Purpose The Ontario Health Technology Advisory Committee (OHTAC) is the single portal for providing advice to the health care system, including the Ministry of Health and Long-Term Care (MOHLTC), regarding the uptake, diffusion and distribution for new health technologies and the removal of obsolete health technologies.

The Ontario Health Technology Advisory Committee welcomes applications for review of Health Technologies. The application form and contact information are available online.

Health technology includes a wide range of procedures, devices and equipment applied to the maintenance, restoration and promotion of health. Technology encompasses interventions at any stage of health care including primary prevention, early detection of disease and risk factors, diagnosis, treatment, rehabilitation and palliative care.

• Individual health technologies
• Groups of integrated health technologies that relate to specific disease states
• Existing health technologies that have already diffused and are either related to a new or emerging technology under review or the health system regards a review of the technology as appropriate

• Examine or provide recommendations for pharmaceutical products or information systems
• Engage in general disease management reviews but rather the integration of technologies related to specific diseases and conditions
• Infringe upon the important role of innovation through health research.

• Examine proposed health technologies in the context of existing clinical practice.
• Provide advice and recommendations to MOHLTC, practitioners and the broader health care system based on a systematic, objective, evidence-based technology assessment and taking into account economic, human resource, regulatory and ethical considerations
• Create a forum to maximize opportunities and prioritize the uptake and diffusion of new / emerging health technologies deemed to significantly improve patient outcomes and/or systems efficiencies relative to other existing or competing interventions.
• Outline implications for implementing OHTAC recommendations including the impact on the public, society, health care sectors and professions
• Provide advice regarding the field evaluation of technologies deemed to be potentially useful but for which there is inadequate existing quality evidence to support multi-million dollar, multi-year investments.
• Provide transparency regarding its recommendations and the analyses upon which these recommendations are made to Ontario's health care system

1. Establish an application process that is accessible, credible, consistent and fair,
2. Institute prioritization, health technology assessment and recommendation processes that are objective, transparent, consistent and timely and facilitate consistency in decision-making
3. Establish an informal horizon scanning process that focuses on technology information gleaned from the MOHLTC, CIHI, MAS and expert stakeholders.
4. Engage clinical experts and appoint provincial expert panels when needed. (Provincial expert panels will have terms of reference approved by OHTAC)
5. Create mechanisms to involve the general public in OHTAC decision-making
6. Receive and consider reports regarding Ontario field evaluation studies to inform its recommendations
7. Establish a recommendation framework that encompasses :
• A robust economic analysis including consideration of budget impact, cost-avoidance, cost-effectiveness, opportunity cost analysis and sensitivity modeling as appropriate.
• An analysis of human resource implications, including training, and recruitment.
• Existing guidelines or new evidence-based guidelines developed from OHTAC recommendations, developed under the aegis of the Program in Evidence-Based Care, endorsed by experts, and disseminated by the Guidelines Advisory Committee.
• An articulation of implementation implications for the public, society, the law, hospital community and long-term care sectors and health care professionals such as physicians, specialists and nurses.
8. Track and report on implementation of OHTAC recommendations, including impact on and diffusion in, the health care system, performance of the technology once diffused, compliance with OHTAC guidelines and the Ministry rationale for inaction, as appropriate.
9. Conduct period reviews with the aim of assuring ongoing relevance and improving overall performance

OHTAC will consist of a minimum of 12 members, including representatives of the Ontario Medical Association and the Ontario Hospital Association. The Assistant Deputy Minister Acute Services Division, MOHLTC will appoint members for renewable two-year terms. The Head of the Medical Advisory Secretariat and the head of the Ontario Guidelines Advisory Committee will be ex-officio members.

Membership will include representatives from the hospital, community and long-term care sectors, nursing and medical professions, as well as experts in health economics, ethics and technology assessment.

When Local Health Integrated Networks (LHINs) are fully established in Ontario, a member representing these organisations will be invited to become a member of OHTAC.

Substitutions of appointed members will not be permitted.

Members who fail to attend three consecutive meetings will automatically lose their membership unless extenuating circumstances can be proven.

The Committee will be co-chaired between a CEO of an AHSC, (appointed by the Assistant Deputy Minister) and the Assistant Deputy Minister, Acute Services Division, who will alternate chairmanship of the committee meetings. Chairpersons will serve for a minimum of two years.

Committee members must ensure that any actual or potential conflict of interest arising in regard to any matter under discussion by the committee is drawn to the attention of the Co-Chairs of the Committee. The Co-Chairs of the Committee will determine what action, if any, is required arising from the conflict of interest and will take appropriate action, including but not limited to, requesting the member absent themselves from participation in discussion of that matter.

