Mr. Chairperson (Marcel Laurendeau): Order, please. The committee will come to order. We will ask the staff to enter the Chamber at this time. When the committee last sat we were dealing with the Estimates of the Department of Health. We were on line 21.2.(a)(1).

Mr. Dave Chomiak (Kildonan): Again by way of information, what I am hoping today is to move right through to 2.(c) and to get into 2.(c) extensively during the course of this afternoon's session. Depending how we go, we may or may not continue that section tomorrow morning when we next meet.

During the course of last year, there were several problems with respect to the drug formulary as well as several problems with the therapeutics committee. The previous minister had indicated he was changing some of the methodologies and the approaches that were being undertaken by the department in this area. I wonder initially if the minister could outline for me whether that change has taken place and in fact what changes have taken place as it relates to effectively the process whereby drugs are put on and off of the formulary.

* (1440)

Hon. Eric Stefanson (Minister of Health): Mr. Chairman, I am prepared to, as well, forward, which the member may have seen before, copies of the terms of reference of the Manitoba Drug Standards and Therapeutics Committee outlining the objectives, the functions, the membership of the committee, the terms of office, the meetings of the committee, the reporting and so on. So I will certainly provide the member for Kildonan with a copy of that. Maybe just before I carry on, I should introduce Mr. Olaf Koester who is the director of provincial drug programs for the Province of Manitoba.

Some of the changes, I am told, that have been put in place are basically the opportunity for more input to the process from either the companies themselves or from stakeholders through the review of the process. It could be the companies, it could be an organization like the Manitoba Society of Seniors or some organization making representation through the process, a faster process both at the front end and at the back end in terms of the approval process to shorten the time frame of the ability to deal with requests, I think giving companies the opportunity to resubmit, even encouraging if something may have changed or depending what is happening in other jurisdictions, to resubmit, and a willingness to look at a particular drug for a second time and so on.

So those are examples of some of the changes that have been put in place. I think the total review time has been reduced from an average time before of about 60 to 75 days, and now it is a range of about 30 to 60. So, certainly, the low end of it has gotten significantly lower, but it still I guess on some occasions can go as high as 60. So the overall time frames have been reduced as well, Mr. Chairman.

Mr. Chomiak: Mr. Chairperson, is it possible for the minister to provide us with information regarding the criteria and the formulae that are utilized in order to have a drug reviewed by the committee?

Mr. Stefanson: Mr. Chairman, the criteria are outlined in the Manitoba Drug Benefits and Interchangeability Formulary document that is available, and there is a section here that deals with the criteria. It is about a page in length. I can either read them into the record, or I could provide the member a copy. [interjection] Copy? Okay, I will provide the member with a copy of that.

Mr. Chomiak: Mr. Chairperson, I thank the minister for that response. Is there any kind of a ceiling that is placed on the committee with respect to drugs in general? In other words, is there a ceiling or is there a budgeted amount or is there a figure or a directive that is given that says that the drug benefits division shall not exceed expenditures of, say, $50 million for this year? Is there any kind of a ceiling or criteria on a financial basis that is imposed on them?

Mr. Stefanson: Mr. Chairman, maybe first it is worth just reminding the member for Kildonan, the make-up of the Manitoba Drug Standards and Therapeutics Committee. I will just take a minute. It is S. Koven, the family practitioner recommended by the College of Physicians and Surgeons; W. Balacko, a community pharmacist; A. Eros, a hospital pharmacist, C. Yeung, assis-tant professor, Internal Medicine, University of Manitoba; G. Zhanel, Faculty of Pharmacy and Faculty of Medicine; and G. Doak, the Depart-ment of Anesthesia. These are the individuals on the committee.

The short answer to the question is, no, there is not a cap put on the overall program. When they do their review, they take into consideration –the word used here was "pharmaeconomics." Obviously, the cost of something versus the benefits and, as well, as is referred to in the criteria, the anticipated cost of a product of equivalent therapeutic effectiveness must offer a potential economic advantage over listed alternatives. So I gather they look at the product itself, what it has cost versus what the medical benefits would be. They also look at obviously other products that might be available to meet the same need as well.

* (1450)

Mr. Chomiak: I will be having more specifics on the Pharmacare program per se when we reach that item. I am going to try to stay toward the Drug Standards and Therapeutics Committee. Would it be save to say that if, for example, two new drugs came out, one for treatment of breast cancer and one for epilepsy per se, and if the costs were even, the cost effectiveness was shown to be very effective–is the minister then saying that, given those criteria that I have outlined, those drugs would be placed on the formulary?

Mr. Stefanson: I think, Mr. Chairman, I want to be clear here that there are no limitations put on the committee and no direction given to the committee in terms of how they function relative to the cost of any particular drug. They obviously make their recommendations based on the medical or clinical evidence, but they also would look at the whole issue, as I have already referred to, of a cost benefit analysis.

Just to give the member a sense of the net additions to the Pharmacare formulary over the last few years: in '92-93, 122 net drugs were added; '93-94, another 26; '94-95, another 64; '95-96, another 127; '96-97, another 126; '97-98, another 148; '98-99, another 180, for a total over that roughly seven-year period of 793.

I think that certainly is evidence of obviously just the number of drugs that are coming on the market being made available for dealing with patients, Mr. Chairman.

Mr. Chomiak: Are we now part of the federal program where drugs are automatically listed based on a federal index? Does the minister know what I am referring to in terms of the program?

Mr. Stefanson: I am not sure I am answering the question, but maybe if I just outline the current process, I might. I think, as the member knows, for any new drug the first part of the process is to receive approval from Health Canada for its safety and efficacy in terms of its value. From there, they would make application within each individual province, and in the case of our province, go through the committee review process as to the recommendation of whether or not to include it in our formulary.

So that is the current process and that is the process that continues to be followed today, Mr. Chairman.

Mr. Chomiak: I stand to be corrected, but I thought we passed legislation that permitted us, by reference, to adopt the formularies on a national basis, which would by reference then include certain drugs that had been listed federally in other jurisdictions, that we would do it on a provincial basis, or did I misunderstand that?

Mr. Stefanson: I think the issue that the member is getting at is an issue that has been adopted by the Manitoba Pharmaceutical Association and, I am told, by pharmaceutical associations right across Canada. It has to do with the federal legislation in terms of what are prescription drugs. They are abiding by that, which then means that the prescription drugs are kept basically behind the counter by the pharmacist. There is national agreement on adopting basically the same approach to dealing with prescription drugs within the pharmacies. I think that is the issue the member was referring to.

Mr. Chomiak: The minister is correct. That did jog my memory. Who administers DPIN now?

* (1500)

Mr. Stefanson: The DPIN system is managed by the Insured Benefits and basically under Mr. Koester's area of provincial drug program. That is where the DPIN is administered.

Mr. Chomiak: I have a whole series of Pharmacare and DPIN related questions. I think it would probably be better to deal with it under the Pharmacare portion, so perhaps, if that is the case, I am going to move on to another line of questioning at this point.

Mr. Chairperson: You will pass then?

Mr. Chomiak: No, I have a couple more questions. Insofar as this section administers the prosthetic and orthotics suppliers portion, can the minister outline, not today, but can he table information as to what the policy is with respect to orthopedic and prosthetic devices from the province? There have been some changes in the last two years, and I am wondering if the ministry can outline what the current policies are in those particular areas. I recognize the minister may not have it today, but I would like to have that information.

Mr. Stefanson: The member is right. We have a number of programs, which I know he is very familiar with, from prosthetic devices to orthotic devices to breast prostheses and surgical brassieres to telecommunications devices to orthopedic shoes, hearing aids for children, artificial eyes, eyeglasses for seniors, infant contact lenses. What I will do is I will provide the member with a summary of each of the programs and try to highlight some of the changes in the last few years. Certainly, one that comes to mind, which he would be well familiar with, the recent changes having to do with hearing aids for children, is one example. So I will provide a summary of the programs and highlight changes in the last few years, Mr. Chairman.

