HEALTH

Mr. Chairperson (Marcel Laurendeau): Will the Committee of Supply come to order, please. This section of the Committee of Supply has been dealing with the Estimates of the Department of Health.

We are on item 2. Management and Program Support Services (d) Facilities Development (1) Salaries and Employee Benefits $673,000.

Would the minister's staff please enter the Chamber at this time.

Hon. James McCrae (Minister of Health): Last week the honourable member for Kildonan (Mr. Chomiak) was asking about personal care homes and the planning guides for personal care homes in Manitoba, and this has to do with current information relating to construction of new personal care homes and renovating existing facilities. We expect personal care home construction and operation to comply with all the existing legislation standards and guidelines related to personal care homes, and I have these rather attractively bound planning guide documents for personal care homes, which I will share with both honourable members in the House.

The honourable member for Kildonan asked also about residence security systems in personal care homes. I have a very brief answer for him. Presently a review is being conducted of all personal care homes in the province to ascertain that the residence security systems are up to an acceptable standard. A number of security systems have been improved whenever an upgrading project has occurred. A number of facilities have upgraded in response to increased need to supervise residents. When the review is completed, a plan will be developed to assure all personal care homes have acceptable security systems.

The honourable member for Kildonan also asked about technology dependent programs. I have a document here to share with the honourable members. It has to do with service co-ordination at home, in daycare, in school and in recreation settings for children and adolescents who have a lifelong disability or who require medical procedures as a part of daily living or who are dependent on medical technology. The honourable member will recall the discussion we had when Mr. Toews was here with us. I will make this document available to honourable members.

Mr. Chairperson: Just to inform the committee at this time we will be moving back to (c) Money Management and Banking. This is the item that we have laid over when the committee last sat.

Mr. Dave Chomiak (Kildonan): I thank the minister for the information he provided; I appreciate it. I think it will be useful in subsequent discussions as well as in understanding the processes.

Turning to the Health Information Systems area of the Estimates, I wonder if the minister will give us a rough outline of what constitutes the Information Systems Management, ISM?

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Mr. McCrae: ISM is the old MDS. We have contracted certain of our requirements to ISM, the requirements related to older systems and related to hardware.

Mr. Chomiak: On page 38 of the Supplementary Estimates book, under Activity Identification, it says that this branch of the department administers agreements between Manitoba Health and ISM. I wonder if the minister could outline what constitutes those agreements.

Mr. McCrae: I would like to apologize for not having done this a little sooner. The gentleman that has joined our group here, Len Alexander, his title is Executive Director of Health Information services. He is with us today to help us discuss these matters. He has been an extremely active person over the last couple of years, I guess, now. In the Health department we were fortunate to have absconded with him, I mean seconded him from another department earlier on, and I thought I should introduce him to the committee.

ISM is a company with which many contracts have been, are, or will have been entered into, a number of contracts not only in Health but in other departments, as well. There are, at any given time, contracts under negotiation, renewals, new contracts, so there are a number of relationships bound up with that particular company.

Mr. Chomiak: I am just trying to get a sense of ISM's involvement and its relationship with the Department of Health. That is where this line of questioning is going. Can the minister perhaps outline a list of some of the contracts that they are involved with with ISM, just so we can get a flavour as to what is happening on that end?

Mr. McCrae: I believe Mr. Alexander is going to give me a brief list of those types of arrangements. While he is preparing it, the honourable member might ask another question.

Mr. Chomiak: I thank the minister for that response. Under Expected Results on page 38 it says a continuing support of 400 existing and new personal equipment installations. Can the minister outline how that is happening, where they are located roughly, who owns those personal computers, et cetera?

Mr. McCrae: While we are preparing a couple of answers for the honourable member, I would like to refer back to the questions he put about the laboratory facilities and tests. There are four laboratory service sectors in the two major geographic settings. Laboratory services in Manitoba are provided in four types of laboratory environments or sectors, defined for the purposes of data collection as first, physicians' offices, physicians' office laboratories who undertake a short list of approved laboratory procedures only. Each physician that bills for laboratory services in this sector constitutes one office.

Second, public or nonhospital laboratories, laboratory facilities that are funded globally by Manitoba Health, such as Mount Carmel Clinic, Westman Regional Laboratories, Cadham Provincial Laboratory, and the Laboratory Imaging Service units located throughout rural and northern Manitoba and are located within a rural hospital. Data for Thompson General Hospital's laboratory is included in the public laboratory category although it is not an LIS unit.

Thirdly, private laboratories, laboratory facilities that are privately owned and are paid for tests according to the fee schedule in Manitoba Health physicians' manual, a negotiation process between Manitoba Health and the Manitoba Medical Association.

Fourth, hospital laboratories. Those are laboratory facilities that are housed within one of the Winnipeg hospitals that are funded through an allocation of the hospital's global budget.

It is a large and complex system, Mr. Chairperson. Throughout Manitoba 869 facilities deliver laboratory services, 769 physician office laboratories, 70 public laboratories, 22 private ones and eight Winnipeg hospital ones. With respect to Brandon and rural and northern Manitoba, of 343 laboratories located in rural and northern regions and Brandon, 272 or 80 percent are physician office labs; 68--that is 19 percent--are public labs; and three, or 1 percent, are private laboratories. Hospitals in Brandon and rural and northern Manitoba are serviced predominantly by Westman Regional Laboratories and LIS units and referrals to Cadham Provincial Laboratory and other referenced laboratories in Winnipeg.

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(Mr. Mervin Tweed, Acting Chairperson, in the Chair)

With respect to procedures, those ones done in physicians' offices, which accounts for 3 percent of the procedures, it is 433,133. That is 3 percent of them. In the public ones, or 27 percent, there is 3,473,891. In the private ones, also 27 percent, 3,409,353. In hospital, which is 43 percent, 5,413,750, for a total of 12,730,127.

I am sorry, I attributed the question to the honourable member for Kildonan (Mr. Chomiak). It was the member for Inkster (Mr. Lamoureux). I apologize for that, Mr. Chairperson.

(Mr. Chairperson in the Chair)

Yes, now I am able to respond to the honourable member for Kildonan about the ISM arrangements that we have. ISM's arrangements with us are basically to manage hardware services, and that hardware contains information like the provincial registry of residents, the continuing care system. There are five hospital systems under the facilities management agreement, and that agreement is being phased out, I understand. This includes maintenance of equipment, which is the Unisys equipment.

With respect to the question the honourable member asked about the Expected Results as set out on page 38 of the additional information, there are some 400 computers, and we own all those as a department. We own all those personal computers. They are mostly used for, if not all, secretarial and administrative support and for the finance and management services. As to the location of all these computers, they are in most Health offices, the majority being at 800 Portage Avenue or 599 Empress.

Mr. Chomiak: I thank the minister for that response. The reason I asked about the 400 computers was I assumed that because last year there were 313, this year there are 400, I was making an extrapolation. I was making the leap that perhaps the additional 70 computers was a result of DPIN or something like that, but I assume that that is not the case.

Mr. McCrae: The honourable member is right. These do not include the computers that pharmacists are using under various arrangements across the province. This has to do with the ongoing operation of the Department of Health itself, and I am advised that in this day and age, that kind of growth is not significant, and I am told that we should be seeing more growth than we are seeing.

Mr. Chomiak: I was not actually, I was not even suggesting that that growth was out of the ordinary.

Now, to return to the ISM, the reason the ISM question actually came about is, last year in the Supplementary Estimates, it appeared there was only one agreement, and that is the facilities management agreement, and now it appears, and I just ascertained that because I paged back through my book, so there are additional agreements now with ISM that there were not in place last year? Is that the case?

Mr. McCrae: Yes, Mr. Chairperson, I think it is a question of language used from one document to the next. Just by virtue of singulars and plurals in last year's document, there might have been left the impression that there was just one arrangement, but there are basically two, which talks about all kinds of endeavours, but two basic arrangements. As I say, we are phasing ourselves out of the facilities management arrangements with ISM, so there is certainly no intention to leave any incorrect impressions. I agree that, if you look at last year's document and then if you look at this year's, the way they are written may have left that impression, but it was not intentional.

Mr. Chomiak: The data that are maintained and collected by Manitoba Health, is it fair to say that it is basically held and administered by this branch of the department?

Mr. McCrae: The technology is something that is part of a contract. The information is the property of Manitoba Health and is very carefully and jealously guarded. Is that the point the honourable member was getting to?

Mr. Chomiak: Perhaps I will just clarify it. If the Centre for Health Policy and Evaluation wants to do a study, or if the Physician Resource Committee wants to do a study, do they then contact this branch in order to obtain the information? That is what I am trying to clarify.

Mr. McCrae: That is correct, Mr. Chairperson. All of us are very careful to respect the confidentiality of individuals.

Mr. Chomiak: So is the area and the branch that is concerned with the protection of the confidentiality of records and effectively the ownership--is it located here?

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Mr. McCrae: Yes, Mr. Chairperson.

Mr. Chomiak: Is there a set of protocols or guidelines that are available for requirements of individuals, groups or organizations, either external or internal to government requesting information?

Mr. Chairperson: While the honourable minister is looking at that answer, I would like to just clarify an error that I had made. I had stated a line back from the Department of Finance when I should have been reading 2. Management and Program Support Services (c) Health and Information Systems (1) Salaries and Employee Benefits $4,143,900. That is the item that we are dealing with at this time.

Mr. McCrae: Yes, there are very strict protocols about the use to which health information can be put. There is a difference between research and idle curiosity, which is badly motivated, and our protocols and the people who are involved in the privacy and confidentiality committee are committed to ensuring that this sensitive part of our health information is handled indeed very carefully and in such a way that would protect the rights and privacy of our fellow citizens here in Manitoba.

Mr. Chomiak: Can the minister indicate who is on the privacy and confidentiality committee?

Mr. McCrae: This committee is chaired by Dr. Bob Walker, and we will make the other members' names available to the honourable member.

