Yes, Madam Chair, I do.
Thank you. Sergeant-at-Arms, would you escort the witnesses into the Chamber, please?
Mr. Beaulieu, welcome to you and your witnesses. If you would introduce your witnesses for the record, please.
Thank you, Madam Chair. To my right is Debbie DeLancey, deputy minister of Health and Social Services. To my left is Derek Elkin, assistant deputy minister of Health and Social Services.
Thank you, Mr. Beaulieu. Committee, we are on page 6-2, department summary. We will defer this particular page to the end. We will go to page 6-4, Health and Social Services, activity summary, health services programs, infrastructure investment summary, total infrastructure investment summary, $31.181 million. Mr. Dolynny.
Thank you, Madam Chair. Welcome to the Minister and deputy minister and team. I’m going to start my questions under the reference of electronic medical records. This is something that I know people, residents, people in health professions have known about for a very long time. This is nothing new, other than the fact that we continue hearing about EMR initiatives with the department and have done so for many, many years. In fact, we’ve gone to the extent of getting health-specific privacy-type legislation already and getting that in place to prepare the Northwest Territories for EMR. Can the Minister give us an update as to what this new amount of money that will be put aside for this capital budget for EMR? We’ll start with that first question. What is this money going to be used for?
Thank you, Mr. Dolynny. Mr. Beaulieu.
Thank you, Madam Chair. I’m just going to have the deputy minister, she has the detail on what this money is going to be used for, to do a response.
Thank you, Mr. Beaulieu. Ms. DeLancey.
Thank you, Madam Chair. The funding will be used to purchase licences for the electronic medical record system itself. It will be used to train staff. It will be used for some technical and equipment upgrades that are required. That’s a general overview. We can provide more detail if need be.
Thank you, Ms. DeLancey. Mr. Dolynny.
I didn’t hear what amount is being spent in it, but maybe I can get that amount as well as what we have spent to date on this EMR project. If I can get that question answered.
Thank you, Mr. Dolynny. Mr. Beaulieu.
Thank you, Madam Chair. I will get the assistant deputy minister to provide the cost details of what has been spent to date.
Mr. Elkin, please.
Thank you, Madam Chair. In previous years we spent roughly $2.1 million in some initial review. Currently we have about $2.2 million in the current year and $1 million in 2013-2014. We’re currently in discussions and negotiations with Canada Health Infoway on the overall project chartered to confirm their contributions to the project. That should be concluded this fall.
Thank you, Mr. Elkin. Mr. Dolynny.
This could be a long afternoon. I guess the question is: What have we spent to date on EMR initiatives from this government?
Thank you, Mr. Dolynny. Mr. Beaulieu.
Thank you, Madam Chair. The total prior year GNWT investment in the EMR project has been $4.175 million, with continued investment of $250,000 in 2012; $1 million in 2013; $774,000 in 2014; for a total of $6.19 million of capital investment. Also, there will be $2.175 million of the initial $4.175 million occurred in previous EMR investment with $2 million carry-over to the current EMR project. Therefore, the current project budget reflects $8 million total, $2 million carry-over, $250,000 in 2012-13, $1.002 million in 2013-14. Again, the $774,000 in ‘14-15, up to $3.946 million of Infoway funding. Canada Infoway funding has approved an investment up to that amount of $3.946 million to the NWT EMR project pending development of acceptable eligibility criteria as well as NWT’s ability to meet the criteria within the allocated framework. That money should be coming through by December 2014. Infoway reimburses GNWT anywhere from 75 to 100 percent of eligible implementation costs to that maximum.
Now I do appreciate the Minister for giving a detailed response to the question. I do appreciate that.
Going back to this EMR project and budget estimates that was talked about not less than a year ago, that budget was just slightly over $4 million for this whole budget. Now, from what we’re hearing, this budget has now exceeded within one year, or doubled to over $8 million during the last fiscal year. Can we get an explanation why EMR has now doubled in price in one year?
