EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
The question that I had on Friday was people with cancer have to go back and forth to the southern hospital and they usually travel by themselves without an escort because they don’t have a physical ailment, but they are under a lot of stress and anxiety.
I wonder if the minister’s department can consider whether they can be escorted by an individual.
I hope that came across succinctly. Thank you, Mr. Chairman.
Hon. Keith Peterson: Thank you, Mr. Chairman. I thank Mr. Enook for clarifying his question.
Mr. Chairman, it’s my understanding that, depending on the nature or severity of the illness or cancer, most patients would have a client escort.
Mr. Enook (interpretation): Thank you, Mr. Chairman. The purpose of my continued efforts to change this policy and the reason why I continue to push for change is the person whom I keep referring to was always travelling alone.
As a matter of fact, he was alone when his doctor advised him that his cancer was no longer treatable.
What I tried to keep highlighting was that this person, although still physically able to travel for his medical appointments, underwent tremendous mental stress, especially when he knew that he may get bad news.
If you have that type of foreboding about your health, I believe it is extremely challenging. God forbid that I ever have to experience that, but our people go through this type of ailment.
Due to the assessment of patients undergoing this situation suffering additional mental stress, even if the patient is physically able to travel, if they have cancer, the extenuating circumstances should be taken into consideration when reviewing the need for an escort for their travel. That is what I am pushing.
I certainly hope that makes it clearer. Thank you, Mr. Chairman.
I would like to thank Mr. Enook for the question and concern. Again, as I said, I think most patients would be entitled to an escort based on the severity of their ailment.
I don’t have the policy in front of me, but if an individual is medically incapacitated, has a physical condition of a nature that he is not able to travel unassisted, and the practitioner assists with that decision or recommendation, if the individual or the individual’s family wish, they can appeal the decision to the regional directors and that will be considered.
Mr. Enook (interpretation): Thank you, Mr. Chairman. I don’t know how to say it another way, but I’ll try to rephrase the question.
The person who has cancer and has to get checked out in the southern hospitals is under a lot of anxiety and doesn’t know what to expect. He or she has to go alone.
There is nothing in the government policy that states that they have to have an escort because they are able to walk and talk or perhaps they can carry their suitcase.
My question to the minister is: can you consider even if they don’t outwardly show symptoms, but they’re under a lot of anxiety and foreboding awaiting the response from the doctor when they travel south, and would that qualify them to get an escort under the policy as written?
Let me try to ask that question.
Hon. Keith Peterson: Thank you, Mr. Chairman. Under the recent Client Travel Policy review, the issue of a mandatory client escort did not come up during the review.
I appreciate Mr. Enook’s concern for the patient. We have many medical patients across Nunavut who have to travel south out of their communities for medical treatment and it is very stressful for them, but we also have boarding homes in all the major centres where people go for medical treatment. Those boarding homes assist with getting people to and from their medical appointments and from the airlines.
Again, as I indicated earlier, if an individual feels that they require a medical escort, there is an appeal provision within the Client Travel Policy.
Let me paraphrase it in this manner.
If I were to have cancer and prior to my medical travel south, even with no outwardly physical frailty, if I am able to walk and travel alone and if I were to try to voice my feelings concerning the tremendous mental stressful effect this would have, that I would want to have another person I can talk to or who can accompany me to the doctor’s appointment, someone I can trust, would that qualify me for an escort or can I even question whether I could qualify for an escort?
I certainly hope that this clarifies the issue I am trying to put across.
Hon. Keith Peterson: Thank you, Mr. Chairman. I don’t know if he would be approved. Again, there’s a practitioner, doctor, or nurse in the community who treats the patient and they make that recommendation.
Again, the Department of Health does all it can to ensure that the stress level on patients is reduced.
We have contracts in place with the boarding homes to ensure that people get to and from the hospitals. I know, once you check in to most hospitals, they ensure that you get to your appointments and to your treatment. I believe they will contact the boarding homes when it is time for you to be medically discharged.
That leaves me confused as to how to make this situation more understandable. I make my point very succinct and clear, at least in Inuktitut.
Mr. Chairman, let me see if I can word it this way. If an issue arises that is outside of the written policies of the government that applies to any patient who will go on medical travel and if their situation is such that it is not mentioned in the written policy or included for an escort qualification, can this be taken into consideration or can only those situations listed in the policy be considered?
I certainly hope that this clarifies my line of questioning.
I thank Mr. Enook for the question. Mr. Chairman, I’m not unsympathetic to what Mr. Enook is saying.
