:
Welcome, everybody, to the Standing Committee on Health. We are delighted to have our witnesses here today, pursuant to Standing Order 108(2), a study of chapter 4 of the Auditor General's 2009 fall report on electronic health records. We have with us Sheila Fraser, Auditor General of Canada. Welcome. Everybody knows your face and your reports.
Some hon. members: Oh, oh!
The Chair: So we have a celebrity with us today.
Neil Maxwell, assistant auditor general, we welcome you. Louise Dubé is the principal, and we welcome you as well. From Canada Health Infoway, we have Richard Alvarez, president and chief executive officer. Welcome, Mr. Alvarez. We also have Mike Sheridan, chief operating officer of Canada Health Infoway.
So we will begin. We'll start with Mrs. Sheila Fraser.
:
Thank you, Madam Chair. We thank you for this opportunity to present the results of our audit on Canada Health Infoway Inc., which were included in our November 2009 report. As you mentioned, I'm accompanied today by Neil Maxwell, assistant auditor general, and Louise Dubé, principal, who were responsible for this audit.
Infoway was created in 2001 as a not-for-profit corporation at arm's length from the government. It describes its role as that of a strategic investor that works with the provinces and territories to foster and accelerate the development and adoption of electronic health records, EHRs, across Canada.
[Translation]
Electronic health records are intended to offer solutions to a number of persistent problems in Canada's health system, some of which can be attributed to the use of paper-based health records. With EHRs, it is expected that health care professionals would be better able to share patient information.
It is anticipated that this could result in reduced costs, improved quality of care, and lives saved. As of 31 March 2009, Infoway had spent close to $615 million and had committed another $615 million on electronic health records, for a total of $1.2 billion.
But it is still in its early days. Some experts have estimated the total cost of implementing EHRs Canada-wide at over $10 billion. We examined how Infoway manages the funds from the federal government to achieve its goal of making compatible electronic health records available across Canada.
Concurrent with our audit, six provincial audit offices audited how electronic health records funded by Infoway and/or provincial governments are being implemented in their respective provinces. The provincial audit offices are each reporting separately and we will table a summary of the federal and provincial audits next spring.
[English]
Overall, we found that Infoway has accomplished a lot since its inception and that it manages well the $1.2 billion in funds granted by the federal government to achieve its goal. There is good oversight of the corporation by the board of directors and Health Canada, the sponsoring department. Infoway has set the national direction for the implementation of electronic health records by developing an approach, as well as the key requirements and components of an electronic health record. It developed a blueprint, or architecture, for the design of the systems, and it developed strategic plans and a risk management strategy. Infoway worked collaboratively with, and obtained buy-in from, its partners and stakeholders, which is critical to the success of the initiative.
We also found that Infoway approves projects, which it cost shares with the provinces and territories, that are designed to comply with standards and align with the blueprint. We noted that Infoway adequately monitors the implementation of projects by provinces and territories.
We reported that Infoway needs to improve in certain areas. Infoway's 2010 goal is for 50% of Canadians to have electronic health records available to their health care professionals. We found that Infoway needs to report more information on results, in particular information on progress achieved toward its 2010 goal. To date, it only reports if systems are completed, not whether the systems are actually being used by health care professionals or whether completed systems meet the requirements for compatibility. This information on systems usage and compatibility would help Parliament and Canadians better understand progress to date.
[Translation]
We also found that Infoway approves projects, which it cost shares with the provinces and territories, that are designed to comply with standards and align with the Blueprint. We noted that Infoway adequately monitors the implementation of projects by provinces and territories. We noted that Infoway's controls over executive pay, travel, and hospitality are basically sound, although it could improve its contracting policy. Infoway has made a significant contribution to the development and implementation of EHRs, but important challenges remain. Reaching the goal of 50% of Canadians having an EHR available to their health care professionals by 2010 will be very challenging because they are only at 17% now.
Other challenges include upgrading legacy systems to ensure compatibility, ensuring that electronic medical records are used by primary care doctors, ensuring the compatibility of systems designed to allow patients direct access and control over their personal health information, and ensuring the privacy and security of personal health information. These challenges also need to be addressed by the provinces and territories.
[English]
Madam Chair, we are pleased that Infoway agreed with our recommendations and that it is developing an action plan. It has committed to clarifying its goal, to reporting additional information on progress achieved, and to revising its contracting policy. Because significant funds are spent on this initiative to implement electronic health records across Canada, and because the potential benefits offered by electronic health records are important to Canadians, this committee may wish to devote continued attention to the initiative by following up on progress achieved against the goal and against Infoway's action plan.
Madam Chair, this concludes my opening statement. My colleagues and I would be pleased to answer any questions that committee members may have.
:
Madam Chair, thank you for this opportunity to be invited here today for the presentation of the results of our recent audit by the Auditor General of Canada. With me today is Mr. Mike Sheridan, our chief operating officer.
I want to start by complimenting the Auditor General and her staff for what we believe is a thorough, balanced, and transparent audit conducted on Canada Health Infoway. Being an organization that strives for continuous improvement, we believe the implementation of the auditor's recommendations will strengthen Infoway.
