Thank you, Mr. Bromley. Next is Mr. Dolynny.
Thank you, Madam Chair. My questions will be on EMR, so that gives the Minister a chance to find the queue in the page.
One of the five priorities of the 17th Legislative Assembly was to ensure fair, reasonable and sustainable health care systems. EMR was not directly mentioned in our original priorities, but it was implied as something we were going to invest in for our future. Currently, Yellowknife and Hay River are fully operational EMRs, and we know that the Department of Health and Social Services has received territorial funding for this as well as federal funding through I believe it’s called the Infoway funding.
Can the Minister or the deputy minister give us a clear indication of how much money we have spent so far in EMR and how much of that money was federal money that we have?
Thank you, Mr. Dolynny. Ms. Mathison.
Thank you, Madam Chair. On the EMR project, Infoway funding is projected to be $4.1 million and GNWT funding is $6.2 million.
Okay. I appreciate those numbers. Now, we’re very much aware that this is going to require a territorial rollout at some point in time. It’s very difficult for me to see here within this budget how much this rollout is going to be in this fiscal budget. I’m assuming there’s going to be some type of O and M cost or operational cost to maintain this EMR program.
Can we get a bit more elaboration? Where is it embedded within the framework of program delivery support in this activity summary, and what is going to be the ongoing cost as we move forward?
Thank you, Mr. Dolynny. Mr. Beaulieu.
Thank you, Madam Chair. We are just going to locate that information and then we will have the… Okay. Perhaps I could get the deputy minister to provide some detail on the expenditure.
Thank you, Mr. Beaulieu. Ms. DeLancey.
Thank you, Madam Chair. I believe that the funding that’s new O and M money in this year’s budget is in fact under hospitals. So we’re not actually on that page yet.
I can talk a little bit about the rollout plan. As the Member indicated, the EMR is being used now in Yellowknife and Hay River. Both Yellowknife Health and Social Services and the Hay River Health and Social Services Authority had chosen the same EMR program, which sets the stage for them to start moving towards greater compatibility.
Work that’s been done to date over the last year, we do have an EMR committee that is co-sponsored by Dr. Ewan Affleck, who you’ve probably all seen on national ads as an EMR champion, identified by the Canadian Medical Association. He co-chairs this initiative with the department. As was noted, we have received a fair amount of support from GNWT capital funding as well as Canada Health Infoway. That funding will support planning, development, purchasing of software, customizing of software and the rollout, but it does not support the ongoing O and M costs. We do have in the budget new funding of $489,000. That’s proposed to support four positions, which would start to address the need for the ongoing O and M.
In terms of rollout, the first step, and we’re doing this right now, we have chosen a vendor. We have a short-term contract with the vendor, the vendor is for the same EMR program that’s currently in use in Yellowknife and Hay River and as part of that short-term contract we are doing proof of concept, doing some adaptation, because right now the two authorities use the program differently in order to realize the benefits to all our residents, to realize the benefits for chronic disease management, we really need to have consistent use across the Territories. So the first focus is on working with Yellowknife and Hay River authorities and then the rollout to the other authorities is going to take place in a phased approach. There’s a number of building blocks we need to put in place. Right now we only have two of our authorities that take advantage of these services of the TSC within the GNWT. That’s the Deh Cho and Sahtu. In order for us to effectively use the EMR, we really need our authorities all to be on the same platforms, to be using the same software. So our first step is to work with all our authorities to bring them on to the TSC.
Then there’s an issue of capacity. Some authorities are more eager or more ready to get started than others. Right now part of the work that we’re doing at our steering committee is planning the rollout, identifying who wants to be first, who wants to be second, who do we migrate to TSC. We’re getting, actually, great support from the Department of Public Works and Services right now in looking at what’s involved in migrating our authorities to the TSC. So it’s a fairly comprehensive undertaking and we would expect the rollout to take as much as four years, depending on how quickly we can put all these pieces in place. Thank you.
Thank you, Ms. DeLancey. Mr. Dolynny.
Great, thank you. I appreciate the deputy minister’s thorough reply there. It’s good to hear that we’re definitely moving along in this area. So the numbers I did receive, I believe my math is okay, $10.3 million that we’ve spent this far; $4.1 million was federal money. We see in the budget, and again I do appreciate leniency, we’re talking about something further on in our activity summary at $489,000. Does the department have a number in mind as to what the annual cost or estimated costs are going to be at the end of the four-year so-called rollout? So something that we can maybe anticipate on a yearly costing for the maintenance and the continuance of electronic medical records. Thank you.
