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.
Chair (1)
Graham Scott
Federal
Government (2)
(HC and STC)
Yukon
And
B.C.
Government
Regional (5)
Nominations
Non-Government
Regional (5)
Nominations
National
Non-Government
At Large (2)
Chair,
CPHI Council (1)
Atlantic
N.W.T.,
Nunavut
and
Prairies
Quebec
Ontario
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
Health Indicator Framework
Health Status
Health
Conditions
Well-being
Human Function
Deaths
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
Equity
Determinants of Health
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
P
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 Participants
Public 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 Participants
Payor/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 – 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
Next Steps
 NeCST HL7 Generic Claims, Pharmacy, ChiroPhysio & 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
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
What We Do: Data Holdings
Returning to Hospital
Hysterectomy
1.0%
Prostatectomy
2.5%
Asthma
6.4%
Heart attack
7.3%
0%
2%
4%
Readmission Rate
6%
8%
What We Do: Data Holdings
Patients Waiting for Transplantation, Canada, 1991-2002
4,500
4,000
3,800
3,964
3,956
2000
2001
2002
3,514
3,229
3,500
2,829
2,592
3,000
2,500
2,874
2,150
2,159
2,000
1,500
1,000
500
0
1993
1994
1995
1996
1997
1998
Source: Preliminary Statistics on Organ Donation,
Transplantation and Waiting List 2003 CORR Preliminary Report
1999
Cadaveric organ donors, Canada,
1992–1999 (Number)1
500
409
407
1993
1994
437
420
429
1996
1997
415
421
1998
1999
475
400
Number
330
300
200
100
0
1992
1 Only
1995
cadaveric donors originating in Canada with a least one solid organ
used for transplant are considered
2000
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 % with Signs
more severe
of Mild or
Cognitive
more severe
Impairment
Depression
Average
MDS-ADL
Long Score
Average
CMI
1997–1998
50.8
13.3
10.4
0.98
1998–1999
55.8
13.7
11.8
1.00
1999–2000
55.4
17.9
12.3
1.06
2000–2001
55.5
16.5
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
Physicians
Other
Professionals
Drugs
$14.5; 11.9%
$19.6; 16.2%
$15.6; 12.9%
Capital
Other
Institutions
$5.6; 4.6%
$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
Public and Private Shares of Total Health
Expenditure, by Use of Funds, Canada, 2003
(% )
100%
99%
92%
91%
73%
80%
62%
Public Sector Share
60%
Private Sector Share
40%
20%
79%
78%
38%
27%
22%
8%
21%
9%
1%
0%
Hospitals
Other
Physicians
Institutions
Source: Canadian Institute for Health information
Other
Professionals
Drugs
Capital
Other
Health
Spending
Total Provincial/Territorial Government Health
Expenditure Per Capita, Age-Sex
Standardized versus Actual, by
Province/Territory and Canada, 2001
$8,000
$7,000
$6,000
Actual
Standardized
Canada Average
$5,000
$4,000
$3,000
$2,000
$1,000
Source: Canadian Institute for Health Information, Statistics Canada
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How Data are Used
Selected Examples
Sound Health Policy
Health
Summit ’99
Federal
 Romanow Commission
 Kirby Committee
 Parliamentary Standing
Committee on Health-Report
on organ and tissue donation
and transplantation
“It’s Time to Act”
Strategic
Health Plan
Ministry
Services
Clair Commission
STD
Plan
Mazankowski
Control
Bédard Committee
Report
Strategy
Fyke
Health Services
Report
Restructuring
Commission
Health Care
Report Card
Clinical Services
Steering Committee
Public Awareness
Better health information for better health, e.g. :
– Maclean’s cover stories
– Extensive media coverage of fact-based reports—
part of the public debate
– Beyond today’s crisis: regions use indicators as
springboard for communicating with public
– FPT reporting
– Orientation of board
members and staff
– Annual report now a
university textbook
Pharmaceuticals
Drugs - The Information Needs
What we know
What we don’t know
•
Drug expenditure
continues to rise; this is not
just Canada
•
•
Prescribed drug
expenditure is driving the
increase in overall drug
expenditure
How does drug utilization
compare among Canadian
populations in terms of:
accessibility, appropriateness,
effectiveness, efficiency, safety?
•
Is drug spending optimal within
the continuum of care?
•
What strategies are most
effective in controlling costs
while ensuring high quality
patient care?
•
Level of drug spending,
growth rate and public
share vary across
jurisdictions
Total Health Expenditure by Use of
Funds, Canada, 2003
($' billions)
Other Health
Spending
$10.2; 8.4%
Other Institutions
$11.6; 9.5%
Other Professionals
$14.5; 11.9%
Public Health
& Administration
$7.9; 6.5%
Hospitals
$36.4; 30.0%
Capital
$5.6; 4.6%
Physicians
$15.6; 12.9%
Drugs (Retail)
$19.6; 16.2%
f: Forecast
Source: Canadian Institute for Health Information
Total Drug Expenditure Per
Capita in Canada, 2001
$197
$340
$140
$232
$60
$241
$134
$270
$444
$170
$332
$170
$234
$179
$264
$167
$166
$315
$321
$323
$180
$284
$200
$384
Public
$145
Private
$405
$164
$384
Source: Canadian Institute for Health Information
Preliminary Provincial/Territorial
Government Drug Expenditure Per Capita,
2003 and 2004
$300
2003
$267
2004
$234
$231
$218
$202
$192
$181
$200
$206
$185
$175
$172
$137
$91 $82
$100
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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
Plan Information Module
Provincial Plan
Data/Information
Formulary and Drug
Product Module
Population Module
Formulary
Population Data
Health Canada
Drug Product
Database
QUERY
&
ANALYSIS
Standardized Drug
Product Data
Statistics
Canada
Claims Module
Claims
Data
World Health
Organization
ATC/DDD
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