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20 février 2019
Comités permanents
Comptes publics
Sommaire de la réunion : 

Chambre d'Assemblée
Province House
1700 rue Granville
Halifax
 
Témoin/Ordre du jour :
Gestion et contrôle des technologies de l’information (TI) pour le secteur de la santé,
Rapport de décembre 2018 du vérificateur général, chapitre 1
 
Ministère de la Santé et du Mieux-être
Mme Denise Perret – Sous-ministre
 
Ministère des Services internes
M. Jeff Conrad – Sous-ministre
 
IWK Health Centre
Dr Krista Jangaard – Présidente et directrice générale
 
Régie de la santé de la Nouvelle-Écosse
Mme Janet Knox – Présidente et directrice générale
 

Sujet(s) à aborder: 

 

 

 

 

HANSARD

 

 

NOVA SCOTIA HOUSE OF ASSEMBLY

 

 

COMMITTEE

                                                               

ON

 

PUBLIC ACCOUNTS

 

 

Wednesday, February 20, 2019

 

Legislative Chamber

 

 

Management and Oversight of Health Sector Information Technology:

December 2018 Report of the Auditor General, Chapter 1

 

 

 

 

 

 

 

 

 

 

Printed and Published by Nova Scotia Hansard Reporting Services

 

 

Public Accounts Committee

 

Mr. Eddie Orrell (Chairman)

Mr. Gordon Wilson (Vice-Chairman)

Mr. Ben Jessome

Ms. Suzanne Lohnes-Croft

Mr. Brendan Maguire

Mr. Hugh MacKay

Mr. Tim Halman

Ms. Lisa Roberts

Ms. Susan Leblanc

 

[Mr. Gordon Wilson was replaced by Ms. Rafah DiCostanzo.]

[Mr. Brendan Maguire was replaced by Hon. Leo Glavine.]

[Mr. Tim Halman was replaced by Ms. Barbara Adams.]

 

 

 

 

In Attendance:

 

Ms. Kim Langille

Legislative Committee Clerk

 

Mr. Gordon Hebb

Chief Legislative Counsel

 

Mr. Andrew Atherton,

Assistant Auditor General

 

Ms. Ashley Richardson,

Audit Principal

 

 

WITNESSES

 

 

Department of Health and Wellness

Ms. Denise Perret,

Deputy Minister

Ms. Christine Grimm,

Senior Executive Director - Digital Health, Analytics and Privacy

 

 

Department of Internal Services

Mr. Jeff Conrad,

Deputy Minister

Ms. Sandra Cascadden.

Chief Information Officer

Mr. Chris Mitchell,

Chief Procurement Officer

 

 

Nova Scotia Health Authority

Ms. Janet Knox,

President and CEO

Mr. Allan Horsburgh,

Vice-President, Corporate Services and CFO

Mr. Tim Guest,

Vice-President, Health Services and Chief Nurse Executive

 

 

IWK Health Centre

Dr. Krista Jangaard,

President and CEO

 

 

 

 

 

 

 

 

 

 

 

HALIFAX, WEDNESDAY, FEBRUARY 20, 2019

 

STANDING COMMITTEE ON PUBLIC ACCOUNTS

 

9:00 A.M.

 

CHAIRMAN

Mr. Eddie Orrell

 

VICE-CHAIRMAN

Mr. Gordon Wilson

 

 

            MR. CHAIRMAN: Order please. I would like to call the meeting of the Public Accounts Committee to order. First, I remind everybody to put their cellphones on vibrate or silence. I will ask the committee members to introduce themselves, beginning with Ms. Leblanc.

 

            [The committee members introduced themselves.]

 

            MR. CHAIRMAN: On today’s agenda, we have witnesses with us to discuss Chapter 1 of the December 2018 Report of the Auditor General regarding management and oversight of health sector information technology. I will ask the witnesses to introduce themselves, beginning with Ms. Grimm.

 

            [The witnesses introduced themselves.]

 

            MR. CHAIRMAN: Thank you very much. I’ll ask the witnesses to have a brief opening statement, please. Ms. Perret.

 

            MS. DENISE PERRET: Thank you for the opportunity to discuss the work we’re doing in modernizing Nova Scotia’s information management and information technology environment, which we refer to as IMIT.

 

            The Auditor General has provided a report on IMIT that raises important questions and has provided us with some solid recommendations. All our four organizations agree with the recommendations made by the Auditor General and we’re working together to respond to them.

 

            You’ll see from the discussion we have today, I think it’s helpful to put this in the context of some of the province’s major restructuring initiatives. From 2014 to 2016, you have three initiatives that stand out. You’ve got the consolidation of the regional health authorities, you have the restructuring of the Department of Health and Wellness, and you have the passing of the Shared Services Act, which consolidated Health IMIT on an infrastructure basis in the Department of Internal Services and on a clinical services basis in the Nova Scotia Health Authority.

 

            These are really important shifts in the system. Typically, departments and public agencies operate within their organizational boundaries and they often operate in a hierarchal structure, but we’re increasingly seeing how technology disrupts these forms of systems. We’ve seen it in retail and transportation from Amazon to Uber, and it’s forcing us to work differently.

 

            The old forms of organizational silos are no longer an option in a modern system. So as we change the way we work, it’s valuable to have feedback - as we received from the audit that we’re discussing today - to make the kinds of course corrections that move us forward towards strengthened relationships and better results for patients and providers.

 

            We are fortunate that we have two ministers of our departments and two chairs of the health authorities who are focused on IMIT issues and who bring a tremendous amount of expertise and experience to the table. I can tell you that they have ongoing discussions in their formal and informal meetings on this topic. Their input and direction, along with the audit, led to the development of the organizational chart, which we handed out, and which we may refer to during the discussion this morning. It sets out the governance structure that we’re currently operating under and which will continue to evolve.

 

            Some parts of this structure have been in place for some time, while others have been informed by and responding to the audit. In brief, we’ve brought existing streams of activity together into a more comprehensive governance structure. This type of move-forward is one of the reasons we appreciate the Auditor General’s Report and have already benefited by the recommendations.

 

            In short, I appreciate the opportunity to be here to address your questions and we look forward to the discussion.

 

            MR. CHAIRMAN: Mr. Conrad.

 

            MR. JEFF CONRAD: Good morning, thank you for having us. As you have heard just a few minutes ago, I’m joined this morning by Sandra Cascadden, the ADM of Internal Services and CIO for the province; and by Chris Mitchell, the Chief Procurement Officer for the province.

 

            I just want to remind you that the Department of Internal Services was formed about five years ago to perform many of the corporate functions of government and a number of our partners. We provide a wide range of services, including financial transactions, procurement, insurance, business continuity management, a host of IT services, and we even house the Internal Audit Centre for the Government of Nova Scotia.

 

            When government made the decision to create the department and then to undertake a shared services initiative, it was an intentional effort to do a number of several related things. One was to allow our service delivery partners to focus on those things which are most important in delivering services that Nova Scotians depend on.

 

I think most of us would agree that what we want my colleagues from the two health authorities to spend their time and effort working on are critical health issues, not on how many people are working on the IT service desk today or whether they have a contract in place to buy new laptops, or even if the computer is going to work in pharmacy and ER today. Those things should be something they can take as a given and be just one more tool they depend on to ensure patient health and safety.

 

One of the other outcomes from shared services was for Internal Services to become an organization with a strong quality service perspective and an economy of scale and technical expertise that provides support our partners can depend on. This has been a transformative process as Denise talked about, with the Department of Internal Services gradually taking on more responsibility over the past five years and providing a wide range of services.

 

I appreciate the report from the Auditor General as it helped remind us of the importance of ensuring we have good, clear governance practice amongst these trusted partners. As you will hear this morning, we have shared many success stories amongst these partners across a range of fronts. For example, more than $150 million in projected procurement savings based on work done over the last four years across government and health authorities.

 

Great successes such as a new health storage area network that provides not only more secure storage for programs, but at a reduced cost of over $90,000 per year just in the calculation of utilities usage; a new experience when you enter the Dartmouth General Hospital reception area and take advantage of patient self-service kiosks and digital signage; and leveraging joint buying power by co-operating on how we buy and set up desktop and laptop computers. These are just a few examples.

 

The Department of Internal Services is on a journey of continuous improvement and reports such as the one from the Office of the Auditor General directly inform our processes. Our ability to adapt and improve our work in a highly dynamic environment has been acknowledged by the receipt of two IPAC innovation awards, an Excellence Canada certification, a National Procurement Award and an independent audit practice confirmation. We have been asked to share our expertise in shared services at a variety of professional conferences and forums both nationally and internationally. I look forward to the discussion this morning.

 

MR. CHAIRMAN: Ms. Knox.

 

MS. JANET KNOX: Good morning, thank you for the opportunity to be here this morning. As you’ve heard, I’m joined by my colleagues Tim Guest, our Vice President and chief nursing executive; and Allan Horsburgh, our Vice President of Corporate Services and Chief Financial Officer.

 

Better health data can lead to better patient outcomes, better patient care and better system performance. Information technology is a very important tool for our health care providers. It helps them have the information they need to provide care to Nova Scotians and the information we need to manage the health system effectively and efficiently. It is critical to the delivery of safe, high quality service delivery.

 

The present health IT landscape in Nova Scotia is a patchwork of applications and databases that have been implemented over many years by the separate organizations that preceded Nova Scotia Health Authority. Within Nova Scotia Health Authority alone, there are hundreds of clinical information systems supporting the delivery of direct patient care. They help patients be registered to our hospitals, clinics, get lab and diagnostic imaging results and ensure they get the right medication.

 

Many of these existing systems are old and costly to maintain, and equally importantly, lack the functionality that our clinicians need and want. They don’t talk to each other, which means it’s not always easy to access and share information needed for patient care for the planning and monitoring of our system.

 

So our goal as a system is a single, integrated health record for every Nova Scotian. While that’s still some time away, we are taking steps to modernize and integrate our existing health information systems, and we are working very closely with our partners in government to strengthen our management and oversight of these crucial systems.

 

For example, Nova Scotia Health Authority and the IWK have signed a service agreement to formalize the service relationship between our two organizations. We have been working to clarify roles and responsibilities and ensure that there are clear owners for each piece of information technology now and into the future. Our teams have done a lot of great work to better support front-line users - for example, there is now a major incident process for system downtime.

 

Risk management is an ongoing concern for the health sector, and we have a number of controls in place to identify and mitigate risks. An example: we have access and privacy controls to limit access to clinical information systems based on an individual’s scope of work. We also have auditing software so we can monitor who goes into that system and what they access while they are in there. It may be surprising for you to know that I have no access to patient information. I don’t need that to do the work that I do.

 

There are constantly evolving issues, so we work closely with government to ensure we are responding appropriately to protect our data through technology such as anti-virus software, firewalls, and operating systems updates. As referenced, we are working with our government partners to adopt COBIT 5 which is the industry best practice for IT governance and risk management. In the meantime, we continue to identify, evaluate, prioritize, and manage our information technology risks through our enterprise risk management system at Nova Scotia Health Authority.