Mr. Chomiak: The other additional area that I will be interested in, although it is under another item, will be the home care equipment supplies and the like, but that falls under a separate category. So I will be querying the minister and letting him know in advance with respect to that item.

Mr. Stefanson: We will make note of that now to be sure to provide that information as well.

Mr. Chairperson: Item 21.2.(a) Insured Bene-fits Services (1) Salaries and Employee Benefits $5,999,600–pass; (2) Other Expenditures $3,060,700–pass.

21.2.(b) Financial Services (1) Salaries and Employee Benefits $1,282,000.

Mr. Chomiak: I do not have a lot of questions in this area on the assumption that the minister is going to be returning to this House with information as to the funding levels. I under-stand the ministry is going to be returning with funding levels for the various regions as well as where possible program breakdowns in the city of Winnipeg because that is basically what I would be interested in.

Mr. Stefanson: Well, again, just to clarify, yes, I did indicate to the member, providing the overall funding to the regional health authorities, we had a discussion about the shift to funding programs and, as I indicated yesterday, the system of funding is still very much based on the historical, the individual facility funding, but the shifts are occurring in terms of shifting to funding programs. Whatever information I can provide in that area I will, but I do not want him to be under the impression that I can provide detailed funding analyses based on all of the programs that our hospitals provide.

Mr. Chomiak: I thank the minister for that response. Traditionally we receive in the Estimates a listing of the funding to external agencies that the minister traditionally provides. Can I just by way of notice ask the minister to provide that?

Mr. Stefanson: Just to clarify, I basically had provided that. That really is the grant soliciting, which I did table. I might have tabled it. So I have tabled the grant soliciting, and then the other part of it is really the funding to the authorities that we are talking about right now.

Mr. Chomiak: The other piece of information that I would like to see is the budgets for the–now, I know that the budgets have to be submitted from each regional authority to the provincial government. I am not asking for the budgets necessarily for next year, although if I can get them, that is fine. Is it possible to have the budgets and the expenditures for the various regional authorities for the past year?

* (1510)

Mr. Stefanson: I think, as the member knows, the process, RHAs now are in the process of concluding their year-ends. They also get an audit, and we certainly make all of that available. We are at that stage of the process. So I am not sure whether the member is asking me when that is concluded that I provide him a copy. Certainly I will.

Mr. Chomiak: Pass.

Mr. Chairperson: 21.2. Program Support Services (b) Financial Services (1) Salaries and Employee Benefits $1,282,000–pass; (2) Other Expenditures $154,800–pass.

21.2.(c) Information Systems (1) Salaries and Employee Benefits $4,452,100.

Did you catch all that, or do I have to repeat it? I did not have my mike on. Okay, it will just take me a second, guys, sorry about that.

21.2. Program Support Services (b) Finan-cial Services (1) Salaries and Employee Benefits $1,282,000–pass; (2) Other Expenditures $154,800–pass.

21.2.(c) Information Services (1) Salaries and Employee Benefits $4,452,100.

Mr. Chomiak: Can the minister indicate (a) what the status is of the desktop initiative and what the costs are related to the desktop initiative?

Mr. Stefanson: I think, as the member probably knows, we are one of the last departments to come fully on stream on the desktop initiative because of the move of the Department of Health to the old Free Press building. So once that move is completed we will be fully on stream with the desktop initiative. The Estimates for 1999-2000 include $1,789,000 for our cost relative to desktop management and that represents, I believe, about 750 for seats in total for desktop.

Mr. Chomiak: Is it appropriate to discuss at this juncture, does the minister have the staff available, the issues surrounding Y2K?

Mr. Stefanson: Yes, Mr. Chairman.

Mr. Chomiak: Let me start by asking the minister if he is confident that the systems and the designs are in place to ensure that there is no significant difficulty in any area. Well, that is probably too broad a question, that there is no significant difficulty that will be faced by Manitoba Health with regard to Y2K.

Mr. Stefanson: Mr. Chairman, as the former minister responsible for information technology when I was Minister of Finance, I used to get regular updates on how we were doing across government. Certainly, the last review across government that I had, I was very pleased with the progress that we are making on Y2K.

I am told that we are in very good shape in the Department of Health and in health in general, that in the department alone, our mainframe is now completely converted, and with the desktop changeover that we have already discussed, that the department itself will be 100 percent complete. Within the rest of health care, all of the equipment is being tested, Mr. Chairman, and, certainly, we expect to be 100 percent complete across all of the health areas by October of this year.

Mr. Chomiak: Mr. Chairperson, is the minister indicating when he says 100 percent complete by the end of October across health, is he talking about as well the various institutions and all the operational equipment that is utilized in the system, or is he only confining those comments to the Department of Health per se?

* (1520)

Mr. Stefanson: Mr. Chairman, when I said October '99 completion, that is across all of health, not only the department, but all of the other health delivery organizations.

But I do just want to clarify one. When I said 100 percent completion within the department and outside of the department, it will be all of the critical, all of the important. There might be some minor areas where there is no urgency or need to be making the Y2K convergence, but, certainly, in all of the important, all of the critical and urgent and so on, Mr. Chairman, and, again, as well, when it comes to the whole issue of medical equipment.

So the October '99 that I referred to is when basically everything that we feel we need to do across the entire health care system, and that we collectively need to do, to address the Y2000, will in fact be done.

Mr. Chomiak: Mr. Chairperson, I believe what the minister is saying, then, is that, for example, at Health Sciences Centre or St. Boniface Hospital, we could have the assurances that by October all critical and significant equipment will be Y2K compliant and the public can have assurances, to the best of our ability, that there should not be a Y2K functional problem.

Mr. Stefanson: Absolutely correct.

Mr. Chomiak: Does the minister have any idea of the cost across the health care system, what the Y2K compliance process cost us?

Mr. Stefanson: I will return with the details. The reason that they are not readily available before us today is that the majority of our Y2K liability, I think, across government, as the member knows, has actually been booked in previous years.

Mr. Chomiak: The minister indicated that he would be providing me with the costs of how much money has been expended under the SmartHealth initiative in terms of the money that has been forwarded. Now I may have been out when that information was tabled, so if I was, I apologize. If not, can the minister inform us as to how much money has been extended in total to the SmartHealth initiative?

Mr. Stefanson: Mr. Chairman, I think, as the member knows, in 1998-99, $8.6 million was set aside for SmartHealth under the Health Information Systems management organization–Health Information Services Manitoba, HISM. This year, as I referred to the other day, we have set aside $20.7 million, but you will not see it as an expenditure within the department because it is set up as a capital investment. What we will start to see through the department over time is the amortization of that investment, and we can certainly talk about how all of that works, and so on. If you are looking for a $20.7-million direct expenditure in health, you will not see that amount. I think I pointed to the amortization portion when we first started discussing this issue a few days ago.

Mr. Chomiak: Can the minister indicate who is now on the board of directors of the HISM?

Mr. Stefanson: The only member of the board of directors today is Mr. Eric Rosenhek, who is the comptroller within the Department of Finance. The reason that we are not looking to reappoint, you know, whether it is an individual from Health or elsewhere, is that, I think, as the member for Kildonan knows, it is the intention to wind up the corporation and wind it basically back into government. That is why we do have the $20.7 million set aside as a capital investment, but none of that can occur, I am told, until all of the appropriations are approved by the Legislature.

Mr. Chomiak: Can the minister therefore explain the amortization process and where the appropriations will be approved with respect to the $20.7 million capital?

Mr. Stefanson: The actual expenditure side, the amortization side, as we discussed the other day, will come through on line account 21.7, actually on page 89 of this year's detailed Estimates of Expenditure. The accounting policy for capital expenditures actually is shown on page 163, again of the '99 expenditures. It gives examples of the estimated useful life of different types of equipment. One can see that if you look at computer hardware, mainframe and mini-computers, that is a 10-year useful life. Com-puter hardware, personal computers are four year; computer, major applications, 15 years; computer software, other, four years, and so on. So that gives the member a sense of the amortization periods for those types of investments.