The Auditor General pointed out in her November 3 news release that Canada Health Infoway has accomplished a lot since its creation. Needless to say, as its CEO I'm quick to agree with that, but I'm also quick to state that a lot more needs to be done.
Across Canada today, every province and territory and the populations they serve are benefiting from a share of the federal government's investments through Infoway in new information systems that will help transform health care. For example, our investments have helped eliminate three-quarters of X-ray films and replaced them with digitized images. The images are cheaper to produce, easier to store, and can be accessed by health professionals in various locations. Most importantly, they can be used to diagnose and help patients thousands of miles away in the remote and rural communities of our country. Today, as many as 40% of radiologists are now reporting on providing services in new or remote sites, eliminating anywhere between 10,000 and 17,000 patient transfers each year.
Leveraging Infoway's investments, drug information systems are now in place in B.C., Alberta, P.E.I., and Saskatchewan. Today, PharmaNet in B.C. captures every prescription dispensed in pharmacies and provides alerts to pharmacists and some physicians. For example, in 2008 more than 55 million prescriptions were processed via PharmaNet in British Columbia. Of those, 2.5 million significant drug interactions were identified. When you project that across Canada, this suggests that drug information systems could reduce about 55 million inappropriate prescriptions and identify more than 20 million significant drug interactions each year. In terms of lives saved and injuries prevented, that is hugely significant.
In Alberta, 20,000 authorized health care providers are active users of the electronic health record. Having the EHR in place has enabled Alberta to begin essential chronic disease management systems, like the management of diabetes.
The investment Infoway is making in the area of telemedicine is making a substantial impact in Canada, especially in the north, where all communities north of 60 are telehealth-enabled or are getting there. We're also on track to get 40% of first nations communities telehealth-enabled, with a focus on mental health and drug addiction services.
The Auditor General has quite correctly defined some of the challenges in making electronic health records available for 50% of Canadians by December 2010, and of course their subsequent use by health care professionals. I want to be clear that without the availability of these systems, use cannot and will not happen. It really is a two-stage process. Our jurisdictional partners are building and implementing the core system solutions for the electronic health records.
Developing such health information systems is very similar to constructing a home or a building. The building has to be available before tenants can actually move into the space, occupy it, and use it as it was designed and intended. In this joint initiative, as the Auditor General has so astutely noted, Infoway can move only as quickly as our jurisdictional partners are able. The jurisdictional deputy ministers of health have told me they are committed to making their best efforts to meet the December 2010 target of 50%. Again, I need to be clear: I believe it will be a challenge.
Infoway has accepted the Auditor General' s eight recommendations. We have completed an action plan for each of the recommendations, have shared the plan with the Auditor General's office, and have received extremely useful comments. It's our intention to file the action plan with this committee and with the public accounts committee by mid December, following a review of that action plan by my board this week. We intend to have the Auditor General's recommendations fully implemented during the next year.
In closing, I would like to say that while we remain committed to our ambitious call to action target of 50%, I do believe that we have a bigger challenge emerging, especially if we need to start equipping our community clinicians with electronic medical records to increase the use of the investment to date.
The time, Madam Chair, doesn't allow me to explain the difference between electronic medical records and electronic health records. However, the auditor's office has done a wonderful job in chapter 4, paragraph 4.4, which explains the difference.
Let me say that in a recent Commonwealth study of primary care in 11 countries, Canada had a deplorably poor showing. In an example from the study, Canada is last of 11 countries on doctors in communities using EMRs. We're second to last of 11 countries on routinely sending patients reminders for preventative or follow-up care. And we're second to last of countries where the practice routinely receives and reviews data on patient clinical outcomes.
These basically add up to one conclusion, as the Auditor General has said in her report:
Unless the percentage of primary care doctors using electronic medical records (EMRs) increases significantly, the potential benefits offered by electronic health records (EHRs) will not be fully realized.
As a country, we really do need to take the next logical step and focus on the implementation and broad adoption of the use of EMRs.
Madam Chair, that concludes my remarks.
Both myself and Mr. Sheridan would be delighted to take questions.
:
Let me answer your last question first. The answer is no. We didn't give any money to eHealth Ontario. We don't even have a contract with them. We have a contract with the ministry.
The funding model that Infoway employs is a funding model that basically pays for results. If you don't get results, you don't get the federal funds.
We've had some terrific results in Ontario, such as the diagnostic imaging systems I've talked about, and certainly such things as having the drug systems for seniors available in emergency centres, as well as many good telehealth systems. We did fund those systems and we did get results.
In terms of the asterisk, we read the report, which said due diligence was being conducted. I would hope that part of that due diligence is what the Auditor General of Canada was doing, and I hope the government will take that into consideration.
Let me give my response in two parts.
I said this is very similar to building a house. You have to have the house built and available and then you can sell it and it can be used. So in terms of having the house available and the systems for 50% available, the answer is yes. The provinces have enough money.