 

            By modernizing and simplifying our information technology environment as we move to a more integrated health information system, we will help ensure the patient information is readily available to health care providers when and where it is needed. This will support the delivery of patient care and allow us to better plan, monitor, and improve system performance.

 

            MR. CHAIRMAN: Dr. Jangaard.

 

            DR. KRISTA JANGAARD: I would like to echo Janet’s remarks and tell the committee that the work we are doing together collaboratively, strengthening and modernizing our IT systems to better support our clinicians and health care workers to serve the patients and families we do is something we value greatly. As the IWK works with our partners that are seated with me here today, we reap the benefits of seeing the system as a whole, tackling our common issues together and planning the future with a shared vision. That vision will not only improve access and efficiency but will provide patients and families with what they want and need: a seamless system that sees them holistically throughout their health care journey, no matter where they are.

 

After over 25 years as a front-line physician, I understand the complexities of health care and the systems that support it. I also understand that there are no easy solutions sometimes when we have a complex patient, and we must take the time to analyze, diagnose, and develop a treatment approach that will ensure long-term health. The same can be said when we are approaching decisions for our health IT systems. Speed should not be the crux of how we approach things. We know that the best solutions often cannot be rushed but, if done properly, will stand the test of time. That is what Nova Scotians expect and deserve. We look forward to being here with you today and answering your questions.

 

            MR. CHAIRMAN: Thank you very much, everybody. Now we’ll open up the floor to questions, beginning with the PC caucus. Ms. Adams.

 

            MS. BARBARA ADAMS: I thank all of the guests for being here today. Last week at the Health Committee, we had an opportunity to speak about the accreditation report for the Nova Scotia Health Authority, so we’re back on familiar territory. I have a question, and I’ll leave it up to you to decide who’s going to answer the questions. 

 

The amalgamation of all of the district health authorities happened several years ago, and as Mr. Conrad said, the department of IT has been functioning for the past five years. I’m wondering at what point we stop referring to the fact that we were in a point of transition. These things happened at least four years ago. When we look at the Auditor General’s Report, how much of the issues that he identified are we maintaining were created because we were amalgamating nine districts versus that we just weren’t following the recommendations instinctively? 

 

The question is, for the past four years that the amalgamation has been over technically, how much of the issues that the Auditor General raised are because of amalgamation and therefore are done and over with, and we don’t have to keep referencing back to the fact that we were in a process of amalgamating?

 

            MS. PERRET: It’s a good question, and it’s a complicated question. I think in part, it’s important to keep in mind that what the auditor focused on, and I’ll refer you to the org chart, is the left side of the chart and some of the amalgamation that took place in the operation of the system with IM/IT. 

 

On the right side of the chart is what I would call the strategic health digital initiatives. Those are key policy initiatives, like One Person One Record, what we call OPOR; MyHealthNS; Panorama, which is a public health platform; and the Drug Information System. In part, where my answer is going is that it’s a very dynamic system. Technology in the health care space is evolving rapidly, and it offers tremendous opportunity. It’s also a very complex dynamic. In part, this is an evolution. It’s a transition that doesn’t stop at any one point.

 

            Our focus, certainly from the department - if you look at it as right side of the chart, policy; left side of the chart, operational - is a policy/operational divide. There may be members here who want to comment further, but I think on the operational side, the left-hand side, which is the focus of the audit, I think that the IMIT steering committee, which is a group of very senior officials in government, many of whom are here, would say that they are at cruising altitude. You’ve seen it in the report that we tabled on the action plan. A lot of that was close to completion, but this is going to be a process of continuous improvement.

 

[9:15 a.m.]

 

            MS. ADAMS: Thank you for that answer. Were any of the recommendations that the Auditor General made a surprise to any of you? Or were you aware of the problems all along?

 

            MR. CONRAD: I think what we would say in terms of the recommendations of the Auditor General is that many of those recommendations were, in fact, in progress. When you see a recommendation, for example, to complete the agreements that we have amongst ourselves, those agreements were in draft form and did exist, so we were working towards completion of those.

 

Again, we appreciate the recommendation of the Auditor General that perhaps they should have had a little more attention a little earlier in the process. But I think as some of the comments that have already been made, the importance of building these relationships, really understanding each other’s work and environment, getting to a stable point in terms of the ability to work together, maybe operationally - we had a little more focus on that side and didn’t spend the kind of time that would have been desired to finalize those reports.

 

Were we surprised that the auditor would look and see that we had relationship management documents in progress and suggest that we should finish those as we were on track to do? That wouldn’t have been a surprise to us. That was certainly work that we had already started.

 

            MS. ADAMS: On Page 9 of the report, for those who don’t have the luxury of having read the Auditor General Report, one of the first comments is that the Department of Health and Wellness is not effectively leading IT in the health sector. It says, “The Department of Health and Wellness has not provided the level of leadership and direction required to effectively transition the health sector to centralized information technology services.”

 

I leave this open to who wants to answer it: What’s the explanation for the lack of leadership and direction? That’s not a document that was about to be finished. What’s the explanation for the lack of leadership and direction from the Department of Health and Wellness in effectively transitioning the health sector to centralized information technology services? What are you planning on doing to address and remedy the information that was missing in terms of the oversight?

 

            MS. PERRET: Again, please have reference to the organization chart. The audit is commenting on the operational side of the equation.

 

I think it’s a fair comment that in Health and Wellness, when we went into a shared services environment, many of our digital health resources went over to the Department of Internal Services, and we did pay less attention on the operational side. The agreements that are in play being finalized largely driven by Internal Services and the Health Authority are under the purview of the steering committee, which Ms. Grimm sits on and some of our staff. Our focus has been primarily on the strategic digital technology side, which is the right-hand side of the chart.

 

Where the audit didn’t comment - and I think we have to be careful not to take the comments in the audit to an overly broad point - is that the health IMIT governance committee that you’ll see on your chart and the right-hand side of the chart has been in effect for several years and has been meeting.

 

What the direction is to the health committee, and the comment is made on Page 10, Paragraph 1.6, the auditor says, “The recommendations throughout this chapter are directed at the entities responsible to act; however, Health and Wellness must provide more leadership . . .” What we have appreciated from this report is that we needed to join the operational side and the policy side under the one governance structure, and that’s what we have done.

 

 In short, I don’t want you to have the impression that there was no governance structure or governance activities. We were focused on strategic priorities. We have the operational side focused on operations, and we’ve brought those two together.

 

            MS. ADAMS: The first recommendation is about having the signed agreement related to information technology, including the roles and accountability for each entity between the Department of Health and Wellness and Internal Services. Somebody referenced, I think at the beginning, that there was now a signed agreement. I’m just wondering when that was signed.

 

            MR. CONRAD: The audit calls for a number of agreements to be signed, and a number of those are amongst the four partners. Some of those are amongst subsets of those partners. The agreement that was signed in November 2018 was the agreement on the transfer of resources and responsibilities between Internal Services and the other agencies. That agreement is now completed and signed. It details which staff came to us, what kinds of duties they have, what kinds of duties we provide back, and some detail around how we do that work.

 

Still outstanding are two more agreements, which we intend to have signed by the end of March - they are across all four partners. One of those is an agreement which is very specific on the IT duties and responsibilities to quite a detailed level. If you would like to know more about that, we could have Ms. Cascadden speak to that. There’s a fair level of detail around the kinds of services and activities that we provide to the partners.

 

The other agreement that is yet to be signed is what we call the master agreement. The master agreement is the one that would sign off on things the audit has suggested around what kinds of committees are existing in place, how we work together, how we resolve disputes should there be disputes in the process, those kinds of things. It will also be signed before the end of March.

 

There are two agreements between the health authorities that do not involve Internal Services. I believe at least one if not both of those are now signed as well.

 

            MS. ADAMS: Given that you said the master agreement is going to outline how you work together and resolve differences, why is it not already signed? What has been the delay? That’s a fairly significant document, to figure out how you work together and how you resolve disagreements. What has been the delay in getting that signed?

 

            MR. CONRAD: Agreed, it is an important document. The reality of how we work together is that these were existing people who were transferred into the Department of Internal Services’ existing responsibilities. We had professional agreements amongst ourselves to work in much the same way it was pre-transition. We talk a lot in these big transformational projects about transition, stabilize, and then transform processes.

 

It’s not that the processes and committees that are in place in the governance document or the master agreement have not been in place for the org chart that we have referenced here. Those committees existed - they were meeting, there were good working groups. There’s wonderful work being done amongst the partners. The master agreement codifies those things and puts in place the written relationships.

 

For the most part, we have resolved a lot of the issues or most of the issues around the IT parts of the agreement. What’s holding up the agreement conversations are the more technical things around, for example, sharing of HR information, liability responsibility with outside insurance companies, things like that where we have lawyers working through making sure that we have the right language that respects collective agreements, partnerships with external vendors, and things like that. We have the majority of the work done, and we’re working on the final technicalities to get those done by the end of March.

 

            MS. ADAMS: One of the other comments from the Auditor General’s Report, on Page 10 was, “Health sector has not formally agreed upon roles and accountabilities, including clinical applications.” I’m just wondering how close you are to having those roles and accountabilities spelled out.

 

            MR. CHAIRMAN: Ms. Grimm.

 

            MS. CHRISTINE GRIMM: Certainly prior to and since the transition to shared services, we went through a high-level roles and responsibilities exercise as part of that transition. At that point, that’s very much an academic exercise. It’s not until you start living and actually doing the work that you realize there may be some areas where there isn’t a full alignment.

 

            As a steering committee, we actually identified ourselves the need to complete a roles and responsibilities exercise. We call it RACI - responsibility, accountability, who else has to be consulted and who has to be informed. That type of an exercise allows you to drill down to the level of work to make sure that there is clarity about who does what. So we had a few areas where we knew that perhaps there was duplication and a lack of clarity and we took that upon ourselves.

 

            The Auditor General referenced that in the audit, but it had been under way for some time prior to the audit. During the audit, we were also in the midst of a big procurement process so most of the people involved with that procurement process in those work streams - we actually put the RACI on hold for a bit and came back to it after that period of time was completed. We’ve since completed the workshops in December and January and we intend to have a report that will go to steering and then to governance before March 31st.

 

            MS. ADAMS: Right now, Ms. Knox, you mentioned that you don’t have any access to the patient records. Who does have access and is there a different level of access, depending on your health profession?

 

            MS. KNOX: A very important question. The privacy of health information is number one for all of us as individuals, and so as a health care organization providing care, it’s very important. So we have job descriptions that define what people’s roles are and access to information depends on your scope of work.

 

            When I referenced myself, my job is not to plan individual patient care or to have any input into that. My job is to make sure that there is an organization with the resources and the right expertise to provide the care. So when we hire people, they are educated in terms of what their access is, what our rules are around privacy. They sign a confidentiality agreement.