* (1530)

Mr. Chomiak: Does the minister have a figure on our total investment in the SmartHealth initiative?

Mr. Stefanson: It is the two amounts that I have provided, the 8.6 that was actually paid in '98-99, and then the amount that has been budgeted for this coming year. I think the member may just be thinking back. There was a period of time where payments did not have to be made, so it is a combination of those two amounts.

Mr. Chomiak: Is the minister saying that we have approximately an asset there of $29 million?

Mr. Stefanson: I am saying basically by the end of '99-2000 we will. We will have an asset, a lot of it deferred development costs but, yes, that is exactly right. It will be an asset of roughly $29 million by the end of '99-2000.

Mr. Chomiak: Can the minister give us a listing as to what comprises those assets?

Mr. Stefanson: Mr. Chairman, I will provide a listing of basically what will have been done and what some of the major projects are within the roughly $29 million.

Mr. Chomiak: Can the minister give us listing who is on the HIN steering committee?

Mr. Stefanson: The steering committee, Mr. Chairman, is the Minister of Finance; the Minister of Health; the acting Secretary to Treasury Board; the Deputy Minister of Health; Mr. Todd Herron, who I did not introduce, I apologize, who is from Information Systems, within the Department of Health; and the CIO, the Chief Information Officer, Mr. Kal Ruberg. So it would be those six individuals.

Mr. Chomiak: Does the provincial govern-ment, in any form, have a shareholding interest in SmartHealth, any interest as a shareholder? If they do, what percentage and what value?

Mr. Stefanson: Mr. Chairman, the short answer is no. The provincial government has no ownership, no equity in SmartHealth.

Mr. Chomiak: Can the minister indicate what the relationship is between the Department of Health and SmartHealth in terms of projects and in terms of who is responsible from the Department of Health for activities that take place under SmartHealth or vice versa?

Mr. Stefanson: Within our government, the individual project analysts and so on report to Mr. Todd Herron, whom I introduced earlier. At the working level, those project analysts would interact with people from SmartHealth, obviously, working on the initiative.

But in terms of the overall initiative, those contacts are between Mr. Herron, and I believe the two main individuals with SmartHealth are Mr. Jim O'Leary and Mr. Al Hurd. I could certainly provide their appropriate titles within SmartHealth, but those are the names of the two main contacts on the overall project today, Mr. Chairman.

Mr. Chomiak: Mr. Chairperson, can the minister give us a listing of what projects have received prefunding in terms of the SmartHealth initiative?

Mr. Stefanson: Well, Mr. Chairman, as part of returning with the status on the $29 million roughly, I will also return with the details on the various elements of the plan that have basically received approval today.

Mr. Chomiak: When last we met in Estimates or perhaps it was the time before, the years do seem to flow into each other–

An Honourable Member: You are due for a shift to a different portfolio, David. Finance. Try Finance.

Mr. Chomiak: I bet. We received a project forecast. Do we have a similar update document that the minister can provide?

Mr. Stefanson: Well, Mr. Chairman, I have just seen a copy. I gather it was last provided to the member back on June 4, '97. I gather one was not produced in 1998, but I am told we can certainly produce a current forecast, so we will do that.

Mr. Chomiak: A number of my questions are going to be related to the documentation that we are going to be provided. It may be difficult to provide that documentation today. I assume we are meeting tomorrow morning at 10 a.m. Do you think that documentation can be provided? If not, that is no problem, we can simply defer those questions, I guess, until another period, but does the minister have any idea?

* (1540)

Mr. Stefanson: Mr. Chairman, the last I heard is I was told tomorrow morning we are dealing with private members' resolutions, unless that is changed, that we might be into Estimates in the afternoon. What I would suggest is we will undertake to try and make it available, but I guess if we do not, we have a couple of options. I think it already is obvious we could certainly deal with it under the section Amortization of Capital Assets. I know it is at the end of the detail lines, but we could certainly deal with this section again there if we are going to need more time.

So we will undertake to provide it. If we can, we can deal with it tomorrow. If not, we could just move on to other lines.

Mr. Chomiak: Mr. Chairperson, that seems to make sense. The issue always comes up every time we deal with Information Systems with respect to the card. I wonder if the minister might update us as to what the status is for the card and what the plans are, if at all.

Mr. Stefanson: I had an opportunity to look back at some of the questions last year. I see this was discussed at that time. The member for Kildonan was asking about encrypted cards. The response at that time was that we were not looking at a smart card for the health cards. It would be like a mag striped card, not a smart card, was the response. Even that is being revisited today, recognizing that mag striped cards in many cases are not being used or are being taken out of circulation. The real key is your number, for all intents and purposes. Having said that, we are looking at a card relative to that kind of utilization. We have had a chance to look at other jurisdictions. I think there is only about one or two other jurisdictions in Canada that still use a paper card today.

Having said that, some still have the mag stripe. Some just have the registration number. We are actually in the process right now of looking at that entire issue, the timing of implementation, of ultimately moving to a hard card here in the province of Manitoba. I think it has been, what, 1993 or thereabouts, which was the last time our current paper card was replaced in Manitoba. So we are looking at it, but also in light of some of these changes in terms of the type of card, Mr. Chairman.

Mr. Chomiak: I was going to indicate that I actually wanted to reflect on discussions that occurred in this Chamber between the former, former, former minister and ourselves and the former Liberals with respect to the card. It is interesting how technology has changed because the former, former, former minister had extolled the virtues given the technological points at the time in terms of the virtues of an all-inclusive, all-encompassing card, and it is interesting how quickly the technological application changes. At that time it looked like it was going to be the be-all and the end-all, which is just one of the difficulties that the opposition New Democrats had warned the government of in the first instance as it relates to that kind of technology.

Having made those comments, the govern-ment, when they announced this SmartHealth, put out an estimated five-year cumulative benefits and an estimated five-year cumulative implementation cost. I know that may be forth-coming with respect to the information the minister is going to provide, but every year in Estimates I tend to take the ministers through each of the component parts of the projected plan for SmartHealth to try to determine where the initiative is in each of those areas. What I have discovered is that the long-term initiatives that were touted in the initial phase of the program have been dramatically scaled back and that the projections for developments in terms of SmartHealth are far more modest than originally projected.

Having said that, I would like to have some idea, and it does not have to be today because it is a complicated issue, as to where we are in terms of the basic three major areas under which SmartHealth was launched–that is, the administrative initiatives, the tactical initiatives and the strategic initiatives–and where we are on each of those particular components.

Now I stand to be corrected, but I believe the only real initiative that has been launched is the drug utilization or the drug component, the DPIN component, and that would be under the tactical initiatives. I wonder if I can get a specific point-by-point analysis of where each of those initiatives is, keeping in mind that the minister has already indicated that he is going to be returning with some of the asset costs or the costs that have been expended, which may give us some of that information. Notwithstanding that, I am looking for the specific point by point of where we are at in terms of the plan for SmartHealth. Or has the plan been revised dramatically so that it no longer is considering those initiatives that were initially announced?

* (1550)

Mr. Stefanson: Mr. Chairman, I will return with a point-by-point analysis for the member. I do want to indicate that the overall areas have not changed. The member is correct that certain aspects have been scaled back. He is also correct that it has taken a little longer than was probably originally anticipated, but I would make the case that I do not think that has turned out to be a bad thing at all in the sense of what we have already touched on, the technological changes, the degree of competition that is out there, and so on.

So I think the end result will be that we will be well served by that in terms of service and product that we ultimately put in place. The whole focus has now shifted to the whole broader issue of the entire health information network that would meet the needs of Manitobans, of which SmartHealth has been one component. So I will return with a point-by-point analysis status report for the member.

Mr. Chomiak: I look forward to that analysis and that opportunity to review it.

The CEO of the Winnipeg Regional Health Authority has been quoted as requiring $60 million for computer upgrades. Can the minister outline for me the ramifications and purposes of that and how that relates to SmartHealth, if in fact it does?