Just by way of correction, we have not actually spent $10 million to date. In fact, we just signed the agreement with Canada Health Infoway for the $4.1 million. We may not spend all of that $4.1 million. The way Infoway works is we are reimbursed as we roll the program out to a certain number of providers. So that’s a maximum amount of money that we could spend. In terms of ongoing O and M costs, we have been told by our technical experts that to fully operate this system throughout the Territories on an ongoing basis could take up to as many as 10 or 12 positions, and these positions, they’re doing security, they’re doing data integrity, they’re training, they’re upgrading the system, they’re testing new applications, they’re supporting practitioners.
No further questions. But I do appreciate the thoroughness of the reply and I appreciate the numbers being shared today. Thank you, Madam Chair.
Thank you, Mr. Dolynny. Next on my list is Mr. Bouchard.
Thank you, Madam Chair. I appreciate the department’s answers to all these questions and I appreciate the Minister’s responses as well. I guess this is the beginning of the process that, when coming into this job, I thought I might find it frustrating being in private business where we implement stuff a little quicker than the government, and this is one area that I think is lacking with our government system, and it’s in the area of midwifery.
The Minister has asked why we’re so concerned about trying to implement things quickly and trying to move things ahead. It’s basically because I think most Members here and the general public are concerned and frustrated with the system the way things are set up. Midwifery is already set up in Fort Smith. In Yellowknife they stopped the process, did a study, which took them a long time to do, re-established it in Fort Smith and that study indicated this is what we should suggest for implementation. Now we’re given that we need to create a bureaucracy where we have a coordinator the first year, then the second year we go into Hay River, the third year we go into Inuvik and Behchoko, then the fourth year we’ll go into other communities like Yellowknife and Norman Wells and other potential sites. So I think the area of timelines is the fact that we’re seeing a project, something that’s been assessed, something that we did a study on, and now we’re looking at implementing it over four years. Why can’t we do a coordinator and implement Hay River in the same year, if that’s the wish of the department or if that’s the way it’s going to go forward? Why can’t we multi-task in this system?
So, as I indicated, I respect the department’s hard work, but I think we should be implementing this quicker. This is what people want. The Minister has asked why we want this so quickly. I’ve been in this House, I’ve shown people sitting in this Legislative Assembly, friends of mine waiting to have a baby in Yellowknife. We want to have babies in our communities and the Minister knows that. These are people that are, you know, the one person it was her third child. She’s got a husband waiting in Yellowknife, she’s got kids waiting in Hay River and she’s got family in Hay River waiting to have a child. That’s why we’re looking to implement this.
So we are frustrated with the system and I’m glad to hear that Fort Smith is doing well, and I know the percentages go up when you have a full-time position and I know the department is working on that stuff. The timeline is also due to the fact that we know once we say, okay, we’re going to implement this in Hay River, it’s going to take just about a year to implement it. So if we’re going to wait a year to do it in Hay River, that means you’re two and a half years from now from actually having a midwife in place and operational. I know that our authority is interested in putting in a new facility, but that doesn’t mean that we can’t have somebody lined up, the hiring process, the review process of that person, the implementation in the authority needs to be in place, as well, for that new facility, and no different in Inuvik or Behchoko.
So the timelines just get extended and extended. Now we’ve got to do more studies, we’ve got to do more implementation, we’ve got to study it some more. That just drags it out. So this four years for Yellowknife to be implemented in the fourth year may take five years. Like, is that reasonable for people, where the program was already in place, to expect them to see that?
I’m just really frustrated with the government system and the fact that we’re implementing something that is operational in Fort Smith. It’s something that was operational before. We have done a study. Now we allow it. It just frustrates me to no end that we’re doing this.
The other area that people are concerned with, and we’re no different, Mr. Yakeleya talked about the short time and attention span of the government. This Legislative Assembly is interested in midwifery, but the next one to two and a half years may not have an interest in it. It may fall off the map. He’s had issues where it was a hot button item, and then the next Assembly it gets dropped and it’s not being implemented anymore. That’s why people are interested in it being implemented now, not as opposed to later. I think we’re very interested in seeing some of these things implemented right away.
