Outline

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(No Transcript)
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Outline

• Who We Are
• Data Holdings
• Reports and Publications
• Drug Expenditures
• National Prescription Drug Utilization
  Information System
• Discussion/Questions

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Our Mandate

• Serve as the national coordinating mechanism for
  a common approach to Canadas health information
  system
• Produce timely information for
• Establishment of sound health policy
• Effective management of Canadian health
  system(s) and
• Generating public awareness about health
  determinants.

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Chair (1)Graham Scott
Federal Government (2) (HC and STC)
Government Regional (5) Nominations
Non-Government Regional (5) Nominations
National Non-Government At Large (2)
Chair, CPHI Council (1)
Atlantic
N.W.T., Nunavut andPrairies
Yukon And B.C.
Quebec
Ontario
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Core Functions

• Identify and promote national health indicators
• Coordinate and promote development and
  maintenance of national health information
  standards
• Develop and manage health databases and
  registries
• Conduct analysis and special studies and
  participate in research
• Publish reports and disseminate health
  information
• Coordinate and conduct education sessions and
  conferences

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What We DoIndicator Development

• Identify and develop priority health indicators
  (national, provincial, and regional), in the
  areas of
• Health status/outcomes
• Non-medical determinants of health
• Health system performance
• Community and health system characteristics

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Health Indicator Framework
Health Status Health Status Health Status Health Status Health Status Health Status
Well-being Health Conditions Health Conditions Human Function Human Function Deaths
Determinants of Health Determinants of Health Determinants of Health Determinants of Health Determinants of Health Determinants of Health
Health Behaviours Living Working Conditions Living Working Conditions Personal Resources Personal Resources Environmental Factors
Health System Performance Health System Performance Health System Performance Health System Performance Health System Performance Health System Performance
Acceptability Accessibility Accessibility Appropriateness Appropriateness Competence
Continuity Effectiveness Effectiveness Efficiency Efficiency Safety
Community and Health System Characteristics Community and Health System Characteristics Community and Health System Characteristics Community and Health System Characteristics Community and Health System Characteristics Community and Health System Characteristics
Community Community Health System Health System Resources Resources
Equity
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Health Indicators Regional Level

• Health Status
• Self-rated health
• Rates for asthma, diabetes
• Non-medical determinants of health
• Average personal income, low income rate
• post-secondary and high school graduates
• Unemployment and youth unemployment rates
• Health system performance
• In-hospital 30-day mortality rates for AMI,
  stroke
• Readmission rates for asthma, pneumonia, AMI, etc
• C-section and VBAC rates

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What We Do Data Content Standards

• Coordinate/promote development and maintenance of
  health information standards, including
• Financial and Managerial Standards
• Data Sets and Grouping Methodologies
• Disease/intervention Classifications
• ICD-10-CA/CCI
• International Revision of the International
  Classification Functioning, Disability and Health
  (formerly ICIDH)

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What We DoTechnical Standards

• The Partnership
• PKI Framework and Guidelines
• Enhanced Health Data Model
• Unique Identifiers
• e-Claims Standards
• HL7 Implementation Guidelines
• HL7 Client Messaging Specification
• International ISO

P
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NeCST - What is it?

• Focuses on developing standards between providers
  and payers to support electronic claims
  submission and adjudication.
• The project is a unique collaboration between
  public and private sector payers, national
  provider associations and vendors.
• The initiative was established to meet current
  and future needs for standardization of
  electronic health claims information.

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NeCST ParticipantsPublic Sector Provider
Associations

• Public Sector/Provincial/Federal Agencies
• Health Canada
• Canadian Institute for Health Information (CIHI)
• British Columbia Ministry of Health
  representing the Western Health Information
  Collaborative
• Alberta Health and Wellness representing the
  Western Health Information Collaborative
• Ontario Ministry of Health and Long-Term Care
• Nova Scotia Department of Health representing
  Health Information Atlantic
• Association of Workers Compensation Boards of
  Canada

• Provider/Professional Associations
• Canadian Pharmacists Association (CPhA)
• Canadian Dental Association (CDA)
• Canadian Healthcare Association (CHA)
• Canadian Medical Association (CMA)
• Canadian Alliance of Professional Associations
  (CAPA)