Mr. Stefanson: Mr. Chairman, I think what the member refers to is the whole issue of the information systems related to the WHA, and even the WCA, really outside of the SmartHealth initiative. It is really the whole integration of their financial information, their patient information, whether it be clinical or admission/discharge and so on, that to date that has all been done on an individual basis, in some cases with different systems, different technology, and so on. In keeping with the whole approach of regionalization, shifting of programs and best utilization of buildings, equipment and people, certainly the heads of those organizations are looking at their information systems as it relates to doing that, as they should be.

What we will be doing as a government is obviously looking at that initiative as it compares to the many IT initiatives that we either have on the go or that we are looking at as a government, Mr. Chairman. Within the Department of Health, it is one of the IT issues that certainly I will be looking at as Minister of Health, but it also then needs to be basically put into the whole review of all of our IT requirements across government in determining the priorities and, ultimately, the staging of implementation. So I do not want to leave the impression it is not important because we all know to make appropriate decisions it is important to have quality, reliable, timely information. It is an issue that we will be looking at in terms of that entire integration within Winnipeg and, in fact, throughout the province ultimately as well.

Mr. Chomiak: I ask this question every year, and I realize it is not a simple task, but if the WHA is going to be expending $60 million on programs and computers–that is not just hardware, I assume that is hardware and software–if the government of Manitoba is potentially spending $100 million, $125 million on our SmartHealth initiative to do some of the things that are going to be undertaken by the WHA, how do the two relate, do the two relate, and what co-ordination is made available to ensure that those services are compatible and indeed not duplicated and that the best value and the best programs are provided?

Mr. Stefanson: Well, Mr. Chairman, I share the caution that the member has raised, but I think it is important to recognize they are entirely different functions. Right now that information is being brought forward by WHA, WCA to the Department of Health, to Todd Herron's department on our behalf, and we will be doing that entire review. We will be taking appropriate steps to ensure that there is no overlap between the two systems. But I think it is important to recognize, by and large, they are different functions, but the caution is an appropriate one. That is certainly why it is all being co-ordinated in terms of the health aspect within the Department of Health under Mr. Herron's department. As well, we will then be going forward within the entire IT initiatives of government through the chief information officer, Mr. Kal Ruberg, and his shop in terms of the priorities across government. So I would suggest and argue we are taking steps to be sure we do not end up with any duplication.

Mr. Chomiak: Just further on that, let me give the minister an example. I hesitate to almost use the example because it is working really well. But, out of the Health Sciences Centre, there is an initiative–as usual, during the course of Estimates, the word escapes me–that entails information with respect to lab tests and information with respect to diagnoses, X-rays, et cetera. It is transported via telecommunications, or via some form, from other hospitals to the Health Sciences Centre for diagnosis, for consultation, et cetera. That is an initiative of the Health Sciences Centre run on a shoestring budget that, to my mind, as a layperson, makes a lot of sense and is actually well done.

Let me then jump to SmartHealth where this kind of activity was promised, was to be put in place, was to be systemwide. Health Sciences Centre is doing it; they are doing it by necessity; and they are doing it on a shoestring budget. SmartHealth is developing some scheme, I presume, to do it or maybe not to do it, although it was promised initially in the SmartHealth initiative that that was going to be one of the main components of the SmartHealth program. Now I know that the WHA is trying to allocate funding for software and hardware.

* (1600)

Now, if I am the WHA, I am going to say we have got a good little initiative here. Let us put the capital into this, and let us expand this program and perhaps do it in other jurisdictions, which then runs–does it run contrary to or does it run into the mandate of SmartHealth?

This is not a new issue. This has been going on for some time, and this is where I think it breaks down, to tell you the truth. So I am wondering if the minister might have comments on that.

Mr. Stefanson: Mr. Chairman, I am told that what the member is referring to is teleradiology at HSC. Again, we would encourage individual facilities to be taking these kinds of steps because it is not going to end up being duplication, and it is not going to end up being wasted investment. The intention would be that ultimately these can roll into the system-wide Health Information Network and have the capacity to service the entire province.

So, again, within reason, some of these initiatives are in keeping completely with the kinds of initiatives under the Health Information Network. This is one example. There are probably a few other examples out there in RHAs or whatever, where they are taking some steps to deal with their immediate issues, but, again, they will and can be rolled into the overall Health Information Network.

Mr. Chomiak: And therein lies the rub. If a regional health authority should come to government and say we would like a $2.5-million allocation to develop this system, where do they go and what is the government's response in that regard?

Mr. Stefanson: I am not sure that there is a "therein lies the rub" here, Mr. Chairman. I think, first of all, RHAs, as part of our capital plans, are providing us with their information system plans within their region. We are also making them aware that they should not be going ahead with any information system development without obviously co-ordinating with us, with the provincial government, for the obvious reasons, so that it is not sunk costs. Having said that, if we see an RHA wanting to develop a pilot within their region that is in keeping with the overall direction of the Health Information Network, we would encourage that that makes sense. It obviously gives that RHA an opportunity to have that service. It gives us collectively an opportunity to assess the performance, and so long as it can be adapted and rolled into the broader network, it is an appropriate way to deal with technology.

So, I guess, I just want to assure the member that through our department now, all of these initiatives under the combination of SmartHealth and the Health Information Network are being prioritized. We are working with regional health authorities, and we are looking for a broader province-wide system. At the same time, we are having individual initiatives go forward that are in keeping with the overall direction of technology.

Mr. Chomiak: Mr. Chairperson, this is where it gets very confusing. Now it might become clear when the minister tables those documents, but in 1995 when SmartHealth was first announced, if I were involved in the development of tele-radiology, I would have said, well, I am not expending my institution's funding on developing a project because it is clear from the initiative that is being undertaken by the government that the government is going to be developing a province-wide teleradiology program. It is 1999. There is not a province-wide teleradiology program. I do not believe it is in the immediate short term. So I, as an individual institution, may very well throw up my hands and say, I am going to budget for that and to meet my own needs, because it is clear it has not been developed in the past five years as was projected, how can I have any confidence that it will be on line in the next five years?

Now this may become clear when the minister tables the information he is going to table, but as far as I could see the only area that we are actually moving on in terms of SmartHealth is in the DPIN approach. Unless the minister is indicating that this particular rollout will allow us to piggyback all kinds of information, all kinds of assistance on the back of it, I am not sure, I do not see why anyone would have any confidence in going to the provincial government and saying, well, we are going to wait for you to develop a system. It just would not make sense given what the history is.

* (1610)

Mr. Stefanson: Mr. Chairman, the challenge, whether there is '95 or 1999, is always one of having had individual facilities, where now we have regional health authorities, so you have a decentralized delivery system, but you are going to have a centralized Health Information Network and certainly most in the system are well aware of the SmartHealth initiative in its general sense, that it is an initiative of govern-ment.

Therefore I do not see a problem with individual RHAs or even individual facilities, if they see a need that they want to meet today, taking those steps to meet that need, whether it is telaradiology or elsewhere so long as it is being co-ordinated with us in terms of the potential for ultimate rollout province-wide. I guess that is what I am suggesting that we have examples where RHAs are doing that and so long as it can be rolled into the Health Information Network and delivered province-wide, I do not see that as a bad thing at all. Rather than wait for an entire system and an entire province-wide rollout, if one facility or one region deems it to be a priority to put the system in place earlier, then we should be encouraging that as long as it is going to improve service and better meet the needs of patients.

Mr. Chomiak: Mr. Chairperson, that in fact has been the crux of our criticism of the process for the past five years and it is still. I do not want to relive history here, but I think there is a major confidence problem here, and it is one thing for the minister to say there is a co-ordination function, but it is another thing to say that–I mean I think we are really in some difficulty with respect to moving ahead on some initiatives because of the initiative that was entered into previously. Having said that, I am not going to flog this. I mean I want to, but I am not going to because I do want to get onto other topics, but it is more fun to flog things when you think you are right because that does not happen that often but I am not going to.

