Outline

• Who We Are

• Data Holdings

• Reports and Publications

• Drug Expenditures

• National Prescription Drug Utilization Information System

• Discussion/Questions

Our Mandate

• Serve as the national coordinating mechanism for a common approach to Canada’s 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.

YukonAndB.C.

N.W.T.,Nunavut

andPrairies

Ontario

Quebec

Atlantic

FederalGovernment (2)(HC and STC)

Chair (1)Graham Scott

GovernmentRegional (5)Nominations

Non-GovernmentRegional (5)Nominations

NationalNon-Government

At Large (2)

Chair, CPHI Council (1)

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

What We Do:Indicator 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

Eq

uit

y

Health Indicator Framework

Health Status

Well-beingHealth

ConditionsHuman Function Deaths

Determinants of Health

Health Behaviours

Living & Working

Conditions

Personal Resources

Environmental Factors

Health System Performance

Acceptability Accessibility Appropriateness Competence

Continuity Effectiveness Efficiency Safety

Community and Health System Characteristics

Community Health System Resources

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

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)

What We Do:Technical 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 PP

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.

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)

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)

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.

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)

NeCST – BenefitsProviders

• 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

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

Next Steps• Develop the NeCST Maintenance, Conformance &

Compliance Strategy

• Complete the NeCST Implementation Guide

• Update NeCST Message Specifications documentation resulting form Membership ballot

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

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

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

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

Health Expenditures

• National Health Expenditure Database

• Canadian MIS Database

• OECD Health Database (Canadian Segment)

• Medical Imaging Database

New Emphasis on Free Aggregate Data

New Emphasis on Free Aggregate Data

Selected data from several CIHI databases

Selected data from several CIHI databases

CIHI’s 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

Health Services

Returning to Hospital

7.3%

6.4%

2.5%

1.0%

0% 2% 4% 6% 8%

Heart attack

Asthma

Prostatectomy

Hysterectomy

Readmission Rate

What We Do: Data Holdings

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

3,9563,9643,800

3,5143,229

2,8742,8292,592

2,1592,150

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

475421415429420437

407409

330

0

100

200

300

400

500

1992 1993 1994 1995 1996 1997 1998 1999 2000

Nu

mb

er

1 Only cadaveric donors originating in Canada with a least one solid organ used for transplant are considered

Cadaveric organ donors, Canada, 1992–1999 (Number)1

Transplant Patient Survival, Cadaveric Organ, Canada, 1991 to 1999

1-yr 3-yr 5-yr

Kidney—Patient 95% 91% 86%

Kidney—Graft 86% 79% 72%

Liver—Patient 84% 79% 76%

Liver—Graft 79% 73% 69%

Functional outcome measurement: a key component of the NRS

Trends in OCCPS 1997–2002

Year

% with Mild or more severe

Cognitive Impairment

% with Signs of Mild or

more severe Depression

Average MDS-ADL

Long Score

AverageCMI

1997–1998 50.8 13.3 10.40.98

1998–1999 55.8 13.7 11.8 1.00

1999–2000 55.4 17.9 12.3 1.06

2000–2001 55.516.5 12.2 1.11

2001–2002 59.7 18.8 13.6 1.16

Health Resources

Total Health Expenditure by Use of Funds, Canada, 2003

Total Health Expenditure in 2003 = $121.4 Billion

Other Professionals

$14.5; 11.9%

Capital

$5.6; 4.6%

Public Health and Administration

$7.9; 6.5%

Other Health Spending

$10.2; 8.4%

Hospitals

$36.4; 30.0%

Other Institutions

$11.6; 9.5%

Physicians

$15.6; 12.9%

Drugs

$19.6; 16.2%

Source: Canadian Institute for Health information

92%

73%

99%

79%

91%

62%

21%

9%

38%

78%

27%

8%1%

22%

0%

20%

40%

60%

80%

100%

Hospitals OtherInstitutions

Physicians OtherProfes-sionals

Drugs Capital OtherHealth

Spending

Public Sector Share

Private Sector Share

( % )

Public and Private Shares of Total Health Expenditure, by Use of Funds, Canada, 2003

Source: Canadian Institute for Health information

Total Provincial/Territorial Government Health Expenditure Per Capita, Age-Sex

Standardized versus Actual, by Province/Territory and Canada, 2001

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

Actual Standardized Canada Average

Source: Canadian Institute for Health Information, Statistics Canada

How Data are Used

Selected Examples

Sound Health Policy

Federal Romanow Commission Kirby Committee Parliamentary Standing

Committee on Health-Report on organ and tissue donation and transplantation

StrategicHealth Plan

Clair Commission

Clinical Services Steering Committee

Health Services Restructuring Commission

Fyke Report

MazankowskiReport

“It’s Time to Act”

Health Summit ’99

Bédard Committee

MinistryServices

Plan STDControlStrategy

Health CareReport Card

Public Awareness

Better health information for better health, e.g. :– Maclean’s cover stories – Extensive media coverage of fact-based reports—

part of the public debate– Beyond today’s crisis: regions use indicators as

springboard for communicating with public– FPT reporting– Orientation of board

members and staff– Annual report now a

university textbook

Pharmaceuticals

Drugs - The Information Needs

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

What we don’t 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?

Total Health Expenditure by Use of Funds, Canada, 2003

Capital$5.6; 4.6%

Public Health & Administration

$7.9; 6.5%

Other Health Spending

$10.2; 8.4%

Hospitals$36.4; 30.0%

Physicians$15.6; 12.9%

Other Professionals$14.5; 11.9%

Other Institutions$11.6; 9.5%

Drugs (Retail)$19.6; 16.2%

($' billions)

f: ForecastSource: Canadian Institute for Health Information

Total Drug Expenditure Per Capita in Canada, 2001

Source: Canadian Institute for Health Information

$170

$332

$444

$140

$384

$164

$405

$145

$323

$234

$384

$200

$284

$180

$321

$166

$315

$167$264

$179

$241

$232

$170

$270

$340

$197

$134

$60

Private

Public

Preliminary Provincial/Territorial Government Drug Expenditure Per Capita, 2003 and 2004

$231

$82$91

$175$185

$206$192

$218

$267

$234

$172$181

$202

$137

$0

$100

$200

$300

N.L.

P.E.I.

N.S.

N.B.

Que

.O

nt.

Man

.

Sask.

Alta.

B.C.

Y.T.

N.W.T

Nun.

Canad

a

2003 2004

Source: Canadian Institute for Health Information

Sales of Patented and Non-patented Drugs in Canada

Source: Patented Medicine Prices Review Board, Annual Report, 2003

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?

Expenditures: The Tip of the Iceberg

• Base– Standards– Data systems

• Below the water– Claims level data

Start with what we have - populate over time

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

National Prescription Drug Utilization Information

System(NPDUIS)

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 Canada’s 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

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.

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

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

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 CIHI’s 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

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 CIHI’s 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

NPDUIS CONCEPT

Health Canada Drug Product

Database

World Health Organization

ATC/DDD

Formulary

Standardized Drug Product Data

Formulary and Drug Product Module

Population Data

Statistics Canada

Population Module

Provincial Plan Data/Information

Plan Information Module

Claims Data

Claims Module

QUERY &

ANALYSIS

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

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

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

Plan Information Module

• Provide longitudinal contextual and comparative information regarding public federal/provincial/territorial 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

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?

For more information,please visit our Web site at

www.cihi.ca