 

We have ongoing education, and so it’s very clear for people what their roles will be. If you’re an individual who is a clerk making appointments, you have a specific access. If you’re a nurse or a physician or an occupational therapist providing care, you have access to the patients for whom you provide care. So it’s very prescribed. It’s a long-standing process in the health system and one that we hold very important to the work that we do.

 

MS. ADAMS: I wonder if you could tell me how many times somebody who wasn’t supposed to access patient records has done so and how do you track that?

 

MS. KNOX: We have an auditing process. I think it’s five times in 2018 that an individual went into - we call it snooping - looking at other people’s information - five times in 2018.

 

MS. ADAMS: Was that one person looking at five different people or was that five different people?

 

MS. KNOX: Five different people.

 

MS. ADAMS: What happened to those people?

 

MS. KNOX: Our process - we have a progressive discipline process - depends on what the level of activity was and intention. There is a whole process, which can include termination.

 

MS. ADAMS: Five people in all that time is very good.

 

MS. KNOX: We have, as you know, 24,000 employees, almost 3,000 physicians, 500 learners and 7,000 volunteers.

 

MS. ADAMS: When we move to One Patient One Record, who is going to have access to that? If I’m in private practice and I want to look at somebody’s X-ray, am I going to have the ability to do that, and is a patient going to have the ability to share their record with whomever they want?

 

MS. GRIMM: There is a work stream assigned to One Patient One Record, looking at that responsibility of a fully integrated record so that each citizen has their own record. That being said, certainly the Personal Health Information Act (PHIA) applies to and does not change as we transition.

 

A lot of the processes that Ms. Knox talked about as far as user access and those types of things will continue within the health care system. People should have access to information within that circle of care that they currently work within.

 

Those types of things don’t change. What we do need to do with this work stream is actually look at specific opportunities around an integrated health record and make sure that we do have compliance with PHIA as we move forward. For example, there is some integration with EMRs. Physicians are custodians of that data, whereas the hospital information systems are under the custodianship of the Health Authority. There are some process pieces to be worked through to make sure that there is the appropriate oversight as per PHIA. It doesn’t really change. It just needs to be planned for and managed.

 

[9:30 a.m.]

 

            MS. ADAMS: So if you’re running a home care company, is there a possibility then that you would be able to access those records?

 

            MS. GRIMM: It’s important to understand the scope of OPOR at this point in time. At this phase, we are actively in a procurement process for a clinical information system that replaces the three hospital information systems. Future phases will look at that, and we’ll have to address that. For this procurement, it is focused on that.

 

            MS. ADAMS: Since the introduction of the Shared Services Act, I know that everybody is trying to work hard to co-operate amongst the four groups that are represented today. In order to meet the needs of the IT health sector, could the representatives here explain to us any internal issues you’re facing that are a hinderance to the pursuit of the co-operation as well as explain how you plan on solving them? You mentioned some difficulties that may have been there in the past in terms of working together. I’m just wondering if each of you could explain to us what some of the challenges are that you’re still trying to overcome moving forward in terms of co-operating together.

 

            MR. CONRAD: Maybe I’ll let Sandra speak in a little more detail. I think one of the things I would say just in terms of structure and process here is that these are very complex systems that we work in. It’s a very complex environment and a very quickly changing environment. The relationships amongst all the partners are really strong. The things I see in terms of future challenges for us are more related to the environment in which we work in terms of changing technology and things like that.

 

I’ll let Sandra speak to some detail around a few things that are coming up in terms of the way the world works in IT.

 

            MS. SANDRA CASCADDEN: Some of the challenges that we experience on the health side are challenges similar to what we would experience in IT in general. One of the major challenges is that the demand is outstripping the supply. The demand for changes associated with moving into the digital world - the numbers of systems, the technology, and the rate of change in the entire industry - those are kind of the key things that really impact how we work together and the speed at which we need to work.

 

The relationships that we have are strong relationships. We have had them for a number of years. The teams work at multiple different levels in the organization. They work at the operations level, they work at the management level, and they work at senior levels for a strategy perspective, with the support of the higher levels of the ministers and the deputy ministers. We have a really good structure to support the things that we’re doing.

 

            MR. CHAIRMAN: Order, please. That’s the time for the PC caucus. We’ll now move to the NDP caucus and Ms. Leblanc.

 

            MS. SUSAN LEBLANC: I would be happy if you wanted to finish your response there. If you have more to say, go ahead.

 

            MS. CASCADDEN: There are other challenges that don’t directly relate to the health sector but to IT in general. The major challenges, from a technology perspective in today’s world, of course, are cybersecurity, privacy, and going to the cloud and cloud-based technology. Those are challenges that we are dealing with from an operational perspective. I’m confident that with the partnerships that we have and the relationships that we have, we will be able to tackle those.

 

            MS. LEBLANC: I have a question for Ms. Perret. We talk a lot about IT systems and all of this high-level technology discussion, which frankly I find interesting but somewhat inaccessible. I want to bring it down to a patient level. I’m wondering if you could talk us through an average Nova Scotian’s patient experience with IT systems in health care. What would it look like if someone presents at their family physician or at the emergency room, for instance, and their journey through that? How does information technology affect them?

 

            MS. PERRET: I’ll refer it to Ms. Grimm, please.

 

            MS. GRIMM: I’m going to keep this at a very high level because there are many systems involved, as Ms. Knox had talked about in her opening remarks. We have kind of bucketed those systems into those clinical systems used by providers: the system that’s used for public health and public health surveillance and the system MyHealthNS, which is used to provide citizens with access to their information. It’s really those three groupings of systems together that provide the foundation and the modernization of what we’re looking for.

 

Within that provider environment, we have many, many systems where patients will enter into the health care journey, and information will be documented at the point of care when they come in. That information often is shared - if it’s a lab DI, a test result, or a specialist report - into what we call the electronic health record, which is SHARE.

 

The electronic health record actually makes up for some of the challenges we have with the multiple systems we have right now. Because we don’t have all these systems talking to each other the way we would like, providers who have user access to the system and have been approved to have that access can log on to the SHARE portal and actually see that information in context as it’s coming through in the patient journey. From the provider perspective, they actually have access to the information, or most of the information. Obviously One Person One Record is meant to modernize that foundation and make it a bit more seamless and integrated and to have more information available at the point of care.

 

On the citizen side, if a citizen’s physician has currently enrolled in MyHealthNS and the physician is releasing results, the patient can have access to their information. That was based on the strategy and the pilot that we did from, I believe, 2013 to 2015. We have since realized that we need to look at that strategy again. We have very busy primary health care physicians who have a lot on their plate right now. Perhaps there’s a more streamlined way to get information to citizens. We’re currently looking at options to be able to do that. We want every citizen to have access to their information, and to have it when they want it where they want it and have it in a digital format.

 

            MS. LEBLANC: Just to clarify, the first part of your answer, if I go to the emergency room and get assigned tests - and blah, blah, blah - and I get admitted to the hospital, in terms of the electronic patient record, many care providers would be contributing to that record. But are there other systems? For instance, the triage system - is that different than the electronic patient record? I’m just trying to get a sense of how many systems one would be affected by or where one’s information is going.

 

            MS. GRIMM: From a clinical perspective, I might refer that to Tim. From a systems perspective, there are hundreds of systems. As Ms. Knox had said, we did procure these by functional need. There’s a cardiology, there’s a nephrology. Within the hospital context, there are three core hospital information systems, but I think it would be appropriate for Tim Guest to talk about the clinical workforce.

 

            MS. LEBLANC: Actually, I think that’s fine. That was kind of the answer I was looking for. That’s okay. I’ll just move on.

 

            The Auditor General mentioned scheduling and registration systems - lab systems and patient record systems are a couple of examples of these - that don’t have adequate risk management. I’m wondering if either Ms. Perret or you could speak to the kinds of risks associated with the IT in those systems. Again picturing the patient who has just been admitted to the hospital, what kind of consequences are we talking about for that person, and bringing it to a personal level, a citizen level, if those systems somehow aren’t working correctly?

 

            MS. GRIMM: Again, I’m going to keep it high level. I believe what the auditor said was that it’s not that we don’t have risks, it’s that we didn’t have a risk register. From our perspective, we actually do manage a lot of risks, albeit in a bit more siloed approach across the health care system and projects and programs. Certainly, from the perspective of the Department of Health and Wellness, we are more on the strategic arm, with the One Person One Record initiative. There is a full risk register associated with that. We have had risks since we started the initiative back in 2017, and we’re actively tracking those risks and three open issues, and we report those to steering and up to governance.

 

            I think it might be more appropriate for somebody in the Health Authority to talk about the management of risks at the clinical level.

 

            MR. CHAIRMAN: Mr. Guest.

 

            MR. TIM GUEST: To be honest, I would need a little bit more context from a question to be able to answer it.

 

            MS. LEBLANC: Basically, I’m just looking for the implications or the consequences for a citizen who is involved with the health care system, and the IT systems that hold their private information - breakdown.

 

            MR. GUEST: I guess from a clinical standpoint, when we think about the risks of those situations, our challenge is more how we maintain our operation when we’re used to it being in a digital format that may not be available. We do have processes in place where we do revert to paper for short periods of time. This past year, we had to make some changes to some technology and we went in a down time period for an overnight while that happened. That’s an example of where we have to put some of those backup processes in place. It’s inconvenient. It does create challenges where it takes time to put the information back into the digital environment.

 

            I would say one of the other issues that we run into is - I think when patients come in for service and they tell a provider information, they make an assumption that every provider everywhere can see that, and that’s not actually true. If they go to their doctor’s office and there is information in their doctor’s system and they go to the emergency department, the emergency department doctor won’t necessarily see the information that their family doctor has. I think that gives you some context to why some of those issues happen and the significance of them.

 

            MS. LEBLANC: I have another question, but just to follow up on that - with One Patient One Record, would that be a change? My understanding of One Patient One Record is that you have a record and so what I say to my family doctor, then the emergency doctor would have access to that for very good reasons - but will that not change?

 

            MR. GUEST: Certainly, it will make a huge improvement. I think the intent with the One Patient One Record initiative is that it will create a foundation that our systems will be able to integrate to so that we can have one true source of information. That’s our goal.

 

            MS. LEBLANC: I just want to give you an example of a constituent of mine who is very concerned about the drug information system. They came to my office - they went to get a prescription filled and they discovered that they needed to provide a bunch of information and that this was going into the drug information system. I investigated opt-out options for them which, frankly, for this person weren’t adequate. This person happened to have been a victim of the federal student loan information breach and is extremely sensitive to their information being accessed, and is in my opinion, quite rightly frightened of offering his private information into the system.

 

            I’m wondering what you might say to him or how I can offer some comfort to my constituent, given that is the law. There is no way for him to not participate - unless he wants to break the law.