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NeCST ParticipantsPayor/Insurer Associations

• InterAssure Group
• Canada Life
• Great-West Life
• Sun Life (including Clarica)
• Standard Life
• National Life
• Equitable Life
• Imperial Life
• BCE Emergis
• ESI Canada/CAPPS
• National Association of Blue Cross Plans
• Alberta Blue Cross
• Pacific Blue Cross
• Atlantic Blue Cross Care
• Ontario Blue Cross
• Manitoba Blue Cross
• Saskatchewan Blue Cross
• Quebec Blue Cross

• Association for Claims Exchange (ACE)
• Green Shield
• Johnson Insurance
• Liberty Health
• Manulife
• AccertaClaim Servicop
• Beneplan
• Claim Secure
• Coughlin Associates
• Empire Financial
• First Canadian Health
• Funds Administrative Service
• MDM Insurance
• RWAM
• Wawanesa
• Canadian Life and Health Insurance Association
  (CLHIA)

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NeCST Development and Approval Process

• NeCST (Special Interest Groups) and the
  (Technical Architecture Group) define the
  messages
• NeCST Executive Steering Committee Approves for
  ballot submission
• Submit to HL7 International
• Once membership is passed it becomes the standard.

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NeCST - Benefits

• Payors
• National standard provides for consistency in
  data capture with significant benefits for public
  and private sector payors
• Reduce cost of managing health billing data
• Reduce cost of processing health claims and
  payment
• Health System
• The health care system can further benefit form
  the success of NeCST through
• Ability to communicate between organizations and
  across jurisdictions
• Ability to collect broader encounter data in a
  format that could be incorporated in the EHR
  (i.e. consistent semantics and structure)

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NeCST Benefits

• Providers
• Reduce number of interfaces required for
  adjudication.
• Send electronic information to public and private
  sector payers in a consistent messaging format
• Consumer
• Increased speed reliability of claims
  processing, while also reducing paper based
  claims processing
• Reduce delays in obtaining claims information,
  and contribute to the goal of secured and
  appropriate sharing of patient data

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Next Steps

• NeCST HL7 Generic Claims, Pharmacy, Chiro-Physio
  Preferred Accommodation Messages have passed
  HL7 v3 membership ballot are now HL7 ANSI
  approved standard (2004)
• Messages from the Vision Care, Oral Health
  Physicians SIGs will be submitted for HL7
  Membership level ballot (Dec 2004)
• Once membership level ballot is successfully
  completed, the NeCST messages will become HL7
  ANSI Standard (2005)
• NeCST Message Specifications -NeCST v1.3 (May 31,
  2004) posted to web and will be updated when
  remaining messages pass membership ballot

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Next Steps

• Develop the NeCST Maintenance, Conformance
  Compliance Strategy
• Complete the NeCST Implementation Guide
• Update NeCST Message Specifications documentation
  resulting form Membership ballot

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What We Do Data Holdings

• Collect, process and maintain data for a growing
  number of national and provincial health
  databases and registries
• Health Services
• Health Professionals
• Health Expenditures

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Health Services

• Discharge Abstract Database
• Hospital Morbidity Database
• National Ambulatory Care Reporting System
• National Rehabilitation Reporting System
• Continuing Care Reporting System
• Canadian Organ Replacement Register
• Hospital Mental Health Database
• Therapeutic Abortions Database

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Health Services

• National Trauma Registry
• ON Trauma Registry
• Canadian Joint Replacement Registry
• Under Development
• Home Care Reporting System
• ON Mental Health Reporting System
• National Prescription Drug Utilization
  Information System
• Canadian Medication Incident Reporting and
  Prevention System

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Health Professionals

• National Physician Database
• Southam Medical Database
• Registered Nurses Database
• Licensed Practical Nurses Database
• Registered Psychiatric Database
• Health Personnel Database
• Under Development
• National Survey of Work and Health of Nurses

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Health Expenditures

• National Health Expenditure Database
• Canadian MIS Database
• OECD Health Database (Canadian Segment)
• Medical Imaging Database

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New Emphasis on Free Aggregate Data
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Selected data from several CIHI databases
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CIHIs Role in Analysis

• Regular reporting data provision from data
  holdings
• Comparative reporting
• Special studies, including research synthesis
• Collaboration with research community
• Supporting capacity building at local, regional,
  provincial, national levels