I do want to ask the minister if he can give us an understanding of what SmartHealth is all about, how many employees they have. Are they still 51 percent owned by EDS and 49 percent by Royal Bank and can you give us some details of the SmartHealth operation?

Mr. Stefanson: Mr. Chairman, I hope I understood the member correctly that he was suggesting he did not get many areas to flog so when he finally had one he thought he might want to stay on it for a while and so on. But to me the issue is one that I readily acknowledge that the whole rollout has taken longer, but I will argue that that has served us and will serve us well and better in the end because added to all of this as well is now we are having even more dialogue with provinces, particularly the western provinces. Because again, I think, as the member for Kildonan knows, that to varying degrees, provinces are all going through this. Again, they are at various stages. I think we can collectively benefit from each other.

So I would accept criticism that it has taken longer. I think, if I recall correctly, the member and his colleagues were critical of the whole initiative back in '95, but I still believe, at the end of the day, we will end up with a system that will better serve patients and create efficiencies in the system and basically be able to pay for itself from efficiencies created in the system because we are all aware of some of the duplication and overlap that still does exist in the system.

In terms of the specific question about SmartHealth, we will obtain those details and return with them as quickly as we can, both in terms of the current ownership make-up of the SmartHealth organization and its current status here in Manitoba in terms of numbers of employees and so on.

Mr. Chomiak: Well, it is one of these issues where we are going to have to roughly agree to disagree, but we did indicate in '95 and since then that the problem with the system was that we thought that this was an attempt to develop a Cadillac, when perhaps we should be working more on an Impala. I am tempted to carry that metaphor further, but I am not going to.

When the minister returns with information about SmartHealth, SmartHealth also indicated, when their 51 percent was bought out by EDS, that there were also going to be 50 permanent positions created in Winnipeg. I wonder if the minister can confirm that as well.

Mr. Stefanson: Mr. Chairman, I will return with those details as part of the status of SmartHealth that I referred to.

Mr. Chomiak: Last year, in the Estimates book, and the year before, the number of EFTs in the department was 98, and now we are down to 83. Can the minister outline what the divergence is or why we have this divergence?

Mr. Stefanson: The difference is that one division that was under Information Systems, the division called Decision Support Services, has been moved over to Corporate Services. We discussed Corporate Services the other day. It is an accumulation of a number of–I think that area, Decision Support Services, has I believe about nine employees, so that should work out about right, I think.

Mr. Chomiak: At some point, can the minister provide us with details as to what these people do? I mean, is there some kind of breakdown, because I never really have understood generally where their breakdowns were. So just general information would be helpful for the 84-odd positions, or at least the EFTs.

Mr. Stefanson: I will provide a more detailed breakdown, but just to give him a quick sense of really six key areas: the executive consists of three FTEs, operations 35, application 24, integration 7.9, technology 8 and business relations 6, for a total of 83.9. I can probably provide a more detailed breakdown and description of some of the functions within those areas.

* (1620)

Mr. Chomiak: I would appreciate that just for our own understanding's sake, because one can usually ascertain the roles and functions in other areas. In this area, it is sometimes hard to ascertain the roles and functions.

I do want to spend some time on the DPIN process. I would like to know, it does indicate in the Supplementary Estimates book that there is going to be completion of the role of the Drug Program Information Network medication dispensing history at the hospital admitting and emergency rooms in 81 sites. I wonder if we have a list of the 81 sites and the status of all of those sites as well as an analysis of if any major difficulties and problems have been encountered.

Mr. Chairperson: Maybe we should give them a break.

Mr. Chomiak: Do you want to do it now?

Mr. Chairperson: Yes, we will do it now. Mr. Minister, we are going to give you a little break. Is that okay? [agreed] Let us take five, okay, guys.

________

Mr. Stefanson: I can certainly return and provide the member with the 81 sites referred to in the detailed Estimates. This is obviously part of the 1999-2000 work that is being done as a rollout to these 81 sites. I am told we are not anticipating any problems with that. Obviously this becomes a very important part for the whole diagnostic side of things in terms of being able to pull up the history of an individual in terms of what medication they might be on or have been taking or whatever, and of course vice versa to put on the system whatever is being utilized at hospitals. So I can return with the 81 sites, Mr. Chairman.

Mr. Chomiak: Can the minister also provide us with information as to the status of the various rollout projects on DPIN that have already been announced? In other words, locations and the status, for example, Beausejour, Seven Oaks, et cetera. Is it functional? Where are we going on it, et cetera?

Mr. Stefanson: Yes, I can. I think the member is referring to the five pilots which preceded the rollout of the 81. Again, I gather that has all gone well, but, yes, I can provide the five sites and just some details on how the rollout has gone.

Mr. Chomiak: Can I take it that if the 81 sites are established and functional and the drug information is provided to the 81 sites, then notwithstanding what the plan is, that the same technology and the same methodology could be utilized to provide patient information, medical information, lab results, et cetera? In other words, is this the groundwork for the expansion of the program beyond drug profiles or not?

Mr. Stefanson: Mr. Chairman, what we will ultimately have is really a series of programs on the same infrastructure. So they will not be fully integrated, as we had questions the other day about the human resource application system, the SAP system, and so on. So, if you have access to the DPIN, it will not automatically give you access to the entire patient history, be it lab tests or a number of others. So I am told it is the same infrastructure but basically different programs that will be run in all of these different areas. I will be returning with more details in terms of the various areas that are being focused on over the next period of time.

Mr. Chomiak: Mr. Chairperson, when the minister provides information with respect to DPIN, I wonder if he might indicate whether or not DPIN is interactive in the sense of–maybe he can just explain it now, but if the drug profile is provided at the particular site, at one of the sites, and then the drug information changes at that particular site, does it then get entered at that site and changes on the entire system? That is what I mean by that.

Mr. Stefanson: Right now the only updating under the DPIN of an individual's situation is through the pharmacy. Once these 81 sites come on stream in terms of the emergency rooms, that will be another source of updating if any drug is used in that environment. Another step along the path is to also include the pharmacies within the hospitals. So right now the only information basically on a patient file or an individual file is information that is put on by the pharmacist and that, I am told, happens immediately. As soon as the prescription is filled and entered, the file becomes current, obviously.

* (1640)

Mr. Chomiak: I might be going further ahead than the information that is going to be provided, but I thought that was my understanding. The minister is saying that, when the 81 sites are rolled out, presumably this year, then not only will the data be that that is onsite from the pharmacies but that the data can be entered at various sites and there will be the ability to enter a change in data either at the emergency room or presumably through the pharmacy location at the facility. So am I correct in that assumption?

Mr. Stefanson: Mr. Chairman, the member is correct, but what I want to clarify is it is being done in steps. As these 81 sites roll out, the first access at the ER will be accessing the individual's file from the DPIN. A subsequent step, not initially, a subsequent step will be able to be inputting from the ER room so that we keep an individual profile of drugs, and then a subsequent step will also be the implementation in the pharmacies in the hospitals. So the member was correct. I just do not want to have the impression that all three components of that are happening all at once. They are going to be done in various stages.

Mr. Chomiak: Mr. Chairperson, so the description in the Supplementary Estimates books which says completion of the DPIN program medication dispensing history into hospital admitting and emergency rooms in 81 sites, what we are talking about is the present pilot project being expanded to 81 facilities with at some point subsequent steps to follow step 2 and step 3 in terms of the input. Is that correct?

Mr. Stefanson: Mr. Chairman, yes, that is correct.

Mr. Chomiak: Mr. Chairperson, now I really would like to understand the second part of the statement on page 38 of the Supplementary Estimates book where it says, and I am quoting: "Establishment of the primary and back up processing sites, the HIN operations and maintenance environment, and establishment of the communications network infrastructure." Perhaps we can just break it down and the minister can describe to me what is meant by establishment of the primary and backup processing sites.