 

            MS. GRIMM: There are what we call consent directives in Nova Scotia, and patients do have the opportunity to have their information not entered in or to have it masked within a medical record. In a lot of our legacy systems, this is a more manual process. The citizen can certainly contact the Health Privacy Office at the Department of Health and Wellness or the health privacy directors within the Health Authorities, and to seek information on that process.

 

            I’d put a cautionary note on that though because there is risk associated with not having your information available for direct patient care. Certainly, One Person One Record (OPOR) is meant to make sure that information is available so patients get the very best care. So when we talk about consent directives and people who purposely choose to not have their information in the system and/or to have it masked, there is a risk associated with that, and some providers will have difficulty being able to provide appropriate care - but there are processes.

 

            Certainly in modern systems, consent directives can be more integrated into the newer modern systems, but we do have a lot of legacy systems so it’s very much a manual process.

 

            MS. LEBLANC: This question is for the deputy minister. I’m wondering if you can talk about the relationship between the Department of Health and Wellness and the Department of Internal Services. When the shared service agreements were made, what kind of relationship did you have between the two departments? Maybe both of you can answer this. What kind of information was the Department of Health and Wellness providing to the Department of Internal Services? Were there periods of checking in to see how things were going? Can you talk about that process a little bit?

 

[9:45 a.m.]

 

            MS. PERRET: I wasn’t here during that time, but fortunately we have two people who were, so I’ll refer to Jeff and Christine.

 

            MS. GRIMM: It’s probably appropriate for the Department of Internal Services to start because they actually led the shared services initiative, and I’m happy to fill in any blanks after that, but I actively participated and can fill in the department’s role.

 

            MR. CONRAD: You could probably get everybody involved in this - thanks for the question. Shared services was certainly a long-standing piece of work, so one of the things I would say is that prior to government making the decision to move forward with the shared services model, there were a number of years of work just in general on the shared services model and how that worked.

 

A number of players here - Janet and I were on committees, Allan and I, Sandra, Christine - were on committees over a couple of years prior to the creation of the shared services initiative in 2014 that looked at the broad structure of - what is shared services, why would you do it, how would it work, what work is going on now in various organizations, where does it best suit, how does it get best placed, what were some of the delivery options. It wasn’t just an instantaneous, “Let’s do shared services and we’ll move on.” There was a lot of excellent pre-work in advance of that.

 

            Internal Services was created in April 2014. The shared services initiative was announced shortly thereafter, and we moved forward in a phased initiative. We originally started in the department with around 550 staff and a sort of core set of responsibilities. So the CIO office and a number of other corporate structures, for example, came over in the very early days. A year later, we added the IT units that existed in other parts of government departments. For example, Health and Wellness had its own IT unit that provided services to a number of departments. We brought them and the other six units over. Then a year later we added other things. Then in 2016, we brought over folks from the Health Authority.

 

            So each one of those transitions - and maybe I’ll give Sandra a chance to talk - there was a process by which we go in and figure out which pieces are coming and which pieces are staying and how we manage that. Would that be useful in terms of the kinds of communications we had going into these discussions? I think that’s what you’re trying to get to.

 

            MS. LEBLANC: Yes, if it can be brief. I apologize for saying that - I know I asked the question and I want the answer, but I also have more questions.

 

            MS. CASCADDEN: As the deputy alluded to, we did a significant amount of work. When the announcement was made that the health sector in particular was moving over, we took 12 months to plan that activity. A lot of committees - a lot of understanding of what the current services are, what the current systems are, the contracts, the number of people, what type of work they were doing, whether a person was doing 100 per cent of the work or 50 per cent or 20 per cent, and then aligning the resources across - all of us who would end up supporting the health sector in some way, shape or form.

 

            From a government department perspective, the Department of Health and Wellness was really the group who had the strategic, as well as the digital health responsibilities. So prior to shared services coming together in 2009, the office of the CIO was formed, and a lot of the technology was pulled in in 2009. So the departments didn’t have their own email system, or didn’t have their own service desks. That was all centralized back in 2009.

 

            The second round of shared services really looked at centralizing the applications within each of those departments so that we can have consistency across how certain applications are delivered. In government we only have one email system because, believe it or not, prior to 2009 there were multiple separate email systems within government. So the opportunity to standardize and consolidate a number of IT services is really what we have the opportunity to do as part of shared services.

 

            The relationship with the Department of Health and Wellness was one that we made sure that we continued to provide services - both technical services to them as well as project management services because most of their sphere was in the project side of the house as it impacted us. So we made sure that when projects and project managers were transitioned over, they still provided the services to the Department of Health and Wellness, and we continue to provide other services like geomatic services and things like that to the Department of Health and Wellness.

 

            MS. LEBLANC: I’m going to move on. I just want to quickly go back to what we were talking about before in terms of the implications of privacy or IT systems not behaving as they should. For the record, I think shared records are a great idea, but I’m really worried, given the issues that we have had with the FOIPOP server breach, and they are complicated systems, as you said. 

 

The Auditor General highlighted the potential for unauthorized disclosure of personal health information: increased wait times for services, increased costs to the health care system, and overall negative health impacts for the people of Nova Scotia. I’m wondering, how exactly could a lack of risk management or lack of clarity around these roles and responsibilities wind up causing this sort of damage? We talked about my constituent. The drug information system is really important, yet these systems get breached, and people’s information is lost. Can you talk a little bit about that damage?

 

            MS. GRIMM: I can speak high level to some of the protections that we have in place around privacy. Some of the things the auditor referenced could happen. I think it’s important to clarify that he’s not referencing that they did happen. That was his interpretation of some of the risks associated with that. I’ll look at it more from the DHW perspective, but I expect it’s not that different for the Health Authority as well.

 

            We do have different approaches to protect information. We obviously have audit. All systems within the health care system are subject to a reactive audit. A reactive audit is when we get some kind of advance warning, or somebody has reported suspicious behaviour. Then we can have our audit teams actually go in and investigate. Some of the newer systems actually have proactive auditing capabilities and more technical capabilities to do that. We often use a system called FairWarning, which sits on top of some of our systems and allows us, based on the user access matrix - if you’re a ward clerk in a particular ward in a hospital, you should have access only to these patients’ information. 

 

That proactive auditing - and we do test samples - allows us to actually look at who has had access. If there’s anything that’s out of the norm or an outlier, then the audit team will actually look and validate, should that person have had access or not? Those reactive and proactive audits do exist within the health care system. There are other safeguards we have. We have a lot of administrative safeguards, which is really having contracts, confidentiality policies, and operational guidelines.

 

Obviously, training on privacy and security are mandatory in organizations - breach protocols, audit processes, service-level agreements, and access agreements. That is the paperwork that goes with this. Part of this is that we have to understand that people have an obligation. It’s not just the IT system here that has to work. We have to have everybody in the health care system working together on those pieces.

 

We have some physical protections in place and certainly Sandra can talk to that. In secure data centres, we house the information, or we have requirements of our vendors who have that information in their systems. Then we also have some very technical pieces on the more advanced system, stronger user access matrixes, firewalls. We also follow industry best practices. As the practices around privacy and security change, we actually need to keep up to date on those things as well.

 

From a resourcing perspective, each of our organizations has health privacy offices within them, and people are responsible for managing access to health information, any concerns that come up, and doing the due diligence on those.

 

            The other thing, as we enter into projects and programs, we also have various assessments. They’re called privacy impact assessments, and threat risk assessments. They’re done early on in a project, more on a conceptual basis, but as we get closer to implementing the project, they move from being conceptual to being an actual privacy impact assessment or threat risk assessment. The intention of those is to actually look at the risks, make sure that we understand what the potential is. Could this happen? What are the appropriate mitigations, so all of our systems do have the PIAs and threat risk assessments associated.

 

            MS. LEBLANC: You said you look at the risks. Can you give me an example, an actual on-the-ground example, of a risk that could happen to somebody, where there was an issue with the security.

 

            MS. GRIMM: I don’t speak to security.

 

            MS. LEBLANC: I mean the system, sorry.

 

            MS. GRIMM: I think the example that you have already referenced is the drug information system breach that occurred. There was a pharmacist who, according to her standards of practice, was not supposed to be looking at other people’s information that was not within her circle of care, so there is a professional responsibility there as well. Certainly throughout that audit and certainly throughout the review of it done by the privacy review officer, we did look at our processes on how we managed that process and we’ve gone about looking at the recommendations that she has put forward, and eight of the 10 have been addressed.

 

            That’s an example of when it does happen. We often - and not just unique to Nova Scotia - hear of people who, through human behaviour, have curiosity and want to look at these records. I will say, through a digital system we have a better opportunity to look at who did that because these records are time-stamped. There are audit logs associated with it. We can go back and look and see where they have had access.

 

            In the case of the drug information system, we know exactly how many people had their information exposed by this particular individual. Certainly there was a follow-up investigation through the College of Pharmacy and through the Sobeys organization that the pharmacist worked for. As part of the report that was published, the pharmacist actually was dismissed. So there are consequences.

 

            MR. CHAIRMAN: We’ll now move to the Liberal caucus and Mr. Glavine.

 

            HON. LEO GLAVINE: Pleased to be here today substituting for a colleague. I do want to get Dr. Jangaard in on the conversation, and I guess publicly, welcome to your new position. I know you’ve been there for a while.

 

            When I look at the IWK, you go and visit the Garron Centre and the NICU and some of the research is world class. Where are you in terms of the IT world and where do you need to go to be state of the art, if you wish?

 

            DR. JANGAARD: I would say that the work that we’re doing on One Person One Record is the first step to take us from a system that, as Ms. Knox said, has organically grown to meet individual needs and individual patients and individual places and individual care provider groups to something that really is a system, that isn’t silos. The reason for sitting here, all of these organizations together, is to understand that the care journey for patients isn’t only in one place.

 

            So the first step of that is, how do we unite our hospital systems with an IT system that supports the modern things that we need to do - not only the information of the patients coming in to care for that particular patient at that time, but to be connected with when they need to go. In our NICU that you referenced, many of those patients come from elsewhere in the province. They need to go back to their own communities in their province. They need to go to my colleague’s care in NSHA. So how do we meet the needs of that family who don’t want to have to tell that story over and over again.

 

            It’s a very tight balance, and it is a balance. What is the risk of disclosure of information inappropriately versus what is the risk if we don’t have the right information to care for a patient? I think balancing those risks is more of an issue than thinking of one risk separate from the other kind of risk.

 

            What do we need moving forward? We need to think about being one system. We need to think about one place that we go to get the best information for our patients. Right now that is starting with looking at when you’re in the hospital or using our resources in the hospital - what is that true one record for that one person - and then looking to have interoperability with what’s already out there in our primary care providers’ offices - looking at how we actually do know what our best drug medication history is on someone. That can be important to know when someone comes in.

 

            If someone comes into one of our emergency rooms and cannot speak for themselves or we don’t have their information from them, how do we get that information out of a system that allows us to take the very best care of them. That’s why this group of people spends so much time working together on those things, because we all have that shared goal of having the best system that supports our clinicians to take care of our patients and families.

