Thursday 6 May 1993

Annual report, Provincial Auditor, 1992

Ministry of Health

Andrew Wyszkowski, consultant and leader, Kenora smart cards project

Brian Aitken, manager, smart cards project, systems development branch

Subcommittee report


*Chair / Président: Cordiano, Joseph (Lawrence L)

*Vice-Chair / Vice-Présidente: Poole, Dianne (Eglinton L)

Callahan, Robert V. (Brampton South/-Sud L)

Duignan, Noel (Halton North/-Nord ND)

*Farnan, Mike (Cambridge ND)

*Frankford, Robert (Scarborough East/-Est ND)

*Hayes, Pat (Essex-Kent ND)

*Marland, Margaret (Mississauga South/-Sud PC)

*Murphy, Tim (St George-St David L)

O'Connor, Larry (Durham-York ND)

Perruzza, Anthony (Downsview ND)

*Tilson, David (Dufferin-Peel PC)

*In attendance / présents

Substitutions present / Membres remplaçants présents:

Wessenger, Paul (Simcoe Centre ND) for Mr O'Connor

Winninger, David (London South/-Sud ND) for Mr Duignan

Also taking part / Autres participants et participantes:

Peters, Erik, Provincial Auditor

McCarter, James A., executive director, ministry and agency audits, Office of the Provincial Auditor

Clerk / Greffière: Manikel, Tannis

Staff / Personnel: Smith, Cynthia, director, Legislative Research Service


The committee met at 1015 in room 228.


The Chair (Mr Joseph Cordiano): Members of the standing committee on public accounts, we'll now be coming to order this morning. We have a few items before us on the agenda. We're going to deal with Mr Callahan's notice of motion. There are two of them. Does everyone have a copy of those notices? Yes? Do you have a copy of the notices of motion that were distributed by the clerk to be discussed this morning? Okay. Mr Murphy, would you like to move these notices of motion?

Mr David Winninger (London South): Excuse me, Mr Chair. Are we supposed to have copies of the notices of motion?

The Chair: Yes. The clerk has additional copies if you don't.

Mr Tim Murphy (St George-St David): I move that the Provincial Auditor conduct a follow-up audit to section 3.10 of the Provincial Auditor's 1992 annual report and that the scope of this follow-up audit include, but not be limited to, the unauthorized use of health registry cards.

Should I move both, Mr Chair?

The Chair: No, we're going to deal with them individually. But can I just suggest at this point -- it was indicated to me by the auditor that it should be amended to read as follows. Let me repeat it and indicate where the changes are to be made:

"That the Provincial Auditor conduct a follow-up audit to section 3.10 of the Provincial Auditor's 1992 annual report and that the scope of this follow-up audit include, but not be limited to, reviewing the procedures used by the ministry to eliminate the unauthorized use of health registry cards."

The auditor has indicated that that would conform more to the reality of the situation. That is to say that it would be very difficult, you'd be hard pressed to actually go out and investigate individuals. I think that would reflect more the case, for the audit to review procedures that are used by the ministry rather than to put the onus on the auditor to review individuals who might have these unauthorized cards. Does everyone follow?

Mr Mike Farnan (Cambridge): Could you repeat that? "Reviewing the procedures used by the ministry to" --

Mr Erik Peters: Eliminate.

The Chair: "To eliminate the unauthorized use of health registry cards." I need someone to move that amendment.

Mr Murphy: That seems to be a friendly amendment.

The Chair: Would you like to move that, Mr Murphy?

Mr Murphy: I accept that as a friendly amendment. I guess someone has to move it, so I'll move it.

The Chair: I'm sorry; we need another member to move the amendment to your motion.

Mr Murphy: How about I withdraw my original motion and I will move an amended motion?

The Chair: That's better, yes.

Mr Murphy: So you have the wording, Mr Chair.

The Chair: I've got it all straight here. It would read as follows, your new motion:

"That the Provincial Auditor conduct a follow-up audit to section 3.10 of the Provincial Auditor's 1992 annual report and that the scope of this follow-up audit include, but not be limited to, reviewing the procedures used by the ministry to eliminate the unauthorized use of health registry cards."

Mr Murphy: Can we make it "the Ministry of Health"?

The Chair: Okay, any discussion?

Mr Murphy: I so move.

Mr David Tilson (Dufferin-Peel): A question to Mr Peters: Did Mr Decter provide you or the Chair of the committee or the clerk of the committee with all of the undertakings that he agreed to when he appeared on this topic?

Mr Peters: Not yet.

Mr Tilson: Not yet? I guess he's too busy.

Mr Peters: I understand there may be something out. I read in the papers that some report is out on this issue, but I haven't seen it.

Mr Tilson: Well, he gave us a substantial number of undertakings when he appeared before us in -- when? I lose track of time.

Mr Peters: It was February some time.

Mr Tilson: February. Obviously I'm concerned about that. Has he given us anything that he undertook to give us?

Mr Peters: Do you know?

Mr James McCarter: I was here at that time. I can't really recollect that there is a specific list of undertakings that he did indicate. I'd have to go back and look. But to date, we haven't had any update on the information vis-à-vis eligibility and where things stand as far as statistics are concerned.


The Chair: Can I just add that the clerk indicates we have not received anything formally to the committee.

Mr Tilson: They would come to the Chair as opposed to Mr Peters, would they, these undertakings?

The Chair: Yes, through the clerk.

Mr Tilson: I leave it in your capable hands, Mr Chair. The deputy minister undertook a number of months ago to provide us with information. The auditor will need it if this motion carries. Notwithstanding whether it carries or not, he undertook to this committee to give it to us. So I support the motion. I don't really have any comments to add, but I am concerned that Mr Decter -- I know he's busy, but that doesn't matter; he still could get this information to the committee. I think the members of the committee need this information, as does the auditor.

The Chair: I think it's a fairly straightforward matter; that is to say, we would follow up. That request is outstanding, and I could simply get the clerk to follow up with a letter to Mr Decter requesting that the information be made available as soon as possible, do a follow-up on that basis.

Mr Peters: May I help you with one brief point? One of the items mentioned was an experiment with a smart card in the Fort Frances area. I, somewhere among the many papers I received, just last week saw a note that the draft report is expected about now, the end of April or early May.

Mr Tilson: That was in your paperwork that research gave us. I saw that.

Mr Peters: That's right. That's the one indication that I have of a delivery date of a document.

Mr Tilson: Actually, it should be here by now. It was the end of April.

Mr Tilson: Yes, the date is now.

The Chair: Any further discussion on the motion before us? If there isn't, then is the motion carried, the motion I just read into the record? Mr Farnan, you have --

Mr Farnan: I was signalling support for the motion.

The Chair: So I gather there is unanimous consent for this motion.

Mr Robert Frankford (Scarborough East): Can we ask that the motion be stood down until next week?

Mr Tilson: Stood down until next week? We'll give you 20 minutes, tops.

Mr Winninger: You're dealing with the section 17 special audit now or section 3.10?

Mr Peters: Section 3.10.

Mr Winninger: We can agree to the section 17 special audit today. We're asking that the section 3.10 special audit be deferred until the next committee meeting.

The Chair: That's certainly something you may wish to undertake. You can do that, if you would like to like to defer the motion.