Committee members must ensure that while they fulfil their duties as a member of the committee, they will not engage in any activity or provide any service for compensation or otherwise, to any other persons or organisations where such service creates an actual or potential conflict of interest with their role as a member of the committee, without prior written consent of the chair of the committee on the advice of the Deputy Minister of Health and Long-Term Care. Committee members are expected to make the Co-Chairs of the Committee aware of any such instances or potential instances whenever they arise.

All information and material of any kind whatsoever acquired or prepared by or for the committee, pursuant to this appointment shall, both during and following the duration of this committee, be the sole property of Her Majesty the Queen in right of Ontario as represented by the Minister of Health and Long-Term Care.

Members may not use any data or information obtained as a result of their membership on the committee for their personal financial benefit or gain, or for the benefit or gain of any entity or corporation in which they have a financial interest or in which they have an interest as an employee or officer.

Members undertake to keep forever secret, confidential and inviolate and not directly or indirectly disclose to any person, association of persons, corporations or government, or use at any time, either during or subsequent to their term as a member of the Committee, any data or information that is not generally available to the public. This includes data in any form or format whatsoever concerning or derived from any data or information provided to the committee.

Members are requested to refer media inquiries about the committee and its work to the co-chairs of the committee.

MAS will function as the OHTAC secretariat. This secretariat function will include facilitating applications, co-ordinating technology proposals for assessment, conducting systematic reviews and economic analyses for technologies prioritised by the Advisory Committee in addition to providing all administrative support for OHTAC.

OHTAC will meet ten times a year or at the call of the Chairs. At least a majority of members must be present for decision-making purposes. Decisions of the committee will be made by consensus. If consensus is not possible, a simple majority will suffice, in which case the vote will be recorded and significant objections noted.

Meetings may be conducted by teleconference or video conferencing or in person and at a location convenient for most members.

MOHLTC will assume responsibility for travel expenses incurred by meeting participants.

OHTAC will communicate its advice and recommendations to the Deputy Minister, Ministry of Health and Long-Term Care, whenever it is developed. An annual summary report of recommendations will be prepared each fall for the Deputy Minister, MOHLTC.

Reviews on which OHTAC recommendations are based and recommendations from OHTAC to the Ministry of Health and Long-Term Care will be posted on the MOHLTC website 60 days following the making of the recommendation by OHTAC.

If an appellant believes new evidence or arguments should be presented to OHTAC within 60 days of the posting of the review on the website, the appellant should contact the Medical Advisory Secretariat to request an appearance before OHTAC. The appellant will be invited to make a 20-minute presentation to the committee followed by discussion.

Reviews prepared by the Medical Advisory Secretariat on behalf of OHTAC will be updated from time to time as required. Specifically, OHTAC has adopted the policy that a health technology review be updated :

• By request from healthcare providers, MOHLTC, OHTAC, or Health Technology Utilization Guidelines of Ontario (Health TUGO)
• If there was ambiguity at the time of the original review, due to conflicting or inadequate evidence, and now there is new, high quality evidence available
• If important study results were anticipated but unavailable at the time of the original review, the results of which may significantly affect the magnitude of effect, efficacy and safety
• If safety concerns regarding the technology have emerged since the original review was completed.

In March 2003, a consultation process with representatives from Academic Health Science Centres (AHSCs) and other key Ontario technology assessment stakeholders supported the concept that a single portal of entry process be established for the coordinated uptake and diffusion of new health technologies with evidence of proven effectiveness in improving patient outcomes. A single portal of entry was believed to provide a more consistent, informed, decision-making process for improving equitable access to new health technologies. In response, the Ontario Health Technology Advisory Committee (OHTAC) was created in October 2003 with secretariat and methodological support from the Medical Advisory Secretariat (MAS) of the Ministry of Health and Long Term Care (MOHLTC).

It was envisaged that OHTAC would provide advice and facilitate the planned distribution of technology and equal access for patients across the province. The process was intended to improve understanding of the economic consequences beyond the immediate impacts of technology where there was evidence of effectiveness. These analyses were expected to provide information that added value to government decision makers.

In February 2005, eighteen months after OHTAC was created, MAS commissioned a review of OHTAC and the MAS processes as part of its ongoing quality improvement initiative. The aim was to identify areas that required different or new processes and methodologies and consisted of a review of documentation and interviews with key informants. Professor Michael Drummond of the Centre for Health Economics, University of York (UK), conducted the review. In brief, he reported broad support for the rational approach to decision-making related to the adoption, diffusion and use of health technologies. He also commented that the Health Technology Assessment (HTA) Program in Ontario was excellent. Recommendations for improved effectiveness processes were made.

In April 2005, OHTAC held a retreat and reviewed the findings and recommendations arising from the Drummond report. Based on the discussion and key decisions arising from the retreat, OHTAC Terms of Reference were revised accordingly. OHTAC adopted the revised Terms of Reference in June 2005.

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