr. Chomiak: The value of the prescription, how much has been charged that year, and if the pharmacist could ascertain that--

Mr. McCrae: I believe where the honourable member is taking us is that the pharmacist could conceivably do a calculation and find a way to determine the income of the customer or client standing in front of him or her, and that is acknowledged. They are under pretty strict rules of their association. If they misuse that kind of information, they are going to be in big trouble.

Mr. Chomiak: Actually, I was not taking it there. I was actually trying to understand the functionality of it. The pharmacist enters into the screen, the line goes into DPIN and automatically that information comes up on screen as to the levels, and it is at that point the pharmacist knows, oh, this person is within $10 of their deductible and this prescription is $12, so they are only going to have to pay $2. Is that how it functions effectively?

Mr. McCrae: For those people who will spend enough money to reach their deductible, at which parenthetically the member has pointed out is not as many as used to be, the pharmacist will know for those people on that one occasion what deductible a level has been arrived at because the computer screen will say, these drugs are $20, you charge zero, or $2 or $10 or whatever it is. At that point and at that point only will the pharmacist have an opportunity to know what this patient's deductible amount is going to be. It is from that point on subsequent visits will it only show the amount, dollar value of drugs purchased up to that time; but it will only show one time the deductible level.

And, yes, from that number, for those people who do qualify, the pharmacist, if the pharmacist was wanting to do something wrong and against the rules of his or her own association for which he or she would be punished if he or she were caught, yes, that calculation could be made in those cases.

* (1710)

(Mr. Chairperson in the Chair)

Mr. Chomiak: Let me take another similar piece of information and try to work it through the system. An individual is diagnosed with some kind of a disease where a stigma may be attached, a mental illness, for example, and is taking an obvious drug that shows up on the screen. But that always happened because the pharmacist dealt with it when there was paper before, and I suppose staff had access to the same paper, staff had access to the machine. It also appears at the Department of Health where it is correlated, et cetera.

Ultimately, we are looking for an expansion of the network to go to doctors' offices, laboratories, et cetera, and that is where we get into the layers of confidentiality issue. I guess what I am asking is: Where are we at in terms of development of that, and how far down the road are we in terms of ensuring as best we can that in fact those protective devices are in place?

Mr. McCrae: We are in the early design stages of the development of the technology required to achieve what the honourable member is talking about. I think we had a fairly lengthy discussion about this technical aspect last year, and I think everything I said last year I would probably say again this year if I were asked, but we are at the early design phase. We were not there last year; we are this year.

Mr. Chomiak: I could assume, though, that those issues will be dealt with in the legislation forthcoming in the spring?

Mr. McCrae: Legislative draft persons are no doubt keeping up on the changing nature of technology and having to find language that appropriately reflects the legislative requirements that would accompany the changes in technology, and yes is the answer.

Mr. Chomiak: Are we still looking at the development of a plastic card or some kind of a card that will be utilized to access or to function in this system?

Mr. McCrae: We are looking at replacing the paper card with a plastic one, and in the future we will make decisions about what information to put on that card.

Mr. Chomiak: I noted how the minister answered that, because that is of course a fundamental issue in terms of what information is or is not contained in the card and where the information is stored. Is the purple card we presently have and the nine-point designation number a vision to be the future course that we are going in the future?

Mr. McCrae: The Department of Health for the purposes of administration of the program would have access to the information in the program for its purposes and those purposes only, subject to people having to take oaths of secrecy and things that public servants have to do, not unlike we have today.

Epidemiology sections of the department would receive information but on a blinded basis that we talked about before. Any research agency that might be able to access this sort of information would get it on that sort of a basis, so the patient identifier information is removed from the information that they would use. It is clearly being put forward as a tool to us to help us in epidemiological studies, so that we can make good health policy decisions in the future. We do not need to know people's names in order to develop good policies. We need to know some information, and we have that now, and that represents no change.

What all our stakeholders need is the assurance and the comfort that the technical protections are built in, so that information does not flow more freely than it does already and, in fact, perhaps can be held back with more facility today from those eyes that are not supposed to be viewing this material and information.

* (1720)

Mr. Chomiak: The minister raises a good point about the question of confidentiality and the security on-line. Actually, I may pursue that further, but I wanted to go down another line at this point, and that was the Center for Health Policy and Evaluation and other research agencies that obtain the information, who is the contact person, who is it obtained from, and where is the authorization for the release of that information?

Mr. McCrae: Applications for data from the system or from the department are channelled through the access and confidentiality committee chaired by Dr. Walker of the College of Physicians and Surgeons.

That committee then makes a determination on whether or not information ought to be made available, and, of course, it would have to abide by whatever legislative or regulatory mechanisms are in place. Then it comes to the people in the department who are able to access and retrieve the information for the party applying for that information.

Mr. Chomiak: On page 38 of the Supplementary Estimates, it indicated that one of the results of the activities of the department is to disseminate information on population-based health data to regional health authorities. Who is doing that? Who is releasing that data? Who is it going through and who has access to that data?

Mr. McCrae: What the honourable member refers to on page 38 is the line that says: “Co-ordinate and facilitate data dissemination to Regional Health Authorities.” That information is now part of established statistical reports that are produced now.

What needs to be done is to arrange the information that is already going out in a way that works for these 10 different regions we have in the province. Rather than having one big book covering the whole province, for example, dealing with the number of tonsillectomies or whatever, it will be broken into 10 books, so that each book will have the number of tonsillectomies in each region. That information will be used for the purpose of health planning in the regions.

Mr. Chomiak: The data is presently available, as the minister indicated, to Centre for Health Policy and Evaluation and other research bodies or organizations. Is it available to any commercial--are there any commercial entities or proprietary agencies that have access to that information?

Mr. McCrae: Proprietary organizations are able to access whatever information is available generally to members of the public, in other words, public documents and public registers or public data, information that you might, for example, table in the House under ministerial statements and tabling of documents. That is available to everybody, including proprietary interests, but nothing that is not available to the honourable member or me is available to proprietary interests.

Mr. Chomiak: Just for clarification, did the minister take as notice my question about information about DUMC? Is the minister coming back with additional information on DUMC?

Mr. McCrae: Yes, Mr. Chairman.

Mr. Chomiak: I thank the minister for that response. How do we ensure at present, given that the arrangement between an institution and the province is via software, that that information is protected from unauthorized access at the level of the various institutions, the various pharmacies and other agencies? What protection do we have to make sure that that information cannot, insofar as the hardware is significantly different, I would think, at various agencies--what protection do we have to ensure unauthorized access to that information?

Mr. McCrae: In addition to the technical possibilities for protection of information to which I referred earlier on when I talked about encryption and all of those things, we have laws, and there will be laws specially designed for a new computerized system that will, as I said, be introduced about a year from now.

Mr. Chomiak: We are absolutely certain at this time that if none of the information on, for example, drug utilization and the like is being made available to those other than--in other words, it is not being made available to pharmaceutical companies, for example, to determine patterns of buying or cost pricing, et cetera?

Mr. Chairperson: Order, please. The hour being 5:30 p.m., committee rise.

Call in the Speaker.

IN SESSION

Mr. Deputy Speaker (Marcel Laurendeau): The hour being 5:30 p.m., this House is now adjourned and stands adjourned until 10 a.m. tomorrow (Thursday).