Mr Farnan: I'm being persuaded very much by my colleague, and certainly I don't think a week --

Mr Tilson: That was easy.

Mr Farnan: -- will put anything askew. I think, in a spirit of collegiality, we can agree that we'll deal with this next week.

The Chair: Okay, then the matter will be deferred until next week.

Could I call on the second motion to be moved by Mr Murphy.

Mr Murphy: I move that the Provincial Auditor --

Mr Tilson: Before we leave that, Mr Chairman, is there any reason why we're deferring this till next week? This has been in the material. It's not as if it's been --

Mr Winninger: Because we don't want to vote it down today.

Mr Tilson: I know you can vote on whatever you want to do --


The Chair: Order, Mr Tilson has the floor.

Mr Farnan: The member asked a good question: Why next week? In reality, this is something I want to give serious consideration to. I have a sense that I will support it, but I want to weigh the issue a little more carefully and I think by next week I'll be in a position to do that. I'm asking the indulgence of my good friend and colleague. If he can postpone this for seven days, I'd be very grateful.

Mr Murphy: I think we can agree, provided you agree to vote yes next week.

Mr Farnan: There's a good negotiator.

The Chair: I suppose, then, there's agreement to defer.

Mr Tilson: No, there's no agreement to defer, but they've got three votes and we've got two over here. There's no agreement.

The Chair: Well, there are negotiations that are ongoing.

Shall we move to the second notice of motion?

Mr Murphy: Yes. I move that the Provincial Auditor be directed to conduct a special audit pursuant to section 17 of the Audit Act, to assess the effectiveness of collection procedures with reference to the quality of information and the timeliness with which it is turned over to the central collection services of the Ministry of Government Services.

The Chair: Mr Murphy moves this motion. Is there any further discussion on the matter? No discussion. Shall the motion carry? Carried.

One out of two isn't bad. I would just point out, on the first motion, that this was in fact discussed by the subcommittee as an agenda item to be dealt with today. Just to add some reason behind having to deal with this motion today, it was determined at the last subcommittee meeting that we would be dealing with this.

Mr Farnan: I would apologize to my opposition colleagues. The fact is and the truth is that we haven't had an opportunity to sit down with our member on the subcommittee and be briefed on that. When that briefing takes place, then we'll be able to look at it again.

The Chair: Fine. So we'll deal with it next week.

Before we move to the second item as noted on the agenda, perhaps we could deal with our budget. There's a proposed budget that the clerk has prepared, and I've just been informed by the clerk that there's a revised budget on your desks. Does everyone have a copy of that? Very good.

The clerk also informs me, very wisely, that there are two budgets, one for the conference which will be held in July and of course our Canadian Council of Public Accounts Committees. Does everyone have a copy of that?

Mr Tilson: Which budget do you want us to look at?

The Chair: We're looking at both. I just want to make sure you have both, a copy of each. Is there any discussion on the budget?

Mr Murphy: Maybe the clerk would know: What was spent last year by the committee?

The Chair: We don't have those figures with us, but the clerk tells me she can make those available at the next meeting.

Mr Murphy: Is there is a sense of whether it was anywhere near the amount budgeted for this year? Less? More? Substantially less? Substantially more?

The Chair: I believe this figure is less than last year's because there is --

Mr Murphy: Less than budget or less than actual?

The Chair: There are travel expenses in this budget and the committee probably will not travel. There was in last year's budget and we didn't travel. So this represents probably very close to what last year's was, right? Or is there a substantial difference?

Clerk of the Committee (Ms Tannis Manikel): The budget itself is very close to last year's budget. It's higher than what was expended last year because, to cover the possibility that the committee will travel, we have money in this budget to travel. Last year, the committee did not travel.

Mr Murphy: Do we have any reasonable expectation that the committee will travel this year?


The Chair: That always remains to be seen, Mr Murphy. If the Legislature demands that we travel somewhere, we will have to accommodate that, so we have to include a travel allowance in the budget to prepare for that possibility, should that arise. Ms Poole, you had a question.

Ms Dianne Poole (Eglinton): Go ahead if you have a question.

Mr Murphy: Perhaps it can wait until after, but in the spirit of the times and the restraint, I'd like to propose a reduction in this budget. I gather if we need more money we can go and talk to the Board of Internal Economy on a special basis. I think we shouldn't budget just on the hope or the chance that something might happen; I think we have to reflect the spirit of the times. I'd like to propose a 15% reduction in this budget, and I also would like to make as part of that motion a suggestion that we ask the Board of Internal Economy if we can debate the issue in here of the elimination of the per diems.

The Chair: Can I make a suggestion that the subcommittee review this matter and report back to the committee, as we're running out of time this morning and there seems to be a disagreement on the amounts pertaining to the budget allocation. I would appreciate it if the subcommittee would have a review of this and then report back to the committee. Is that acceptable?

Mr Murphy: What I'd like to see, if that's going to happen, is what the actual expenditures were last year, what the actual budget was, and perhaps the year before as well, and then review this budget in view of the restraint that's being forced on every Ontarian. I think we have to reflect that restraint here. I'd also like to have the subcommittee consider the issue of talking to the Board of Internal Economy about the possible elimination of per diems.

The Chair: About what, sir?

Mr Murphy: About the possible elimination of per diems.

The Chair: Each of the caucuses has a representative on the Board of Internal Economy. It is in that spirit that these matters are discussed, through the representative of each caucus on the Board of Internal Economy. Of course, you can make that point here and I'm sure you will make it elsewhere, and each of us has our own views on these matters. It's certainly a matter that can be dealt with at the Board of Internal Economy, but I'm not sure it would be dealt with through the committee route.

I think, with respect to the budget, we can review the expenditures that are being proposed with that in mind. It's my feeling that these budgetary items and these amounts have been steadily declining, as there has been very little travel over the last three years on any committee that I've been a member of. So I think the amounts, you will see, have been reduced quite significantly.

Having said that, we can review each of the items, but I would like to do that in subcommittee, unless we defer this matter for the whole committee to review at some further date. But we do need to establish the budget.

Mr Murphy: Mr Chair, I'm prepared to have the subcommittee consider these issues, provided they come back with a report on actual expenditures and some sense of the reality of this budget. No insult intended to the clerk, but I would like to have the information in order to be able to assess it.

The Chair: I see this has generated some interest, so I'm going to start taking a list. Margaret was first. I'm sorry: It's Margaret Marland -- Mrs Marland.

Mrs Margaret Marland (Mississauga South): No, it's quite appropriate to say "Margaret." That is my name.

I apologize for being late, due to another responsibility. I realize I haven't heard very much of what Mr Murphy has been saying, but if he is proposing a reduction -- is he proposing just an arbitrary reduction in the budget?

Mr Murphy: The proposal was a 15% reduction in the budget. We had an absence, I gather, of information about what the actual expenditures were last year, and that information would be helpful to ascertain whether that number is an appropriate number. I wanted the issue raised so that we could discuss it.