Mr. Chomiak: Can the minister perhaps assist us by either providing us with the mandate and the objectives of the committee and/or the protocols, if they are available, of confidentiality concerning health materials?

Mr. McCrae: Yes, sir.

Mr. Chomiak: In the expenditures of this department, under other operating, we see an excess of $2 million which is a consistent pattern for this branch. Can the minister indicate what those expenditures are comprised of?

Mr. McCrae: We will obtain a more detailed breakdown of that, but there is, I believe, within that number the ISM contract amount, but we will obtain further detail for the honourable member.

Mr. Chomiak: Continuing down that line of questioning, I must assume that there is a fair amount of consulting work or some consulting work in this branch of the department. I had asked earlier in the Estimates if a list of consulting contracts could be tabled and that might be too onerous, but can I have a list of consulting contracts that are contracted for in this area, in this branch of the department?

Mr. McCrae: Mr. Chairperson, knowing the honourable member's views about consultants, we are very mindful of that so there would be very, very few, if any, here. But here again we will check.

Mr. Chomiak: Some of my best friends are consultants.

I would like to turn now to some direct questions with respect to SmartHealth. As I understand it, there is a structure now or a working body or a group that is set up known as SmartHealth. Can the minister outline for me who that is comprised of?

Mr. McCrae: Yes, sir, SmartHealth is a fully owned subsidiary company of the Royal Bank of Canada. I think that is what the honourable member wants to know.

Mr. Chomiak: SmartHealth is a subsidiary of the Royal Bank of Canada, it is a separate corporate entity, I believe that it is comprised of three partners. Can the minister outline who those partners are?

Mr. McCrae: Mr. Chairperson, as I said, SmartHealth is a wholly owned subsidiary of the Royal Bank, but as part of this contract or arrangement, as I will call it for the time being, SmartHealth has partners with whom it is working and that would be IDT, IMT and KPMG.

Mr. Chomiak: Can the minister indicate precisely at what stage the agreement is at with respect to SmartHealth?

Mr. McCrae: Over the last two, three months, there has been a fair amount of discussion, public discussion and otherwise, about the whole concept of the SmartHealth or public health information system. The honourable member and his colleagues have raised significant questions and criticisms, so we have taken those things very seriously indeed.

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The contract discussions have taken some period of time and for good reasons, many of them outlined by the honourable member, about extreme care should be taken to ensure peoples' confidentiality of their records. Care should be taken to ensure that the government and the taxpayers are well protected in all events that we can foresee. We do not yet have that contract signed, but I expect that that will not be very long from now before we can get to that point but, indeed, we have taken the honourable member's advice. We did not take it all, but we took some of it, and care ought to be exercised and we are doing that. It would be wrong for us not to proceed. That would be a decided disservice to Manitobans and all of the people who have been pressing us to get on with this project.

There is no money allocated in the budget this year for this contract. That is why there was so much point and counterpoint during the election campaign, because the honourable member's colleagues and himself were out spending all this $100 million that they were not going to spend on SmartHealth and, yet, there is not a nickel in the budget for SmartHealth. It needed to be made clear that promises were being made, spending promises were being made on the strength of money that did not exist.

I do not know if the honourable member ever figured that out, but the fact is, for some 18 months under this contract, when it is negotiated, no money would flow from this government. Even then we expect that we would see savings occurring in the system at some point or in a number of points in the system.

I am anxiously awaiting information from the Drug Program Information Network so that we can show how well it is working. We know that some aspects are working. We know that already. We know that it is more convenient for people. We know that the public likes it, the public likes it a lot. We know that it can be--or at least earlier on I think this year it was demonstrated that there were things that could be improved. The Leon case pointed that out not only in the system but also amongst the practitioners of pharmacy and medicine. We are all learning from that particular experience, but we also know that the Drug Program Information Network is already a vast improvement over the old Pharmacare system we had. We know that when we apply the principles of the DPIN to the PHIS working with our partners KPMG and IDT and IMT--

An Honourable Member: G-o-o-d.

Mr. McCrae: We know that it will be g-o-o-d for the consumer, and that is what the consumer is demanding nowadays. Whether it is run by the private sector or some big bank or some small company, consumers want excellence because they know that in a system where there is competition they can get excellence. Where there is a monopoly, there are still doubters out there about the achievement of excellence.

I listen to those doubters. I am listening to the consumers of our health care system. They are saying, you know, you can do a lot better job than you are doing. They are also saying, use technology, technology is there, why do you not learn to use technology that exists, you have good people in Manitoba, all kinds of them, and why do you not use their talents to the benefit of the consumer.

We are saying, yes, that is exactly what we should be doing because you know if we were running a one-payer system here in Canada, which we are trying to do, and contracted everything out to the private sector, I will bet you we could show in some areas at least better results than we are getting because of the simple reason that there would be competition injected into that system.

I am not advocating that, but I am saying that if we are going to be living in a world where there is a private sector at work in all the other sectors except health care and doing things more efficiently than we are doing in health care--and the fact that we are not doing everything as efficiently as we could is no criticism. I would like that to be understood, because it is a system that we have all been working in, and we have all sort of got to the point where we all know we can do a better job because of the technology that exists.

That is why I think we have partners in this project. That is why on our advisory committee we have a large number of organizations working with us. I will not at this moment go through that list of organizations; I have done it before. But they range all the way from the Manitoba Assembly of Chiefs to the Manitoba Nurses' Union, the Provincial Lab Committee. You name them, if they represent a part of the health system that is important to an information system, they are involved.

Similarly with the privacy committee, those people who have a direct interest and experience with and an ability to speak out on privacy issues, that is why they are on our privacy committee. It is just not the government and a bank working together to somehow do some of the things that my colleagues, friends and associates talked about during the campaign.

In short, we do not have a contract to lay before the honourable member at this point, but we are taking his advice seriously. We are negotiating it extremely carefully so that, when we do come forward with that contract, it will have addressed the concerns raised by the honourable member. I am not so sure that those concerns were not already addressed, but I have asked that extreme care be taken in the negotiation of this contract.

Mr. Chomiak: The minister indicated that there is no money expended from this budgetary year towards SmartHealth. The SmartHealth project is on a five-year time line.

Can the minister indicate if that time line will be retroactive to this budgetary year, or whether it will commence at some future date? When will the clock start ticking with respect to the five-year time line, which I think we can all agree that they are on in terms of SmartHealth?

Mr. McCrae: Yes, we envisage a five-year contract that starts when the contract starts, and it has not been signed. I can see around the time when we are out there talking about this again on the hustings. If we are able to stick to the terms of contract timewise with the development of the various modules, we should have that system in place that we can take forward and show to the people of Manitoba.

It needs to be clearly understood, though, that the way we are designing this contract is that, as I have described once before or twice, there are points at which decisions will be made along the way in this contract so that we are not bound to all aspects of the project. There are points at which our advisory committee, our steering committee or whatever committee we are talking about here will have an opportunity--and I assume the government, which is very much a part of that, would have an opportunity--to say, no, we are not ready to go with that piece of it.

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Maybe as things work, it might be necessary to bring a module forward as opposed to waiting until certain other steps go. I do not know how that will work at this point, but when the contract comes forward, I expect those types of eventualities will have been dealt with in the contract.

Very quickly, a little earlier the honourable member was asking about the access and confidentiality committee. I am looking at the 1993 report of Manitoba Health which says that members of the committee include representatives from the College of Physicians and Surgeons, the Manitoba Association of Community Health Centres, the Manitoba Health Organizations, the Manitoba Health Records Association, the Manitoba Medical Association, the two major teaching hospitals, as well as Continuing Care and Mental Health Program representatives.

Mr. Chomiak: Mr. Chairperson, can the minister outline for me who are the individuals responsible, at this point, for negotiating the SmartHealth contract?

Mr. McCrae: We are fortunate that we have in the room with us the individual responsible in the person of Mr. Glenn McKenzie--Glenn Alexander, sorry. Mr. Alexander, of course, reports to the department. The honourable member will understand how we are asking Mr. Alexander to be very cognizant of the issues that the honourable member and I have been talking about.

Mr. Chomiak: Are there any other government departments involved in the negotiation of this contract?

Mr. McCrae: Mr. Chairperson, Mr. Glenn McKenzie is--did I say McKenzie again? Mr. Glenn Alexander--I am not trying to confuse him with anybody else--is our representative in the negotiation of this contract.

Mr. Chomiak: Is there any legal assistance being provided with respect to negotiations?

Mr. McCrae: Yes, the firm of Pitblado and Hoskin in the city of Winnipeg has been acting as counsel for the negotiation of this contract.

Mr. Chomiak: Have there been any other government departments involved in the development or the implementation of either the proposal for tender or the contract itself?

Mr. McCrae: Mr. Chairperson, a number of resources in government are brought to bear on an important project like this, and initially the Department of Justice was there to advise us, as well. The Finance department clearly has to be consulted when you are talking about financial implications down the road, savings that can be achieved. The Finance department is interested, not only in making sure that the departments are so well-resourced, like my department is, for example, but also if there are revenues or savings or--that part of it is of interest to the Finance department, as well.

The government itself is behind this proposal, so that basically brings in everybody on this side of the House, if you want to take it to that extent. Basically, we have had input from the Department of Justice and the Department of Finance and the Department of Health.

Mr. Chomiak: Clearly, I think it is evident that this particular project, the SmartHealth project, is in scale and in philosophy unique in terms of information system development, particularly in comparison to what other jurisdictions have done. It has been said as much, the minister said as much in terms of the description of the system.

I am wondering if the minister can outline for me where the principles for the development of this particular system came from.

Mr. McCrae: The seed was basically planted, Mr. Chairperson, by the government of Manitoba in response to many, many entreaties by stakeholders in the public who have been urging that Manitoba become a centre of excellence for information technology for some time. I think, in response to that, our government could see potential for a smoother operating, more efficient and more compliant patient-focused system if we used the tools that are just lying there waiting to be picked up.