Do they have enough money for the use? The answer is no. To incent use, which involves a lot of training and change management, we are going to need more money. And that was part of the $500 million.
One of the incentives for provinces is not just building it but making sure that people come and use it. So use goes hand in hand with construction.
The goals, first, are a call to action. They are premised on the goals put forward by the provinces and the territories. As Madam Fraser has said, at Infoway we can only move as quickly as the provinces and territories move, so based on the plans put forward, we felt that by the end of 2010 we should be able to get to 50%.
These are complex projects. Today we're at 17%. Remember that the larger the province you are--meaning Ontario, Quebec, and British Columbia in particular--the more you will contribute to that 50% goal. With the best evidence we have today, we're still fairly confident that we're going to get close to the 50%, on the understanding that the provinces keep their commitments and keep driving the projects forward.
And thanks to all of you. This is an issue of particular urgency for our committee, as we grapple with health human resources and the renewal of our health care system. Electronic health records have been seen as key to this whole area of renewal. The government made a commitment in the last budget to advance the agenda for that reason and other reasons. But this issue goes back to 2001, and progress, by all accounts, has been very, very slow.
Madam Auditor General, I know people are interpreting your report as a clean bill of health for Health Infoway, and on that basis they are urging us to urge the government to flow the $500 million. I'm not sure we're ready to do that yet. Beyond the straight accounting practices, I'm not sure whether this program has met its mandate. I'm wondering if you can help us figure out what questions to ask and where to take it.
For example, if they've already spent $1.6 billion and only covered 17% of the population, is that getting the job done? Is that a clean bill of health? Reports that go back to May, June, July, August, and September all show there are big concerns with the whole Infoway program. We had the health council before us in May, and they had big concerns.
There have been news reports suggesting that Health Infoway could be headed toward the same problems that eHealth in Ontario faced...without accountability, according to news reports—and I'm asking whether this is true or not—without oversight by federal watchdogs, without accountability with respect to contracts, with the use of outside consultants but no requirement to proactively disclose contracts, whether sole-source or otherwise.
I think we need some of those questions answered. Maybe it's not in the context of this report, but I would certainly like to hear your advice, Madam Fraser, so we'll know what advice to give to government.
:
I think it's important to note at the very beginning that the role of Infoway is very different from eHealth or provincial organizations that are putting electronic health records in place. Infoway is a funder, so it is about how well they assess the projects being brought to them. Are they in line with the strategies that have been developed—the blueprint? The actual development of the electronic health records is a responsibility of the provinces and the territories. Our audit looked at how well Infoway was managing in that role of strategic investor.
To compare the 17% to the $1.2 billion that has been spent is a false comparison, because much of the money—and Mr. Alvarez may have the numbers—has gone to provinces that have not completed an electronic health record. The 17% is for two provinces at this point, but much funding has gone to other provinces to help them develop the electronic health record. Getting to that goal of 50% is very dependent upon the provinces putting in the necessary funding and having the necessary management in place to be able to deliver on electronic health records.
As I mentioned, there are six auditors general looking at doing audits of electronic health records within their jurisdictions. I'm hopeful that when we come in the spring we can give the committee a better idea of the actual state of affairs. To date the reports have not been particularly positive on the management within the provinces.
I think we have to separate the roles and responsibilities of the various players. While Infoway has a very important role to play, the success of these projects is not its alone.
:
Madam Chair, thank you for that question.
I've been working at the national level now, having come from a province, for the last 15 to 20 years. I've never seen the kind of collaboration that is taking place between the federal government and the jurisdictions as I've seen around this particular project. Make no mistake about it, the jurisdictions are very keen to modernize the health care system. There are problems in sustaining our health care system and funding it. This is clearly an area where it could not only save lives but could actually save money. So they really want to get on with the job.
It is a complex job. If it were an easy job, incidentally, it would have been taken care of a long time ago. And it hasn't been taken care of in most parts of the world.
There is a high level of collaboration. Never before has the country agreed to a blueprint, an architectural diagram, of how these systems should work. Never before have they agreed to a set of standards, with federal leadership coming into play, so that every single province is not developing its own standards. After all, we have portability as part of our Canada Health Act. They've agreed to a set of standards. Now implementing the standards is always a challenge, depending on what they're starting with.
Never before have they agreed to a role wherein Canada Health Infoway does not fund provinces on a per capita basis. We fund them on the basis of results, and we fund them as a strategic investor in terms of take-up rates. As Madam Fraser has talked about, the use is going to be really important. We hold back 50% of those funds. The provinces have played by those rules. They realize that to leverage federal dollars, they need to get their own money as well. They need to get commitment from the highest level.
The level of collaboration from the provinces, I have to tell you, has been quite outstanding. For the last three or four years, I can tell you, the health ministers have made this the number one priority in health care, as they've written to the federal health minister and to others. We enjoy a very high level of collaboration in what is typically a fractious environment.
:
I tried to point out some of the successes. I pointed out one success in British Columbia where, with a project like PharmaNet, pharmacists will have access to all dispensed prescriptions. They're picking up something like 2.5 million adverse events that could occur and are changing the prescription, typically in collaboration with the prescriber.