We don’t have the detail of why the cost has escalated with us here today, but we can provide that detail to the committee.
I do appreciate that response. My next series of questions with this page deal with a lot of facility upgrades and renovations within a number of communities. My question is, from a standpoint of a user, or basically, a health professional, as we are all aware, a number of our health professionals do travel and do work in various communities, whether you’re a nurse or in any type of health capacity. Do these facilities, when we’re looking at doing these retrofits, these replacements, is there a common theme on trying to create some universality in the design so that there’s a familiarity when a health professional goes from community to community but there is some degree of uniform design? I’ll leave that as a question.
Generally, with communities that have approximately the same types of needs, we build a prototype. A facility in a community of approximately 500 to 1,000 people would generally have the same building built in their communities.
I guess my next question: These prototypes, are they vetted through the different associations, the Nurses Association, the Medical Association, for their input on usability and getting some ideas from the ground up, in terms of making these so-called pilot designs user friendly and adaptable to the northern climate and to the northern type of experience that health care does require?
We work with the practitioners that use the facility to provide the health service in the design aspect of the centres, and also during the development of the design, we consult with the health and social services authorities responsible for that particular community.
No further questions.
Are there any further questions on this section? Mr. Hawkins.
Thank you, Madam Chair. I believe we’re still in section 6.3, just to confirm?
Pages 6.4, 6.5.
Thank you, Madam Chair. I just wanted to make sure. I was just looking at health services programs, and I understand it’s a bit of a challenge here in some particular regions where they qualify for doctors under their health portfolio of funding, and in some cases they’re unable to hire physicians. There has been a logjam on the policies. I understand it’s some method, and I’m just trying to hash it out here. It may take a bit of work to get to the bottom of it.
As I understand it, if you have doctor money, it’s meant to be spent for doctors, but in some cases they can staff positions in some of the regional health authorities, and so that money sits empty and not expended for the appropriate need. There’s always been discussion about, for example, being able to change the formula of doctor money and maybe, for example, use it and allocate it to nurse practitioners.
What type of flexibility does the Minister or Minister’s team see in that policy shift; whereas if we bracketed it and said if you’re unable to hire a physician, which obviously is our first choice in certain circumstances, are we able to transfer it to NP only to ensure that people don’t turn around – when I say people, I mean authorities – and buy a pickup truck with the type of money? Again, health services for qualified health services that are in a similar manner but obviously not equal. What does the Minister think about that typical policy and has he seen any problems with it under that concept? Thank you.
Thank you, Mr. Hawkins. Minister Beaulieu.
Thank you, Madam Chair. The money usually doesn’t sit unused, first of all. When they’re unable to fill the doctor positions, the physician positions, then we use the money to bring in locums. In as far as the flexibility of funding goes, we are looking at putting some flexibility into the funding. The funding for physicians is restricted by FMB direction, so in order for us to build flexibly into that, we have to go back to the Financial Management Board to build that flexibility to bring in, as an example the Member used, nurse practitioners to fill the role in certain communities. We are doing that. Three of our authorities were asking for flexibility in the funding to allow us to do that exact thing.
My next question is: This is a particular issue that I’ve raised with previous deputy ministers of Health, and I understood it from a similar sort of positioning on-the-ground perspective that they too saw the benefit of requesting that formal flexibility through FMB.
Has anyone ever written FMB to request this type of policy ability, or flexibility I should call it? Rather than treating it as a one-time process, request the authority to use it as an ongoing flexible option.
I mean, the way I see it, and this example may not be perfect for the exact circumstances we’re under today, but, I mean, if you’re in the Fort Smith region, you have four doctors under your catalogue of options, you’re only able to fill it with two. What is to stop the authority from saying, well, let’s use that doctor money? We can’t seem to hire two doctors so let’s use some flexibility and give the authority that type of flexibility to make choices on the ground. And who better knows their operating environment than the local authority for the local people?
That’s the type of question I’m really getting after, which is: Has the Department of Health ever requested a formal support or formal dispensation from FMB in order to do this formula as I’m talking about?