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By using the talent that we have here in Manitoba amongst people who have made information technology their career, we could do a much improved, vastly improved job in the delivery of health services in Manitoba.

Really and truly I think we would have to say Manitobans had the vision. This government was able to divine that that vision was there and was able to attract the appropriate people to assist us to put before the people a proposal which I think--since the honourable members opposite were able to make SmartHealth an issue in the campaign, we believe the people of Manitoba have said, do it, do it carefully and show us the results down the road.

Of course, encouraging as the DPIN has been, we learned from that DPIN experience the potential that is there for us. You can bet that a year ago about now we were very much anticipating with trembling--in not too much fear, but trembling because we were so excited to get going with the Drug Program Information Network, anxious to get on with learning what we could learn from that so we could apply what we learned to the next phases. We used to describe DPIN as a spoke in a wheel of information. We have other spokes to get into this wheel, so we can benefit all the more from information technology when it is applied to the various dimensions of health care delivery in Manitoba.

The vision, it is hard to place it in any one particular quarter, but the government itself--I think honourable members have heard the Premier (Mr. Filmon) talk on many occasions, a recognition that we are into an information age as opposed to some other kind of age, industrial or otherwise, and that we can be leaders in this world as Manitobans by taking up the challenge. We are doing that. In careful, measured steps, the contract that will come forward will demonstrate the care that we propose to take in the development of this system.

You see, we are in a very good position to take up this challenge because in Manitoba we have a lot of information with which we can put an information system to work. We are lucky in that sense. We are very fortunate that somebody had the foresight over the years to ensure that we developed a data base that would lend itself to the kind of information system that we are talking about.

Maybe the vision goes back even to before our government, to governments for some years that have paid careful attention to the gathering of information. We just have not applied the technology that we could. I do not say that as a criticism because I think the time is right right now. Even now we are on the leading edge with respect to the type of system that we are talking about here. We have an opportunity to show other jurisdictions what to do. We hope that we do not show them what not to do, because we expect to take enough care in the development of our system that will keep mistakes to a bare minimum.

We do not want to see continued the process of disposal of medical records in the way that we have heard about in the past. The honourable member will recall stories about medical records being found in all the most inappropriate places. That is not something that I want to see continue.

So I think that when we can demonstrate how we propose to achieve improved health outcomes as a result of an information system I think then we ought to be moving forward with that. But we ought not to do it without due regard for that consultation process which has brought us this far.

I know that during the election campaign and during the time that allegations were coming out about our health information network, the only comments I remember seeing were those of the honourable member and very few others, and his Leader, about health information because, certainly, we did not hear from the Assembly of Chiefs or Cadham Labs, Consumers' Association, Mental Health Association, and all of those people who are usually the ones who would have a concern.

We expect them to have concerns. We expect them to bring their concerns to the table where they are invited to be present and to have their input. That is what makes this proposal easier for me to take to the public, because I know that I have the partnership of the Manitoba Centre for Health Policy and Evaluation, the Manitoba Nurses' Union, the Manitoba Association for Rights and Liberties, organizations like that who are there to tell us what their concerns are. We want to hear them so that we can do something about those concerns before we move forward with this proposal.

Mr. Chomiak: Mr. Chairperson, one of my concerns is precisely what the minister alluded to because, after the SmartHealth was announced, I went to a lot of these organizations. I said to them, tell me what you know about the SmartHealth proposal and, without exaggeration, they knew very, very little. Most, and I want to be fair, because I am generalizing, of the comments were yes, we attended a meeting, or, we had had an involvement with the committee at some other point, but they were not aware of the scope and the magnitude of this particular proposal.

I know that the Health Advisory Network submitted a recommendation. There was a provincial steering committee set up. Five principles were adopted in terms of the health information system. The tender proposals went out. What came back with a winning proposal from the Royal Bank was something very, very expansive and quite beyond, I think--now, I am not saying what these organizations said, but what I think--more expansive beyond what these organizations that had had contact before were even remotely aware of.

I would like to ask the minister--I will ask for the record, but I recognize it is a difficulty--I would like to see copies of the information proposals that came from those people who offered proposals up at tender, but I suspect that confidentiality provisions apply. At the very least, I would not mind seeing the Royal Bank's. Is that possible?

Mr. McCrae: I think the honourable member knows that that is not the kind of information that we can properly make available in the way that he would ask.

I am interested though in what he said about his contacts with some of the organizations that I have referred to, for example, the Manitoba Association of Registered Nurses, the Manitoba Cancer Treatment and Research Foundation, the Manitoba Medical Association. I will be interested in their concerns right down the line. That is the point that I am making. I do not propose to consult once and then go merrily about my way. This is a big project and each module that we enter upon is going to require the expertise of some of these organizations.

How can we build a system that deals with people's medical records without consulting further the Manitoba College of Physicians and Surgeons? How can we enter upon issues relating to building in safeguards for confidentiality without consulting the people we have identified as being the appropriate ones to be on the privacy committee?

This is not one quick conversation and then on our way to build an empire. That is not what this is about. I think the honourable member has made the mistake of assuming that was the approach that we were embarked on. It is not. I admit there may be times when we will hear people's concerns and views and respond to them with whatever kind of technology is required to address those concerns and somebody might remain with a concern at the end of all of that. That may happen. I do not know. I hope not but it might happen.

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That is where when you are in the opposition, you kind of never lend your support to anything until everybody else does. I am not going to say I would want to be a part of an opposition like that but that happens. You cannot just listen to what the last person said and then run with that. I am not saying that we have to embark on a program that--and I think the honourable member once referred to consultation as--

Mr. Chomiak: A monologue disguised as a dialogue.

Mr. McCrae: That is the one, a monologue disguised as a dialogue. That is not what this is about and, yet, that phrase does not describe what happens at the end of all of the consultations either.

What I am trying to say is we have a whole group of people sitting and working together and representing various interests, and I hope that there will be true unanimity, peace and harmony. That would be my dearest wish. Being a realist, however, I suspect that there may be times when someone might have a remaining concern that they do not feel was dealt with the way they would deal with it and, yet, we will proceed with our partners showing them every bit of respect to which they are entitled, because they are all entitled to respect.

I just want to reiterate the privacy committee again, because I know privacy has been an important part of this. I get questions from New Democrats, for example, what about the computer hacker who is going to get into this information system? And then I say, and what? What information is it that people want? Who should not have it? Let us get into that question. Let us do that because that is important. The question is, what information is it you want protected from whom? Answer that question and then we go from there.

I remember this discussion--and I suggest caution for the honourable member for Kildonan not to fall into the trap of the former member for St. James. He is not present in this House, and it is entirely parliamentary for me to say so. His name is Paul Edwards. I can say that he is not present in this Chamber because he is not a member of this Chamber, Mr. Chairperson.

The honourable member might recall too that Paul Edwards was Justice critic and he kept asking questions about our arrangements with CSIS, Canadian Security Intelligence Service, about information related to people's whereabouts and that type of thing. What he did was he placed himself squarely on the side of the terrorists where you really do not want to be if you want to win an argument. People who blow up planes and kill women and children and things like that are not people I would like to defend.

Neither would I like to defend some of the things that are wrong with our health system, like leaving people's medical records out in the back alleys of Winnipeg for people to drive by, pick up, have a look at, use to their hearts' content in whatever way they want.

We have the Consumers' Association. If they are concerned about the computer hackers and what information they might find, what they might do with it, they should tell us. Who would be more interested in the privacy of people's health records than the Canadian Mental Health Association? Well, that is the organization we have on the privacy committee. The honourable member may even have people that he knows involved with the Manitoba Association for Rights and Liberties. Those people are very concerned about issues related to confidentiality, so we have asked them for their input on our privacy committee.

Of course, there are regulatory agencies like the College of Physicians and Surgeons and the Manitoba Association of Registered Nurses. We have also asked the Manitoba Society of Seniors to be involved in that committee as well.

When the honourable member raises concerns and wants to play this game about the monologue disguised as a dialogue--

An Honourable Member: You raised it, not me.

Mr. McCrae: You raised it first some time back, and I am just quoting the honourable member. I think it is a clever expression. I do not know where he got it from; maybe he actually made it up himself.

An Honourable Member: No, I did not make it up so I cannot take credit.

Mr. McCrae: Oh, okay, because I think it is really good. If it were true, I would be very concerned about it. I do not want to have a monologue disguised as a dialogue. I do not want to disguise anything here. I want to have a quality well-built system of technology to deal with the information which is ours. It belongs to the people of Manitoba. It does not belong to the Royal Bank, never will.

That unfortunately was an impression that some partisans tried to put across during the election campaign, that the Royal Bank of Canada, this huge profit-making bank in our country, was going to somehow get hold of our health records and just have their way with our health records. No, sir. That is not what we are talking about at all. Anybody who would say a thing like that would be out trying to mislead a whole population, which somehow to me does not have any place in a system where we are trying to make improvements.

Anyway, I am very sensitive to the issues the honourable member is raising about privacy, about consultation. He makes the point that some have said this. If he would please identify to us who those people were that said that, we would be very happy to follow up.

Mr. Chomiak: Mr. Chairperson, I will clarify for the minister what I said in my statement. That was, when the SmartHealth deal was announced and I contacted a number of the organizations that the minister has listed, they were aware of the deal but not even remotely aware of the scope and nature of the project, including some of the organizations that the minister referenced, some of those organizations. I am not saying that they were not talked to. They had been talked to, but they were not aware of the scope of the project.

When I look at the recommendations of the steering committee, and when I look at the task force reports, and when I look at the five principles surrounding this project, and then I look at the final product that came forward, I have to ask where that came from.

Now, the minister indicated it came from the government and their move towards information, move into the year 2000. If that is the case, I will accept that, but it seems to me that somewhere between the requests for tenders and the final product, this project became a much bigger project than I think most of the groups initially involved were aware of. I could be wrong. That is the impression that I have.

Mr. McCrae: Well, we all get impressions and sometimes when they are based on no information, you can be mistaken, and that is what the honourable member is.