Mr. Stefanson: The primary site will be at the new location at 300 Carlton Street, and the backup site will be at Health Sciences Centre. So the primary site will have the computer access to all of the data, the processing and so on. HSC, I am told, is really just that, a backup site in case there are any problems, any difficulties, basically a protection for all of that information.

Mr. Chomiak: So the actual hardware will be located at 300 Carlton, if I am correct, if that is what the minister is saying, the hardware and the software input. Is that correct? Also can the minister indicate where it is located right now?

Mr. Stefanson: I am told that both sites, 300 Carlton and HSC, will have hardware and software, and that the HSC has a complete backup of the data, and that currently the system is at the Empress Street location.

Mr. Chomiak: The HIN operations and maintenance environment will be located where? At the primary site, is that what that statement is? HIN operations and maintenance environment. Is that what is meant by that statement?

Mr. Stefanson: The member is correct. That will be at 300 Carlton, yes.

Mr. Chomiak: And how about the establish-ment of the communications network infra-structure? What is meant by the establishment of the communications network infrastructure?

* (1650)

Mr. Stefanson: That really is the expansion and opening up of the provincial backbone network to all of the regional health authorities. That is done basically through Government Services, so that is what this will allow. The provincial back-bone network is a provincial data network which has traditionally been just within government. This is allowing it to be expanded to access the regional health authorities and obviously these individual sites.

Mr. Chomiak: So the provincial communication network is now being expanded to include all of the regional sites. If that is correct, who is co-ordinating that, and under whose auspices does that fall?

Mr. Stefanson: That issue is being co-ordinated by Mr. Todd Herron, but it is also with Government Services. Government Services administers the provincial backbone network. They have the contract and so on. It really is the network that is used for information technology government-wide for all of the various depart-ments. But it is also secure. There is not a cross-pollination or whatever, or access. It is really the network that is currently in place that is built upon or expanded to access these sites and the RHAs.

Mr. Chomiak: These issues we have just been talking about since the break relating to HIN, can we have any idea of the cost of these initiatives and where in the budget these costs are coming from? The appropriation under this item is $8.1 million. If you take salaries out of that, we are only talking about $3.6 million. Is it coming out of this component of the budget, or is it coming out of the capital allocations for SmartHealth or a combination of both? What are the costs for these various operations that the minister has now described?

Mr. Stefanson: I will return with the best estimate we have on these 81 sites recognizing that they are going to be rolling out in 1999-2000. What that investment is you will not see, just like we discussed earlier, an operating expenditure for that, because the policy is you do not start amortizing any of these investments until they start to basically deliver the service. I would expect that that will not happen until roughly the end of the year, beginning of next year, by the time they are fully functional, but the investment will be made through capital investment. So I can return with the best estimate we have as of right now of the rollout of those 81 sites recognizing, just so it is clear, that is not an operating expenditure. It is a capital investment.

* (1700)

Mr. Chomiak: Can I assume that the establishment of the primary backup process sites maintenance environment and the com-munications network infrastructure, those expenses will come out of this appropriation of $8.1 million?

Mr. Stefanson: It is the same answer as the previous question. Again, the initial expen-ditures from capital investments and these will be amortized once they come on line which I am told will be roughly the end of the year. At that point in time on a go-forward basis, there will be some operating costs attached but we are really talking in both of these cases about additional operating costs for the year 2000-2001.

Mr. Chomiak: Those particular costs will be allocated through the 26-odd million allocated to the HIN, or will they be included on the Supplementary Estimates allocation contained on this document? I am trying to find out exactly where the expenditures come from.

Mr. Stefanson: Mr. Chairman, I think the member was basically correct. Once these systems are operational, the operating cost will come through from one of two areas, either through the Information Systems that we are looking through now or potentially through operating costs of the regional health authorities and that will be dealt with through the funding to the regional health authorities, so that is the operating side of the system.

In terms of the implementation of this system that we have talked about, the establishment of this, the capital, the hardware and so on, that will come through our capital investment. We will ultimately see the impact of that through the amortization. Once it is up and functioning it will be amortized, depending on what all the components are, how much is hardware, how much is software. It will be amortized based on that schedule of useful life that I referred to earlier on page 163. So the operations are separate. The capital comes from capital investment, and we really will start to see the amortization of the capital probably starting next year once these systems are completely up and functioning and operational.

Mr. Chomiak: Mr. Chairperson, can the minister indicate whether or not any of the nursing stations will be part of the 81 sites that the DPIN is going to be rolled out to?

Mr. Stefanson: I would just like some clarification first, whether the member is talking about nursing stations within the hospitals or nursing stations like on our reserves?

Mr. Chomiak: Northern reserves.

Mr. Stefanson: Northern reserves. I am told that of the 81 sites, none of them currently are for nursing stations on our reserves or in remote communities. We are certainly interested and are prepared to look at providing this at the nursing stations. I am told part of the difficulty to date has been lack of co-operation from the federal government, but we will continue to pursue the issue. We are certainly open to look at providing these services at nursing stations in our province.

Mr. Chomiak: In previous references to the Health Information Systems in the supple-mentary Estimates books, one of the activities was listed as protection of the department's health databases from unauthorized organi-zations or individuals. That is not included in here, and I am just wondering why it is not included in here and, secondly, what provisions are in place to continue this developing field.

Mr. Stefanson: Certainly that important service is still being done. What has happened in the last year, under the chief information officer there actually is a security officer who was retained several months ago who has the overall responsibility for security government-wide. Within this division in Health, there is an individual who has the function of also being responsible for security within Health who interacts and liaises with that central system. So it is being done. It is being done on a corporate basis, but we also have dedicated a person within Health to deal with the issues. I think the removal of reference is the fact that the overall function, the overall co-ordination, is now under the chief information officer, which is, from my perspective, needed and appropriate. Certainly the feedback that I have had in terms of the job that this individual is doing, it is excellent.

Mr. Chomiak: It seems to me in terms of a proactive or prophylactic function, would not there be an expanded role here at Information Services as more data are being put on file rather than a more restricted role? I am just looking for an opinion. I have no reason for knowing that is not the case. It seems to me logically, that is the case. In fact, it would be more of an expanded role, given that the plan is to expand the amount of data and the kind of data and the forms of data. I just throw that out for comment from the minister.

* (1710)

Mr. Stefanson: The member is right in terms of the heightened need for security just from the combination of the volume of activity and the nature of the activity. I do not want him in any way to have the impression that because there is not a line item reference to it, whether it was under activities or wherever it was listed last year, that it is in any way less important this year.

In fact, I would argue quite the opposite. I am told that the person we now have dedicated, that that did not exist before. That is just within the Department of Health, but even more so, it has been elevated in terms of the government view by the hiring of an individual who, certainly, I recall in his credentials comes highly regarded in this whole area of security for information technology. The feedback I have had from our CIO is that he has already done an outstanding job of identifying areas that need to be addressed and should be addressed.

The member is right on the one hand to say there is a heightened need for security, and I would indicate to him that that has, in fact, been identified and addressed by the hiring of a security officer from the corporate point of view and by the dedicating of a person within Health to deal specifically with the security issue.

Mr. Chomiak: I want to go back to an issue that we addressed earlier because of its importance in this area. I will start out with another example. The minister may have had occasion to attend at Concordia Hospital, I know the previous minister did, to look at the Drug Program Information System that they provided at Concordia Hospital which was independently produced. In fact, the developers of the program at Concordia Hospital were actually giving tours and lectures in terms of the effectiveness.

What it was was a drug information program that provided patients and others with profiles of drugs, interactions, et cetera. In fact, I indicated to the previous minister that I thought he should attend at Concordia to have a review of this program because it made sense to me in terms of functioning at all of our facilities, or finding some way of putting it on-line.

Having said that, is the department aware of that initiative, for example, and has it been reviewed? Again, in terms of this co-ordinating function, how does it fit in with the department's information initiative, because it seems to me it should fit, and, if it should fit, where does it fit?