That was some seven years ago. Had this initiative not been started by the federal government and the provinces, I can tell you that today those systems would not be available in Alberta, Saskatchewan, P.E.I., or certainly in Ontario with all the emergency rooms.
There was a system that was producing great stuff, but there was no stimulus and no incentive to move it along. That has happened. Since we've been around, three-quarters of X-rays are now gone. We have the entire provinces of Newfoundland, Nova Scotia, and Alberta in which you won't handle an X-ray. No matter where you move, they can pull up your digitized images. Very important results have been produced.
I have to tell you that our 2010 goal really is a two-part goal. Part one says that by 2010 every single province and territory will benefit from some aspect of what we're funding. That, I can tell you, is happening. The other part says—the call to action—that 50% will have all of their meds, labs, and diagnostic imaging available through their practitioner. That's the one that is tough.
:
I wouldn't say that they got a lot more than their per capita share; they've just completed their project.
I'll take one second to explain what we mean by this, because there's some confusion.
There are six fundamental elements that make up an electronic health record. There is one uniquely identifying Canadians, which we call a client registry. There is one uniquely identifying providers; we call it a provider registry. There's medication history, there's a drug database, there are lab results, and there is the diagnostic imaging. Those are the six components.
We're saying that Alberta and P.E.I. have switched on all six components, and they're working. The rest of the provinces are switching them on gradually, but they haven't switched all six on.
:
Thank you, Madam Chair.
I appreciate the review of this very important issue and the enthusiasm that Mr. Alvarez brings to the work he's doing.
This is near and dear to my heart, and within our region we've just made incredible progress, from the X-rays, by which you can clear people in a rural emergency and they don't have to transfer to larger communities, to chronic disease toolkits.
In Williams Lake right now, they have a nurse. The thoracic surgeon in Kelowna is reviewing.... Through telemedicine, the thoracic surgeons are seeing them, doing consultations. In another community, again funded by Health Infoway, the congestive heart failure patients are being sent home and are being monitored through some home devices. They're having a huge impact upon stays.
I have a few questions, and my first one is this. I understand that public health is looking at a Canadian-wide system—Panorama, is it? What is Health Infoway's role in that? How, with this current H1N1, would it have made a difference—how, and what difference?
Mr. Alvarez, could you respond?
:
Panorama is a system that is being built for the country. It's a system where B.C. took the leadership role on behalf of the country. It's the only system I know of where every single public health officer and chief information officer came to the table over several months, probably 18 months, with a common specification and design. It is a system that will cover alert management, outbreak management, case management, immunization, etc. Unfortunately, it wasn't ready to roll out in time for the H1N1. It will make a huge difference, as further pandemics—unfortunately—come to our shores, in terms of an alert perspective, an outbreak perspective, an inventory control perspective, just controlling how many vaccines we have and who's getting what vaccines.
In this country, for example, public health physicians have never had access to lab results, and that's going to happen. With the Panorama system and the EHR as we're building it, with the lab results, they will have access to those.
There is no system of its nature anywhere in the world that is being rolled out like that, including in the U.S. Unfortunately, I say, really, we didn't have enough time to roll it out for H1N1, but it will make a substantial difference. It's being rolled out in B.C., Ontario, and Quebec at this stage.
:
Thank you very much, Madam Chair.
Good afternoon to everyone.
Ms. Fraser, I can't help but ask you a question since you are here before us. If you can't answer it, I'll understand. Please feel comfortable. This is not a trap. I simply want to know what the situation is.
Health Canada has had difficulty planning the human and financial resources and the necessary time to approve natural health products.
I simply wonder whether your office was asked to look into this matter to determine in greater detail why all that had happened. If not, would it be possible for you to do that?
Welcome to the committee. We're very pleased to have you here today.
We have before us, pursuant to Standing Orders 110 and 111, the order in council appointment of Bernard Michel Prigent to the position of member of the governing council of the Canadian Institutes of Health Research, referred to the committee on October 21, 2009.
Welcome, Dr. Prigent.
We also have here today, from the Canadian Institutes of Health Research, Dr. Alain Beaudet. We're very pleased to have you here.
We ask that you make your presentations, but prior to that, Ms. Wasylycia-Leis has asked for a point of order to be addressed.
:
Thank you, Madam Chair. I won't take too much time.
I originally brought this motion to the committee, so I have a real concern with making sure it is followed through appropriately.
I want you to know, Madam Chair, that I did speak to Dr. Beaudet and indicated to him that I would have no trouble with his appearance here today. I thought it was only appropriate. However, I certainly didn't assume it would mean no other witnesses would be permitted, so I want to do a couple of things right now.
First I want to table my letter to you, Madam Chairperson, as of this past Friday, indicating my concern for the refusal on your part to entertain any other witnesses who were willing and able to come. They include Dr. Patricia Baird, Dr. Noralou Roos, Dr. Joel Lexchin, Dr. Abby Lippman, Dr. Steve Morgan, and Dr. Trudo Lemmens.