We are engaged in a very sincere and very consultative approach to building a better health system. Does the honourable member seriously think that we are all sitting here trying to destroy our health system? I mean, give me a break, Mr. Chairman.

An Honourable Member: That is not a worthy thought of Super Dave.

Mr. McCrae: My colleague the Minister of Agriculture (Mr. Enns) would be the first one to be offended if someone would ever think like that. He has got what, 27 years of service?

Mr. Enns: I have 29.

Mr. McCrae: Twenty-nine, counting what?

Mr. Enns: Next June it will be 30.

Mr. McCrae: Oh, my goodness. Time flies, Mr. Chairperson, 29 years of service to his fellow Manitobans, and here we have the honourable member for Kildonan (Mr. Chomiak) coming along and not coming right out and saying it, but somehow leaving the impression that we are here somehow to do some disservice to our fellow citizens, that we deliberately go out of our way to leave our homes every week and come here to Winnipeg to serve in this place to do a disservice.

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Come on. Let us get down to the basics here and discuss what is really happening. The election is over.

An Honourable Member: Right, and guess what, Super Dave, we won.

Mr. Chomiak: Yes, you did and he mentions it about, say, three or four times an hour.

Mr. McCrae: All right, I will try not to be so repetitive about that, but it does come up from time to time that you cannot just keep on--there is an old expression about beating on a dead horse, and there is no need for that.

I am here, and my staff people are here to try and engage in some useful dialogue. I am trying to learn from my honourable colleagues to try to anticipate what their genuine concerns will be. I mean, when they are genuine, I will treat them that way, but when they are made-up concerns, you know, you get a little frustrated running around after all these shadows that--

An Honourable Member: I gave you three genuine questions this afternoon. They are not fun questions.

Mr. McCrae: The honourable member for The Pas (Mr. Lathlin) tells me that today he asked three genuine questions, and he did. They were about as meaningful questions--

An Honourable Member: Do not say we ask meaningless questions.

Mr. McCrae: I did not say the honourable member for The Pas asked any meaningless questions. His questions today were extremely important questions and they go--I just acknowledged it twice in a row, Mr. Chairperson.

Mr. Chairperson: Order, please. I would ask the honourable minister to be relevant to the question placed before him, and I would ask the honourable members to refrain from entering into this debate. There is a question to be answered.

Mr. McCrae: Mr. Chairperson, it is only because I take the honourable member for The Pas (Mr. Lathlin) so seriously that I was distracted momentarily by a very genuine issue that he raised in his questions earlier on. I apologize for straying from the path of relevancy that I should be staying on.

The point that I am getting at is our efforts are genuine and I believe, as I was saying, the people of Manitoba agree that our efforts are genuine. The people of Manitoba also say that even Conservative governments of the '90s can be fallible, can be, under certain circumstances, fallible. So they said move forward with your reforms including SmartHealth. Do it very carefully and listen to Manitobans when you consult with them.

So I would reject any suggestion that any consultation in which we are engaged is a monologue disguised as a dialogue. We are engaged in sincere dialogue. If it was as the honourable member says, we would not be bothering to talk to the Consumers' Association and the College of Physicians and Surgeons. Why would we bother talking to the MMA if we already had our minds made up? Why, indeed why would we bother to consult the Manitoba Nurses' Union if we just wanted to go our merry way.

We have representatives from the laboratory sector. We have people from Manitoba Health, people from emergency services, people from the Society of Seniors, pharmacists, hospital representation, regional representation from around our province, in total some 25 people involved in our circle of people with whom we consult. If the honourable member has doubts about the quality of that, we will address that.

Mr. Chomiak: Mr. Chairperson, can the minister outline specifically what the ten-year proposal was from the Royal Bank concerning the SmartHealth system, what the projections were for cost-savings and what the projections were for cost to the province?

Mr. McCrae: Mr. Chairperson, there has been a lot of thinking done on this topic and a lot of speculation too. We have heard some wild, wild numbers bandied about with respect to the costs associated with the public health information system. There was a wild, wild speculation, but there was also some more realistic speculation as high as $118 million, although that has been reduced somewhat because input costs have already been demonstrated to be less than $118 million. However, I cannot seem to get the honourable member to stop using those wild and wonderful numbers. So the value of the contract is estimated at $100 million. It is expected that there would be savings achieved of $200 million over five years.

Now, the honourable member may, indeed, based only on that information, want to come to the conclusion that you will not achieve your savings. Well, that is all right. If we do not achieve our savings, it will be because we do not want to achieve those savings, and the project has been broken down into what has been bite-sized pieces. It may be a play on words, considering the nature of the work we are doing.

For an example, DPIN has been broken into three modules-- expansion of DPIN to hospital pharmacies, northern nursing stations, and hospital emergency rooms. Each bite-sized piece, or module, is broken into five stages which have to be completed before the next stage proceeds. If there cannot be demonstrated the savings that are expected to be achieved, then you do not proceed.

At each stage the health care community gives their response to government for a go or a no-go decision. I mean, what better, more quality consultation does the honourable member want but to have the stakeholders being the ones in a position to recommend go or no-go on certain important aspects of the contract?

The viability assessment for this, and the cost-benefit analysis determine the economic viability of implementing a health information network. All stakeholders have supported the concept, and have bought into that whole idea, and that is why I am just a little perplexed or concerned when the honourable member would put on the public record that the stakeholders do not agree when we say they do agree. So we are going have to get to the bottom of that one.

Potential benefits were broken into three broad categories. First of all, administrative initiatives. These are initiatives designed to automate manual or paper processes, such as claim processing for hospitals and health providers, and for monitoring health delivery to reduce incidences of double servicing, abuse or fraud. That is important.

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How many constituents does the honourable member have? I know the member for The Pas has some because I have been there. I have probably spent as much time, or more time, in The Pas as I have in Kildonan, and I have been there, too. But I say, everywhere I go, and that includes Kildonan, what are you doing about the abuse in our health system? All these people abusing our system and costing dollars that should be spent properly because it is so important. Yet we do not get support for trying to put an end to abuse.

There are people in the New Democratic Party who think there is no abuse, or if there is some abuse that it should be allowed. I really disagree very strongly with that because any government program that is abused becomes the subject of a lot of public ridicule. Even the issue of young offenders. There is a sense that this young offenders business is running rampant and we have a terrible, terrible situation. Well, because of the actions of 5 percent of the kids, we have problems, all right.

Ninety-five percent of the children in this province, young people in this province are good and decent and law abiding and contributing members of our society, and they should be given a lot of credit for that. But do not use that figure as an excuse to do nothing about the other 5 percent, because we have to do something about those. The other 5 percent are causing no end of problems in our communities and we need good, strong action to deal with it.

Similarly, in the health care field, Mr. Chairperson--I am coming around to my point here. Why is it New Democrats want to sit there in their places and defend people using 72 doctors 247 times a year? I do not think I want to defend that. I want to put a stop to that. It is wrong and New Democratics should be ashamed of themselves for wanting to see that sort of thing continue.

Why do they want to defend health records lying around in back alleys? I do not think that is good. I think there is a real potential for abuse of the information contained in documents lying around in back alleys of Winnipeg. I really do. I think it is a dangerous situation that ought not to be encouraged, and so I say to the honourable members opposite they ought not to continue encouraging that sort of thing.

I was talking about the potential benefits of the program here being broken down into three broad categories. The second category has to do with the tactical initiatives. That means that--and I do not refer to NDP tactics or anything like that. I am talking here about improving patient services.

Mr. Chomiak: Like drug utilization reviews or specialized formularies perhaps, electronic storage, transmission of lab results. How about remote lab testing?

Mr. McCrae: Is this speech No. 10?

Just in case the honourable member is reading from a different briefing note than I am, I will put my briefing note on the record if that is all right with the honourable member.

An Honourable Member: You can put that in your recipe box, Dave.

Mr. McCrae: You would be surprised the things that fit in that little box of the honourable member. He has so much information in there. How long did you keep us going last year? Was it 45 hours, 50 hours, something like that? We are approaching that now? [interjection] Oh, well, we have a long way to go yet then. Well, we are at about 30 hours now and we are just barely scratching the surface I think.

An Honourable Member: You could have finished around 25 if you would have been relevant.

Mr. McCrae: Could have beens and would have beens do not count. I think though with respect to the potential benefits and these broad categories, we have talked about the administrative initiatives and we need to talk about the tactical initiatives, like drug use reviews. We should build on the drug program information network that is now in place. The health information network can automate the collection of drug usage information across the population. We should establish more effective clinical treatment guidelines.

You know, clinical treatment guidelines sounds kind of bureaucratic, but it has a lot to do with the way the doctor looks at you, Mr. Chairperson, and then how another doctor of the same specialty looks at me. Should those doctors not be using similar criteria in order for us all to point towards and achieve better health outcomes? I think so. [interjection] The honourable member for River Heights (Mr. Radcliffe) has indeed agreed with this particular approach. We have discussed it on repeated occasions.

This system would also assist in developing specialized formularies, that is, for specific population sectors or illness, for example, a specific drug formulary in Manitoba developed for the geriatric population.

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

Now, here is a really big one that I think--[interjection] Right on. The honourable member is a mind reader, Mr. Chairperson. He has a crystal ball over there in that little box.

Here is an area that I just know the honourable member is very concerned about--labs. He has raised it before, and I know the honourable member and his Leader would not want to see duplication of lab tests or any kind of inefficiencies in that particular area. A large part of the spending of government on health is paying for lab tests, and I think more expedient electronic access to past and current lab test results could reduce duplicate tests.

Why should it be that a Manitoban can visit one doctor today and get a test, a particular test, visit another doctor tomorrow and get exactly the same test done, another doctor the next day and get another test done of exactly the same variety. Why should that be happening? The honourable member must know about this, because I certainly have colleagues on this side of the House who know about it happening--[interjection] Well, I hope so, because there is so much that can be done with appropriately used information shared by the appropriate people. We do not want to have all these duplicate tests, and maybe there is much more to it, and I agree.

