Brief to the Standing Senate Committee on Social Affairs,
Science and Technology
Thursday, January 30, 2014
John Wright, President and CEO
2
Brief to the Standing Senate Committee on Social Affairs, Science and Technology
Good morning,
On behalf of the Canadian Institute for Health Information, I would like to thank you for the
opportunity to appear before the Standing Senate Committee on Social Affairs, Science and
Technology.
For the last 20 years, CIHI has played a unique role in Canada’s health sector. As an
independent, not-for-profit organization that provides essential information on our health system
and the health of Canadians, our vision is simple: Better data. Better decisions. Healthier
Canadians.
We work in partnership with stakeholders to create and maintain a broad range of databases,
measurement tools and standards on health information. We produce reports on health care
services, population health, health spending and health human resources.
Of interest to this committee are CIHI’s data holdings related to a number of areas such as
prescription drugs, addictions, loss of effectiveness of antibiotics, drug shortages and counterfeit
drugs.
CIHI has produced analyses and public reports that inform and support work in these areas.
Here are a few highlights:
Prescription Drug Use
CIHI’s Data Holdings
CIHI holds data regarding prescription drug use in the National Prescription Drug Utilization
Information System (NPDUIS) Database.
The NPDUIS Database captures high-level trends in drug use over time and also allows
people’s drug use to be analyzed by measuring things such as the number and types of drugs
they are taking, how consistently they are taking these drugs and when they switch drugs.
CIHI’s Continuing Care Reporting System (CCRS) collects clinical data, including information on
prescription drug use, for seniors and other Canadians living in more than 1,100 long-term care
facilities.
CIHI’s Work
CIHI has produced a number of public reports and quality indicators on the safety of prescription
drug use, primarily among seniors. Topics that have been covered include potentially
inappropriate drug use, polypharmacy (meaning the use of a high number of drugs) and
hospitalizations related to adverse drug reactions.
The information from these reports has enhanced awareness of the issues and informed policy
changes and the introduction of new programs such as medication reviews. Comparative
information among the provinces also generates dialogue regarding differences and subsequent
sharing of best practices to address drug safety issues.
Key findings from these reports include the following:
3
Brief to the Standing Senate Committee on Social Affairs, Science and Technology

About 70% of seniors were taking five or more drugs, with nearly 10% taking 15 or more.

Seniors were five times more likely to be hospitalized because of an adverse drug
reaction than other Canadians.

Roughly 1 in 10 seniors was taking a drug considered to be potentially inappropriate
(based on the Beers list of drugs).

About one in three long-term care residents was taking anti-psychotic medication without
a diagnosis of psychosis.
Medication Errors
CIHI’s Data Holdings
CIHI collects information on medication errors that occur in hospitals and long-term care
facilities in the National System for Incident Reporting (NSIR). NSIR facilitates sharing and
learning from medication errors at local, regional and national levels. The information is used to
better understand the factors that lead to medication errors and identify potential system
improvement strategies.
CIHI’s Work
Medication error data that CIHI collects and shares helps support a better understanding of the
factors that lead to errors and the identification of system improvement strategies.
Examples of the impact at the national level include the following:

Sharing data with Health Canada supports its work related to the naming, packaging and
labelling of pharmaceuticals.

Sharing data with the Institute for Safe Medication Practices Canada supports its work in
creating awareness and identifying system improvement strategies.
Addiction
CIHI’s Data Holdings
CIHI collects information on prescription and illicit drug–related disorders through our Hospital
Mental Health Database (HMHDB) if drugs were a contributing factor to the hospitalization. CIHI
also collects clinical information on drug abuse among people in designated adult mental health
beds.
CIHI’s Work
CIHI examined the impact of combined mental illness and substance-related disorders on
hospitalization patterns across Canada. The results highlighted the higher use of hospital
services, in terms of both readmissions and days stayed, when individuals with mental illness
also had issues with substance use.
Key findings included the following:
4
Brief to the Standing Senate Committee on Social Affairs, Science and Technology

Canadians hospitalized with concurrent mental illness and substance use disorders
made up close to a third of all psychiatric inpatients in 2010–2011.

When compared with individuals hospitalized for psychotic disorders only, those with
comorbid substance use disorders were about 25% more likely to be readmitted within a
year of being discharged.
o In the year after initial discharge, they were expected to stay in hospital 19%
longer than individuals without comorbid substance use disorders.
Looking Ahead
Potential Future Use of Data
While CIHI’s current data holdings provide some information on the unintended consequences
of prescription drugs, there is the opportunity to do more.

Loss of Effectiveness of Antibiotics
Although we do not hold the detailed clinical information required to assess the
effectiveness of antibiotics, CIHI does capture data that could be used to track trends in
antibiotic use (primarily among seniors), to identify changes in the medications being
used and the length of antibiotic courses, or other signals that the effectiveness of
antibiotics may be changing. In some provinces, it would be possible to monitor
incidences of infection-related hospitalization among those taking antibiotics.

Drug Shortages
CIHI’s data could be used to track how many people may be affected by a drug
shortage. The data could also be used to study the effect of drug shortages on patient
treatment, such as how many patients switched to another drug and how many stopped
treatment altogether.

Counterfeit Drugs
Our data could be used to track trends in the use of drugs with counterfeiting issues,
such as identifying regions where there may be a particular concern.
CIHI continues to seek commitments from our provincial and national stakeholders to help put
this—and other valuable data—into action. Improving how we collect, standardize and share
data is key to reaching this goal.
Data Gaps
The quality, importance and impact of CIHI’s work on pharmaceuticals hinges on one factor:
better data. There are several gaps in our current drug data that—if filled—could allow us to
provide even more insight on the availability, use, safety and cost of drugs and their impact on
Canadians and our health system.
Examples of data gaps and CIHI’s work to address them include the following:

The NPDUIS Database holds limited data for younger Canadians due to the design of public
drug plans. There are also data gaps in the area of hospital drugs. Pan-Canadian data for all
drugs is required to provide a more comprehensive picture of drug use and safety.
5
Brief to the Standing Senate Committee on Social Affairs, Science and Technology

CIHI recently added B.C. data on drugs paid for out of pocket by patients or by private
insurers, in addition to public drug program data. CIHI has also done some preliminary work
on the feasibility of collecting this data from other provinces.

CIHI’s ongoing work on secondary use of data from the electronic health record (EHR) will
provide opportunities to further explore the use of data from drug information systems.

CIHI has done some preliminary work investigating the availability of chemotherapy drug
data across Canada.

We capture limited data on medication errors, and there are other gaps, such as radiation
oncology incidents and adverse drug reactions.

More information is needed on alcohol and illicit and prescription drug–related disorders and
services. Currently, the Canadian Centre on Substance Abuse collects limited data on
addiction treatment services in Canada. Enhancing this information would allow us to
examine clinical aspects and outcomes.
What’s Next
CIHI will continue to produce analyses on prescription drug use. We are currently working on a
comprehensive review of drug use among seniors in public drug programs. The study is
expected to be released in the spring and will include drug claims data for about 70% of seniors.
Thank you for the opportunity to present this information to you. Along with my colleague, I
would be pleased to answer any questions you may have.