In the letter I'm tabling, Madam Chair, I indicated that I certainly didn't expect all of these witnesses to come. I knew we were limited in time. I suggested that one voice bringing an alternative perspective to this debate would have been very useful. I'm disappointed that you disregarded the recommendation and did not bring it to either the steering committee or this committee as a whole before you made that decision. I will table the letter and seek the advice of other committee members as to appropriate action.
Let me also table a petition of some 2,085 names of concerned citizens around the appointment of Dr. Prigent to CIHR.
Finally, let me reference the considerable correspondence that we've all received from numerous scientists, researchers, and health care specialists around the country. If it is appropriate, I would be happy to table all of those as well.
I don't want to take up the time of the committee. We have two courses of action. One is to schedule another meeting to hear from other witnesses, which would be my preference. However, it would have to be done, and a report sent back to Parliament, before December 9. It would mean we would have to make this decision rather quickly and have it happen by no later than next week.
The other option for us would be to just swallow what has happened, to grin and bear it, and to bring a motion later on for how we as a committee will deal with this kind of situation in the future. I'm certainly prepared to do that.
:
Thank you, Madam Chair.
I wish to thank you and your colleagues for providing me with the opportunity to outline my role and contribution as a member of the governing council of the Canadian Institutes of Health Research.
Let me begin by sharing with you my experience and credentials, which are relevant and consistent with CIHR's overall objectives and mandate.
[Translation]
I received my general medical training in France. At the start of my career, I had to deal with the major clinical and public health problems experienced by immigrants settling in the suburbs of Paris.
My interest in global health issues stems from my involvement in a medical mission to Cambodia, in a war zone where, among other threats, civilians suffered from the ravages of multi-resistant malaria. That experience led me to write my thesis on tropical medicine and public health.
I also worked for five years in various demanding clinical and hospital environments in France, Asia and Australasia. The diverse nature of those clinical experiences led me to discover emergency medicine, obstetrics, but especially, for nearly two years, the role of district physician. That was in a tropical environment, in Samoa. There, as the only practitioner, I had to provide care and promote public heath to a rural population of 20,000 inhabitants.
All those experiences formed me and made me always keep in mind the viewpoint and interest of the patient, even when my career strayed from clinical medicine to medicine in a pharmaceutical environment.
[English]
I joined the pharmaceutical industry in 1984, working for the international medical and clinical research operations of three major European pharmaceutical companies before joining Pfizer in Canada in 1995. I have worked on the clinical development and commercialization of new medicines in a variety of therapeutic areas, including cardiology, respiratory medicine, infectious diseases, rheumatology, urology, neurology, and oncology. I was able to pioneer the conduct of pivotal studies more than 20 years ago in countries like Poland, Hungary, and Russia, and developed medical and clinical capabilities in Africa and in the Middle East.
My interest in the management of research and development led me to complete an MBA in the United Kingdom at the Henley Management College, where my main research was on the management of global research and development organization.
In Canada I'm actively involved in the building of research and development capabilities that foster the collaboration between the public and the private sectors. Such activities have enabled me to become chair of the scientific committee of the research foundation of Canada's Research-Based Pharmaceutical Companies; a member of the strategic advisory committee of the Centre of Excellence in Personalized Medicine; a board member of the Centre of Excellence in the Prevention of Organ Failure; chairman of the strategic orientation committee of the Québec Consortium for Drug Discovery; a member of the national advisory board of the Canadian Dementia Knowledge Translation Network; and co-president of the research working group of Montréal InVivo.
[Translation]
I believe that my international clinical experience and my contribution to developing new drugs and to their accessibility for patients will be useful on the governing council of the Canadian Institutes of Health Research. The CIHR recently launched its five-year strategic plan. In particular, that plan emphasizes the importance of cooperation between the industry and the research community so that research work leads to improved health products, technologies, tools and services.
More specifically, the plan sets out a commitment to launch a new flagship initiative in patient-based research that will enable Canada's health system to more effectively use research results to improve care and health.
[English]
In recent years we've seen some measure of success in patient-oriented research, most notably in cardiovascular care, critical care, stroke, and HIV. However, Canada is rapidly falling behind other industrial countries in terms of the capacity to carry out high-level, patient-oriented research. In Canada we have some of the best health researchers in the world. Where we are less successful is in moving health research results out of the laboratory and into hospitals and clinics where they can improve health outcomes.
I believe my significant experience in clinical research and multilateral research collaborations across the world involving industry and academic-based research can assist CIHR in developing solutions to remedy these shortcomings.
[Translation]
As a member of the CIHR governing council, I undertake to strictly observe the Conflict of Interest Act, the Ethical Guidelines for Public Office Holders, the Guidelines for the Political Activities of Public Office Holders and the CIHR's Policy on Conflict of Interest and Confidentiality in the Context of Merit, Relevance and Peer Review. As a new member of the governing council, I have received orientation from CIHR management personnel and have carefully read all documents.
In closing, I repeat to the committee my dedication and commitment to meeting the highest ethical standards in this position, as I have in all those I have held in the past.