We all know that government policies and procedures govern how we do business. It’s based on consultations with people in the communities, medical practitioners, and standing committees. There are funding sources that we have to take into account.
As I stated earlier, there is the policy an individual practitioner recommends and if the patient is dissatisfied with the decision, there are appeal provisions that they can appeal, and that’s within the policy. A lot depends on the medical condition of the patient and that’s in the policy as well.
So it’s not a real detailed, finite list of what has to be ticked off, but if an individual can make a compelling appeal, then it will be considered carefully.
Let me try to share how I think I understand this matter. Whoever is going on medical travel and feels they require an escort for whatever reason can mention it to the decision-makers of their wish for an escort.
Do I understand that every patient has the right to request an escort if they’re going on medical travel, Mr. Chairman? Is that the case?
What I have been saying is that the health practitioner has to make that recommendation and if they’re dissatisfied with the recommendation and decision, then they can appeal. I apologize, Mr. Chairman, but the policies and procedures, like I said earlier, are with government and the funding where it’s in is to develop policies and they’re developed in collaboration with the funding agency, this being, I believe, the Government of Canada.
I don’t know what more I can say beyond that. If the practitioner recommends yes or no, then we go from there.
If the patient is dissatisfied, then they can appeal. It happens all the time.
Some people are happy with decisions and some people are unhappy.
Let me try to pose the question in this way: (interpretation ends) does a patient have a right to request an escort? Irregardless of the situation, does a patient have a right to ask to have an escort if going on medical?
Hon. Keith Peterson: Mr. Chairman, the patient can always ask the health practitioner, whether it’s a nurse or doctor.
Again, it’s the health practitioner who makes the recommendation.
Mr. Enook: Thank you, Mr. Chairman.
When a patient asks for or requests to travel with an escort, the patient has a right to ask, irregardless of whether it’s covered under a, b, c, d, e, f, g of the travel escort policy, or does it have to always be covered under one of those bullets?
Mr. Chairman, the requests still have to fall under the various categories within the policy so that it’s clear, transparent, and accountable.
Mr. Enook (interpretation): Thank you. (interpretation ends) I finally thank the minister for that answer because I’m finally starting to understand and appreciate the information, which leads me to my first questioning of four days ago on Friday and that was: is the department willing to add or able to put a new bullet under a new heading under what I have been talking about regarding cancer patients having to travel under tremendous stress without escorts?
As I mentioned earlier, the issue of a mandatory client escort was not an issue that came up or was recommended.
I think what Mr. Enook is referring to is covered under one of the areas in the policy.
Again, it’s the decision of the medical practitioner; they make the recommendation.
I think I want to move on, so if you can give me a chance to ask another question, (interpretation ends) Mr. Chairman.
Chairman (interpretation): If it’s under Directorate, it’s fine. Mr. Enook.
I have some questions in regard to billing.
Maybe it’s under some of the funding.
Can I proceed with my question?
I want to ask what I have seen and I have mentioned when I became MLA that I will be an observer of the government practices and to ensure the funding is properly used. Some of us should be in that situation.
It’s very expensive to buy medication. Regardless of what they are, it’s very expensive.
Do the government and their department have a category called “checks and balances” to ensure they’re not overcharged for medication that they purchased?
The reason being that after receiving medication, they are returned because they no longer use those certain pills.
How do we know that we pay for this medication that they sell to a third party?
Are we aware if things like these are going on? Do we just pay for medication which is no longer used?
If I understand Mr. Enook correctly, we follow the non-insured health benefits formulae for pricing for pharmaceuticals through the health purchase program.
I’m sorry, Mr. Enook, but your time has expired.
You will have an opportunity to ask questions later on.
At this time, Mr. Elliott can now ask questions.
Under H-4 and it’s also mentioned in the minister’s opening comments on page 2, I was wondering if the minister could elaborate on the development of an all-hazards health emergency plan.
As you can appreciate, Mr. Chairman, we have a lot of paper down here at this end of the table; briefing notes.
We’ve got to find all the stuff and it takes a little coordination.
The all-hazards management program, what we’re doing there is that is a program that coordinates with the emergency management program in Nunavut. We want to coordinate our health services with the overall emergency health programming in Nunavut in case there are issues; pandemic influenza planning; influenza outbreaks.
So we just want to be prepared as the health department across the territory.
How does his department work with CGS on creating these emergency management plans?
We are developing the all-hazards emergency management program on our own, but we’re part of the Territorial Emergency Response Committee and CGS is involved in that committee.
For each individual community, do the health centres come up with the plan that fits their community or is this like government-wide, produced within the department, and then passed down to each individual community?