 

            MR. CHAIRMAN: Mr. Jessome.

 

            MR. BEN JESSOME: I would like to welcome my colleague, Mr. Glavine, back to the Public Accounts Committee for the first time in a decade. That is actually a great segue to my first comment. I couldn’t agree with you more - the reason that we’re all here is we’re coming at this today from an IT perspective, but the goal ultimately is to improve patient care. It’s critical - the focal point of all of our efforts, and I’m really impressed and grateful for the level of positive criticism that has taken place so far today. We’ve all got a role to play and it’s clear that government, Opposition, the AG’s Office, and our respective entities that have joined forces here are all committed to doing this work.

 

            We’ve talked a little bit about the response and the activity that has taken place with respect to the AG’s recommendations, and I’m wondering if we could take a focus on the procurement process for One Person One Record. The AG’s Office was critical that there were some lacking accountability mechanisms and oversight in place. I’m wondering if a couple of our witnesses today would provide some insight about how the procurement process for One Person One Record reflects the importance of imbedding those accountability mechanisms in place from the start.

 

            MR. CONRAD: I’ll let Chris Mitchell, the Chief Procurement Officer, speak to this in detail; I’m sure he’s excited to get a chance to participate. I would refer you back to the org chart that Denise has referenced a number of times just to remind you that in terms of the comments - I think to be fair, what the Office of the Auditor General said is, when you acknowledge and look at the things that were raised in the audit, can we be confident and comfortable that other processes are following a good process and good management practices?

 

            I think, as Denise said, we’ve spent a lot of time on the strategic side of the house really thinking about how we make sure well we’re doing on these big, incredibly complex pieces of work and projects, like OPOR. I think it’s a great example of a place where - although we are certainly taking seriously the recommendation that we learn lessons from the IMIT world where we already knew there were important things to be done in terms of how we framed up the procurement piece and made sure from the beginning we had really good process and structure around it.

 

I’ll let Mr. Mitchell speak to a little bit of an overview of how we make sure a big procurement like this goes well and is well-positioned.

 

            MR. CHAIRMAN: Mr. Mitchell.

 

            MR. CHRIS MITCHELL: Thank you very much. I think it’s important, as the deputy just mentioned, that one of the things pointed out was that we need to learn from things which have happened before. In fact, right from the very beginning of the One Person One Record initiative, we were doing exactly that.

 

We brought a number of critical external resources on board right from the beginning from a fairness monitor that do not only later in the process help to determine if we’re doing things correctly, but also they helped us from the very beginnings of the design of the process from a selection of how we would do evaluations, from any number of different critical decisions on the path of that program through the RFSQ or the supplier qualification phase to the now-RFP phase.

 

            We’ve done some things to set some pieces in motion that have created an environment of increased transparency, increased openness, and allowed the government to actually say we’ve taken it seriously - as mentioned earlier - in these large, complex procurements.

 

            We went through a very defined conflict of interest and conduct for everybody involved in the program. Normally in a procurement process, that would involve the evaluators or the people who are involved directly in the RFSQ and RFP phase. That’s when we actually broadened that out. We’ve taken it to everybody who had any kind of interplay in this program at all, signed those conflict of interests, signed the conduct code because many of the vendors, which we are expecting to have to deal with, we do daily business with them on an ongoing basis.

 

            We wanted to ensure that there was a transparency for everybody who was involved from the vendor community, but also some sense of responsibility on the government’s side.

 

            The follow-on from that is - and it has been touched on a couple of different times - there is a very robust governance set up for the One Person One Record file. It not only is robust in the fact that it has multiple levels and all having their own responsibilities for decisions, but it’s across all four of the organizations, which you see in front of you today.

 

There was a recognized need for both departments and both health authorities to be participative in in all of the decisions made inside of this, from who would be evaluating, how we would evaluate, what decisions made sense - from the very start to where we are now, which is in an open RFP phase with two very solid candidates who can deliver solutions that we’re looking for, for Nova Scotians.

 

            MR. JESSOME: My next question was going to be related to the governance or the accountability beyond, but I think I’ll sidestep that and move forward because it sounds like there is a heightened consciousness that the upfront accountability mechanisms have follow-up measures in place once we get to an operational side of things. This is kind of an interesting conversation. I’m not IT savvy by any means. It’s interesting, and it’s exciting to see that as we develop, there’s a major amount of opportunity to improve the way that we deliver through the enhancement of technology and the evolution of technology. It’s neat to be a part of this conversation.

 

In saying that, simultaneous to the work that is going on with respect to improving the governance of these systems, I would like to talk a little bit about the people who were involved from a health care provider perspective. What types of care providers were involved and how many? These are the folks who have to operationalize and maintain the use and adopt the use of these new technologies. Can we receive a little bit of insight as to who was consulted throughout this process?

 

            MR. GUEST: There have been a variety of clinicians from a multitude of disciplines participating in the process all the way along. There were clinical individuals who participated in the development of the RFSQ documents. Clinicians participated in the development of the clinical scenarios that were used in the evaluation phase during the current RFP process. I’ll give you a little bit of context into the magnitude of that.

 

We brought together around 331 individuals to do the scenario evaluation. Those 331 were from all four zones in the Nova Scotia Health Authority; they also were from the IWK. They included 94 registered nurses and 49 physicians. They also included laboratory technologists, dietitians, radiation technologists, physiotherapists, nurse practitioners, pharmacists, infection control practitioners, epidemiologists, and the list goes on and on. It was a fairly robust group of clinicians that came from direct client care roles. They also were researchers, educators, and administration.

 

            MR. JESSOME: Throughout those conversations, were there lessons learned about how best to onboard health care providers to use these evolved systems? To point out something that I think has been a challenge, when we initiated MyHealthNS, there’s a requirement that physicians and patients actually use the system. In keeping with that level of consultation with health care providers, is there simultaneous work being done to ensure that our health care providers are actually going to use these things and can use these things in a way that doesn’t take away a whole lot from actually providing care to Nova Scotians?

 

            MR. GUEST: I guess I have a couple of comments to respond to that. Clinicians went with us when we went out and did site visits to see how the source systems were operating in some example locations. They asked really specific questions about how those systems impacted their work lives. They were able to talk to individuals in those organizations who were actually using them. I think that’s one context of which we did that.

 

            I think the other that I would say is that we’ve developed a really robust plan for how we’re going to do readiness and how we’re going to build the system. It’s very clinician-focused. There are a multitude of work streams that have been planned with a large number of clinicians that we will populate them with once we move to that phase. That is the sole focus of that work - having clinicians participate in a massive amount of work as we standardize what we now would have hundreds of different assessments as we focus going toward much fewer. They have to be involved. There is no possible way to go forward without them.

 

            MR. JESSOME: Parallel to the health care provider side of the effort, how have patients been engaged? As a like question, what work is being done to ensure that we increase the opportunities for patients to utilize and maintain One Patient One Record when it comes online?

 

            MR. GUEST: What we have planned for is adding patient advisors to our workstreams. They would be engaged in the process. We’ve talked about doing focus groups. Certainly both the IWK and the Nova Scotia Health Authority have organization-wide patient and family advisory councils. It would be our intention to capitalize on those as well. I think there are a variety of ways that we can do that, but certainly building that voice in right at the work stream level is an essential way of being able to do that.

 

            MR. JESSOME: A lot of my questions initially were around the evolution of shared services, and we have had quite a bit of dialogue on that thus far. I’ll pass it to my colleague, Ms. DiCostanzo, for a line of questioning.

 

            MR. CHAIRMAN: Ms. DiCostanzo.

 

            MS. RAFAH DICOSTANZO: I’m actually very excited because finally I hear that we’ve got our computer system being upgraded and we’re moving forward. I have had a couple of constituents calling me - a gentleman from Israel actually who just moved to Nova Scotia. He wanted to tell me that even in little Israel they can look online and book their family doctor or book an appointment at the hospital, and how come Nova Scotia is not there?

 

            I am really excited to see that we are moving forward and I’m sure we will have many different aspects to this new system that I can reply to my constituent and be proud of it. This, to me, is a very exciting time. How will we rate - where are we, once we get the process going, and where are we compared to other provinces in Canada or to other systems in the world? What are we aspiring to reach with OPOR, and if you can maybe compare us to - I know it’s going to take some time to get there, but where are you hoping to reach in comparison to other provinces and other countries?

 

[10:15 a.m.]

 

            MS. GRIMM: Certainly Nova Scotia on the journey to One Person One Record has done a lot of background information. It started with a business case for change, looking at what we need to do differently and what problems we are trying to answer in this problem to make health care better in Nova Scotia using these systems. Many of the big organizations in the U.S. as well as many across Europe use these big clinical information systems.

 

More and more, we’re seeing published peer-reviewed literature out there on the benefits of these systems. Many of these literature pieces focus on the outcomes associated with a clinical information system - the ability to enhance patient safety, reduce serious medication errors through the alerts and some of the protocols and templates that could be imported into the system; the ability to improve patient care, quality of care, and clinical outcomes; and certainly using that data to better support patients. 

 

Improved patient experience - I think we all have friends, even ourselves, who have gone in and told our story over and over again to a physician or to a resident. The mere fact that that information is now available for health care providers when they come into the system is a measurable outcome of the system that we need to track. Improved access to health information for our health system planners and our clinical program service planners is very important as we go forward as well, and certainly the ability to actually use data to measure improvements in population health.

 

The literature is actually showing some of those benefits. They’re proud to highlight their work. In Canada, there are a few similar types of CIS projects under way. Ontario has approached it with some consolidation or working together - I guess it’s not consolidation but . . .

 

            MR. CHAIRMAN: Order, please. That ends the time for the Liberal caucus. We’ll now move on to the PC caucus. Ms. Adams.

 

            MS. ADAMS: I’m going to continue to follow up on One Person One Record. I just want to be clear for when people ask us questions, once this is in place, will a patient be able to go in and look at whatever is on their record.

 

            MS. GRIMM: The system hasn’t been procured, so I can’t speak to the functionality that would be provided. Certainly access to health information is a priority for the Department of Health and Wellness. It’s why we have MyHealthNS. It’s a separate application that could potentially be integrated with the OPOR system and/or these clinical systems also come with patient portals as well. What we have seen again in leading and best practice is it’s more than just giving lab results. It’s more than just providing specialist reports. There are jurisdictions now that currently enable access to the clinical notes.

 

So as we go through the remainder of the procurement, we get into negotiations, and we identify what we’re actually procuring here through that negotiation scope, we’ll have a better understanding of what OPOR will do and also, through our interoperability with some of our core systems, make sure that that connectivity happens to something like MyHealthNS so that we continue to evolve that. Right now our current state is e-results, lab reports, and specialist reports, that transition to citizens who are on MyHealthNS. But there’s opportunity to expand that as we go forward with OPOR.

 

            MS. ADAMS: Will MyHealthNS be over with if we move to One Person One Record?