[English]
I now welcome the opportunity to answer any questions you may have. Thank you.
:
Thank you, Madam Chair. I'm pleased to appear before you as part of the review of Dr. Prigent's recent appointment to the CIHR governing council.
[English]
Let me tell you right at the outset how much CIHR's governing council and I personally welcome and support this superb addition to our board. Dr. Prigent was appointed by Governor in Council because of his vast knowledge, his unique experience, and his keen understanding of the Canadian international health research landscape. Like all other council members, Dr. Prigent was appointed as an individual and not as a representative of his employer.
[Translation]
The mandate of the CIHR's governing council is to oversee the agency's orientation and management. It defines its strategic orientations, objectives and policies, and assesses its overall performance. It is important to emphasize that it is not the council's responsibility to examine or approve funding applications. There is no doubt in my mind that Dr. Prigent's appointment meets the criteria for the appointment of members to the governing council as set out in the Canadian Institutes of Health Research Act.
That act states that council members must meet the highest standards of scientific excellence and represent a range of relevant disciplines and communities. No one will doubt Dr. Prigent's exceptional qualifications and experience in this regard.
[English]
Dr. Prigent is a distinguished international researcher and vice-president of Pfizer Canada Inc. He is a member of the Canadian Society of Clinical Pharmacology and the Canadian Arthritis Network. He sits on the board and chairs the Scientific Advisory Council of Rx&D's Health Research Foundation, and he co-chairs the research committee of Montréal InVivo, a non-profit group of over 600 public and private organizations in Montreal that promotes scientific partnership and innovation.
Dr. Prigent brings to the council an unparalleled background in matters ranging from global health to research management, particularly a vast experience in innovation and commercialization, thereby filling what the governing council had identified as a major expertise gap in its midst. His unique knowledge in this field will enable us to better fulfill our responsibilities with respect to the achievement of CIHR's objectives, as stated in section 4 of the CIHR Act:
to excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products, and a strengthened Canadian health care system, by
(i) encouraging innovation, facilitating the commercialization of health research in Canada and promoting economic development through health research in Canada;
[Translation]
Innovation and commercialization are key elements in the CIHR's mandate for improving the health of Canadians and the effectiveness of our health system.
As you are aware, Canada ranks poorly in private sector research and development investment. In fact, in its last report card on innovation, the Conference Board of Canada gave the country a D for its innovation performance in the past three decades.
This unfulfilled need has been underscored in the Government of Canada's National Science and Technology Strategy which, on this point, specifically recommends:
As the government fills vacancies on the councils' governing bodies, it will seek out more business and community representation to ensure that the composition of granting council governing bodies reflects Canada's broad economic and national interests.
[English]
Up until now, this call had been heard by virtually every single federal research agency except CIHR. Indeed, members from the biopharmaceutical sector sit on the boards of Genome Canada, the National Research Council, the Natural Sciences and Engineering Research Council, and the Canadian Foundation for Innovation.
Several provincial health research organizations, including the Manitoba Health Research Council and the Fonds de la recherche en santé du Québec, also have members from the biopharmaceutical industry sitting on their boards. Likewise, sister councils in other countries—for instance, the Medical Research Council in the U.K.—have board members from this sector.
In all cases, these individuals have been appointed not as representatives of their employers but as unique individuals willing to share their knowledge and able to help build bridges between the private and public sectors for the common good.
In closing, I would like to remind the committee that all governing council members must observe the Conflict of Interest Act, the ethical guidelines for public office holders, and the guidelines for the political activities of public office holders, as a condition of appointment.
In addition, disclosure of conflict of interest is a standing item on governing council meeting agendas.
[Translation]
I am deeply convinced that Dr. Prigent's appointment will have no negative impact on the CIHR's integrity. Quite the contrary, his presence will be of great assistance in carrying out our mission. Dr. Prigent shares CIHR's vision and brings unique expertise to its implementation.
Thank you.
:
I have to admit, Madam Chair, that I've been quite taken aback by the objections to this appointment that have been flooding into my office. I think we all know that part of the mandate of CIHR is the commercialization. I think there was, from a lot of the community, a well-articulated need to have someone on the board that had some experience in getting research into practice and into the market.
Dr. Beaudet, you have stated the ethical declaration, the conflict of interest. What's also being expressed is that a present employee of a company that has its prime responsibility to its shareholders.... The concern would be in terms of the conflict of interest declaration. There has obviously been articulated a great deal of concern about recusing oneself at multiple policy-setting positions of the governing council, which could provide a huge gap if there were another appointment, like somebody from an incubator side, or somebody from the MaRS side, or a retired professor emeritus who doesn't actually see that. I don't think any of us wants to see CIHR reduced in the estimation of the public by the fact that any policy decision could be perceived to be questioned because of the interest of the pharmaceutical industry.