Mrs Marland: I'm just wondering on what basis Mr Murphy would come in here and make a recommendation to arbitrarily reduce it by any percentage or arbitrarily increase it by any percentage. If you're going to make that kind of motion, Mr Chair, to make a reduction or an increase in the budget, I think you've got to have done your homework and have some basis for that kind of motion. I say that with respect to Mr Murphy, but I don't think these budgets are drawn up in a superficial way by the clerk and the Chair, and I would like to know on what basis Mr Murphy is making that suggestion before we have the subcommittee spend a lot of time going into a lot of work about just reducing it.

You know, it's a very interesting thing that's happening here at Queen's Park. There's some -- well, I might as well say it as I see it. I think we are getting some political grandstanding going on by all three parties. I'm not attacking any one party, but we're getting political grandstanding on all three parties' parts and I'm wondering where we're going to end up.

If we end up saying that no committees will travel in this province, then I think we're shutting out anybody who lives outside of the greater Toronto area in terms of true, responsible representation by those members. If there is a matter before this committee that is of interest, concern, involvement, any number of areas, to people outside of the greater Toronto area, are we going to say to the public who live in Thunder Bay, which the leader of the Liberal Party represents, "You come down to Toronto and find out what's going on at Queen's Park"? Is that what our future representation is going to be? When we have pieces of legislation that --

The Chair: Mrs Marland, just let me interrupt you for a moment. I see I have just about every member on the committee on the list for speaking on this matter. I would like to point out to members of the committee that we have Mr Wyszkowski here to deal with the issue that was on the agenda. Now, we could continue to discuss this matter, but I say to members of the committee that we did have an agenda that was established and I think it would be wise for us to refer this to the subcommittee and then perhaps have a period of time at some point in the future on our agenda to discuss this in more detail.

Mr Murphy: I think, Mr Chair, I already indicated I was amenable to that suggestion as the mover of the motion, so I'm more than happy to have that occur so we can have the debate on the basis of sufficient information and proceed to go on that basis. I'd be happy to do that.

Mrs Marland: Well, can I just say --

The Chair: On this point, Mr Farnan?

Mr Farnan: On this point, Mr Chair. We've had comment from the Liberal and Conservatives. I would suggest that you take comment from the government member and then put it to the subcommittee, so we're all on the record.

The Chair: I'm going to do that. I don't mean to cut anybody off, but in the interests of saving some time --

Mrs Marland: I'll just finish, then.

The Chair: Could you just finish, and then I'll turn to Mr Farnan.

Mrs Marland: I'll just finish that I hope we will not lose sight of the responsibility of the committee and the purpose of the committee. As far as I'm concerned, when matters are referred to legislative committees, generally it's for public input, and when we decide that we can't afford to have any money in a budget to make that committee available to the public in the north, west and eastern parts of this province and that everything revolves around the greater Toronto area, then I think we are doing a disservice to the public because we're shutting them out from what is going on at Queen's Park. This is a public process, and in order for it to be available to the public, we have to be prepared to spend some money taking committee hearings, when necessary, to other parts of the province.

The Chair: I'm going to allow Mr Farnan to have a say and then Ms Poole and then we'll come back to Mr Murphy's original motion for discussion.

Mr Farnan: I would have thought, Mr Chair, that this would wrap up the debate, one comment from each section, without starting another round with Ms Poole, because it will just snowball. My advice at this stage --

Ms Poole: Mr Chair, I was the first one on the list, and the Chair heard --

Mr Farnan: But having said that, you must --

The Chair: Order, please. Can I just say this, please? I'm in the chair. I'm going to take a reasonable approach to the order of speakers on the list. I try to keep it balanced. I'm going to allow a round of discussion on this and then we're going to move on, if the committee wishes. If not, we can continue to discuss this and I'll continue to take speakers on that list. I think it's a reasonable approach to have the subcommittee look at this matter, but if members do not agree with me, we can continue to discuss the matter. Mr Farnan, would you please continue.


Mr Farnan: Mr Murphy raises the issue of restraint. Let me just say that I am delighted; I'm thrilled. It's novel to find a Liberal member of the assembly looking at the concept of restraint. It sort of gives me hope --

Mr Murphy: Your committee members voted against this motion in justice committee. I'm glad to see you're on side.

Mr Winninger: We supported your motion.

Mr Farnan: -- that the Premier's and the government's message is getting out.

The Chair: Order.

Mr Farnan: It strikes me almost as equivalent to St Paul on the road to Damascus: a great change of heart, a realization, a new vision and just a clarity of opening up that there is a world out there where restraint is a reality. I welcome Mr Murphy and the Liberal Party to the real world, the world my colleagues in the Conservative Party and ourselves have recognized for some time.

Mr Tilson: Don't drag us down.

Mr Murphy: I'm glad to see the NDP and Conservatives are aligned. It's a beautiful marriage; it really is.

Mr Farnan: Having said that, let me say that of course it is incumbent on all of us to be cost-effective, but Margaret makes a very good point: It's also incumbent upon us to do our job.

So, yes, budgets must be looked at very carefully. There must be every effort made to reduce any fat that is in the budget, but not to sacrifice the job we're here to do, and that is to listen to the public, the people of Ontario. That means not Toronto; it means all of Ontario.

So there is a balance that has to be drawn and, of course, this is precisely what this government is attempting to do: to be cost-effective, but to maintain services. So, yes, we would support some examination of the budget with an effort to reduce, while at the same time maintaining a quality level of service.

A little bit of personal advice to the member, Mr Murphy: If he has problems with the per diem, he personally does not have to apply to accept the per diem. This is something that is there; it's part of a member's remuneration. If, indeed, Mr Murphy has a problem with receiving that, donating that to a charity has been a case and some members have chosen that; it's an option for Mr Murphy.

The Chair: Ms Poole, you have the final say on this.

Ms Poole: First of all, I might say that the member for Cambridge has very conveniently --

Mr Farnan: Mr Chair, I don't understand. Are we going to -- my colleagues are going to want to debate this if you want to introduce another round.

Mr Winninger: We do have a majority on this committee.

The Chair: Order, please.

Mr Winninger: Why would we hear from two Liberal speakers, a Conservative and one government member?

The Chair: You're welcome to challenge the Chair's rule.

Mr Farnan: I move that we move on.

Mr Winninger: A round is one from each side, not two from one side and one from each of the others.

Ms Poole: He introduced the motion and we have one speaker from each side.

The Chair: Order, please. Ms Poole has the floor. If you would like to challenge my ruling, you can do that and I will step aside.

Mr Farnan: I'll move a motion that we move on with the business of the committee for this morning. We've heard from every group.

Mr Winninger: I second the motion.

The Chair: There's a motion on the floor we have to deal with. Does the motion carry?

Mrs Marland: Which motion?

The Chair: Mr Farnan moved that we end the business.

Ms Poole: Mr Chair, can he move a motion after you've recognized a speaker? Does he not have to have the floor, which he did not have?

The Chair: Ms Poole, there's a motion on the floor. We have to deal with the motion. The motion's moved, there's a vote; we have to take a vote. All in favour of Mr Farnan's motion? Those opposed? The motion carries.

Ms Poole: Point of order, Mr Chair: There has been misinformation put before the committee today. I have served on the public accounts committee for a total of three years, both in opposition and in government and have been Vice-Chair before, and I have never seen the public accounts committee go across the province in public hearings. That is not a function of the public accounts committee.