 

            MS. GRIMM: MyHealthNS is the brand that Nova Scotia has chosen to brand the gateway for citizens. Just like citizens need to know they can call 911 and get an emergency response or 811 to find out about other health care services, MyHealthNS is a gateway that makes it seamless for patients to enter the IT systems. I think we need to focus on the access to the citizens into our systems. They don’t need to know what systems are in the back end. They don’t need to know what systems a GP in the community is using. If they want to provide virtual care, that gateway should enable seamless access for citizens.

 

Again, that’s a planning piece that we have to do. Canada Health Infoway, with their access initiative, is focusing on this a lot across Canada. We’re actively involved in those discussions as well. It’s a real opportunity. Again, we need that core foundation of the systems - the provider system, the patient system, the public health - to be the core system, and then we can layer on things like e-services.

 

            MS. ADAMS: Right at the moment with MyHealthNS, physicians are paid to be using that system, so they have to sign on before a patient can gain access to their lab work or specialist reports. Is that going to change once One Person One Record comes on, or are the physicians no longer going to be paid to use IT services like that?

 

            MS. GRIMM: We’re actively looking at streamlining the approach for citizens having access to their information. I think I mentioned it a little bit earlier. We appreciate the work that primary health care doctors have done to sign up their patients. There is a stipend associated with MyHealthNS, as we speak right now. We also know that there is probably a better way to deliver results directly to citizens, and we hope to do that before One Person One Record.

 

            MS. ADAMS: Right now, somebody on MyHealthNS can email their physician and the physician has to email them back within a certain period of time. Is that going to change moving forward or are patients still going to be able to email their physician?

 

            MS. GRIMM: In MyHealthNS, the ability to secure email - I want to make the differentiation. It’s not just email. Secure communication with their provider does exist if the provider is currently on the system.

 

Again, as part of the bigger planning piece that we have underway, there is an opportunity to look at how we provide these e-services. So when we talk about virtual care, there are different ways. Secure communication through email is one means of virtual care. We also want to look at adding what we call synchronous care, which is device-to-device care options. Certainly work has been underway in the health authorities piloting some options on that as well.

 

So there are planning pieces around this. Most jurisdictions are looking at this. A lot of this work has been done in pilots. Of course, from a provincial perspective as we look at our planning for OPOR, we want to look at how we do these things once, how we scale them, and not get too caught up in these individual pilot approaches.

 

MS. ADAMS: I’m wondering what happens when I travel to another country or another province to get my medical care - how does that get entered into my record? Or if someone comes here from New Brunswick, they’re not having the same One Person One Record system in their province. I’m wondering what we do about that, and I’m wondering whether there was any discussion that all of the provinces buy into one system, instead of each province possibly doing its own thing.

 

MS. GRIMM: That has been an ongoing discussion at the pan-Canadian level. I guess it goes to readiness and willingness. I would say we’re not there yet. We certainly plan within the jurisdiction of the area that we currently reside in. I think the opportunity to make sure that information is available is to give it to the patients, to the citizens themselves.

 

Again, the interoperability of our system with a system in the U.S. or - I’ll give an example - I was in Africa a couple of years ago. It probably is quite a number of years out before we have that type of opportunity.

 

By going into MyHealthNS, if I have internet connectivity, I should be able to access my information. Again, we have some limitations with the current strategy right now if providers have not invited their patients or if providers haven’t adopted the system - and again, I do want to credit them for the good work they have done, but they are busy clinicians. We need to streamline how we get information to the citizen so that the citizen always has that opportunity to provide their medical information, if they’re able to, when they’re travelling or in a different province.

 

MS. ADAMS: You just mentioned that we require internet capability. This province does not have 100 per cent internet capability, so hopefully that problem will be solved.

 

What happens if something gets put on my record that’s not correct? What are the steps that I go through to fix that?

 

MS. GRIMM: There are processes to be able to make a correction that needs to be documented in the medical record. It doesn’t get erased from the medical record; it gets documented as an error and a correction. I don’t know if one of the clinicians who may have more experience in that want to speak to the specifics?

 

MR. CHAIRMAN: Dr. Jangaard.

 

DR. JANGAARD: There is a process done on paper for how you would make it. If I write something on a patient’s chart that I then find out is incorrect, there is a way in which I need to document that it is an error, timestamp it, and date it. I am not familiar with what the processes are when we go to a fully electronic record - remembering that in my hospital right now, most of the record is currently on paper first and then is scanned and archived - but those solutions are available.

 

The nice thing about the electronic version of it is it’s already dated, stamped, and timed, and you know who has made the correction.

 

MS. ADAMS: I’m going to give you a couple of examples. I was in emergency a while ago and I was given a prescription for a medication. I didn’t honestly look at the thing; I just knew what it was for and faxed it to my pharmacist. They called me back and said, Barbara, your name is not on this.

 

It never even occurred to me until today - I know that I had to call emerg and get them to write it with my correct information on it, but somebody else - it has their identifying information at the top of it, so presumably it got scanned into their record. Would emergency automatically go to correct that on their record, and what would that look like?

 

            MS. GRIMM: If I were to understand your question, I think that would be considered a breach and would have to be managed as a breach.

 

            MR. CHAIRMAN: That concludes the time for the PC caucus. We will now go to Ms. Roberts with the NDP.

 

            MS. LISA ROBERTS: I’m going to ask everyone who I’m asking questions to to respond with brevity because I know I have far more to ask than I have time for.

 

Continuing for a moment around the One Person One Record, Mr. Mitchell referred to having two strong proponents. I know that negotiations are ongoing. There was also some concerning coverage in the media in the Fall about the process of going from some five interested possible proponents to just two. I’m wondering what you can tell me to assure me that the procurement process has been robust and fair, and also that Nova Scotians are getting the best value for money, given that some possible proponents were eliminated before we got to the final stage of the procurement process.

 

MR. MITCHELL: It’s probably easiest to answer that in a more fulsome sort of way. Very quickly, a fairness monitor was involved very early on the process - that’s a third party, which we hire to ensure that they get an opportunity to provide commentary on decisions like, we’re going to go with two proponents instead of four proponents. Why is that? Well, it’s because we left that door open when we wrote the RFSQ to say, if there was a dramatic difference between the number of proponents, that the government reserves the right to go with the number that they would like to go with.

 

What you have to understand is, it’s an enormous process. People might say, why didn’t you take three or four of those folks? There was a considerable amount of difference in the technical evaluation done between the top two proponents and the next - the third and the fourth proponents. The decision was made at steering that we had the competition that we wanted to make sure for Nova Scotians to ensure we drove the best possible solution, that they were the two most technically competent that we saw in the RFSQ submissions.

 

I think what we could say is, that process was able to take the RFSQ, which we had expected between five and six submissions to come in. We took a look at all five of the submissions, which were forwarded in for evaluation.

 

At that point, one was dropped as a result of not submitting all of the information that they were required to, and so we did a full evaluation on the four consortiums that were in play at that time. There was a significant scoring difference between numbers one and two, and numbers three and four, so the decision was we had all of the competition that we were looking for; we had all of the potential excellent delivery in both of those two providers, and so the decision was to go forward with the two versus a number larger than that.

 

MS. ROBERTS: Just to clarify, my understanding is that one proponent - that package was never looked at because it was couriered to the wrong address on the day of the deadline, and even though it was in the same building and had come from out of country, somehow it wasn’t able to get from whatever floor it arrived at to the floor that it was supposed to be on, and therefore it was eliminated.

 

So, you feel like we haven’t left some value for Nova Scotians sort of in the wrong mail slot as a result of that?

 

MR. MITCHELL: The easy answer to that is, yes, I’m very confident. The more sort of detailed answer is there is a lot of procurement law, which identifies the requirement for bids to be not accepted if they’re not at the right place and at the right time or in accordance with the closing times. I know it seems that that is a bit of a nuance, but we were looking to protect the sanctity of the entire process. By letting a bid in which would have been easily argued by the other proponents that it had not been received on time and at the right place would have called the entire thing into question.

 

It’s actually a really good example of the transparency and openness that we have followed throughout the entire process, which was, tell folks what’s required, follow what you tell them, and make sure that you hold steady to what you have actually outlined in your documents.

 

[10:30 a.m.]

 

            MS. ROBERTS: When you referred to the use of this fairness monitor, is that body - I don’t know if it’s a body or if it’s an individual - are we as legislators, are members of the public able to see reports from that fairness monitor while the procurement process is ongoing? What’s the reporting schedule?

 

            MR. MITCHELL: It’s an actual firm that we went out through an RFP to hire. They have on our request provided two interim reports to date. One was at the close of the RFSQ portion and one was at the close of the proof of concept portion, which was in the RFP phase. Those reports have been requested through a FOIPOP process and been released already.

 

The answer is there’s really no secret in there. What we do is, we ask the firm to actually sit in on every single decision made, whether it’s how we have structured evaluations, to whether we followed what we structure them as, to giving us the common person on the street - how would you see this happening? Do you feel that this is fair? They use both the procurement law perspective as well as a legal perspective to give us their feedback on, this is what I would do in this case, or this is how I would follow that.

 

            MR. CONRAD: To Chris’s point, while they have been released, if the committee would like us to just provide those to save you the search of trying to find them on our site, we would be glad to do that.

 

            MS. ROBERTS: Thank you. I would appreciate that. Part of me is thematically trying to learn from one audit to the next audit. Some of the themes from the recent audit about the breach of privacy are relevant, I think, to the discussion today.

 

One theme for me, or one area to be curious about is about the relationship and the reliance on vendors. Clearly, private sector vendors are very important to the provision of health information and to many different systems that we rely on in government. Yet there is always that need for the government officials, for public servants, to be working for the public interest and recognizing that there is a boundary there between the public interest and the private sector interest.

 

Another theme that is coming back to me from the most recent audit report that we examined is the role of oversight and this Architecture Review Board. I’m wondering if anybody sitting in front of me is part of this mysterious Architecture Review Board that was referenced in the last audit report that we talked about.

 

            MS. CASCADDEN: The Architecture Review Board is a committee that exists within Information, Communications and IT Services. It’s a group of individuals. Some of the individuals are representative of the health sector as well as representatives from other government departments, technical representatives as well. 

 

What they do is, their role is to look at what we’re bringing into our IT systems and to make sure that it will work within our existing systems, not cause any issues, and is aligned with our standards, policies, processes and things like that. They would look at a submission coming from maybe a project manager, for example, and make sure that the project manager and the project team have articulated what we’re buying, what it’s going to do, how it’s architected, the technical components of the system, what it’s connected to, where it’s going to reside, and then would make a determination about whether that solution is a good solution and can be implemented, put in our environment, and we support it and manage it, and it doesn’t add to the risks associated with having that system in with all the rest of our systems.

 

            MR. CHAIRMAN: That concludes the time for the NDP caucus. We’ll now move to the Liberal caucus. Mr. MacKay.

 

            MR. HUGH MACKAY: I think we all recognize that the Office of the Auditor General plays a very, very important role in the continuous improvement process in health care and many other things, and I think we’re all very grateful for the work that is done by the office.