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Health Services
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What We Do Data Holdings
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What We Do Data Holdings

• Patients Waiting for Transplantation, Canada,
  1991-2002

Source Preliminary Statistics on Organ Donation,
Transplantation and Waiting List 2003 CORR
Preliminary Report
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Cadaveric organ donors, Canada, 19921999
(Number)1
1 Only cadaveric donors originating in Canada
with a least one solid organ used for transplant
are considered
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Transplant Patient Survival, Cadaveric Organ,
Canada, 1991 to 1999
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Functional outcome measurement a key component
of the NRS
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Trends in OCCPS 19972002
Year with Mild or more severe Cognitive Impairment with Signs of Mild or more severe Depression Average MDS-ADL Long Score Average CMI
19971998 50.8 13.3 10.4 0.98
19981999 55.8 13.7 11.8 1.00
19992000 55.4 17.9 12.3 1.06
20002001 55.5 16.5 12.2 1.11
20012002 59.7 18.8 13.6 1.16
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Health Resources
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Total Health Expenditure by Use of Funds,
Canada, 2003
Total Health Expenditure in 2003 121.4 Billion
Other Professionals 14.5 11.9
Drugs 19.6 16.2
Physicians 15.6 12.9
Capital 5.6 4.6
Other Institutions 11.6 9.5
Public Health and Administration 7.9 6.5
Hospitals 36.4 30.0
Other Health Spending 10.2 8.4
Source Canadian Institute for Health information
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Public and Private Shares of Total Health
Expenditure, by Use of Funds, Canada, 2003
Source Canadian Institute for Health information
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Total Provincial/Territorial Government Health
Expenditure Per Capita, Age-Sex Standardized
versus Actual, by Province/Territory and Canada,
2001
Source Canadian Institute for Health
Information, Statistics Canada
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How Data are Used

• Selected Examples

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Sound Health Policy

• Federal
• Romanow Commission
• Kirby Committee
• Parliamentary Standing Committee on Health-Report
  on organ and tissue donation and transplantation

Health Summit 99
Its Time to Act
Strategic Health Plan
Ministry Services Plan
Clair Commission
STD Control Strategy
Mazankowski Report
Bédard Committee
Fyke Report
Health Services Restructuring Commission
Clinical Services Steering Committee
Health CareReport Card
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Public Awareness

• Better health information for better health, e.g.
  
• Macleans cover stories
• Extensive media coverage of fact-based
  reportspart of the public debate
• Beyond todays crisis regions use indicators as
  springboard for communicating with public
• FPT reporting
• Orientation of board members and staff
• Annual report now a university textbook

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Pharmaceuticals
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Drugs - The Information Needs

• What we dont know
• How does drug utilization compare among Canadian
  populations in terms of accessibility,
  appropriateness, effectiveness, efficiency,
  safety?
• Is drug spending optimal within the continuum of
  care?
• What strategies are most effective in controlling
  costs while ensuring high quality patient care?

• What we know
• Drug expenditure continues to rise this is not
  just Canada
• Prescribed drug expenditure is driving the
  increase in overall drug expenditure
• Level of drug spending, growth rate and public
  share vary across jurisdictions

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Total Health Expenditure by Use of Funds, Canada,
2003
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Total Drug Expenditure Per Capita in Canada, 2001
Source Canadian Institute for Health Information
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Preliminary Provincial/Territorial Government
Drug Expenditure Per Capita, 2003 and 2004
Source Canadian Institute for Health Information
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Sales of Patented and Non-patented Drugs in
Canada
Source Patented Medicine Prices Review Board,
Annual Report, 2003
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Drugs - The Information Needs

• How does drug utilization compare among Canadian
  populations in terms of accessibility,
  appropriateness, effectiveness, efficiency,
  safety?
• Are differences in the prescribing of drugs due
  to differences in Prescribers, underlying
  morbidity, or differences in insurance coverage?
• Is drug spending optimal within the continuum of
  care?
• What strategies are most effective in controlling
  costs while ensuring high quality patient care?