If committee members wish to discuss that as a separate topic, that is fine.

Mr Tilson: She's out of order, Mr Chairman.

Ms Poole: The travel referred to in this particular budget would be travel of the committee to seek information from experts in the field.

The Chair: Order. I'm going to call a five-minute recess to, I think, allow everyone to reflect on the issue at hand. We'll return in five minutes. Thank you very much. We're adjourned.

The committee recessed at 1046 and resumed at 1052.

The Chair: Order, members of the public accounts committee. I call members to order. We shall resume with this morning's meeting and continue with the matter before us on the agenda. I'd like to call on Mr Wyszkowski, who is here to help us understand the project on smart cards in Kenora. Welcome to the committee, Mr Wyszkowski. Would you like to introduce the person with you this morning.

Mr Andrew Wyszkowski: Yes. This is Brian Aitken. He's manager within the systems development branch of the Ministry of Health and he's the gentleman I work for on this project.

The Chair: Welcome to the committee.

Mr Tilson: Mr Aitken, what's your position with the Ministry of Health?

Mr Brian Aitken: I'm a project manager in the information systems division.

Mr Wyszkowski: Honourable members and ladies and gentlemen, it's my pleasure to be here to assist you in any way I can, and I'll be guided by the Chair as to how to respond.

The Chair: Thank you. If you want to make any statements or opening remarks or comment on anything before us, you can at this point.

Mr Wyszkowski: Let me very briefly simply introduce myself: Andrew Wyszkowski. I'm a management consultant specializing in informatics or the use of computer technology. I have more than 25 years of direct experience in systems design, software and hardware, and applications in various fields including health, finance and manufacturing.

I've been associated with the Ministry of Health on a variety of projects since the fall of 1989. I was involved in the initial development of this encounter card pilot concept and subsequently came back in the middle of 1992 to assist Brian Aitken in completing the pilot.

The pilot project was conceived in 1989 as one of a number of initiatives by the ministry to improve the information systems, the quality of information, throughout the health care segment. Over the years, due to various reasons -- funding was one of them, but other understandings of what were the priorities -- some of these activities were not followed through. So the pilot had a much more ambitious role initially as seen four years ago than ultimately was carried through.

The pilot was just ended at the end of February and I noted that some of the honourable members are interested in seeing the report. I will comment now that the report is a little late. I'm partly involved in it. There's another outside evaluator involved. So the ministry has not yet received the draft reports. Those should be there within the next week or two. I think the committee might expect to see something by the end of May.

The Chair: Anything further to add? If that concludes your remarks --

Mr Wyszkowski: Well, I know your interest is in the smart card, so I'd like the honourable members to sort of put forward the kind of questions you like. I'll respond to anything at all.

The Chair: Okay. I have Mr Frankford on the list first.

Mr Frankford: If I could perhaps ask for a bit of clarification first, Mr Chair, because in some ways I wonder why this committee has this particular witness. Isn't the mandate of the committee to be reviewing public accounts? This seems to have moved off on a bit of a tangent. If we're talking about smart cards, this is not something that is --

Mr Tilson: Are you kidding? The health card system is in a shambles.

The Chair: Order, please.

Mr Frankford: If I can respond to Mr Tilson's comment, are we to look at ways of improving the organization of the health care system, which interests me very greatly, or are we looking at smart cards? Are we discussing whether they're a good or a bad idea?

The Chair: Perhaps I can answer then and turn to the auditor as well. He would like to add some comment.

Mr Tilson: Mr Chairman, on a point of order: I know we've read the material. I still think it would be useful, before we get into specific questions, that Mr Wyszkowski give a brief presentation on what the smart card is and the pros and the cons. I know we've read the material, but I think it would just be helpful in his own words to tell us what his observations are on the smart card.

The Chair: We can certainly do that.

Mr Tilson: Before we get into questions.

The Chair: Absolutely. We can do that.

Mr Frankford: Could I have a response to my point first?

The Chair: Can I answer Mr Frankford's query and then move on to do just that?

Mrs Marland: Is it Dr Frankford and are you a physician or a PhD?

Mr Frankford: I'm a medical doctor in family practice.

Mrs Marland: And are you practising now?

Mr Frankford: No.

Mrs Marland: I was wondering whether he was coming from that background. That's all I wondered.

The Chair: I'm so glad we were able to straighten that out on the record. I'm going to continue calling you Mr Frankford, unless you wish for me to call you Dr Frankford.

Mr Frankford: As you wish. I'm used to being called Mr Frankford in my legislative role and I have no problem with that.

The Chair: Okay. Dr Frankford.

Mrs Marland: Who knows about OHIP billing, right?

The Chair: Can I just say this to that question? There really isn't a boundary in terms of what we can look at on this committee as long as it entails the expenditure of funds by the government and the efficacy of those expenditures. Really that's the mandate of this committee. So something like the smart card certainly falls within those boundaries, because it does entail the expenditure of funds to gain better efficiencies.

The auditor wanted to comment briefly on that.


Mr Peters: Just a very quick one too for the new members to get into a little bit of background, because some of the members were not here when we were discussing chapter 310 of my predecessor's report.

Just very quickly, the cards became an issue very simply that at the time of the OHIP numbers there were some 27 million cards outstanding for 10 million Ontarians and we dealt with the new health card issue. In the process of following up on the report, we found that again there are more cards issued already under the new system than there are Ontarians. One of the questions that arose in the committee is what steps are being taken to deal with this particular issue, and in response to that question, there was a response from the ministry advising that they had conducted an experiment with a new kind of card that did a lot of things, but among them might have also some bearing on the question as to how we cope with unauthorized cards that are out there. So I just wanted to put this on the table as part of the background and to answer your questions, to help you.

The Chair: Mr Tilson, your point of order, perhaps I could turn to Mr Wyszkowski. Would you further comment on the technology behind the smart card? I believe that's what was being asked of you by Mr Tilson.

Mr Frankford: Mr Chair, can I still have the floor?

The Chair: Dr Frankford.

Mr Frankford: Could I just ask that I continue to have the floor after this presentation?

Mr Tilson: Are you kidding? You wait your turn.

The Chair: Well, I'm going to take a list of speakers.

Mr Frankford: Well, I had the floor and I asked for clarification.

Mr Tilson: Well, you lost it.

Mr Frankford: No, I just --

The Chair: Order, please. When we entertain questions on the next sequence, I will rotate the order in terms of party caucuses and will proceed in that fashion. We have done so in the past and I wish to continue to do that, unless the members have difficulty with that. We're going to rotate questions. Is that fair? We have approximately an hour left and I'll try to divide the time up equally between the caucuses. Mr Wyszkowski.

Mr Wyszkowski: As the auditor pointed out, the issuance of a card gives the appearance of controlled access, so a card allows you to identify yourself to a health care provider and receive services.

But it's just a piece of plastic; in our case, we have a magnetic stripe on it which has some information, but it's not currently being used. So in terms of access control, people have wondered: How do we make it more secure? Technical people have devised a device such as this, which is a plastic card with a computer chip where that little gold spot is. The computer chip is a fully operational computer which can be programmed and it has built-in security features so that in this form on the card it demands information that will assure it that access is authorized. If it isn't, it has a means of shutting things off and, in the worst case, just causing a lockout so that the computer then becomes inoperable. That's one aspect of a controlled computer within a card which is a direct size, as our present health card.