I think some of the reason that the honourable member is so very aware of these issues, and I say this as a compliment, not as anything else, is that he indeed has engaged in some consultations, the honourable member has. So he knows. He just happens to have come to some of the wrong conclusions. That is all. Because he has certainly been involved in talking to health professionals in various parts of Manitoba. Almost everybody who is involved in the health system who has a voice has been part of this and understands the benefits and supports this.

With respect to remote lab testing, tests can be taken locally in remote areas and interpreted or analyzed through technology such as remote imaging or access to diagnostic specialists in major medical centres. This could reduce the need for people to leave their home communities to obtain medical tests. Does this not mean anything to the honourable member? I mean, maybe he does live in Winnipeg, and there is certainly nothing wrong with that. I have done that and do so a good part of my life now. But there are other parts of this province and people who live in those other parts who would very much benefit by reduction in the need for them to travel, either by car, bus, airplane, or however else you get to Winnipeg to obtain medical tests.

There is a better way, and I think we should support that better way. This is all about revising and developing new clinical guidelines. The health information network will complement the existing Manitoba Health data base for anonymous population-wide statistical information on illnesses and treatments that researchers use to identify the most effective treatment strategies. This whole program will provide electronic access to patient information.

Here is an area of concern for the honourable member, but because he has a concern, he says, stop everything. No. Address the concern--that would be more to the point, Mr. Chairperson. Fix the problem whatever it happens to be and move forward. Improved access to more complete computerized patient-controlled health information can reduce uncertainty and improve decision making for determining effective treatments. That is important. It is very important, and it is missing to too much of an extent in Manitoba and elsewhere.

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For example, access to immunization records can reduce duplication of overimmunization. Maybe the honourable member remembers last time he was at the doctor. Maybe he was asked, when was the last time you had this or that? What if you do not remember, like me? I forget things from time to time--[interjection]--once in a while, not very often, but it happens. If I was asked something like that, I would say I do not remember when the last time, say, my cholesterol was checked.

Well, if it was last week, and I forgot about it, maybe there is something else wrong with me too. But, if it was last week, why should I be asking for more cholesterol tests again this week? Just because it was so much fun to have it last week? There is a reason for doing these things and a reason for doing them within appropriate time intervals. You do not want the danger of overimmunization.

A pharmacist armed with the correct information can protect you from giving you medicine that would react in a negative way with other medicines you might be taking. Would it not be nice if the pharmacist could say, oh, I should not be giving you this medicine today because I understand from my records that you are already on this other substance and when you mix the two up you get very sick? Does the honourable member for Kildonan (Mr. Chomiak) realize how many people have to go to the hospital every year for that very reason? I would like to put an end to that. Not because I want to save money only--I mean, saving money is an important thing to do.

Some people actually die as a result of negative drug interactions or, at the very least, get very, very ill. That is a worry for them and a worry for their families, and it is sometimes very, very preventable. I think, as I said, this kind of information reduces the onus on the patient's memory for maintenance and storage of their own health history. I do not think we can all carry around in our heads a total health history, even for ourselves. It would be nice if we could, but we cannot all do that.

There is another very important thing here that we want to achieve. I think it is important for us to try to keep people healthy in Manitoba--

An Honourable Member: Through strategic initiatives.

Mr. McCrae: --through strategic initiatives. I am glad the honourable member is listening anyway. There is another expression that goes beyond this dialogue and monologue one. It is the expression about the fellow who--there are none so blind as those who will not see. Well, you could say the same about people, they listen but they do not hear, or they hear but they do not listen. Sometimes I think the honourable member falls into that category. I know he is trying, but I want him to listen even harder because he is not giving me the benefit here of listening hard enough.

We want to keep people healthy through the proactive clinical guidelines the honourable member refers to. If he is suggesting that, I am saying, good for him. I think we should do it. [interjection] Well, that is what proactive clinical guidelines do. They enable preventive care programs, and if the honourable member does not see that, does not agree with that, let him stand in his place and say so.

More sophisticated computer applications can help identify individuals at risk for illnesses in the future based on heredity, age or other factors. Protective or preventive measures can be implemented early, and everybody knows about early implementation and how important that can be, especially with some particular conditions that people get. The system could incorporate patient monitoring for specific illnesses, along with periodic test scheduling and a reminder system.

These two sheets that I have been talking about that the honourable member has been following along with me today says a lot about what we are trying to achieve with the public health information system. If the honourable member wants to remain against that, let him say so, but I am telling you, Mr. Chairperson, the people of Manitoba want it and they are going to have it because they are paying for it, and they want to get good quality out of it. They want us to do a good job with this. They want us to keep mistakes to a minimum, and so do I.

Perfection being such an elusive thing for most of us, we do make mistakes. Let us bring as many people into this exercise as we can and as makes sense so that they can point out to us the danger. [interjection] Me, too.

I think that the people that we are working with, and I have given the member the list on a number of occasions, we can listen to what they have to tell us. They can tell us what to watch out for, they can tell us what to be concerned about. But do not always just tell us because of one concern, do not do anything. That is not government in the '90s. The people of this province want a better government than that.

An Honourable Member: If you do not do anything, then you will never make a mistake.

Mr. McCrae: It is true that if you never do anything, you do not make a mistake, but I say to my very dear colleague the honourable Minister of Agriculture (Mr. Enns) that that in itself is a big, big mistake.

An Honourable Member: Your are right. I stand to be corrected.

Mr. McCrae: To do nothing is to make the biggest mistake.

Mr. Chomiak: In keeping with the tradition that we have developed in these Estimates, perhaps we should take a five-minute break at this point.

Mr. McCrae: I am comfortable with that this time, Mr. Chairperson.

The committee recessed at 4:28 p.m.

________

After Recess

The committee resumed at 4:39 p.m.

Mr. Chomiak: The minister was taking us down the micro path. I will be going into each of those areas systematically through the course of these questions, but I just want to take us back to the general question at first. That is the proposal that was made by the Royal Bank to the government with respect to its proposal. Within the context of its proposal, the Royal Bank proposed over a 10-year period that they could achieve savings of about $700 million, with gross cost of $200 million, for a net benefit of about $500 million.

I wonder if the minister could outline for me where those numbers came from, because the initial Royal Bank tender was for a 10-year time frame amounting to $700 million in gross savings, at a cost of $200 million, for a net benefit of about $500 million. That 10-year projection is now down to a five-year framework, and I am just wondering where those figures and those numbers came from.

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Mr. McCrae: Yes, I think it is always fair to suggest and appropriate to contemplate that, as you are getting ready to embark on a major undertaking, you look at the various options that might be available, listen to the various vendors who might have some insight to share. Suffice it to say, it was felt that a five-year horizon was more along the line of what we felt would be appropriate.

The world was changing so much that to begin planning over a 10-year period as opposed to a five-year period--I think judgments were made along the way that a five-year program would be more in the interests of good results and the achievement of better outcomes for Manitobans. It was simply a decision made in the course of, I suggest, many, many discussions along the way.

Mr. Chomiak: But where do the numbers come from in terms of the projections? Were those proposed by the Royal Bank? Were they proposed by the Department of Health and put into the Royal Bank's figurings? How did those numbers and those savings come about?

Mr. McCrae: The numbers were derived from the interpretation and extrapolation of local, national and international studies and information, regardless of what numbers were being touted or bandied about, ultimately the department came down where it did.

Mr. Chomiak: I do not have the other information packages that were provided by the other 15 or 16 companies that proposed. Did they also have the same data and the same kind of information, and were their proposals along the same lines in terms of these figures?

In other words, did these figures come from the Department of Health to say, this is what we want to achieve, this is where we think we can go? The Royal Bank came back and said, yes, we can do this, this amount of savings. Was it the Royal Bank that came up with these numbers? Was it the Department of Health that came up with these numbers and did other tender proposals come up with similar numbers?

Mr. McCrae: The various numbers were the result of a viability assessment, and all those who were invited to tender were in possession of the same basic types of information.

Mr. Chomiak: Will the minister table the viability assessment upon which this was based.

Mr. McCrae: Yes.

Mr. Chomiak: I thank the minister for that response. The decision to choose the Royal Bank versus other systems was obviously based on a number of factors. Can the minister outline for me what were the major factors that determined that the contract would be awarded to the Royal Bank?

Mr. McCrae: The two factors were the technical ability know-how, and the other one was the demonstrated ability to work with stakeholders and to engage in consultation with stakeholders. There were only those two major ones, and I note the importance that we have placed on the ability to work and consult with stakeholders, that is key to the success of this project.

Mr. Chomiak: Is the minister aware of whether or not the Royal Bank has any experience in the health care field?

Mr. McCrae: The Royal Bank has significant experience in the technology aspect of it and significant experience in consulting with stakeholders. If the honourable member will accept what we have said earlier, then the answer makes good sense because we are dealing with our information, not the Royal Bank's information.

Mr. Chomiak: One of the issues surrounding the actual proposal is concerning the methodology--oh, methodology is the wrong word--concerning their technological approach toward this kind of information. As I understand it, there is a form of technology whereby the card itself contains the information in a chip or whatever and the information is stored in a particular card and the information is owned and maintained by the individual in their card, and then there is the other system, which is the system that has been accepted, which is a sort of on-line system, where the information is maintained in a central repository and is accessed by use of the card. I am simplifying it, but I hope I am making the right distinction. I am wondering if the minister can outline for me why the Royal Bank on-line system was chosen versus the on-card system, if I could break it down into those categories.

Mr. McCrae: Mr. Chairperson, even if you went with the kind of card with the chip on it, as the honourable suggests, you lose out on the potential for the epidemiological research policy-building aspect of it. While the information is your information or my information, when you take your name out of it or my name out of it, you have some very, very important epidemiological information on the basis of which government and other stakeholders can then make and adjust their policies, build their protocols, and do all the things that we want this health information system to help us do.