Like I talked about the hiring, we know, through physicians, that it takes a while to hire physicians. Your midwives are the same way, training. But let’s get this process going now as opposed to hiring a coordinator the one year, having that person do, a manager or coordinator doing something when there’s no staff there and no midwives to coordinate. So what’s the coordinator doing? Let’s implement them at the same time, if that’s the wish of the department to have a coordinator. I question whether we need a coordinator or not. I’m just saying, if the department wants to do that, let’s do it the same year.
The other issue that is frustrating with me is the department talks about midwifery implemented in Hay River will be regional. We’re going to use the other parts of the communities. That’s fine, that’s a great concept, but Hay River is funded not as a regional hospital. It’s a community health centre. We’re not only funded that way operational-wise, but we’re funded that way capital-wise. When they’re building this new facility, it’s not a regional hospital; it’s a community centre. Now the department is talking about bringing things into the regional. Now we in Hay River are being asked to do more capacity with less infrastructure money and less operational money.
If the department wants to do this, I want to make sure the department knows that Hay River wants to be funded for this. If the dollars we’re getting now are going to be the same dollars we get when we have to do a regional implementation of midwifery, that’s more burdensome on our system and it impacts the community of Hay River.
I’m very frustrated with the system. I don’t really know if I have any questions for the Minister other than a statement of frustration with the way this thing is being implemented.
Thank you, Mr. Bouchard. Perhaps your question is why are you frustrated. Order please, Members. Minister Beaulieu.
Madam Chair, although we feel at the department that there’s some risk to manage in monitoring and auditing what we’re doing, we need to provide comfort with the physicians that are going to work within the system. There seems to be a groundswell of support to go into the midwives. If we just added the midwives this coming fiscal year in Hay River, it would cost us additional money. If we were to move money within our midwives plan, move money around, we could move to hiring midwives. But to clearly understand here that we could run into some serious issues with managing risk, we need to have a process, a quick… We will try to speed up the process. We need to have a process where we are dealing with the physicians.
At the end of the day, many of the people that go to midwives choose to have their babies with a doctor. If we are moving into it without this proper consultation with doctors and we are moving into another midwife program or another midwife delivery, then we are going to have to fast-track this process or consultation with doctors, discuss the management of risk with doctors. We will essentially have to drop some of the monitoring auditing of what we are doing, and we have to do a consultation with the Hay River Health and Social Services Authority.
Because there is no board, we will talk to the public administrator and the CEO in Hay River to do this. This will require us to then do some shuffling within the entire midwife budget as we plan to roll it out. It essentially could mean that we will drop what we think is a very, very essential piece of developing this whole thing that is a midwife coordinator at the department level. We want to move through this system to make sure that the midwives and the system are able to stand up to any scrutiny and would be able to also be something that has long-term success.
I recognize that people from Hay River are having their babies in Yellowknife. That has been going on for quite some time. We are seeing the light at the end of the tunnel here in trying to set up a system that is going to bring midwives in what we consider to be a reasonable, coordinated fashion. MLAs are saying that they want us to put midwives in Hay River now. So we will go back and start our consultation process with the health authority, health and social services authority, Hay River and Stanton. They will be involved. Stanton is going to be the people that don’t want to, and that is proven. Fifty percent of the people in Fort Smith still choose to have their babies at Stanton. There is communication between the midwives in Fort Smith and Stanton. Stanton is a territorial hospital. If the people are not comfortable going from the prenatal stage right through birth with midwives only in the room, then those people have to be moved to Yellowknife because we don’t have physicians in Hay River at this time.
As much as I sat here for the past several months trying to explain that we need to move this through in an orderly fashion, it appears as though the MLAs are going to push until we actually put midwives in Hay River. So we’re prepared to warn, I guess, the MLAs that there could be some risk involved here, but at the same time maybe move some funding around to provide some midwives. I couldn’t really say midwife service in Hay River, but midwives in Hay River. I guess if several months ahead of schedule, if that is what the MLAs want to do… We don’t really know how they’re going to engage into the system at this time. But if that’s what the MLAs want within our current budget, we will look at that.
Thank you, Minister. Mr. Bouchard, your time has expired. I’ll put you back on the list, if you need to be. Next on the list is Mr. Hawkins.