I want to know how you would deal with the perception, but also the actual practice of declaring a conflict of interest on so many issues that would come to the governing council, and how often it would be seen as inappropriate. I think you actually have to deal with the fact that the advisor, unfortunately, has a history of transgressions against the integrity of science, and since 2002 has paid substantial--
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As I said in my presentation, there is a very strong framework that's put in place to manage conflict of interest. But before we talk about the tools, I want to refer to the fact that you don't leave integrity and standards of integrity when you move from a sector to another. The responsibility of individuals serving the governing council is to, first of all, be driven by standards of integrity, and I think that throughout my career I've demonstrated the highest integrity in everything I've done.
Now, in terms of managing what is available in terms of managing the conflict of interest, there is clearly the Conflict of Interest Act, there are the ethical guidelines for public office holders and the guidelines for political activities. In addition, conflict of interest declarations have to be made in a preamble of any agenda of the governing council. Every member of the governing council may be in a position of conflict of interest. Conflict of interest does not belong just to one sector. Every one of us, as individuals...we're all representing different institutions and we all have potential conflicts of interest. So the best way to manage it is to have a strong framework, as defined by the act, and to have procedures, which are indeed put in place by CIHR.
The number of activities that I've mentioned to you follow exactly the same guidelines, where you have around the table very often people representing private interests, public interests, government interests, and we all have to declare any conflict of interest before any decision is made.
In addition, there is something that is very important to realize: the governing council does not make decisions on investment towards any institution or any projects. So the review of funding is not a mandate of the governing council. I think it's very important for this committee to understand.
:
I can definitely do that.
First of all, I would like to go back to the question from your colleague Ms. Bennett.
In fact, they are all potentially in conflict of interest. There is a vice-president for research. Is he speaking for his university? Should we have former vice-presidents of research? There's also a dean of faculty of medicine. Is he speaking on behalf of his faculty of medicine? Should we have former deans of faculties of medicine?
We want people who are in the thick of the subject because health research changes extremely quickly. We want the country's leaders, people who absolutely and completely know all research aspects, both basic research aspects, which you referred to, and more applied research aspects, commercialization aspects such as aspects of research on health services.
The important thing is to be able to have expertise around the table. We are clearly looking for varied expertise that enables us to respond more effectively to our mission as a whole.
More specifically, it is quite rare for members of the governing council to have to recuse themselves because we do not make financial decisions. Active researchers nevertheless do sit on the governing council, and they may at times feel uncomfortable in certain discussions.
For example, one council member is an active stem cell researcher. When we discussed ethical issues related to stem cell research, that member recused himself. This is a question not only of conflict of interest, but of apparent conflict of interest as well, to which we are very sensitive. We do not want to give the impression that we favour one player over another. We are very sensitive to that.
:
Thank you, Madam Chairperson.
And thank you, Dr. Prigent and Dr. Beaudet, for being here.
I want to begin by saying, Dr. Prigent, that I have no doubts about your professional expertise, your integrity, or your significant experience. This is really about whether it makes sense to have someone who is currently a vice-president, or in any position with a major drug company, sitting on the governing council of the CIHR. I know you said the governing council doesn't actually give out money. The governing council governs the CIHR, whose mandate is to make decisions about where to target money, what priority areas should be focused on, how we can increase the research capacity in this country, and how we can support a new generation of health researchers. So it is rather important.
My question to you and to Dr. Beaudet, who I believe submitted your name in the first place--
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The nomination of someone representing any sector does not touch on the mandate of independence. The independence is there. I find it hard to believe that the presence of one person from one sector could derail the mandate of the governing council.
Once again, I have been asked to sit on the governing council as a citizen and as someone who brings experience. And that experience can be brought to the service of the public good.
I tend to take my cues from the international environment. As I said, when you look at the Medical Research Council, the United Kingdom is paying a lot of attention to issues similar to those here. And they have this as a standard practice. If you look at the similar body in Australia, it's the same. If you're looking at a similar organization in France, it's the same.
So the principle, if you like.... And I fully share your concerns. But we cannot have a situation where, when it comes to thinking strategically about the health of Canadians, we're creating some kind of intellectual apartheid, with some people not being asked to the table.
I find it extremely surprising. If there's one thing I pay attention to, it's the conflict of interest. I think it's important.
If you go into a private research institution and a public research institution, there is no difference. These people come from the same background. They have the same goals. They want to do good and they want to bring innovation to the service of patients. It's important to take that into consideration when you're looking at the appointment.
I understand the sensitivity, but it's really important for Canada and for CIHR to move forward and tackle--
To follow up, Dr. Beaudet, you mentioned expertise. As you know, before I was the PS to health, I was the PS to industry, and one of the biggest complaints I got was that there's not enough real-world experience. Government makes these programs and regulations without enough input from the private sector. You mentioned that this sector is huge in Canada. Occasionally, government, though well meaning, is sometimes not very practical in promoting things like innovation, commercialization, and applied research.
That's what we want to do as a country. We want to create good quality jobs; we want to stimulate the economy. You mentioned we were given a D. So there are some things that we need to do better. Internationally and in Canada, these types of appointments are nothing new. We talked about the health research board in Ireland and what they've done. If we look at the amount of research and development that Ireland has seen over the last 20 years.... Dr. Prigent, you mentioned that Australia, the United States, and the U.K. all have private representation. In Canada, even four provinces have the private sector involved.