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Expenditures The Tip of the Iceberg

• Base
• Standards
• Data systems
• Below the water
• Claims level data

Start with what we have - populate over time
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Initial set of indicators

• Drug Expenditure trends in Canada
• Total drug expenditure as a percentage of
  healthcare spending
• Prescribed/non-prescribed drug expenditure as a
  percentage of total drug expenditure
• Hospital drug expenditure as a percentage of
  total hospital expenditure
• Prescribed drug expenditure per capita
• Publicly/privately insured and out-of-pocket
  expenditure as a percentage of prescribed drug
  expenditure
• Average cost per prescription claim
• Volume changes and mix in Prescribed Drugs in
  Canada
• Percentage of total expenditure and volume of
  claims by therapeutic class
• Intensity of Drug Use in Canada
• Average number of claims per claimant
• The percentage of the population that has made at
  least one claim
• Average number of Defined Daily Doses (DDD) per
  1000 residents per day

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National Prescription Drug Utilization
Information System(NPDUIS)
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NPDUIS

• ... to provide accurate and timely national
  prescription drug utilization information to
  support public drug programs in the establishment
  of sound pharmaceutical policies, and the
  effective management of Canadas public drug
  benefit programs
• The potential to complement and to support other
  national initiatives such as the Common Drug
  Review, Best Practices and Post-Marketing
  Surveillance
• Other stakeholders, e.g. academic researchers
• In collaboration with PMPRB

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NPDUIS

• CIHI and the PMPRB work collaboratively to
  develop and to maintain the National Prescription
  Drug Utilization Information System (NPDUIS),
  each organization taking the lead in areas in
  which that organization has the expertise/
  experience.

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NPDUIS - The Scope

• Current
• Prescription claims level drug data
• Pseudonymous prescription claims level drug data
• From publicly financed drug benefit programs in
  Canada
• Additional supporting data
• Formulary and Drug Product data
• Health Canada Drug Data base
• F/P/T Formulary Information
• ATC/DDD
• Population statistics
• Information on Drug Benefit Plans/Programs

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NPDUIS - The Scope

• Expansion of NPDUIS
• Prescription claims level drug data
• Pseudonymous prescription claims level drug data
• From privately financed drug benefit programs in
  Canada

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Uses and Disclosures of Information from NPDUIS

• The permitted uses of NPDUIS data are set out in
  the CIHI NPDUIS PIA
• CIHI will disclose NPDUIS data in accordance with
  CIHIs Principles and Policies for the Protection
  of Personal Health Information, and subject to
  Agreements between CIHI and the jurisdictions to
  disclose data under their authority

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Uses and Disclosures of Information from NPDUIS

• CIHI will use NPDUIS data to produce
• An annual statistical report of Pan-Canadian
  statistics
• Reports accessible through CIHIs web site for
  authorized and registered users
• Longitudinal and other analytical studies to
  address specific health related questions
• Conduct analyses for third parties through ad hoc
  data/information requests

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NPDUIS CONCEPT
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Formulary and Drug Product Module

• Provide longitudinal contextual and statistical
  comparative information regarding coverage of
  drug products and other benefits on public
  formularies across the F/P/T Jurisdictions
• Support analytical and reporting requirements of
  the NPDUIS

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Claims Module

• Provide longitudinal descriptive and statistical
  comparative information regarding drug
  utilization related to publicly funded drug
  benefit plans across the F/P/T Jurisdictions

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Population Statistics Module

• Provide contextual and statistical comparative
  information regarding demographics of the
  populations of interest to NPDUIS
• Population statistics will be used as
  denominators to enhance comparability of drug
  utilization statistics or indicators
• Geographic information (i.e. postal code) will be
  used to provide socioeconomic and demographic
  information

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Plan Information Module

• Provide longitudinal contextual and comparative
  information regarding public federal/provincial/te
  rritorial drug benefit plans/programs across
  Canada
• Relevant references/links to drug benefit
  plan/program information across the NPDUIS will
  be essential to support the interpretation of the
  information derived from each of the other
  modules, or information derived at the system
  level, i.e. from the integration of the modules

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Drug Utilization Informing on

• National Pharmacare
• National Formulary
• Catastrophic drug coverage/program
• Expanded drug coverage
• Disease management programs
• Primary care reform
• Outcome Measures
• How healthy are Canadians?
• How healthy is our healthcare system?

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For more information, please visit our Web site
at www.cihi.ca