Thank you, Madam Chair. I just want to come back to something that I was thinking about when I asked questions about the health and social services authorities’ administration money. I think it was mentioned that $1.4 million, I assume we are still talking about the same pot of money of $15.5 million but $1.4 million is allocated to staffing, sort of, compensation and benefits. If that’s the case, why wouldn’t this be further labeled or better labelled as a travel fund, and maybe if they could talk specifically around who accesses this funding.
Thank you, Mr. Hawkins. Minister Beaulieu.
This is for staff of the Department of Health and Social Services, not the authorities. This is for staff that are in Inuvik.
Is the Minister saying that just, you know, making numbers easy, $14 million is used for travel by the staff in Inuvik?
Thank you, Mr. Hawkins. Are we talking about the same numbers, perhaps? Minister Beaulieu.
I apologize. I thought that the Member had indicated that he was talking about the health services administration again, as he did in the first question. This is a question on the health and social services authority administration. I will have the director of finance provide a response.
Thank you, Minister. Ms. Mathison, please.
Thank you, Madam Chair. This budget line item encompasses funding to the authorities for their administration areas. At the hospital, for example, their finance or their executive offices or their HR. Not HR necessarily, other than in Hay River. The registration and just more administrative areas of the authorities. It is typically mostly about 70 percent compensation related.
Thank you, Ms. Mathison. Mr. Hawkins.
Okay. Then earlier I had asked a question to expand on what it actually represented, and I think I understood it was, unless we were talking about two different areas, I got a $1.4 million figure and then the rest was travel and some of it was office supplies. Are we talking about all the same thing or are we talking about two different items here? I just want to first make sure we’re talking about the same item, and I’m speaking to health and social services authority administration, and then, of course, if you read the detail, it includes the funding for HSS authorities for activities associated with management and administration. Let’s make sure first, I guess, we’re talking about the same one and how did we have $1.4 million in compensation before and now we’re not.
Thank you, Mr. Hawkins. Minister Beaulieu.
We were initially responding to the third item down on program delivery details on 8-17. We thought we were responding to health services administration so, yes, we were responding to a different item the first time when we talked about $1.4 million for salaries. We were talking about that item. I just for a minute thought that we were still talking about that line item, but now we’ve moved to the bottom one and that’s what we’re responding to now.
Okay. No problem. I understand accidents happen. No, I was always speaking to HSS authorities administration. Maybe, for the record, if we could get the breakdown of exactly what that is. Let’s start with that. Let’s start with the full breakdown in some detail.
Thank you, Mr. Hawkins. And you’re referencing $15.588 million? Mr. Hawkins.
That’s correct, Madam Chair. I believe that’s the only item, financial item that’s attributed, but that said, maybe the Minister can clarify if there’s more as well. Thank you.
Thank you. I’m just trying to clarify. Minister Beaulieu.
Thank you, Madam Chair. To read the fine print I have to remove my glasses. The $15.588 million, I could give the breakdown of the authorities first of all. Starting with Beaufort, $3.3 million, roughly; Deh Cho, $1.4 million; Fort Smith, $1.4 million; Hay River, $2.6 million; Sahtu, $1.2 million; Stanton, $2.6 million; Tlicho, $900,000; YK, $2 million. This is for executive, corporate board trustees, planning and development, quality assurance, risk management, internal audit, finance, human resource system support, communications, material management and volunteer services.
Okay. That’s the type of detail that was very helpful. Thank you very much.
Next on my list is Mr. Moses.
Thank you, Madam Chair. Just for some clarification here. I didn’t really want to get into all the super detail about the Midwifery Program, but responses that I’ve been hearing from the Minister this afternoon have really got me concerned, actually. My first question, he mentioned earlier, and I could go to Hansard for clarification, but just for the record, I want to ask the Minister of Health and Social Services, when he made reference earlier to looking at a territorial model as the model that he was looking at implementing, can he confirm that under his leadership that he was confirming that he wanted to implement the territorial model out of Yellowknife?
Thank you, Mr. Moses. Minister Beaulieu.
Thank you, Madam Chair. We were looking to put the territorial midwifery program in place three fiscal years from now, so we are discussing, assuming that the mains that we’re talking about now is 2013-14, so 2014-15 of the next phase and then 2015-16 would be the regional. The expansion for Yellowknife would be in year 2016-17. I guess it would not be in this government but we would hope to have all of the funding approved and the program moving through the system if we stay with that schedule.