Now, that's one reason that a smart card is used, but because there is a computer and there is storage on it, besides being able to retain personal information about you and me -- who I am and why I am entitled to use this card -- it has additional capacity to retain information. So, in view of the fact that the delivery of health care is very information-intensive and that all providers, besides securing your identification, need to know more about your history and recent occurrences, drug therapy etc, the possibility of recording some small, representative medical profile on the card is attractive.

The fact that this is a computer that has built-in security and can be made secure in various ways, such as requiring an input of a personal identifier number like on a bank card -- in fact, the smart cards can be used to store a photo of you on the card. A small amount of the space is stored for a photo so that when the card is activated a photo comes up and identifies you.

Other countries, for instance in Europe where smart cards are starting to be used, have a fingerprint option so that you use the card: You insert it into a reading device and you stick your finger into another reading device. That checks whether the fingerprint that it read out corresponds with the one that's on the card. It's a control mechanism, from that perspective.

In addition, because this is a computer access storage device, this idea of a personal portable health record which can be taken by a patient anywhere he or she goes, and the information shared among providers, again is attractive to people in the health care arena.

The idea of a card that quite accurately identifies you and also has your medical health record was attractive.

Since we're using plastic cards -- and we now have the magnetic stripe on the cards and that can be used -- the thought was that some time in the future, as the cycle of card usage progresses, a smart card could be employed to assist the quality of health care information by retaining a personal portable health record, as well as being a positive control device.

That's the basic interest in the technology. The technology is quite diversified. I mean by that there are a number of card manufacturers and they have different standards and different devices on them, so even though this looks like they're all the same, they're all slightly different. They require different card readers to read them, different support technology. This is still a developing field.

Some wags have identified the smart card as a technology in search of an application. However, because it has these control aspects and recording aspects associated with it, it has been an irresistible type of technology to look at. In 1990, the deputy ministers of health of Canada organized a conference on the personal portable health record in Winnipeg, and I was involved on behalf of Ontario in organizing it. One hundred people from various governments met to discuss these various issues and they all were quite interested in what a card could do.

Of course, there very quickly came questions: What are the costs of such a technology, and what about the standardization of data and confidentiality? What are the issues of retaining data, and would consumers be able to say no or yes etc? A lot of policy issues are behind that, and all governments are keenly interested, as well as, of course, the Ministry of Health in Ontario.

There is a need to understand this technology so that it doesn't creep up on the health care field and insinuate itself inappropriately, and that's part of the reason for conducting a pilot, to be able to understand some of the issues that are behind it.

I might just finish off by saying that at that 1990 symposium, which was for government planners only -- there were no outside vendors or private sector people represented; there were a number of medical practitioners involved and also pharmacists -- the fundamental underlying issue was that the health care field needs automation badly, and information has to be used more effectively and more efficiently and has to be shared and made more available, but one of the last things that needs to be done in the short term is to introduce a card. A lot of infrastructural work has yet to be done.

Again, the pilot itself was not looking at the technology, it wasn't saying, "Which card is the best card?" or "Which one runs better?" We were looking also at many of the infrastructural issues, compliance among consumers, how the health care professionals react to it, what are the issues involved with data standardization and so on.


The Chair: I'm going to allow a 10-minute round for each caucus. We shall start with the official opposition and move on to the third party and then the government.

Ms Poole: Mr Chair, perhaps you wouldn't mind just telling me when five minutes expires, because I think Mr Murphy also has some questions.

The Chair: Yes.

Ms Poole: When we were looking through the background information, there was a reference to a Green Shield project, which was in North Bay.

Mr Wyszkowski: Yes.

Ms Poole: Then there are other references to a Kenora pilot project.

Mr Wyszkowski: I think that the Kenora pilot is actually the Fort Frances pilot, which we conducted. Kenora is the seat for the district health council, which includes Fort Frances, but our pilot did not include Kenora.

Ms Poole: Okay, so there's a North Bay pilot project and then there's a Fort Frances pilot project.

Mr Wyszkowski: Yes.

Ms Poole: Could you tell us some of the differences in what those two pilot projects were looking at and in their conclusions.

Mr Wyszkowski: The North Bay pilot was a private sector initiative by Green Shield, and they were looking at improving the veterans' health care administration, so the pilot was conducted among veterans. There were 514 members enrolled. It included all the pharmacies in North Bay, which I believe were 16. The card at that time, because this was done in 1985-86, had a very small capacity; it could only retain a small amount of information. It was used to maintain a drug profile of each of the patients so that the pharmacist could read the card, see what drugs the patient was using and then be able to look out for drug interactions or advise them appropriately if there was any change of therapy suggested or not.

The findings of that particular pilot were that veterans are very disciplined people and they like to carry a card; they seldom were without it. They enjoyed having access to even a drug record. There was one not startling but intriguing finding, but it wasn't substantiated by clinical facts. There was an implication that with the use of the card and the knowledge of your drug therapy, there seemed to be a reduction in utilization of prescriptions, but that was very well qualified by the evaluators, who said that this appeared but there was nothing to be able to really prove it.

That pilot was conducted, as I said, by Green Shield in order for them to assess whether they could use such a card for some of their health plans, third-party drug plans.

Our pilot was started, as you know, in July 1992, and in November 1992 Green Shield started another pilot. This is called the Essex pilot. It's run in the Windsor area. It involves a group of 10,000 municipal employees, and it's again focused on the drug plan data. They're using a more modern, up-to-date card and they again are working towards determining whether they could use this to make their plan administration more effective and also save money by perhaps reduction in utilization.

Ms Poole: If I could just interrupt for one second, would either of these two particular projects you've been describing have used any type of identification mechanism on the smart card, either the photo that you mentioned or fingerprint or anything else?

Mr Wyszkowski: No.

Ms Poole: This was strictly to monitor the medication and prescription bills.

Mr Wyszkowski: That's right, but they are using protection. There's name, date of birth and the usual biographical information being used, but none of the more advanced types of techniques.

The Chair: Ms Poole, your five minutes are up.

Mr Murphy: I was wondering, how much information can you put on one of these smart cards? I'm thinking that obviously there's a use for monitoring drug use, with the possible application, I assume, to the use of drugs under the drug benefit plan, some medical profile, obviously the sort of information on the use-control aspect. Can all of these functions be accommodated on the one card?

Mr Wyszkowski: Yes. The card that we use in our tests is one of the most advanced. It has an 8,000-character storage capacity; that is, 8,000 letters, more or less. We use that. Using various coding schemes, we could put in quite a lot of information. Besides the biographical information, we were able to provide family history, up to 10 different incidents. We could store 20 medications. We could store a very large number of tests. We could indicate what tests were taken and when. We did not keep -- we didn't have the results, but it would be a pointer that yes, last week you had these and these tests. We stored blood type, allergies, drug interactions, and we could store up to 40 server interactions, or encounters, as we call them; hence the encounter card name. So we were able to pack in quite a lot.

Of course, it's not uncommon that you run a lot of encounters if you're quite ill. Then we had a scheme where the physician or provider could determine what rolls off the card and what stays on.