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Mr. Chomiak: It seems to me that the card chip system does not preclude the collection of epidemiological--does not preclude the retention and the compilation of this kind of information. It is not precluded by virtue of a card chip system. It seems to me the two can function side by side. I am certainly not an expert in this, but it seems to me that it is quite possible to do both.

Mr. McCrae: I would not quarrel with the honourable member on that point; however, if I present or am delivered unconscious or some such thing to an emergency room and I do not have my card and the number is not accessible, I think we have a problem in that we could not bring the full force of the health information system to bear on an emergency situation like that, and there probably are other examples I could use.

Mr. Chomiak: How is the system going to function, therefore? Can the minister give an outline as to what the procedures will be, and how the system will actually operate with respect to the card accessing the system and receiving the information?

Mr. McCrae: We will be developing an answer to the honourable member's question in consultation with our partners and stakeholders.

Mr. Chomiak: Does the minister mean by that response that it is not yet developed?

Mr. McCrae: Yes, we are embarking on a very comprehensive health information system which requires, every step of the way, input from the stakeholders with whom we have partnered.

So, if I had my mind made up about all these things, the honourable member would have been right in some of the things he has been saying; but, as it turns out, he is not because my mind is not made up. We have plenty of work to do, along with the stakeholders who are working with us.

Mr. Chomiak: I would presume that it is the technological experience of the Royal Bank with regard to their information management system that the government is going to utilize in order to develop this particular process.

Mr. McCrae: That is right. The Royal Bank is--I do not want to reduce their role in any way, but they are a contractor. We want things. We will put those things to the contractor, i.e., SmartHealth. They will deliver the technology for us to achieve what we and the stakeholders ask SmartHealth to achieve for us.

As I have said before, the information is ours. The outcomes we want to achieve will be put to the vendor, i.e., SmartHealth. SmartHealth will then help us design the systems that will do what we want to get done, and they will be designed in such a way that our needs and our requirements have to be taken account of--i.e., one of those requirements is the very, very important matter of confidentiality and building within the system the safeguards that are needed to guarantee that.

Mr. Chomiak: The system costs are very precise at $118.7 million and are broken down into very specific categories. I certainly had the impression from a review of those particular categories that the system was far more advanced and developed than the impression I am getting from the minister with regard to his particular response. It seems to me that the process and the system is not as developed as one would be led to believe by the very specific costs that have been allocated toward the operation of the system.

Mr. McCrae: I do not think anybody else felt we were so far down the road. After all, we have not even signed the contract yet, so I do not know how we could be as far down the road as the honourable member suggests. He is probably looking at the document that comes up with this figure of $118.7 million and saying, well, that is what it is going to cost, when we already know that there are some items in here that were overstated, bringing the total up high.

We do not want to get into a serious cost overrun issue here either, so I think you have to estimate on the side of--well, I was going to say, conservative, but I better be careful around here of that kind of language. The point is the $118.7 million, and Mr. Alexander has explained publicly that that number is an inflated number because of certain events that have happened since that number was first come up with.

The document in front of the honourable member says, estimated five-year cumulative benefits, and the benefits would be estimated and the costs would be estimated. After very, very careful examination of potential costs, you contract for a reasonable amount, and then you expect to see a contract carried out whereby the real costs are not inflated and so on.

So a contract like this has to be carefully monitored, and that is what we fully expect to do.

Mr. Chomiak: Is the minister saying, in the course of the contract that is presently being negotiated by Mr. Alexander on behalf of the province, that within the context of that contract the cost to be borne by the province is less than the $118 million and that will show itself in the final contracts soon to be proofed?

Mr. McCrae: Yes, absolutely. That is why when I deny the figures that are bandied around daily, sometimes as many times daily by the honourable member--I am serious, I do not mean to understate the numbers either, but I do not think the honourable member should take a sheet of paper, head it up estimated benefits and estimated costs and go with that and say, that is what it is, when it is estimated only. I do not remember him making that clear. In fact, I heard figures that went much, much higher than $118.7 million.

Mr. Chomiak: I believe those figures were contained in a newspaper article that reviewed the costs and indicated that they could potentially go as high as $150 million. I am simply dealing from information that was published and that was provided concerning the cost of a project that is substantial.

I would like the minister to explain to me what the network charges component of this operating cost factor is.

Mr. McCrae: For example, network charges estimated in this document are $27.6 million. The estimate we have today, and this is an estimate too, is that that number would be somewhat reduced in the neighbourhood of 20 percent.

Mr. Chomiak: That is all. That is great. Can the minister explain for me, what is entailed by these network charges?

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Mr. McCrae: Telecommunications costs associated with the Manitoba Telephone System.

Mr. Chomiak: So these costs are charges from Manitoba Telephone System to the Department of Health for the provision of services in order to allow the system to function. Is that correct?

Mr. McCrae: That is correct.

Mr. Chomiak: Are these one-time costs or are these ongoing expenditures?

Mr. McCrae: Both.

Mr. Chomiak: So, in the future, when an individual in the system wishes to access information, the costs to the individual or to the system will be covered within this $27.6-million figure, give or take 20 percent less. [interjection] Take, to use the minister's word, this reduction of 20 percent, that the costs will be covered within the $27.6 million.

Mr. McCrae: Yes, sir.

Mr. Chomiak: This money will be paid to Manitoba Telephone System.

Mr. McCrae: Yes, sir.

Mr. Chomiak: There is also an estimate of $35.2 million for hardware and operating costs, which includes core services, operating software, work stations, interim bridges and operating. Can the minister perhaps flesh out what those expenditures are for?

Mr. McCrae: I can repeat that it is for core servers for operating software, work stations, interim bridges and operating costs. Now operating costs, I assume, relate to maintenance and repair of equipment, but basically hardware and operating costs are the ones set out in the document that the honourable member has in his hand.

Mr. Chomiak: Whom will these costs be paid to?

Mr. McCrae: Whoever provides the services, Mr. Chairperson. I do not mean to be oversimplistic, but SmartHealth will be subcontracting lots of work and supplies and equipment. Whoever provides the services or equipment would be the recipient of the dollars.

Mr. Chomiak: Mr. Chairperson, the provision of this kind of service will require a fair amount of hardware. Where are the costs for that hardware included in these projections?

Mr. McCrae: The number the honourable member is asking is hardware and operating costs $35.2 million. Hardware costs are in that number.

Mr. Chomiak: The minister is saying within that $35.2 million expenditure item will be all of the costs to effectively wire and provide workstations, computer outlets and functioning hardware across the province of Manitoba to all users for the SmartHealth system. Is that what the minister is saying?

Mr. McCrae: Where needed, Mr. Chairperson, yes.

Mr. Chomiak: The department has done a complete inventory of all of the hardware presently in the system and has done a calculation of what is required and what is not required. Within that complete inventory, we know how much we will have to pay in order to get the system up and running. Is that correct?

Mr. McCrae: Yes, that was done, Mr. Chairperson, and as part of this exercise, some dollars were added just to be on the conservative side.

Mr. Chomiak: Mr. Chairperson, can the minister give me an indication of how many more dollars were added in order to achieve that end?

Mr. McCrae: We are dealing with estimated implementation costs, so the amount that was added would have been an estimated amount, too, and do not forget the--[interjection] Yes, do not forget that. No, I was going to say that this inventory also is not an exact science either, so we are dealing with an estimated inventory and an estimated add-on to be conservative. I am not able to break that down further for the honourable member.

Mr. Chomiak: Mr. Chairperson, I am certainly not an expert in this field, and I certainly am aware of the experiences in terms of hardware development and systems in terms of the province. I am certainly aware that different jurisdictions and different hospitals are going in different directions perhaps from each other. I just want to be very certain about this, that the province therefore is confident that within this particular expenditure item, the entire province, including all the institutions, all the community health centres, all of the doctor's offices, all of the end users that are projected in terms of SmartHealth, can be equipped and functioning on line for $35.2 million.

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Mr. McCrae: Every time I am asked about my level of confidence, Mr. Chairperson, I give a cautious response. I am cautiously optimistic in the confidence that we have put into these numbers.

Mr. Chomiak: I take, from that response, there is a cautious affirmative response to my question.

Mr. McCrae: I am decidedly affirmatively cautious.

Mr. Chomiak: Mr. Chairperson, I am a bit surprised but happy to see that we could wire the whole province based on that actual figure. I would be really interested to see if it is possible to have an inventory or if the minister could table the inventory of the analysis of the province in order to determine where we are at in terms of the hardware in the province. Is it possible to table the documentation in that regard?

Mr. McCrae: The honourable member will probably agree that we are looking at a moving target in a sense. The inventory that we are talking about was done a couple of years ago, and we know that many, many doctors' offices have since been fitted with computer equipment which renders this even more of a conservative sort of estimate, I suggest. If they had been doing that, that will make the network that much less cumbersome, shall we say, later on when we are hooking everything up.

I did not mean to be unnecessarily facetious a little while ago, but I am cautious by nature, I hope, and I am given some pretty good assurances about the quality of the estimates, the conservative nature of the estimates.

In other words, the sense I get is that we have overestimated, if anything. When we were at $118.7 million, we were overestimating then, and we already know that there is at least 20 percent off one major factor of that that the network charges, so if that is the nature of the--why are words failing me today. When we are making considerations along the way, and we are consistently on that careful or conservative side, when we do get to actually contracting, the numbers should be conservative enough that we can feel fairly confident or cautiously optimistic about achieving or surpassing.

Do not forget, also, that even at the point of the signing of the document, the performance of the contract is more important than the signing of the contract because as we move along technology changes may indeed present us with greater opportunities than we have today. That is why I referred to the moving target. Things are changing so fast a future ain't like it used to be, as one person used to say, or as another one said--what was it that Dwight Eisenhower said that time--things are more like they are today than they have ever been before.

If you can make any sense out of that, do your best, but the fact is times are changing. I think this contract will ultimately show that we have addressed it from a very cautious perspective, and I think that the people of Manitoba are owed that from us.