Also for clarification, the Minister had mentioned managing risks, and he made reference to it on more than one occasion. I just want to get clarity on what the Minister means when he says managing risks. In terms of the Midwifery Program, residents of the NWT, the report, all the stakeholders made a recommendation that the community-based model is the most recommended model that we should be moving forward with. They didn’t ask for a consultant. They asked for a community-based model. I want to know what these risks are that the Minister is talking about.
The risk that I am referring to, the management risk that I am referring to was the involvement of physicians. We have a Midwifery Program in place that, as I indicated, would involve physicians as well. Some of the risks associated with childbirth are considered to be risky, so we just wanted to ensure that we had the support of the physicians in order to manage the risk surrounding childbirth. That’s what I was referring to when I said we were trying to manage the risks by engaging the physicians.
There are just so many areas that I can continue on. Managing risk. The Midwifery Program is put in place to help a lady when she finds out that she’s pregnant. It helps support her through her pregnancy so that she gets the counselling that she needs, she gets the support, she gets the alcohol and drug treatment, healthy pregnancies. If midwifery is not there to give the support, especially for single mothers, then the high stress level of flying to Yellowknife from the small communities and spending all the time here to give birth without the support of a midwife in the community, the cost to the government as well.
There was a question about costs. It’s in the report. I think on average it was somewhere around $12,500 for perinatal care, and the highest cost was in Ulukhaktok for about $16,000. Managing risks, we can manage risks during the birth, but we can do a lot of preventative and supportive work nine months leading up to the day of the birth.
Other questions here. In terms of legislation, in the report it says the NWT government passed the Midwifery Professions Act in 2005. If this Minister wants to update these regulations, there’s probably going to be a cost to change the act. There’s going to be also, following regulations – the midwifery professions general regulations, prescription and regulation of drugs and other substances regulations, and the screening and diagnostic test regulations – there are going to be added costs to that.
Can I get confirmation on whether that legislation is going to need to be revised, or reviewed and amended, as well as all the regulations? And does the Minister believe there’s going to be a cost to changing those as well?
We don’t see any need to change the act. If he’s referring to the cost of changing the act, then no, we don’t see any cost.
How about the regulations? The Minister said he was going to change some of the standards earlier, in the discussions earlier today. I think that is going to have an effect on regulations. And when it has an effect on regulations, there’s going to be something in there that’s going to have an effect on the act. I just want to get confirmation if the Minister feels there’s going to be also some changes needed to be put to those regulations.
We’re not anticipating that change. We were going to change the standards. Maybe we could have further clarification. We weren’t thinking of changing the act or regulations but putting in territorial standards and other standards around education and so on. Perhaps I could get the deputy minister to provide some detail on what we consider or think the cost would be around that change.
Thank you, Mr. Beaulieu. Ms. DeLancey.
Thank you, Mr. Chairman. I’m not a practitioner, so I can only go so far. My understanding is that the act is relatively recent, would not need to be updated. The regulations are also timely. The act does provide for the Minister to approve a framework of practice. My understanding is that when we talk about standards, we do not have an updated framework of practice.
The Member has noted that there was some work done in 2005 but that it may not be current with standards nationally, it needs to be updated. That is the work that we are talking about when we talk about establishing this consultant position that would initially do some of that developmental work and then would have on an ongoing basis a training mentorship and oversight role.
When we talk about risk management, we’re talking in large part about being able to monitor midwives. I understand, from a professional perspective only a midwife can monitor or audit the practice of another midwife. So we need to have somewhere in our system the capacity to do that on an ongoing basis.
Thank you, Ms. DeLancey. Mr. Moses.
Two really quick things before my time runs out here. In terms of doing more consultation, the co-ordinator position there, I just want to, for the record, mention the groups that were consulted initially. There were 31 participants throughout the NWT as well as national organizations from the communities, as well, also a topical expert. Actually, I won’t even get into it. Hopefully the Minister does know who they are as it is in the report.
For the record, can the Minister let me know what the total costs of all the consultations – all the costs to get this report done in terms of consultation and hiring staff – what was the total cost to the government to put this report through that he seems like he doesn’t want to put any action to?