Mr Murphy: A couple of other questions: One is, can it, in that context, be used, for example, to monitor the frequency of going to different doctors for the same prescription?

Mr Wyszkowski: Yes, it could, of course. We had to set up a matrix of who could look at what, and that's certainly one of the important issues in any consideration of implementing on a broader scale. All the stakeholders, all the health care providers, would have to be involved. In our pilot, we had agreement that the doctors could look at anything, so any doctor could look at all the data on the card. We had comments from consumers who sometimes said, "I don't want that doctor to know that I'm going to this doctor," but in this case it's too bad. Of course, the pharmacist could look at drugs and drug allergies and sensitivities, and that's it. So I can say that, looking at a card, providers would be restricted to their compartments of information.

The Ministry of Health was not entitled to look at the card data itself. Appropriate card information, which would be the same as required for claims payments today, was collected at the workstation when the card was updated, and if the card was updated and permission was given by the patient to do so, then the abbreviated information for the Ministry of Health was collected and then sent over. Then we could look at that in the same way that we look now at claims.

Mr Murphy: Because you can carry a medical profile, I assume you have a sort of Medic Alert -- I guess that's a brand name, but that kind of function. I'm wondering, are there portable readers, for example, that emergency health care providers could have, and how much does that unit cost?

Mr Wyszkowski: This is a prototype. It's Canadian-made. It was made three years ago. It doesn't work, so I can't demonstrate it but --

Mr Murphy: I hope that's not a reflection on where it was made.

Mr Wyszkowski: -- it reads like this: You just stick it in and read it. I was told that this could be produced in large numbers for $200.

Mr Murphy: That's obviously portable. There are larger ones?

Mr Wyszkowski: Yes, there are larger, clunkier ones.

Mr Murphy: How much are those? Would that small reader be able to get all the information?

Mr Wyszkowski: This would be a little slow. It could get everything, but slowly, because it's got only a little screen for about 15 characters. The readers we used had a retail value of $1,500 each, but that was because it's old technology, and actually we didn't have to buy them, thanks to Toshiba; they lent them for the duration of the pilot.

The banks are doing a lot of smart-card testing and one company which produced about 400 card readers specially for the Royal Bank said it could make them for about $400 or $500 each. This is here in Canada again. So if you get larger volumes, the costs come down.


Mr Tilson: I'm just thinking of the irony that you're producing something that doesn't work, because that's the problem we've had, of course, with the existing system. That relates to my first question. How does one get a card? How would you propose that a resident or a citizen of Ontario get a card? Because the problem with the current health card system, as you know, is that the application was based on the existing OHIP numbers. The difficulty was that there was a tremendous number of illegal OHIP numbers out there. In fact, that's why the new health card system was created, to do away with the previous system that was not satisfactory. There were holes in the system. I guess that leads to my first question: How do you start this system?

Mr Wyszkowski: You might not like my answer, but let me qualify this because I'm the system and technology adviser to the ministry staff. As a consequence, I can't comment on the policy issues that are behind dealing with the system and the controls etc.

What I would say, though, is that when a system for distributing cards and personal identification would go into place with such a card, you have to provide a fair amount of information, and you also have to get a medical profile from your doctor. So the combination of tying those together with the appropriate procedures and safeguards would be a process which would be a little more time-consuming, but certainly far more effective in controlling the access.

Mr Tilson: I think that's been the problem with our whole health system. It's been too easy to have access to it. If you're going to get a card, any sort of card, you're going to have to proceed when there are very rigorous standards to get that card, and that's why this existing system has failed.

I guess that leads to the next question, and you have partially answered it by putting a finger on a machine or a photo image on the chip, and I understand these can do wonderful things but at great cost, perhaps. That leads to my second question: What happens if the card is lost or stolen or there is some fraudulent activity, if someone lends their card to their friend from England to use medical services here? How would the smart card do away with all that activity?

Mr Wyszkowski: Assuming that there is a system in place supporting it, it depends how smart the card is made. As I pointed out, it might have a photo or fingerprint and that would be very difficult to override. If it was based on only a personal identification number like a bank card, a four-digit number, and somebody passes it on, then it's feasible that at some health service centre that could provide access to inappropriate services.

However, it certainly would be no worse than having one of the fraudulent cards out there now. In terms of control, the controls would be much greater, and if the ministry felt such a system was effective and worthwhile, then by virtue of the commitment, the investment, it would also institute those rigorous procedures you're likely looking for.

Mr Tilson: In your comments on Mr Murphy's questions, the issue of confidentiality, obviously, with medical records is most crucial, and with this equipment -- I go back to the incident a year or so ago, and perhaps other members can assist me. I seem to recall there was a great problem with the registrar general where -- I can't remember whether it was birth certificates or some sort of certificates that came out of the registrar general's office -- there was a certain amount of illegal activity by staff. Subsequently, there were criminal charges laid, and I don't even know where those have gone.

On the issue of confidentiality, an individual's medical records now are going to go out of the doctor's office; they're going to be out of the doctor's office. Normally, today, they're in the doctor's office, albeit perhaps in a hospital, but that confidentiality is with the doctor.

With the smart card, as you speak of it, in your response to Mr Murphy's question as to how much you can put on these little chips, you can put an unbelievable amount of information on these chips. I guess the fear would be that a whole slew of people are now going to have access beyond the doctor, whether it be staff at the ministry, staff at OHIP, staff at the hospital, or who knows where this information's going to go.

In your pilot project, can you elaborate on that issue of confidentiality as to what some of your findings are?

Mr Wyszkowski: First of all, we had a two-card system: The patient had a red card and the doctor or any health care provider had a white card. Both cards had to be present in order for the patient card to be read. A card could only be read with an authorized provider card, and the provider card was secured by a personal identification number. A doctor or nurse or optometrist had to put in their card, put in their code at the appropriate work station and then be able to read and update the patient card.

Access to the portions of the patient card were maintained by the matrix of who's allowed where. In this case, we had a fairly simple list, 58 different providers, and they had different access possibilities of getting at the information, with the proviso that the physician have access to all the card, and that was the understanding we had with the pilot group.

Mr Tilson: What about the person at the other end, the group of people that has this master source of information? What about that issue of confidentiality?

Mr Wyszkowski: The way we arranged it was that the medical record is on the card and in the physician's office, in his or her computer. The ministry only got claims information, which was peeled off and sent in without the health number, so it was a transformed health number. It was an individual record but it couldn't be traced to an individual person, and it had some of the information in terms of what the service was, who the provider was, when it was done and what the diagnosis was.

There were 10 pieces of information that were sent for each encounter, but all the medical information was retained on here and in the physician's office, and the physician's office, of course, has the full record growing. This maintains a certain window on the record and it rolls over after a year or more; you know, things will roll over. It's a window on your current activity plus your family history and allergies and sensitivities.


Mr Tilson: I guess, sir, I have a little concern. I think I'm understanding what you're saying. Obviously, today the doctor has all the information.

Mr Wyszkowski: Yes.

Mr Tilson: But it just seems to me that the government, that terrible word "Big Brother," is now going to have more and more information about individuals. I understand your ways of protecting it, but I'm concerned about how foolproof those methods are, that someone can get access to the medical records of a great many people.