So my question to you, Dr. Beaudet, is what has been the experience in these countries around the world? Are these countries prisoner to the private sector agenda? How are they finding this type of expertise to have on their agencies?
:
First of all, I can only state what I know. I know for a fact that there's a heavy presence in the U.K. on the board of MRC of the biopharmaceutical sector, and I must say that they are fairly successful at curbing the trend and doing things differently in terms of innovation and public-private partnership. I think it has certainly been a major plus in that country.
I am also familiar with the CNRS in France, where there have also been, as you know, members on the board from the biopharmaceutical sector. There again, I can see only positive aspects. It's obvious that I would not have recommended Dr. Prigent to Minister Aglukkaq if I didn't feel it was an area where I thought we needed to do better.
As you know very well, we are in the midst of an economic downturn. I happen to believe that the way we're going to get out of it for good is through research and innovation, and it's not the public sector alone that's going to do it. It's the public sector and the private sector, and we have to work together. We have to understand what the needs of the private sector are. The private sector must understand where the public sector is going. We have to join our efforts. As Dr. Prigent mentioned, when I was head of the FRSQ in Quebec, we did that in a variety of initiatives.
I can tell you that we're not talking here about the protection of the intellectual property of a specific company. We're talking about areas at the pre-competitive level, where research benefits everyone. It benefits the public sector. It benefits Canadians, and of course it also benefits the private sector. That's what we want, isn't it? We want the private sector to invest more. We don't want to see them investing outside Canada. On the contrary, we want them to come back and invest in Canada so that we can actually gain economically from R and D investments.
I think we have a role to play in helping them do their job and doing our job better. It's our mandate. It's in the act.
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I think one of the specific things that I will bring to CIHR is the experience that I've acquired working in various provinces, where that research for the right interface between public and private has been set in motion.
If you look at Quebec, if you look at British Columbia, if you look at Ontario, there is a series of initiatives at the provincial level that has encouraged and fostered innovative partnerships. We've talked about the creation of a consortium, which is at the pre-competitive level. In British Columbia, there has been the launch of not only the CDRD, the Centre for Drug Research and Development, but your government has launched centres of excellence for commercialization and research. Many companies have embraced those initiatives, and I think these are lessons, these are early days. But I think as an individual who is working and immersed in some of those initiatives, there is some experience that I can bring back to CIHR. CIHR is trying to develop an agenda to force the relationship with the private sector.
The other areas where clearly I'll be able to provide insight is around the reinforcement of the clinical research capability, or, even more so, as was mentioned, the patient-centred outcome initiative, which is much broader than the clinical development of drugs, if you like. There are many elements where I think my expertise can enrich the thought process and the thinking among the members and the leaders of that initiative.
Those are just short examples. Another interest that goes beyond my current appointment is my background in global health. I know that CIHR is looking strategically at partnering around the world with global charities and other governments to address global health. I'm extremely convinced that a closer collaboration with the private sector can bring solutions to the health of many people in need, in Canada and beyond.
And thanks very much to both of you for being here with us this afternoon.
We're hearing different, conflicting stories here. We're talking about all these letters of displeasure, and so on. I received four letters of displeasure and one of support, and now you're telling me there is another one that hasn't been circulated. So in my mind, it really isn't heavily weighted here.
Then there's something else you just said, Dr. Beaudet, that it was a unanimous decision by the council.
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Certainly. Actually, I can even recommend excellent reading, which is the strategic plan of CIHR that was just launched a few weeks ago, where our priorities are very clearly outlined.
Without going into a large presentation of our strategic plan, I'll just insist on impartiality and excellence in what we fund, based on excellence, and focusing on excellence and competitiveness internationally, a few select but very important health research priorities based on the needs of Canadians, which includes better support for patient-oriented research, including clinical research; better support for research on our health care system and improving the sustainability of our health care system; better support of research on aboriginal health issues and other vulnerable populations; support for chronic diseases and mental health, which, as you know, are major issues in our society and are only growing with the aging of the population; and further support of research into emerging threats. As you know, some of these emerging threats are infectious in nature—we are living it right now—but we can foresee more of these threats that are, for instance, brought in by climate change.
Those are the five major priorities of CIHR for the next five years. Quite clearly, I can see how critical Dr. Prigent's expertise in clinical research will be in helping us to implement our priority on patient-oriented research strategy, how his superb expertise in research management will help us with our strategy on improving our health care system and the translation of the results of health research into better health care and health outcomes for Canadians. I can see how his expertise with global health will help us respond to the priorities on vulnerable populations, on aboriginal health issues, which, as you know, are very similar to the ones in developing countries, but also on emerging threats, particularly infection. And finally, Dr. Prigent has, as you saw, a wealth of expertise on a number of chronic diseases, which is the last focus in our strategic plan.
So I feel, actually, that he's exceptionally qualified to help us implement these different priorities during the next five years.