We will be coordinating out of headquarters with our all-hazards emergency management program, but the health centres in each community will coordinate with the hamlets’ overall emergency response planning.
Does the minister’s department have copies of all the emergency plans for each of the communities in terms of whom the partners are within the hamlet’s emergency plan?
What I’m asking is I don’t see how the fit is. I know the Department of CGS has spent a lot of time and energy when communities came up with emergency plans, had stakeholders involved, were involving different agencies, the RCMP, search and rescue, and a lot of the volunteer organizations in the communities.
So there has been a lot of work done already. I think, a lot of times, we try to not duplicate services. I can see this probably has a spin towards health and emergency care, but I’m not seeing the fit in how they’re different or how they’re going to be done separately.
We talk all the time in the House about nurses, their roles, and how busy they are in the health centres.
Are we providing more work for them to do?
I believe that at the regional level, there are community emergency response plans and the health centres are part of the planning.
I believe it’s led by the Department of Community and Government Services. We have the territorial planning and we’re part of the Territorial Emergency Response Committee.
We’re developing our all-hazards management plan.
There’s a lot of coordination and people are involved. I can’t speak to specific committees, but it will probably involve nurses, doctors, and other medical practitioners. Obviously, we expect them to be involved in the event where we lose satellites or the power goes out in the communities so that everybody knows what their responses would be to the emergency.
I strongly agree that it’s better to be prepared with some of the huge accidents that we have seen across the territory. It’s nice when you have coordination and people know the roles. I see people falling over each other when they’re trying to help when they’re actually not helping because they’re getting in the way.
In terms of your priorities in the future for 2014-15, I see one of the priorities is actually to run some simulation exercises. I’m just wondering: what groups within the community will you ask to participate? Just for clarification, that’s on page 93 of the business plan.
The all-hazards management plan is specific to health and we’re currently working on scenarios that health centres and health departments across Nunavut would respond to under those different scenarios.
In regard to the interoperable electronic health records, on page 92 of the business plan for priorities for 2013-14, it talks about implementing the program in referral sites located in Ottawa, Edmonton, and Yellowknife.
I had asked questions in the past about this. As we start to expand out into using this type of technology, I think I have been given assurances by both Minister of CGS and his department that these records are kept and are confidential, and there is no fear of tampering with some of the safety measures that are put in there. I believe those were from questions that were raised during Committee of the Whole last year.
I’m just curious this year about what types of information is collected on patients.
What I’m getting at is I know that one of the things that came out of the Auditor General’s report was the idea of tracking different diseases and maybe coming up with plans.
I know that some of the responses from the Department of Health and Social Services were to better track either flu or different types of diseases that are happening across the territory, and then using that to come up with better figures as to how much money was going to be needed within the territory to provide services to clients.
So that gives you a bit of a background of why I’m asking the question. Maybe now if we could get an answer as to what types of information is the Department of Health collecting on individuals across the territory.
Hon. Keith Peterson: Thank you, Mr. Chairman. I thank Mr. Elliott for the question. It’s very fortunate that our assistant deputy minister is here today and she knows this program inside out.
I would like to redirect the question to her to respond to.
Ms. O’Connor.
Ms. O’Connor: Thank you, Mr. Chairman.
I’m happy to respond to the question. The work with the electronic health record is really a foundation piece for us to gain very accurate and timely information to be able to answer a lot of the questions about what are the services and treatments provided and being able to do this in a timely way.
So the information that we would be able to collect will be within the Nunavut system because with the referrals, doctors treating, and visits that people have, that information will be registered. Rather than on paper in a file put away, it will be in an electronic system that’s easy to aggregate and collect that data.
The question about the referrals to Ottawa means that the transfer of referrals around the appointments, setting up for people, and making travel arrangements can be more seamless and more quickly without duplication or delay.
Chairman: Thank you, Ms. O’Connor.
So in terms of some of the materials, there would be general information, social insurance numbers, health card numbers, that type of information, but you’re also saying things like our X-rays, maybe dental records, MRIs, and CT scans.
Ms. O’Connor: Thank you, Mr. Chairman. The information that’s in the electronic health record is an integrated comprehensive module that will track.
For each individual, you will know that your diagnostic tests like MRIs, CTs, whether they had been done in the south or what can be done in our own hospital, will be collected.
You do have individual health insurance numbers and you do not need individual patient information for gathering that information for planning purposes, although a doctor will have that information available to him when he may want to look at a patient’s record.
Chairman (interpretation): Thank you, Ms. O’Connor.