 

I’m going to direct this question to Deputy Denise. The OAG challenged the HW for not providing leadership, and we’ve heard some comments on that already, particularly in the sense of these formalized agreements not being in place. I think that’s a message that has carried over into the public domain - a lot of the talk. I’m just wondering if you could speak to that a little further as to the co-operation between the organizations now.

 

            MS. PERRET: As you’ve heard, the four organizations work closely together on a day-by-day basis, and we’re not that big that we don’t know each other and know how to pick up the phone and talk. As I said, there’s a basic split in responsibilities between policy and operation service delivery. In this case, the Department of Health and Wellness plays a policy role. The Health Authorities and the Department of Internal Services are on that operation service delivery side.

 

            In our policy role, certainly the department has been focused on strategic digital technology, so we’re talking One Person One Record, we’re talking the drug information system, we’re talking MyHealthNS, and Panorama in the public health sense. That has been our primary focus. The structure for those discussions is on the right side of the org chart you see, so there is a governance structure in play.

 

            Our senior official - and you’ve met Ms. Grimm today - is on the operational side. She is part of the IMIT steering committee, and that’s a busy piece of work. I think where the Auditor General commented is when that audit found outstanding matters such as issues that weren’t properly documented from their perspective or a formality around risk assessment, which I want to underscore is important feedback to us and there’s a discipline to that we like - I think the Auditor General said, then who makes sure those things get done at the end of the day or where does that get reported.

 

            The audit doesn’t remove the responsibility for any of those from the actual responsibility and accountability from each organization, but said, where does it go if it’s not happening? While I think we have it very tight on the strategic side, that’s where we combined both sides of our structures, and you can see at the bottom how busy they are. That’s where we combined them, so they all report up to the health IMIT governance committee. We have put on top of that an oversight committee. The oversight committee is the Ministers of both Health and Wellness and Internal Services, and the two Chairs of the Health Authorities.

 

            MR. MACKAY: I’ll switch over to Deputy Jeff. I am a little confused on one subject and it’s one that the Office of the Auditor General highlights in many of the audit reports and it’s in regard to risk management. I am a little unclear still as to where risk management or the different components of risk management are handled between your department, between DHW and then between the other organizations such as IWK and NSHA. Could you perhaps elaborate on this a bit?

 

            MR. CONRAD: I think Ms. Leblanc had some questions in this regard as well during her questioning. I guess one of the things I would highlight is, when you read the audit, the work that the office has done to help highlight to us the importance of collaborative and more comprehensive risk frameworks. To your specific question, I think each of us would undertake our own individual risk processes in terms of the activities that we do.

 

            We recently used our Internal Audit Centre, for example, to do a risk assessment of what we needed to do to improve our cyber security frameworks and how we improve those. We know that things have been done around individual project risks, so Christine framed up that we have from the very first day on the OPOR project an ongoing risk register that identifies risks, mitigation factors, and things we can do to help those risks - because these projects have risks.

 

If we don’t do these big complicated projects, there’s a risk that health care in Nova Scotia will not get better. That’s a risk. If we do them, there’s a risk that things will happen, like we’ll put things on an online system now and that becomes vulnerable for a breach. That’s a risk. What we need to do is mitigate those risks really well.

 

            I think one of the lessons in the audit that we need to think about is that when we do our own risks internally to each of our organizations and we don’t come together and talk collaboratively about those risks, we miss seeing things. A specific kind of concept might be, if you think about things like health information, the Personal Health Information Act has a contingency that, during the time of an emergency, allows you to share information on a patient in order to respond to an emergency.

 

            The FOIPOP Act doesn’t have that. The FOIPOP Act does not allow us to knowingly breach in order to protect patient record. We need to get together and have conversations about what that means, in practical terms, when we’re working together on some of these projects - which risk is higher, which risk is lower, how do we manage those risks, how do we do those things collaboratively?

 

            There may be risks identified in one of our partner organizations that we wouldn’t be aware of. The IWK works with a certain foundation that they have to share information with. We didn’t know that, so on our risk register we said, all internal clients, a very low risk. Someone else says, hold on, we have an external client that uses that system, and that heightens the risk.

 

            I think the lesson learned for us - in terms of the work of the Auditor General - is to say that in the go-forward, we need to do things. One of the things we’re doing is adopting an international framework called COBIT. COBIT is an IT framework that provides both a strategic framework and an operational management framework on how you manage IT services. It doesn’t tell you what to do. It tells you what we think about in terms of how we move forward - what are the critical blocks in managing big collaborative IT systems that you need to work your way through and come up with responses to?

 

COBIT, which we’re just in the process of implementing - both on the health side and just starting on the government side - gives us that external framework independent of what we think. That provides us a framework of things like how do you share risks, how do you talk to each other, how do you establish risk tolerances, and things like that - a really important message from the Office of the Auditor General.

 

            In part, we’re adopting COBIT because we know that auditors move to COBIT as the framework by which they audit us. They look at that standard and say that this is the international standard organizations should be held to. With that in mind, we’re in an active process of adopting COBIT. If you want to know more about COBIT, I’m sure either Christine or Sandra could speak.

 

            MS. PERRET: I would just add that, as part of the action plan that we tabled with this committee, we have an internal audit function in government that has a tremendous amount of COBIT expertise. They are going to oversee a health-risk assessment process that we think will take about four months to complete.

 

            You’ve heard from both Ms. Grimm and Deputy Conrad that we do risk management on individual projects. This will be a chance to have a more integrated, coordinated approach to that.

 

            MR. CHAIRMAN: Order, please. Thank you very much. That ends the time for questioning.

 

I’ll now ask the witnesses if they want to make any closing remarks, please.

 

Ms. Perret.

 

            MS. PERRET: Simply to extend our thanks for having us here today. I think it’s a technical subject. It has garnered a lot of headlines in some respects, so we really do appreciate the opportunity to address your questions and hopefully to have provided some good information to you and to Nova Scotians.

 

            MR. CHAIRMAN: Mr. Conrad.

 

            MR. CONRAD: Thank you very much for having us. Really penetrating, thoughtful questions, and I do appreciate that. Thank you.

 

            MR. CHAIRMAN: Ms. Knox.

 

            MS. KNOX: Thank you very much for your questions today, and most importantly, for your focus on this important tool that will really be a gamechanger for us in terms of the future of providing services to the people we serve here in this province and beyond.

 

            I just wanted to add, because I didn’t have an opportunity, that risk management is central to how we do our work. We have enterprise risk-management strategies in our organizations. Dr. Jangaard can talk to hers.

 

            The other thing I wanted to say is that the way we move forward here is around co-operation and a common vision. I hope you’ve seen that this is what we’re trying to create here, and that doesn’t happen just because we say so. It happens with a lot of hard work and effort, but most importantly, understanding why we’re here, who we are serving, and what our collective and individual contribution is to that outcome. So thank you for your very interesting questions and stay tuned - this is really important work.

 

[10:45 a.m.]

 

            MR. CHAIRMAN: Ms. Jangaard.

 

            DR. JANGAARD: The beauty of going last is that everybody has said everything already. I’d just like to thank you for taking the time to ask the important questions that hold us accountable for the care that we provide to our patients. We hold that central to what our mandate is and we want to continue to work on that. Thank you very much, we’re glad that we were here.

 

            MR. CHAIRMAN: Thank you very much for your presentations and your questions and answers. We do have some committee business to take care of so if you guys want to pack up and exit you can and we’ll just continue on as we go.

 

            We do have some correspondence which is an email from Dr. Krista Jangaard, CEO, IWK Health Centre, clarifying information provided on the February 6, 2019 meeting. It says that Nos. 1, 2 and 7 would be complete by March 31, 2019. The correction is that it will be 75 per cent complete by March 31, 2019, and complete by December 31, 2019. Are there any comments regarding this correspondence? There being none, we’ll move it into accepting that correspondence. Ms. Roberts.

 

            MS. ROBERTS: I would like to make a motion.

 

            MR. CHAIRMAN: Yes, go ahead.

 

            MS. ROBERTS: Whereas the mandate of the Public Accounts Committee is to:

 

(1)   Examine and inquire into all such matters as may be referred to it by the Assembly and to report from time to time its observations thereon, with the power to send for persons, papers and records and to examine witnesses under oath;

(2)   Review the Public Accounts of the Province of Nova Scotia and the issues raised in the Annual Report of the Auditor General which have been referred to the committee;

(3)   Examine and inquire into any other financial matters involving public funds of the Province of Nova Scotia; and 

 

Whereas changes to the way this committee operates made over the course of the past year have weakened the committee’s ability to exercise its mandate; and

 

Whereas changes made to the schedule of tabling of audits by the Auditor General in Spring 2018, along with the reduction of in camera meetings has allowed more room in the committee schedule to examine departmental implementation of Auditor General recommendations;

 

Therefore be it resolved that the motion of Mr. Gordon Wilson of the 6th of February 2019 be rescinded.

 

            MR. CHAIRMAN: Comments? Ms. Lohnes-Croft.

 

            MS. SUZANNE LOHNES-CROFT: May we have that in writing in the recess, please?

 

            MR. CHAIRMAN: Sure. We shall recess but we will have to ask the committee - we may have to extend the time. If we’re going to recess we’re going to extend the time that far. Is everybody okay with that?

 

            Okay, we’ll recess for a few minutes. We’ll come back at 10:55 a.m.

 

            [10:48 a.m. The committee recessed.]

 

            [10:56 a.m. The committee reconvened.]

 

            MR. CHAIRMAN: Order please. We’ll call the meeting of the Public Accounts Committee to order. The motion at hand is that the Public Accounts Committee rescind the motion of February 6, 2019, by Mr. Gordon Wilson which limited the committee meetings to monthly. Are there any further questions? Ms. Roberts.

 

            MS. ROBERTS: I’m bringing this forward because I think it’s very important that this committee do a reset and recognize that for this committee to function as it is intended to function, it requires a certain amount of co-operation across Parties. The motion that was brought forward at our last meeting layered on top of the motion last September has contributed to a situation where I fear for the future impact and efficacy of this committee.

 

            I also asked the clerk to circulate - I call it a cheat sheet, but it’s actually called a Quick Reference, The Role of Public Accounts Committee (PAC) Members. Of particular relevance for me is under the Vice Chair’s role - the Vice Chair, of course, is ordinarily Mr. Gordon Wilson. He’s not here today - “Is usually a member of the governing Party. Assumes responsibility of Chair in his/her absence. Works with the government to build support for the committee. Sets a co-operative tone for the committee.”

 

            There has been a lot of justification for changes that have been forced on the committee unilaterally by the Liberal members using their majority on the committee, justified by what is best practice or what every other committee does. Well, the fact is that across jurisdictions, one of the most important practices of the committee is that work is done to make changes in a way that keeps everybody feeling like they are on the same committee and on the same side on behalf of taxpayers working together to hold the operations of government to account for how taxpayers’ dollars are spent. This is about good administration. It’s about good government.