The process used is a business case. We have to develop a business case working with the authorities. The three authorities in which we’re building business cases for to create flexibility in the physician funding is Tlicho, Fort Smith and Hay River.
As I understand it, there are still a few other authorities out there as well. If I’ve understood my facts correctly, I mean, over a period of a fair bit of time, every authority has had some type of difficulty or challenge with this issue and this could be a solution. I am just curious as to why the Minister would say it in a manner of building their business case. Have they not seen or recognized this as a particular problem and a potential solution?
The business case allows us to provide a cost-benefit analysis seeing the full cost and the other benefits of creating this flexibility into the physician funding. That is what is needed for us to give the FMB comfort if and when they make a decision to create flexibility in the funding to allow us to bring other than just doctors into this type of funding.
Mr. Chair, to the Minister, the obvious question is: When do you expect this to be a business case proposal presented to FMB? This problem that I am familiar with goes back two if not three years. I am curious as to why the department wouldn’t have actioned some form or request to this date. That may be a challenging question to answer, but the real issue is when do we expect the business case to be presented to FMB on this option? Thank you.
Mr. Chair, we are having an O and M discussion. This business case will be completed before the end of this calendar year so that we can possibly have inclusion for the next fiscal year in O and M.
I guess the only thing I would ask is if the Minister would keep me up to date as to the progress on this initiative. That will be all. Thanks.
Mr. Chair, no problem. We can do that.
Thank you, Minister Beaulieu. There are no further questions. We will go next on the list. Mr. Moses.
Thank you, Mr. Chair. I just want to commend the department for all the work they are doing in building all of these new infrastructure projects throughout the Northwest Territories and to our regional centres. I am sure the staff and residents will appreciate the efforts and having new facilities to do their jobs more efficiently.
Specifically in this section here, I want to talk about the seclusion room upgrade in Inuvik. It is a very positive project and something that is much needed in terms of the business of the emergency room and the business that they have there.
Can I ask the Minister if this is a standard practice that he is going to be doing throughout the Northwest Territories in all the other hospitals such as Norman Wells, Fort Simpson, Hay River? Thank you.
Thank you, Mr. Moses. Minister Beaulieu.
Mr. Chair, this is a new standard. We are incorporating this into all of our new facilities.
Mr. Chair, as this is the new practice, are we going to be looking at seeing in future capital budgets where we look at one… This cost is only for one room upgrade. Can we look at seeing maybe two a year or one a year per hospital? What is the plan for future capital budgets? Thank you, Mr. Chair.
The Member is right; this is in the Inuvik Regional Hospital. We will be incorporating this into the Hay River Health Centre and also into the renovations that would be… We would plan it into the renovations of Stanton.
Mr. Chair, in terms of the other hospitals in the other communities such as Fort Simpson, Norman Wells and Fort Smith, once we see those seclusion rooms put into the capital budget to get those identified, because obviously this isn’t just a problem in Yellowknife, Hay River, and Inuvik, it is something that his happening right across the Northwest Territories. When can we see that in the capital budget plans? Thank you, Mr. Chair.
Mr. Chair, they are required in the health centres that are in the regional centres, we would likely see one. I don’t have the information. I would likely see one that would be incorporated into probably the health centre in Norman Wells, the health centre/long-term care centre. Also Fort Smith would have one included in the health centre there. The health centre in Hay River, as I indicated earlier, and likely Fort Simpson as well. Again, I don’t have the information on the Fort Simpson one here also.
It is a room that is used for emergency situations and people that can possibly harm themselves. Right now there isn’t any in Inuvik and there might be multiple cases. For the larger centres, are we looking at doing possibly multiple rooms and not just a single room? Is that in the budget plans for future years as well?
Mr. Chair, based on the assessment, we determine what is needed. Generally there is usually one room needed, even if it is used frequently. There is only usually one room needed. If there is a need for a second room to be added for this use, then we would incorporate a second room into either a renovation or a new design, depending on the need.