Mr Wyszkowski: Exactly, and of course there are other people who share the same concern. The privacy commissioner has these concerns. He has developed a report on the points that have to be maintained with respect to health cards and smart cards. That's one of the very important issues that would have to be well debated, well discussed, by a whole host of stakeholders before the ministry would consider such a system. It's not an immediate issue.

But let me return, just to reassure you, what's on this card is very difficult to read. As you know, it's not impossible to read but, at the very worst, if you get a card and some find a way of breaking in, you have only one card.

The Chair: I hate to interrupt, but we've run out of time for that question. We'll move on to Mr Frankford, who now has the floor.

Mr Frankford: First of all, I don't know if you're the right person to ask, but could I request that the committee get the budgets and the actual expenditures on the Fort Frances project to this date?

The Chair: We can certainly request that as a committee, if that's the committee's desire, yes.

Mr Frankford: I think if we're talking about the costs of cards, then that would be very useful, so I'd request that.

The Chair: We are to make that request. I don't know if the auditor can shed any light on that but --

Mr Peters: No, I can't. That's a good request.

The Chair: Okay, we can do that.

Mr Frankford: Secondly -- I would like to spend a long time on this because I have interest and experience in computers in health care -- it really seems to me that this is a solution in search of a problem. There are various aspects -- perhaps if I can just address Mr Tilson's last point about the confidentiality and the ministry having a big database. I believe that is what is happening right now, independent of the smart cards. The health cards, which have been established, I think potentially can do exactly that. The ministry has a database of all those encounters, so I don't really see that the card makes any difference to that per se.

If one is talking about individuals carrying around their records in an electronic form, let me suggest that there is a far easier way of doing it without investment in new technology which would be to -- I could give that to a patient on a three-and-a-half-inch floppy. Why not? This wouldn't require any new investment and it could be used on the computers which are being used in doctors' offices right now. It seems to me that this is very much driven by technology enthusiasts who see that one can miniaturize things, but why not look for something cheaper using commonplace technology?

The question is raised around who gets to read it. Well, there is an interesting debate about patient-held records, whether the patients should actually read their own records. I think this is well worth considering. I have not heard this discussed here.

Let me give you an example. As I understand, the capacity on the cards is really low. It sounds good but in some ways it's really very limited. Let me give you an example of something which is commonplace which is very important for health care which is the Ontario ante-natal record. It seems to me that this should be turned into an electronic form.

Mr Tilson: I'm sorry, the --

Mr Frankford: Ante-natal record. There is a standard form in which all the information, the basic patient's health information, family history, risk factors, blood group and record of each visit is put on to a paper form. I think that this would be extraordinary helpful, if this could be turned into an electronic form. It would be more legible, one could do studies, one could strip off the identifier and do some really useful epidemiological studies. I don't see that you even have the capacity of doing that on this one.

I'm still puzzled as to what is being achieved here. I've read the Green Shield study and I really don't see what has been achieved there. It really says it was acceptable to 500 veterans to carry a card around with it. So what? Maybe some of that is the Hawthorne effect where people feel better if they're being studied. It's not part of any sort of broader plan about health care reform that I can see.

This study was done several years ago. It is not something which has become standard procedure. So where is it going? I'm really afraid that we're dealing with something which is very attractive to administrators and consultants and people who are convinced that there are technological solutions, which I don't deny, but I think that there are also much more basic grass-roots technological solutions I've mentioned in one particular area. Then again, I'm really not quite clear why this committee is discussing this, much as I would love to discuss health care reform. Any comments?

Mr Wyszkowski: Just a few. One of them, of course, is that I think your concerns about finding the most effective cost and time-wise procedure is something that is pursued by many management people within a ministry. I'm here as one of those "techies, " right? So I'm focusing on a particular project and obviously I've been pursuing it in order to provide the best results there.

There will be people who will ask those questions, who will examine to see whether there are pros and cons. On a broader scale, across North America, across the world in fact, there's a lot of debate about it. As I did mention, there are people who view this as being a technology that wants to insinuate itself into the situation.

There are, however, some interesting side benefits because we do use the symbolic things as cards for identification and access control etc, so it has one aspect of access control. There are aspects of health care reform associated with it, which I'll just mention a few.

One is consumer empowerment. The fact that you create a personal portable health record and you then empower the consumer to say yes or no and interact with the health care system --

Mr Frankford: Yes, but the consumer cannot read it himself or herself.

Mr Wyszkowski: No, but, in the case of the pilot, we had view stations where people could go in and under the pilot conditions we had --

Mr Frankford: But you'd admit that a 3.5-inch floppy in ASCII can be --

Mr Wyszkowski: Of course, that's right. It presents other issues, control issues, but that's fine. You're quite right. Someone will be measuring these things, but because there is a strong enough pressure, not just caused by me -- that would be too flattering -- but by lots of people throughout the world for dealing with cards, then the responsible ministries and government agencies are looking at: What does it represent in terms of policy issues? What are the cost issues of course? Is it something that we need to go in?

In every jurisdiction there's legislation about personal information and other things. So in some jurisdictions a card would never work. In other jurisdictions a card will work beautifully, particularly in a dictatorial-type of environment. They love it. So throughout the world you have different agendas for it.

Now I will say quickly that it's picking up steam in Europe and peaceful democratic people like Austria, Sweden, Italy, Spain are going towards cards in spite of the issues that you've raised. I'm not saying they'll necessarily go, but there is reason to look at it and what the possible implications are. That's why we got involved in the pilot. There's no suggestion that we're going to go rushing off and doing it.


Mr Frankford: Let me get back to one of Mr Tilson's points about entering the data, a very valid point. It's easy for the people who plan this to say, "Okay, we'll just get doctors to enter everyone's history." I quite agree that is a major concern. I like using computers, but a standard practice could be 2,000 individuals. Am I going to have the time to do that? Again, why not do this using bread-and-butter microcomputers, PCs or Macs?

This is something which could be implemented in a gradual fashion. The medical organizations might encourage people to gradually get their data into it. I would think starting with prescriptions, which makes a lot of sense if one is going to have direct linkages from physicians to pharmacists, this could happen.

It almost seems we start off with the North Bay one, which is 600 people, and ostensibly somebody, I imagine, thinks that it worked. I don't think it did. Then you move to Fort Frances, which is a rather larger population, and then there's some belief that this is all just technological inevitability. In two more years you'll do Metro Toronto and then the entire province. I just do not see the practicality of doing this.

Have you worked out how you're going to pay doctors? This could be a wonderful windfall if every doctor gets paid for a visit to enter everyone's data.

Mr Wyszkowski: You obviously see into many of the issues that we wrestled with, yes.

Mr Tilson: Don't worry about it. Your government is going to do away with doctors.

The Chair: We have run out of time for that round of questioning. Are there any further questions? We do have a little bit of time left. Any more interest? Mr Tilson, do you have any more questions?

Mr Tilson: I don't, no.

The Chair: I'll take note of Ms Poole. I just want to see if there's another round that's needed, or we'll do it on an individual basis. Ms Poole, you can ask another question.

Mr Tilson: Just that I think the question about the cost is perhaps the most important question of all. I think we'd all be interested in seeing that report in due course.

