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Outline Who We Are Data Holdings Reports and Publications Drug Expenditures National Prescription Drug Utilization Information System Discussion/Questions.

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Presentation on theme: "Outline Who We Are Data Holdings Reports and Publications Drug Expenditures National Prescription Drug Utilization Information System Discussion/Questions."— Presentation transcript:

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2 Outline Who We Are Data Holdings Reports and Publications Drug Expenditures National Prescription Drug Utilization Information System Discussion/Questions

3 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.

4 Yukon And B.C. N.W.T., Nunavut and Prairies Ontario Quebec Atlantic Federal Government (2) (HC and STC) Chair (1) Graham Scott Government Regional (5) Nominations Non-Government Regional (5) Nominations National Non-Government At Large (2) Chair, CPHI Council (1)

5 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

6 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

7 Equity Health Indicator Framework Health Status Well-being Health Conditions Human FunctionDeaths Determinants of Health Health Behaviours Living & Working Conditions Personal Resources Environmental Factors Health System Performance AcceptabilityAccessibilityAppropriatenessCompetence ContinuityEffectivenessEfficiencySafety Community and Health System Characteristics CommunityHealth SystemResources

8 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

9 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)

10 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 P

11 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.

12 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)

13 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 )

14 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.

15 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)

16 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

17 Next Steps NeCST HL7 Generic Claims, Pharmacy, Chiro- Physio & Preferred Accommodation Messages have passed HL7 v3 membership ballot & are now HL7 ANSI approved standard (2004) Messages from the Vision Care, Oral Health & Physicians SIGs will be submitted for HL7 Membership level ballot (Dec 2004) Once membership level ballot is successfully completed, the NeCST messages will become HL7 ANSI Standard (2005) NeCST Message Specifications -NeCST v1.3 (May 31, 2004) posted to web and will be updated when remaining messages pass membership ballot

18 Next Steps Develop the NeCST Maintenance, Conformance & Compliance Strategy Complete the NeCST Implementation Guide Update NeCST Message Specifications documentation resulting form Membership ballot

19 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

20 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

21 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

22 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

23 Health Expenditures National Health Expenditure Database Canadian MIS Database OECD Health Database (Canadian Segment) Medical Imaging Database

24 New Emphasis on Free Aggregate Data

25 Selected data from several CIHI databases

26 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

27 Health Services

28 What We Do: Data Holdings

29 Patients Waiting for Transplantation, Canada, Source: Preliminary Statistics on Organ Donation, Transplantation and Waiting List 2003 CORR Preliminary Report

30 1 Only cadaveric donors originating in Canada with a least one solid organ used for transplant are considered Cadaveric organ donors, Canada, 1992–1999 (Number) 1

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

32 Functional outcome measurement: a key component of the NRS

33 Trends in OCCPS 1997–2002 Year % with Mild or more severe Cognitive Impairment % with Signs of Mild or more severe Depression Average MDS-ADL Long Score Average CMI 1997– – – – –

34 Health Resources

35 Total Health Expenditure by Use of Funds, Canada, 2003 Total Health Expenditure in 2003 = $121.4 Billion Other Professionals $14.5; 11.9% Capital $5.6; 4.6% Public Health and Administration $7.9; 6.5% Other Health Spending $10.2; 8.4% Hospitals $36.4; 30.0% Other Institutions $11.6; 9.5% Physicians $15.6; 12.9% Drugs $19.6; 16.2% Source: Canadian Institute for Health information

36 Public and Private Shares of Total Health Expenditure, by Use of Funds, Canada, 2003 Source: Canadian Institute for Health information

37 Total Provincial/Territorial Government Health Expenditure Per Capita, Age-Sex Standardized versus Actual, by Province/Territory and Canada, 2001 Source: Canadian Institute for Health Information, Statistics Canada

38 How Data are Used Selected Examples

39 Sound Health Policy Federal  Romanow Commission  Kirby Committee  Parliamentary Standing Committee on Health-Report on organ and tissue donation and transplantation Strategic Health Plan Clair Commission Clinical Services Steering Committee Health Services Restructuring Commission Fyke Report Mazankowski Report “It’s Time to Act” Health Summit ’99 Bédard Committee Ministry Services Plan STD Control Strategy Health Care Report Card

40 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

41 Pharmaceuticals

42 Drugs - The Information Needs What we know Drug expenditure continues to rise; this is not just Canada Prescribed drug expenditure is driving the increase in overall drug expenditure Level of drug spending, growth rate and public share vary across jurisdictions What we don’t know How does drug utilization compare among Canadian populations in terms of: accessibility, appropriateness, effectiveness, efficiency, safety? Is drug spending optimal within the continuum of care? What strategies are most effective in controlling costs while ensuring high quality patient care?

43 Total Health Expenditure by Use of Funds, Canada, 2003

44 Total Drug Expenditure Per Capita in Canada, 2001 Source: Canadian Institute for Health Information

45 Preliminary Provincial/Territorial Government Drug Expenditure Per Capita, 2003 and 2004 Source: Canadian Institute for Health Information

46 Sales of Patented and Non-patented Drugs in Canada Source: Patented Medicine Prices Review Board, Annual Report, 2003

47 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?

48 Expenditures: The Tip of the Iceberg Base –Standards –Data systems Below the water –Claims level data Start with what we have - populate over time

49 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

50 National Prescription Drug Utilization Information System (NPDUIS)

51 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

52 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.

53 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

54 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

55 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

56 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

57 NPDUIS CONCEPT Health Canada Drug Product Database World Health Organization ATC/DDD Formulary Standardized Drug Product Data Formulary and Drug Product Module Population Data Statistics Canada Population Module Provincial Plan Data/Information Plan Information Module Claims Data Claims Module QUERY & ANALYSIS

58 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

59 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

60 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

61 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

62 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?

63 For more information, please visit our Web site at


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