Mr. Stefanson: Madam Chair, again, I know the member is very familiar with the DPIN, the provincial DPIN program, starting with pharmacies, rolling out to ERs, rolling out to pharmacies within hospitals, with the ultimate objective being that everything to do with the prescribing of drugs would ultimately end up on the system.

I believe what has been referred to at Concordia is a drug dispensing system and information system, so ultimately that system would be incorporated in the DPIN. I am certainly prepared to look in more detail at what they are currently doing and how it can be integrated in the future with the DPIN network. So that is where DPIN will end up; it is not there yet. If individual hospitals have seen some merit to introducing a system like this in terms of dispensing and providing information, again, that is not something we would oppose, in fact, we would support. But the key would be that hopefully it has either been done, or, if it is going to be done that it can be fully integrated with the DPIN network. That is the end objective of DPIN.

Mr. Chomiak: I agree with the minister's response, and I guess that is my point that this project also was developed independently. Again, I do not know what initiatives or what contacts were made, but it seems to me that part of DPIN is drug interaction and drug relation-ships and drug education. This program actually went further than the DPIN, as far as I am aware, and it is much more user friendly than DPIN. Not only did I think it would be more effective in terms of providing information, but it should have been integrated. I agree, it should be integrated with DPIN. The question is how do we get there from here?

The second point is that it seems to me that it would be of extreme importance to have that information not available just to institutions but to other care providers through Home Care, et cetera, because one of the very important functions of nurses and Home Care, for example, is to ensure that–or to evaluate the drug situation particularly by the elderly. So, again, it is a frustration in the system, it is a frustration of mine, and I do not know how one–I mean, it is a very complex area. Short of putting everyone into a room for three weeks and letting them come out with co-ordinate ideas, I do not know how exactly to do it, but there must be a way to do it. I had assumed, and I would assume, that if the department is taking leadership, then the department ought to be aware of all of these activities and ought to have a response or some kind of input into these activities. Maybe that is asking for too much in a system, but it seems to me that if we are spending hundreds of millions of dollars on this, we could do it a lot better.

* (1720)

Mr. Stefanson: Madam Chair, well, again, recognizing the magnitude of this undertaking alone–we have discussed HIN and these initiatives for the last couple of hours–this is being done in stages. It is being rolled out in stages. I think one can argue this both ways and say, sure, we want to see all of our hospitals completely on it, not only their ER but everything; we want to see all of our physicians on it.

That is the end objective. Do you wait until you have a system completely designed that can accomplish all of that throughout the entire system, or do you start doing it in steps? I guess I would argue you usually do it in steps. Certainly, that would be my preferred approach in most cases, both in terms of starting to reap some benefits, but also it is in many ways a more cautious approach. As you are doing it in various steps, you can take advantage of the changes that are occurring, the latest technology and so on. If you spend many years building one entire system, then technology can pass you by or you can miss other opportunities.

So I am not disagreeing with the overall objective that the member is talking about. Certainly, we want to see Concordia on this as deeply and fully integrated as we do all the hospitals, but I would argue we are heading in that direction and we are taking it a step at a time.

Mr. Chomiak: See, I would almost suggest or recommend a technological development fund independent of SmartHealth that would allow for innovation. That would be one way of perhaps monitoring or accessing so that the various institutions or regional authorities could access that fund, and that would allow one to have control over some of the ideas and some of the processes and, at the same time, provide some funding to launch some of these projects. I think that would make some sense.

You are right; I mean, you could argue this both ways, but I am concerned because I have talked to people in the field, and they have told me this, you know, across the board. There is a frustration with the process and with the fact that while the structure may be built here and there may be ideas proceeding, projects that could be very functional are not moving ahead. There is never a simple solution in complex organizations, but I think a better job can be done with it, for what it is worth.

Mr. Stefanson: Madam Chair, I am told that the Concordia system is basically a patient medication history, has limited use. It was initially funded, I believe, by the pharmaceutical industry. It hooks up to the hospital discharge, doctors' offices and retail and pharmacy, and it really is, in many ways, an interim program. So, again, I think we have already agreed in terms of the end objective, but it is probably important to remind ourselves of the first stages of DPIN. It was a combination of patient profile but also the whole issue of the payment system.

If you think back not many years ago where Manitobans used to have to save their prescriptions, stick them or glue them to a pad of paper and send them in for their payments and so on, it was a very cumbersome, paper-intensive system, whereas now, in many cases, once individuals hit their deductible, the payments are made by Manitoba Health. It is certainly much more user friendly to the person using the pharmacy and so on.

If you look at the prioritization of which one should you do first, I think the motivation was to do the pharmacies first for a number of reasons in terms of that whole issue of the payment and the benefits to the users, and obviously just the fact that the pharmacies are a large source of access to prescription drugs. So I am sure one could work on an entire system and work towards that, but I think in this particular case to do it a step at a time has been the right approach.

Mr. Chomiak: Of course, we should not forget in this process that this is one of the big new hobby horses of the federal government and the present minister, and I am sure they have all kinds of ideas in this area and may or may not be willing to afford the capital. It might be an interesting area of discussion in terms of allocating funds from the federal government to do some of these initiatives and/or to pilot some projects.

I do not have any more questions in this area pending information probably, I would assume, tomorrow afternoon, so I am wondering if maybe we should move on without passing this item, move on to the next item. See how far we can get just on the other items. I have not prepared specifically, but let us see how far we can get. Then we can come back to this tomorrow, but in terms of the interest of time let us perhaps move on.

* (1730)

Mr. Stefanson: Maybe just on that, I am still not certain I can have the information tomorrow. It is my intention, and if we can, we can come back to it, but if not, we talked about how there is another opportunity to deal with SmartHealth and the Health Information Network under the Amortization of Capital Assets. So unless there is a concern about passing this and recognizing we will have an opportunity there to deal with it, we can either just come back to it tomorrow if the information is available. [interjection]

The department seems awfully nervous about having all of it ready for tomorrow, so I guess I am saying it might well be that it will take a couple of days, and then it might be more appropriate to deal with it under that section of Estimates.

Mr. Chomiak: Well, perhaps we will pass it. I am fine. We can deal with it under Amortization of Capital Assets, and then we will just go on. Let us assume that tomorrow it will not be ready. We will just move on tomorrow and try to deal with all of the other items and get as far as we can the rest of today and tomorrow, and then when we reach the amortization section, we will deal with it.

Mr. Chairperson: Sounds like a deal. Item 21.2.(c) Information Systems (1) Salaries and Employee Benefits $4,452,100–pass; (2) Other Expenditures $3,615,300–pass; (3) External Agencies $33,800–pass.

21.2.(d) Capital Planning (1) Salaries and Employee Benefits $698,600.

Mr. Chomiak: Do we have a capital plan that outlines, that links the provincial strategic priorities, regional health plans and capital requirements?

Mr. Stefanson: Yes, we do. I was pleased the member for Kildonan was able to join me at Concordia Hospital when we announced the 1999 capital program. It really was done on this basis. I think we have talked about this before, or I had responded to a question during Question Period, that how the capital plans were developed, the RHAs put forward their capital plans. They also prioritize the projects in their regions. The Department of Health goes over those with the RHAs, and it is really on that collaborate and co-operative kind of approach that the ultimate capital plan was prepared for 1999-2000.

So the 1999-2000 capital plan that I announced a few weeks ago that I know the member has seen, that is exactly what is referred to here under Expected Results, Mr. Chairman.

Mr. Chomiak: Last year the Minister of Health described in detail the community contribution policy. Has it changed, and if it has changed, where has it changed?

Mr. Stefanson: Mr. Chairman, I will try to return with that tomorrow and I will highlight any changes from a year ago. There may have been some minor changes. I will certainly high-light any changes from a year ago.

Mr. Chomiak: If X, Y, or Z organization wishes to construct a personal care home, for example, and they require information as to capital, what is approved, what is not approved, what is required and what is not required, presumably there are departmental outlines and departmental guides to provide them with that. Can we get a copy of those, please?

Mr. Stefanson: Yes, Mr. Chairman, I can return with a copy of that document for the member tomorrow as well.