Mr. Chomiak: Mr. Chairperson, can the minister explain how this will work if we have, for example, 800 doctor's offices that are equipped with some form of hardware, and 200 doctor's offices that are not or 200 doctor's offices have hardware that is archaic and cannot be utilized in the system, who will pay for the upgrade of their hardware?

Mr. McCrae: I do not know, Mr. Chairperson, but I do know that we faced the same question when we were working with the pharmacists, and maybe it is because of the leadership that we have in our branch here that we managed to work our way through, working very closely with the Manitoba Pharmaceutical Association.

We will continue the same approach we have used in the past. I guess the arrangements were made so that appropriate credits were given and appropriate supplies made available, and some had them and some did not. We came through all that. We can do it again, and we do it through various negotiating mechanisms that really did get us through and right down to the wire last July 18. There were issues arising from time to time as we came close to that deadline. We were going to go ahead with our public information campaign and so on, and those were items that were getting resolved.

So the answer is I do not know at this time, but I know that we have proved that we can do it before and we can do it again.

Mr. Chomiak: Mr. Chairperson, I do not doubt the fact that it can be done. I guess the question is, who is going to pay the cost of it? I started off with the example of the doctor's office for a specific reason. One of the major claims made by doctors and physicians is the increasing cost of overhead, and one would think that this could entail an increasing overhead cost that they may not be prepared to bear.

The other issue, of course, is if you go into X institution, be it a hospital or a community health clinic, and their hardware is redundant and given the budgetary constraints that have been put on them they are certainly going to come back and say, if you want us to implement the system we are going to need an ex-million dollar upgrade of our hardware equipment. I just wanted to assure myself that all of that, all those considerations, were figured into the $35.2 million.

Mr. McCrae: Of course they were, but I am not so quick to jump to the same conclusions that the honourable member is. From my experience dealing with physicians in Manitoba their bottom line is not always dollars. They are professional people who can see the opportunity to better serve their patients, to do a better job as physicians, to do a better job consulting their colleagues.

There is something here that I think the deep inexperience tells me pharmacists were not bottom-lining us every step of the way. They could see that we are doing something better.

The honourable member, I am sure, may know how it feels to engage in the best practice. I do not know if you can put a number on that always. But to know that the end of your day, if you are a lawyer for example, that your clients because of whatever information system you were using maybe to access materials in the law library or whatever it happens to be, you are able to use your skills as a professional to the benefit of your patients in society. Something in that. And it is an intangible, I realize that. Something in that drove the pharmacists of Manitoba because I know some of them made some sacrifices in order to get on the system. And I appreciate it, their time, their effort, their working with us.

Doctors are no different. Doctors want to do the best that they can for their patients. I know that overheads are somewhat going to be squeezed as we carry through with the Manitoba Medical Association government of Manitoba contract, but I do not see every physician in Manitoba saying, well you know we cannot co-operate with you unless you put a bunch of money on the table because lurking not too far away is this whole issue of providing a better practice, providing a better service. Which there is, albeit intangible, but, a real satisfaction that a professional can feel.

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Now as I said in my previous answer we are not totally satisfied that we can get through without some pretty tough discussions and negotiations or difficult ones in one way or another. Our performance thus far has demonstrated that we can do it, and the answer to the honourable member's question that have these types of contingencies have been factored into the Estimates that we are talking about, and the answer is yes, they have.

Mr. Chomiak: The expansion of the program, and I use medical doctors as an example because of the overhead, will be of course to ambulance services; personal care homes; community health centres; labs; pharmacies, et cetera. I might remind the minister that all members of this House unanimously passed a resolution concerning the introduction of the Pharmacare program several years ago and saw it as an idea whose time had come.

The expansion of this system seems to me to be an extensive expansion and, in fact, given the experience of governments and information systems I think is probably going to be more rife with difficulties, but I know there is expertise, and I am not questioning the expertise. I am simply raising what I think will be some problems--and it may be that all eventualities have been considered and all of the costs have been projected and there is an accurate assessment--but given the dramatic change in technology, I just anticipate we are going to have more difficulty in this area than I can see from just the surface analysis that I have been able to make this afternoon. I hope I am wrong.

This area, I think, will be far more difficult to achieve than simply the idea of installing PCs into pharmacies across Manitoba but, clearly, experts have looked through this and have arrived at different conclusions.

Mr. McCrae: I, without consulting Mr. Alexander, would say that probably DPIN was rife with difficulties. We were breaking new ground. We had a lot of things to do. We had a lot of little brushfires to stamp out in the development of that, and I expect to see just as much or more as we enter into a much bigger project. However, the experience of DPIN will be invaluable to all of us as we proceed along with the next steps.

I certainly hear what the honourable member is saying. I would like to be a little more optimistic than he is on the point but I certainly hear him. I am not here to tell him that everything is going to run just exactly the way we think it is going to run today. We are making every reasonable forecast, I believe. I say reasonable because, as I said, I do not think we can be perfect or we can look at every possible contingency that will arise but I think we can see every reasonable one.

(Mr. Chairperson in the Chair)

We are not working alone which gives me a lot of comfort. I would be far less comfortable standing here answering the honourable member's questions if it was just me or just the government behind all this but it is not. I keep referring back to the stakeholders and our partners. If it was not for them, yes, I would say the honourable member would be making a far better point. He makes good points in the sense that we should be listening to him and looking at what he is saying. If we followed the advice that flows from what he has said, we would not do this. I think that would be a mistake in the evolution of our health system.

You know, we have serious challenges ahead, fiscal ones. If it is not this way and if it is not reducing dependency on acute sector, I do not know where else we would be saving money. If it is not in any of those places where there is money being saved, how are we suppose to respond to the challenges that are coming at us? That is a fundamental question.

The honourable member may have the answer, but he has not given it to me other than to say put more money into it which you can get by a fairer tax system, and I do not want to adopt all his approaches. A fairer tax system is not just going to bring in gobs more money. A fairer tax system might take a little less from some and a little more from others but not significant dollars that we can just throw into health and social systems any more. It is just not there for us.

If the honourable member says I am wrong, consult the people of Ontario. What did they say about it just a few days ago? They were very clear on the point.

I sense the sincerity in what the honourable member is saying. Yes, we do have all these experts that are advising us. We think that it is the right direction to go. We can deliver health care services for a lot less money than we are today in the future, and we can do it better. We can actually do more with less. I believe it; the honourable member does not. However, what is the option, if we do not do this and we do not do some of the other things that we have talked about?

We agree on doing the kinds of things we see in the Health of Manitoba's Children document. We agree on those approaches to do more in the community, but you have to get the money from somewhere to do more in the community. Here we are presented with a technologically proper or doable alternative that will, while we are at it, improve health care in Manitoba. No one is really arguing that that cannot happen.

What are the main arguments? The main arguments are privacy issues, which we have tried to build as much comfort around as possible by consulting the stakeholders. Another one is like you are dealing with a big fat rich bank--is really basically the other argument which appeals more to our emotions than to our sense of actually getting something done.

I put these points on the record. I build a little caution around all my answers. I do that because, in regard to the performance of this contract, we do not know every twist and turn today because we have not worked every twist and turn out with our stakeholders. Indeed, once the contract is written up, it is still going to be the stakeholders that are going to be involved in helping us make decisions about whether we move to the next component of the contract or when we move or whether we move to it in the very same form that we are talking about today.

Do not forget I said we are talking about a changing environment. The contract is going to have to take account of the fact that we are working in a changing environment over five years.

I just ask the honourable member to have a little more faith than he has demonstrated thus far. He is asking all the right questions. If the answers do not give him the assurance that he needs--they do not seem to give him enough assurance, but the alternative to doing what we are doing is to leave things as they are. That is a sure recipe for the destruction of a good-quality health system that we have. That quality can be preserved and it can be improved, enhanced, made much better. We can make it so that more and more Manitobans can share in it without having to pay a lot more money for more and more Manitobans to share in it.

We know more and more Manitobans are going to, with the population aging as it is, with technology presenting us with so many more opportunities for various surgical procedures that help to enhance the quality of our lives, make us live longer and all of those things that are important to human beings.

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They do not come without a cost. Are we going to be ready to accept all the new technologies that will improve our lives so much if we do not enter into arrangements that allow us to preserve those best parts of our system, that allow us to remove the duplication that exists in various areas, notably the laboratory testing area where everybody is aware that double testing has happened on occasion--and how many occasions nobody dares to speculate. We know it has been happening, and we know there is something we can do about it. This is the technology that will help us do something about it.

Patient utilization, talking about that, we have touched the tiniest part of the surface of issues relating to patient utilization. The honourable member does not say anything about somebody who uses 72 doctors 247 times--

An Honourable Member: We will get to that.

Mr. McCrae: He says we will get to that. I appreciate that. If that is happening with one individual, we know there is a lot of education that could be done in Manitoba to help people use physician and other medical services more appropriately, but even for some, education will not work and you have to have something else. Information available to health professionals will help put a stop to that. We know that it already has in the area of our drug programs.

I do not want to present to the honourable member a sure-fired approach here. I want to present to the honourable member a cautious and consultative approach, which is my best guarantee of getting a good job done.

Mr. Chomiak: Mr. Chairperson, I certainly have reached a different conclusion with respect to this contract as a result of this discussion than I did going in. That is, if one takes the $118.7 million, give or take the 20 percent contingency built into the system infrastructure costs earlier alluded to by the minister and/or the variations that the minister alluded to--let us take the round figure of $100 million. Not all that money is going to SmartHealth. In fact, maybe $60 million is going to SmartHealth and $20 million, for example, is going to the Manitoba Telephone System to do the network charges, maybe another $15 million is going to go to hospitals, doctors' offices, community health centres and ambulance services in order to buy the hardware. So the contract with SmartHealth will not be $100 million. In fact, the contract with SmartHealth will be something like $60 million or $70 million, because the other costs are going to be to other partners or to other components of the system.