 

            My particular objection to the motion of last week was that it was entirely unilateral and it did not set a co-operative tone for this committee going forward. In addition to the fact that saying that this committee can only meet monthly means effectively we will not have time.

 

            A full year before Mr. Gordon Wilson raised these great concerns about the committee functioning because of the Auditor General writing a report asking us to make sure that we were scheduling departments about their implementation of recommendations, the Auditor General said essentially the same thing here in committee after which over a period of months, I made the proposal of, why don’t we create some more space in our schedule to schedule departments and we can do that by eliminating in camera meetings? As a committee, we used to meet for a full committee meeting in camera after performance audits were tabled.

 

[11:00 a.m.]

 

Therefore, instead of having two meetings with the Auditor General per performance audit, we could just have one and that will create more time to actually schedule in the departments. That change was made last April with the hope that there would be more room in our committee to hear from departments so that we could fulfill that important component of our mandate, which is to hold departments to account.

 

I am fully in favour of that, fully supportive, and wishing for us to work well with the Auditor General’s Office, but the fact is that this committee will not work well if it is the Liberal majority making changes without setting a co-operative tone for the committee going forward. That is the motivation behind this motion.

 

MR. CHAIRMAN: Ms. Adams.

 

MS. ADAMS: I would just like to speak in favour of this motion on the same document that was provided, the Canadian Audit and Accountability Foundation. On the common questions to consider when evaluating the PAC’s effectiveness, it said, “What percentage of chapters of its auditor’s report, and other mandated reports, does the committee plan to examine annually?” It goes to the heart of the issue as to how much you can get done if you’re going to meet monthly versus weekly.

 

The only people who are being hurt by going from weekly to monthly are the Nova Scotians that we represent. There is no logical reason for silencing the PAC three of the four weeks of the month. I believe that Nova Scotians’ best interests are served by returning back to the weekly meetings for the PAC, and I’m going to be supporting the motion.

 

MR. CHAIRMAN: Mr. Jessome.

 

MR. JESSOME: I’d just like to add that if we’re talking about the spirit of co-operation, I think today’s meeting was a prime example that that ability, that function of this committee still exists. All three Parties were able to ask direct and critical questions of our witnesses today. Our position has been made clear. This is the direction that we believe is - it doesn’t take away our ability to be critical of government entities, and our caucus will not be supporting this motion.

 

MR. CHAIRMAN: Ms. Leblanc.

 

MS. LEBLANC: I would agree with Mr. Jessome in that today’s meeting was a prime example of how effective this committee can be. Co-operation is key, and I think that’s exactly why we need to support this motion.

 

The fact is, we can be extremely effective when we have witnesses in front of us, and therefore, because we have so much to talk about and so many reports to go through and so many witnesses to call, we need to be meeting more often. The fact is that 12 meetings a year will not address all of the Auditor General’s Reports and the witnesses we need to call in relation to those reports.

 

This is an extremely important committee to hold government to account, but not only that, just to hear from witnesses and to clarify what is happening in departments. Nova Scotians deserve this information and they deserve to get the full picture of what’s happening in the accounts of the province and in the performance of departments in the province.

 

Again, I want to reiterate that I agree with Mr. Jessome in the spirit of co-operation. It’s such an effective committee that we should be extending that effectiveness to meeting more often - weekly, if we need to.

 

MR. CHAIRMAN: Ms. Adams.

 

MS. ADAMS: I just want to comment on what Mr. Jessome said about the fact that going from weekly PAC meetings down to monthly doesn’t take away our ability to get answers. Well, it may not take away from the government’s ability to get answers, but it certainly takes away from the Opposition Parties to get answers, and from Nova Scotians who watch this intently to find out how our money is being spent.

 

I will disagree that it doesn’t take away from our ability to get answers. It’s exactly what it does. It takes away our ability and it knocks it down to 25 per cent of what we had the ability to do before this motion was passed.

 

MR. CHAIRMAN: Is there any further discussion? If there’s no further discussion, we’ll have a recorded vote.

 

            On the motion that the committee rescind Mr. Gordon Wilson’s motion of February 6, 2019, which limited the committee to monthly meetings, we’ll have a recorded vote, starting with Mr. MacKay.

 

            YEAS                         NAYS

 

            Ms. Adams                  Mr. MacKay

            Ms. Roberts                 Mr. Glavine

            Ms. Leblanc                Mr. Jessome

            Mr. Orrell                    Ms. Lohnes-Croft

                                                Ms. DiCostanzo

 

            The motion is denied. Further business?

 

Ms. Adams.

 

            MS. ADAMS: Mr. Chairman, I have a motion to put forth and there are copies for everyone here:

 

            Whereas on Thursday, February 14, 2019, the Minister of Transportation and Infrastructure Renewal in a media scrum repeatedly denied knowing the details of an agreement to move the port of call for the Nova Scotia-to-Maine ferry;

 

            Whereas subsequent media reports indicate that the department had been in possession of information dated January 23, 2019, that outlined the details of the move, that the cost could be as much as $5 million, and that the province was expected to be a funding partner;

 

            Whereas to my mind there are three possible outcomes: (1) the minister knew the details and the cost and knowingly represented otherwise; (2) the department had entered into a financial arrangement without the knowledge and approval of the minister; or (3) the minister approved the spending without fully understanding the details that he approved;

 

            Whereas the function of this committee is to review the public accounts, the annual report, or other reports of the Auditor General and any other financial matter respecting the public funds of the province;

 

            Whereas there are serious questions about the funding for this service and whether the upgrades in Maine were properly approved; and

 

            Whereas the sailing season is mere months away and there is a tremendous amount of uncertainty and this issue demands the scrutiny of this committee immediately;

 

            Therefore be it resolved that the Public Accounts Committee approve and immediately schedule a meeting on the topic of funding for the Nova Scotia-to-Maine ferry, including the funding for land or leasehold improvements and any staffing or services in Maine, with witnesses to include the Minister of Transportation and Infrastructure Renewal and the Deputy Minister of Transportation and Infrastructure Renewal.

 

            MR. CHAIRMAN: Comments? Ms. DiCostanzo.

 

            MS. DISCOSTANZO: I would like to call a five-minute recess, please, so we can discuss this.

 

            MR. CHAIRMAN: We’ll recess for five minutes.

 

            [11:07 a.m. The committee recessed.]

 

            [11:15 a.m. The committee reconvened.]

 

            MR. CHAIRMAN: Order please.

 

On the motion that the Public Accounts Committee approve and immediately schedule a meeting on the topic of funding for the Nova Scotia to Maine ferry, including the funding for land and leasehold improvements and any staffing or services in Maine, witnesses to include the Minister of Transportation and Infrastructure Renewal and the Deputy Minister of Transportation and Infrastructure Renewal, any questions on the motion? Ms. Lohnes-Croft.

 

            MS. LOHNES-CROFT: This is an important topic for Nova Scotians and it’s very important for my constituency in particular. We rely on the ferry for a lot of economic development. Therefore, I’d like to amend the motion, that this be taken to the Natural Resources and Economic Development Committee, of which I am the Chair, and be put on the agenda at next week’s meeting.

 

            MR. CHAIRMAN: I am just told by Legislative Counsel that you can refer it to the Natural Resources and Economic Development Committee, but you can’t put it on the committee.

 

            MS. LOHNES-CROFT: I will refer it to the Economic Development Committee and have the deputy minister, not the minister.

 

            MR. CHAIRMAN: That’s not a motion for this committee.

 

            MS. LOHNES-CROFT: No.

 

            MR. CHAIRMAN: On the topic of the motion at hand, any more comments? Ms. Roberts.

 

            MS. ROBERTS: I also sit on the Natural Resources and Economic Development Committee. My experience at other committees is that they do not have the same way of operating, there is not the same focus on administration of government.

 

            The Public Accounts Committee is a different committee than other committees, in a number of ways, including the fact that Opposition members get a more substantial amount of time for questions, also the focus on the administration of government, as opposed to policy. So I want to register that that is in no way referring a topic from the Public Accounts Committee to another committee. It’s not a substitution of the same thing. That’s the point that I would like to make. I think if we have a concern about the administration of public resources, then that belongs at this committee.

 

            MR. CHAIRMAN: Ms. Leblanc.

 

            MS. LEBLANC: I’d like to echo what my colleague said. It is an important discussion. We should be talking about it in the Public Accounts Committee in the way the Public Accounts Committee is mandated to work - televised, and as my colleague has said, the way the time is allotted for questioning, et cetera.

 

            To me, this speaks exactly to the reason why we need to have more Public Accounts Committee meetings. We should be mandated to have meetings weekly so that we are able to adjust for these types of circumstances. While I appreciate the Liberals’ effort to collaborate, I don’t believe that this does the trick, so I wouldn’t be able to support that motion.

 

            MR. CHAIRMAN: Ms. Adams.

 

            MS. ADAMS: I don’t support the amendment to the motion. If my colleague is as interested as I am in hearing Minister Hines and the Department of Transportation and Infrastructure Renewal, she’ll understand if I don’t want to pass this along to another committee that may or may not bring it forward. There is no guarantee that it would be brought forward, so I am not in favour of the amendment to that motion.

 

            MR. CHAIRMAN: Any further comments on the amendment to the motion to refer to the Natural Resources and Economic Development Committee?

 

A recorded vote has been asked for on the amendment. We will now record the vote, beginning with Mr. MacKay.

 

            YEAS                                     NAYS

 

            Mr. MacKay                           Ms. Adams

            Mr. Glavine                             Ms. Roberts

            Mr. Jessome                            Ms. Leblanc

            Ms. Lohnes-Croft                   Mr. Orrell

            Ms. DiCostanzo

           

            The motion is carried.

 

On the main motion that the Public Accounts Committee approve to schedule that meeting, would all those in favour of the motion please say Aye. Contrary minded, Nay.

 

The main motion was that the Public Accounts Committee approve and immediately schedule a meeting on the topic of funding for the Nova Scotia-to-Maine ferry. (Interruptions) The main motion is down to the Natural Resources and Economic Development. Would all those in favour of the motion please say Aye. Contrary minded, Nay.

 

The main motion now is amended that it be sent to the Natural Resources and Economic Development. Would all those in favour of the motion please say Aye. Contrary minded, Nay.

 

            The motion is carried.

 

            Is there any further business to come forward at today’s meeting?

 

If I may, I’ve got to say that the spirit of collaboration that we supposedly wanted to work with here has gone out the window. I’ve got to say, I’m very disappointed in the committee. We’ve bent over backwards, since I’ve been the chairman, to be collaborative in this committee. We’ve brought it to the attention that we would do the Public Accounts Committee from the Auditor General’s Reports, but the mandate says others. I’m very disappointed in the committee members, especially on the side that keeps denying anything else that would come to this committee.

 

I just had to get that on the record. The meeting is adjourned.

 

            [The committee adjourned at 11:24 a.m.]