Mr. Chomiak: Mr. Chairperson, I thank the minister for that. Does the capital planning section here also include capital equipment planning?

Mr. Stefanson: No, the equipment side of capital is not under the capital planning. This is really the facility side, the building side, but I think, as the member knows, in this budget we allocated, I believe, $27.5 million for equipment, about $8.5 million goes really unconditionally to the RHAs to use for some of their basic equipment needs. The remaining $19 million is allocated on the basis of, first of all, all of the RHAs as part of their capital submissions; they do submit an equipment listing request. That equipment listing request is then reviewed by a department equipment committee, which is across the various divisions of the department. Depending on the nature of the equipment, some of the equipment requests might be referred to the Provincial Imaging Advisory Committee, which deals with CT scans and so on for their recommendations. Then all of that comes back into the department, and they bring the recommendations forward to myself. If it has to go into any other aspect of government, it is taken forward on that basis.

So the short answer is, no, it is not under here, but that is how the process of allocation works for equipment. The director of this section of the capital planning is a member of the department equipment committee, but it is not a function that falls directly under this section.

Mr. Chomiak: Mr. Chairperson, this next request, since we just touched on this, this is sort of an advance notice to the minister. I am asking this because I know that it is available, because I know this is obviously a major undertaking that I am requesting, and that is, is it possible for us to get copies of the inventories of the capital equipment throughout the regions? Now, I understand it has been done for Y2K and it has been done for internal purposes as well, but that is a general listing of the equipment that is available in all of the regions. Is it possible to get copies of that information?

* (1740)

Mr. Stefanson: I will follow up on that. The member is correct that certainly from the Y2K and so on we have been inventorying equipment, so I am sure it is available to some extent. I am imagining it will be a fairly extensive list, but I will certainly undertake to provide that. If I have any problem or any reason, I will return and explain that.

Mr. Chomiak: The bulk of the capital questions that we have will deal with specifics on acute care and personal care homes, so I do not have any problem passing this section. We will have to come back to the specific capital projects when we go to another section.

Mr. Stefanson: That is fine, Mr. Chairman. If the member has anything in advance relative to any capital projects that he can provide me, I would welcome that too, and certainly help in terms of providing it, but that approach is fine.

Mr. Chairperson: Item 21.2. Program Support Services (d) Capital Planning (1) Salaries and Employee Benefits $698,600–pass; (2) Other Expenditures $212,100–pass.

21.2.(e) Evaluation Monitoring and Appeals (1) Salaries and Employee Benefits $486,700.

Mr. Chomiak: Do I understand this correctly to be a relatively new section that has sort of been a put together of a number of areas online with some administrative changes, which incidentally makes some sense from an administrative standpoint?

Mr. Stefanson: The member is correct and the staff thanks him for the compliment. He is right. These were housed in about three different divisions before, and they are now consolidated here.

Mr. Chomiak: Mr. Chairperson, in the Expected Results it says: Initiate 1999/2000 evaluation projects, continue/complete 1998/99 evaluation projects. Is it possible, is there a listing of what the evaluation projects are and can we get copies of that?

Mr. Stefanson: Mr. Chairman, just to give the member a sense, and I am certainly prepared to provide a listing under both of those, the '98-99 evaluation projects and '99-2000. But '98-99, some examples would be consultations on the supportive housing initiative, addiction service agencies, some external consultations regarding the St. Vital community nurse centre, the Aboriginal Health and Wellness facility, and as well to assist the diabetes centre in the Burnt-wood RHAs. Some current evaluation projects for '99-2000 would be some of the community nurse resource centres at Burntwood, The Pas, Ethelbert, the Francophone primary care centre, some other initiatives with the RHAs and some information system developments.

So those are some examples of some of the evaluation projects, but I will return with a listing both for '98-99 and '99-2000.

Mr. Chomiak: A receipt of that information would be most appreciated. Recently the minister provided me with information, in letter form that I had queried on, with respect to the Home Care Appeal Panel. I wonder if the minister can provide data on the functioning of the Manitoba Health Appeal Board and information regarding the items that have been brought to its attention, as well as, the volume and the types of issues that it has dealt with, if it has dealt with any recently.

Mr. Stefanson: The Manitoba Health Appeal Board really deals with, I guess, two or three areas of appeal that are responsible for hearing and determining appeals made under–I am told it really covers three areas. It covers an opportunity to appeal the residential rates being charged, for example, in our personal care homes; a chance to appeal anything an individual feels should be covered under insured benefits; and, it also can deal with any issue that the minister refers to the board.

I can certainly provide generic information on the nature of the appeals over the course of the last year to give the member a sense of the numbers of appeals and so on.

Mr. Chomiak: We have talked often about the regulations to implement changes at personal care homes. Does this evaluation monitoring appeal section have anything to do with the production of those regulations, that is, the regulations on standards and evaluation of personal care homes?

* (1750)

Mr. Stefanson: Mr. Chairman, as the member knows, we are just finalizing, in fact we discussed that during Estimates, the whole issue of the standards and regulations, and I offered to arrange for a more comprehensive briefing for the member. At this particular point in time, it has not been finalized where the appeal mechanism will be lodged. Obviously, there will be the need for an opportunity to appeal from either perspective, I would imagine. If a facility feels that they have something to appeal relative to the standards and regulations or if an individual or a family member feels that something is not being properly addressed, it might well be that it is one of these boards here. That has not been finalized yet, but that certainly will be a part of going forward with the revised standards and regulations.

Mr. Chomiak: Mr. Chairperson, I do not really have a problem passing this subsection, but before that, just where we are heading again. I assume we will be at 2.(f) which is Human Resource Planning and Labour Relations. I anticipate some questions there. I also know the member for Inkster (Mr. Lamoureux) wanted to ask nursing-related questions, as we do. I am looking to the minister for direction. Should it be here that those questions ought to be asked under 2.(f) or some other section?

Mr. Stefanson: Well, if the member is in agreement, this is probably the appropriate section. It makes sense to do it here. There would be others. Subsequently, we could probably find a way to do it, but this is as good as any.

Mr. Chairperson: The honourable member for Kildonan, I will pass.

Mr. Chomiak: Pass it, and then I will talk to it.

Mr. Chairperson: Item 21.2.(e) Evaluation, Monitoring and Appeals (1) Salaries and Employee Benefits $486,700–pass; (2) Other Expenditures $370,300–pass; (3) External Agencies $88,000–pass.

21.2.(f) Human Resource Planning and Labour Relations (1) Salaries and Employee Benefits $1,039,200.

Mr. Chomiak: Mr. Chairperson, since it is rather late in the day, I do not think it is probably appropriate to start this section. Again, in terms of where we are going, tomorrow if the information is not completely available, then I presume we will go through this section and perhaps get into several other sections. I anticipate that aside from this section, all of the other sections leading up to Section 4 will not be overly lengthy in terms of questions.

I anticipate next week a fairly extensive review of Section 4, sections dealing with hospitals, dealing with physicians, dealing with Pharmacare. I anticipate that to be fairly lengthy next week. Perhaps, we will even make it into Capital next week, but that is where I roughly see us going.

So tomorrow I guess we will deal with this section unless we come in with all kinds of information in return. Well, I guess that will be the minister's call. I will leave it to the minister to let us know if he wants to bring back the individual to deal with all of the Information Services questions or whether that is not the case, then we will just deal with the nursing and related labour questions.

Mr. Stefanson: Mr. Chairman, I think we should count on carrying on here. If something changes, if the information were available, I would contact the member. If we are into Private Members' in the morning, I would contact the member before or afternoon, but as of now, I think we should just plan on doing–

Mr. Chairperson: Is it the will of the committee to call it six o'clock? [agreed] The hour being six o'clock, committee rise. Call in the Speaker.

Mr. Deputy Speaker (Marcel Laurendeau): The hour being six o'clock, this House is now adjourned and stands adjourned until tomorrow (Thursday) 10 a.m.