Mr. McCrae: Sometimes when you work a long time, as we have just done, to try to formulate the answer, you forget what the question was. What the honourable member is talking about is, is this more or less following along on the discussion about the level of comfort we have with the numbers.

Mr. Chomiak: What I am trying to ascertain is that we are not talking about a $100-million contract with SmartHealth. We are probably talking about $60 million or $80 million with SmartHealth. The other money is being paid to MTS and to hospitals and to doctors' offices, et cetera, to do the hardware, et cetera. So it is really not a $100-million contract with SmartHealth. It is something less than that.

Mr. McCrae: The best analogy I can think of off the top of my head is the analogy of the general contractor who gets involved in building some kind of a building of whatever kind. Some of the dollars that will flow through this contract will flow through SmartHealth to IDT. It will flow through SmartHealth to IMT; through SmartHealth to KPMG, their partners in this endeavour. Some of it will go to suppliers who will provide other supplies or equipment or services under the contract.

So what it is, is in a sense a general contract which will have built into the contract a cap which the government will not go beyond. But it is also a little different in the sense that we are deliberately building into the contract the opportunity for the stakeholders to review every step along the way.

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The Drug Programs Information Network you could call a module if you like. It is already done. But there will be others and decisions will be made along the way about what and when and what each module should look like, leaving the government the flexibility that it requires, I suggest, in a changing environment, leaving SmartHealth with a fair opportunity to deliver services under the contract and leaving Manitobans in a far better position.

The traditional contract is either you did it or you did not, you achieved or you did not achieve it. This one is going to be a little harder for people, including the honourable member, to judge how we are doing, because if we build modules along the way, you are going to wonder what benefit we are going to get. We are going to have to satisfy ourselves that the benefit is going to be sufficient to justify moving onto that next compartment, if you like, or the next part of the next spoke in the wheel.

I do not propose to be making those decisions on my own. The honourable member would be the first one to say, well, check with the society of seniors as to whether you need that--I do not know what kind of component we are talking about here--check with another organization as to why you would need or whether you need an emergency services component to this computerized system.

That is exactly what we are going to be doing. We are going to be asking for them to be involved in the monitoring of it. I will be very mindful, if the honourable member comes back to me and says, oh well, I talked to MOS president the other day and the MOS president is very upset because you did not hear a thing he had to say or you did not listen to anything he had to say, or you did not give him an opportunity to be heard.

The first thing I would do would be to ask in those circumstances the partners, including SmartHealth, deliver on that part of the contract that we thought that you could do well. That would be to work with the stakeholders and to consult. That is one of the reasons SmartHealth was chosen.

I would demand that part of the contract be followed through on appropriately, because I do not want to hear the honourable member come back here and say that you are off on your own agenda and never mind all the stakeholders. The stakeholders are the strength of this.

SmartHealth is indeed part of the strength of this, too, because they have the appropriate expertise to do this work, but it is very important that SmartHealth deliver on that part of it, and that is to hear what the stakeholders have to say. Sometimes stakeholders can bring forward very positive advice. Sometimes all they need to be is to be assured that we are not going off in the wrong direction. I found that so many times, a little bit of misinformation can have people going off down the wrong road miles and miles, when all it really required was a little time spent developing the consensus that is required to take the next steps.

I listen very closely to the honourable member because I am very excited about this. I think this is a very, very good thing for us to do. I think we will be showing other provinces some things, and they will be watching us very carefully, so knowing that the world is watching, we are going to want to do the best job we can.

Mr. Chomiak: Mr. Chairperson, this is not meant as a criticism, but I think the minister generally answered my question in the first line of his response when he likened and drew an analogy to this arrangement as being similar to a general contractor. I recognize that particular analogy.

Can the minister indicate within these expenditures, has it included the annual operating cost of the system to Manitoba Health?

Mr. McCrae: Yes, for the five years, which assumes that the first year, the operating costs will be less than they would be in the last year, because you will have more components running in the last year.

Mr. Chomiak: Mr. Chairperson, were the costs of the development of DPIN built into this particular cost model, since the minister indicated DPIN is the first module that has been developed in this regard?

Mr. McCrae: I hope I have not said anything that would lead the honourable member to think that DPIN numbers are built into this. DPIN is done. It is up and running and paid for. If DPIN expands to emergency rooms, hospital pharmacies, that would then form part of the cost associated with this contract, but DPIN is already done.

Mr. Chomiak: Is DPIN being utilized as a prototype for this system, or is DPIN a separate entity that is running under its own steam?

Mr. McCrae: DPIN will be an integral part of this wheel. It is going now, but it would be integrated into the whole system, so at some point down the road, information gleaned under what we now call DPIN will be available, where appropriate, to other health professionals in the total PHIS, Public Health Information System.

Mr. Chomiak: Mr. Chairperson, the application costs are set at $55.9 million and I am wondering if the minister can indicate whether or not any of that software has been developed at this point or any of that money has been expended to this point.

Mr. McCrae: We do not have a contract signed and no money has been spent on a contract that has not been signed yet.

Mr. Chomiak: Mr. Chairperson, is the minister saying there is no ongoing developmental costs occurring at SmartHealth at this point that will be part of the contract when signed?

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Mr. McCrae: We, Mr. Chairperson, have announced that we are moving forward with this program. We announced that we would be doing it with SmartHealth, albeit we agreed not to sign the contract until an appropriate time, certainly, not before an election, in any event. SmartHealth may, indeed, and I think they are undertaking certain expenditures. It is not on our account, so I do not know exactly what they are. We are not going to get a bill some time down the road under the contract for expenditures undertaken to this point. The bills will be associated with the work that is performed after the signing of the contract.

Mr. Chomiak: Mr. Chairperson, can the minister indicate what modules of this module system are presently being worked on for the purposes of this contract?

Mr. McCrae: None, Mr. Chairperson.

Mr. Chomiak: Mr. Chairperson, can the minister indicate what modules are visioned to be commenced working upon, upon the final signatures and finalization of the contract? What are the first modules that are going to be operated in this first 18-month period or in the first period of the contract to be developed with SmartHealth?

Mr. McCrae: Mr. Chairperson, in addition to the expansion of the Drug Program Information Network to include northern nursing stations, hospital emergency rooms and hospital pharmacies, the plan would be to embark on a provincial laboratory study and then preliminary work to bring the physicians of Manitoba into the automated network. Those would be the first steps.

Mr. Chomiak: Mr. Chairperson, just to make it clear then, it is an expansion of the drug network, a lab study--the minister said lab study. I am not sure if he meant a lab study, per se. [interjection] He meant a lab study. I actually would like details of what they are proposing on a lab study--and then thirdly, to bring all physicians into the system as the first steps.

What does the minister mean by a lab study?

Mr. McCrae: I would not want anyone to think that the way I put the answer led one to believe that we would only do one thing and then, when that was all done, move on to the next thing. A number of things might be happening at the same time.

When I talk about the lab study, I am talking about a very detailed look at the cost benefits to be achieved, a very detailed effort in the sense of working with the various stakeholders.

The honourable member knows from looking at the various developments of recent times with the lab report going on that there are indeed varying opinions and varying points of view. We want to make sure that whoever the stakeholders are and no matter how much sometimes their views might differ one from the other, that we carry on with an approach that keeps on bringing people together. You keep doing that and you are going to end up getting some results at some point down the road.

That is a very detailed look at everything to do with labs and how an automated lab system would work and how the details of cost benefits would come out and then the question of raising that with the various people with whom we consult.

I think it is obvious what the expansion of the DPIN is all about. We have them in all our privately run pharmacies, but we do not have this system in the emergency rooms or the hospital pharmacies or the northern nursing stations. We know there will be benefits of doing that. So that can begin. In addition, at the same time, we ought to be working with the physicians.

Even though we know that in principle everybody wants to move forward, once you get down to actually doing things there are going to be plenty of things to talk about and plenty of concerns for us to hear, plenty of concerns for us to address. When I say us, I mean us and SmartHealth and everybody who is in the process of trying to build this house or whatever we are going to call it.

I guess as you build a house with your general contractor, there are certain steps that you must take in preparation. One of the very important ones is to consult with everybody who is going to be involved with that building and who is to be using that building over the years to make sure you build into that building the appropriate systems, the appropriate protections and all of those things.

It will be a busy first year or two. I expect near the tail end, like so many other things, you will see more things happening more quickly because we will have been doing so much consulting up front that by that time, people will know the direction we are going in, and no one will be wanting to stand in the way because it will be so clear, the benefits that we can achieve by moving on these various parts.

These are the ones that we foresee moving on in the near future, moving in the direction of achieving, and I very much look forward to doing it. I assure the honourable member again that the steps will be very measured and very carefully taken. I do not have the same doubts that the honourable member does. Just in case there is a little bit of a grain of need for concern, we are going to be extra careful in our application of this contract.

Mr. Chomiak: Mr. Chairperson, I take it from the minister's response, that the lab initiative will basically deal with the electronic storage and transmission of lab results, which is under the tactical initiatives indicated in the estimated five-year cumulative benefits. Is that the case?

Mr. McCrae: Yes, Mr. Chairperson.

You know it is just about six o'clock, and I wonder if the honourable member could tell us how he sees the remainder of the evening unfolding.

Mr. Chomiak: I think perhaps, given the way we are proceeding, I am suggesting that we go from eight till nine o'clock on SmartHealth. The member for Inkster (Mr. Lamoureux) I think concurs with this. At nine o'clock, we can then bring in the Mental Health people and deal with that until the end of the evening. I can indicate we will most certainly be back into SmartHealth tomorrow afternoon, if that is appropriate.

The other alternative would be to simply go with SmartHealth the rest of today and proceed to some other item in the Estimates tomorrow and go to Mental Health on Wednesday.

Mr. McCrae: This sounds like a good plan, Mr. Chairperson. The more Mental Health issues we could deal with tonight the better, from our point of view.

Mr. Chairperson: The hour being 6 p.m., I am now leaving the Chair until 8 p.m.