Ms Poole: I'd like to follow up on some questions about identification of the holder of the card. Back when they did the audit in I think it was 1987, the problem was they had something like 25 participants on the claim files and the population of Ontario at that time was 10 million, so there was obviously a real necessity to get a new card system out.

But the card system that has been implemented has not carried, in my mind at least, sufficient identification to prevent selling of the cards, duplication of the cards and problems where the cards are so accessible that the control that needs to be there isn't there. The technology that you've been talking about would certainly appear to remedy that.

My questions are, you've mentioned two specific further things you could do for identification. One is a photo and one is fingerprints. The machines that you've developed, both the portable reader and the full-fledged reader, would they, for instance, be able to do a fingerprint match?

Mr Wyszkowski: No. They could do the photo thing, because a photo is just a digital thing that comes up on the screen. There are fingerprint-reading devices, but we didn't go into the whole range of security items. It remains an issue that can be checked out, but we used, as I mentioned, simply the personal information number by the physician. We even did away with the necessity of the patients having to put in their own PIN, recognizing that this is a very difficult thing for people to remember consistently and to manage well, especially on a short-term basis.

Ms Poole: I see the system that you've developed in the pilot projects as being extremely advantageous as far as being able to let doctors and pharmacists and clinics know the health history of the patients so that they can be properly prescribed and cut down on duplicate prescriptions and this type of thing. But I don't see that it's going to solve the other side of the problem, which is to control the expenditures and ensure that people aren't abusing and misusing the system. I wondered if you had investigated whether the technology is there to incorporate, for instance, the fingerprint-reading component to what you already have.

Mr Wyszkowski: The technology is there. We did not use it or investigate it. We are identifying that information for the decision-makers, both technical and policy, in terms of their own consideration.

Ms Poole: One final question: If you have any projected costs of what the difference would be, for instance, in utilizing the photo identification on the smart card as opposed to fingerprinting, judged on what's happened in other jurisdictions, if you could give us that type of information for the committee's use at the same time as you provide your project budgetary figures, I think that would be very helpful to us.

Mr Wyszkowski: We could make some ballpark estimates, yes.

Mr Tilson: About that question, I was interested in Dr Frankford's comments. It sounds like an awfully expensive procedure. I mean, add all this up. I imagine when we see your figures we're going to be shocked. Dr Frankford may be correct that it may be cost-prohibitive to do what you're trying to do.

Mr Wyszkowski: Yes.

Mr Tilson: Along with Mrs Poole, I don't know whether you're able to provide comparisons to other systems. It would be nice to have all this information on computer, but maybe it's cost-prohibitive, and the idea of a simple photo card that's renewed every year as far as identification is concerned -- I don't know whether you are able in your experiment to compare what you've been looking into to other programs and whether that would be able to be reduced to paper so that we could compare not only the issue of cost but the issue of effectiveness.

Mr Wyszkowski: We haven't done that specifically, but I'm sure that this is in the ministry's interest to be --

Mr Tilson: I'm sure it is too.

Mr Wyszkowski: -- able to see that before it even makes any serious consideration.

Mr Tilson: So you don't have anything yourself.

Mr Wyszkowski: No.

The Chair: The auditor has a few questions he would like to ask.

Mr Peters: I know your report is now coming out at the end of May, but can you presage for the sake of the committee basically which of the objectives you had set for this particular study were actually met and which were met successfully?

The second question that is still on my mind is because the entire question was raised really in connection with the eligibility of the person presenting the card for health services paid by the province of Ontario. Currently, we were pointing out to the ministry at the time that the current exposure is running potentially, using current figures, up to about half a billion dollars a year of ineligible use of health cards. Was there any benefit out of the study that may deal with this eligibility question?

Mr Wyszkowski: No. The eligibility issue was in fact not a specific objective of the pilot. It's there incidentally as part of the technology. But we were looking at the consumer compliance, the professional acceptance of the card and the collection of certain types of information beyond what claims information requires. We were looking at the type of enabling technology. In other words, how do we collect the information? Is it on line? Does every doctor have to do it directly? How do you collect it in a hospital? We wrestled with some of the options there and examined those.

The findings are more technical and procedural. I'd prefer to hold them for ministry management because I think it wouldn't add an awful lot for this committee. But I think Dr Frankford's comments are indicative of the kinds of issues that are there that we've examined, that we've run into ourselves. We can cite issues that develop.

The only point I could make is that this is not something that can happen rapidly, because even if the cost was very acceptable to everybody, which it won't be, the process is very dependent on the infrastructure and the involvement of all the stakeholders: consumers, health care providers, regulators and ministry.

It's a much bigger task, especially the data standardization. There are legal issues involved with what happens if pharmacies don't have the same drug number and there's a misinterpretation. There's a great variety of use of coding among practising physicians. Some use ICPC; some use the schedule of benefits; some use something else; others use the ICD-9. The whole coding issue is very, very important. It's going to take time.

Mr Peters: Just a second question: When you introduced yourself, you indicated that you were a consultant and that you had worked on organizing a conference of deputy ministers of Health across Canada in Winnipeg. Do you know of any other province that is addressing this question in some way?

Mr Wyszkowski: Yes. Quebec is running a two-year pilot, 10,000 cards in Chicoutimi, and it's being conducted by both the régie and Laval University. Theirs is a very interesting project, slightly different. We've been in touch, so they've picked up some of our ideas and they've skipped issues that we've already touched on and they're doing other things. That's the only province that's looking at it.

It might be interesting for you to note that in September when I met with representatives of all the provinces in Ottawa for a little meeting, Alberta is contemplating issuing a new plastic card. They weren't even sure they would put a magnetic stripe on it. They were just going to go with a card, a symbolic card, but they will put a stripe on it.

The Chair: I hate to end here. There's certainly a lot of interest in this area, but we do have to move on. I'd like to thank you this morning for attending and shedding some light on this area. I think we are scheduled to have some more meetings with regard to smart cards and the other technology that's available some time -- I think it's June 3 that's scheduled on our agenda. But I would like to thank you for appearing this morning.

To members of the committee before we move on -- Mr Tilson?

Mr Tilson: Just on that point, I think the meeting is scheduled for June 8, when a bank official is coming to talk about the bank cards --

The Chair: June 3.

Mr Tilson: -- and it would be useful, if it's at all possible, for the committee members to have a copy of this report. It may not be possible by that time.

The Chair: We'll certainly try to do that. Before we do move on, thank you, Mr Wyszkowski and Mr Aitken.


The Chair: To members of the committee, we need one more housekeeping matter. We have to review the subcommittee report, and I need a motion to approve the subcommittee report to the committee. Everyone have a copy of that?

Ms Poole: I don't think I do, Mr Chair. Do you have an additional copy?

The Chair: I believe we do. Yes, the clerk will make those available.

The subcommittee met last Thursday and we had come up with a draft agenda, which is also before you. Do I have a mover for that motion to accept and adopt the subcommittee report?

Mr Tilson: So moved.

The Chair: So moved, Mr Tilson. Carried? Carried.

Thank you, members of the committee.

We are adjourned until next Thursday. I would just like to also remind you that we're not meeting on the week of the 24th. That's constituency week. We're adjourned. Thank you.

The committee adjourned at 1154.