In terms of patient confidentiality, who has access to the information that could be personal to the individual? It’s mentioned here on page 92 of the business plan, the referral sites located in Ottawa, Edmonton, and Yellowknife.
Don’t get me wrong. I think it’s great that we can share the information, but if someone does not want their information shared, I’m just wondering: how many people have access to that information or what protocols are in place to ensure that it doesn’t get into the wrong hands?
With that, I would just sort of state that in the past, we have seen news stories in CBC about health records in different territories being faxed to other locations.
I honestly think that this might be a safer way to do it, but there have to be protocols in place to make sure that it is safe. I’m just curious to find out what those protocols are.
I think that for a technical answer to that, we would need to get back to you.
All I could say is that there has been considerable work through CGS and the health information system to ensure security of the flow of information and that there is security and who can access the information that is shared, where you’re making referrals to other specialists, then it is restricted to those people. There is a very technical way that these things are secured. There has been a lot of study over the years to ensure that.
We can get back to you on more technical information if you would like.
Yes, I would appreciate that information just to put my mind at ease.
I know we try to work as hard as we can for our constituents to make sure that all the information that’s out there could be held in the highest confidence.
At the same time, in terms of photographs or signing up for things on the Internet like Hotmail or Facebook or Twitter, you have to make an agreement or consent that your information is being shared.
I know that in Facebook, you click on “Like,” it comes up with a little page that says, “By clicking this, your information will be shared with X, Y, and Z,” and telling what the different departments or where it’s going to be shared.
Our information from Nunavut on an individual patient is going to be shared in different jurisdictions.
Are consent forms being signed by the patients so that they know where their information is going or are they told where it’s going when they’re going into the health centre or is it just sort of generic, when you accept your health care card, you are under this health care system and your records will be part of this system?
We have a fellow who is working very hard on this whole interoperable electronic health record system. He has done a tremendous amount of work.
If the members are concerned, at some point, we’re going to offer him to come in and give a briefing to the standing committee just to put everybody’s concerns at rest.
The way I understand the system to work is that no consent form is required. It’s implied consent when the patients present themselves at the health centres or the hospital.
Now, if there’s secondary information requested from other jurisdictions, then there would have to be a consent form signed and the patient would have to sign that release to use that information.
That does help. That’s good to know.
Again, sometimes I think, when we ask the questions as regular members, the idea is to have some information to put in our toolkit. When we go back home, when someone actually comes to us and says, “Ah, we just read on the newspaper” or “We saw that something is happening,” we would be able to pass on that information.
So it’s good to know that within the territory, if you go in, then it’s that way, and then they do sign consent when it goes to a third party.
In terms of the back-end of what I had asked earlier where, once the records are starting to be collected, is there going to be an analysis of the data that is collected in terms of tracking trends?
I know that one of the things that the Auditor General’s report had talked about in terms of the way that the Government of Nunavut, through the Department of Health and Social Services, spends its money, is sometimes we even had one of the former deputy ministers say in Committee of the Whole that the budget and money that comes from the federal government is not enough to do it.
So if we have the tracking mechanism in showing maybe increasing rates of diabetes or different trends that we’re finding within the territory, it might be a better way to leverage funding from the federal government. Now with Nutrition North and the federal government trying to change all people’s diets across the territory into eating whatever they want on the specific list of foods, is there a mechanism within this system to track different things like that?
Hon. Keith Peterson: Thank you, Mr. Chairman. I think Mr. Elliott asked an excellent question.
Gathering information in the health system is something that all jurisdictions across Canada are working really hard to do so that we can start to track trends in the health system.
We recognize that health care costs in all jurisdictions are increasing seems like exponentially across Canada.
We don’t believe that it’s sustainable, so all jurisdictions in Canada are tasked with finding ways to, the phrase they have been using in the last couple of years is, “bend” the cost curve, but to do that, you need information.
We’re hopeful that the electronic health records will be able to help us in that regard.
We have that initiative and we have some other little initiatives within the department. We have retained an individual who can help us gather that information.
If the member wishes, I can ask the deputy minister to provide some information while he’s here.
I think the lights come on in my head too.
Before I answer, I’ll just back up a little bit on Member Elliott’s line of questioning here.
The whole rollout of the electronic health record is also helping us to streamline our manual processes. A lot of the processes in terms of work and workflow were never really documented. So this has actually forced us to document a lot of the processes in terms of the electronic health record.
Concurrently with the electronic health record, we have started a project this year that we’re calling for now anyways the health management information system project. The whole point of the electronic health record is to give us better information so that we can actually track and do some analysis in terms of what’s going on. We’re in the early days of this project.