Government & policy
Auditor finds fault with eHealth in British Columbia
VICTORIA, B.C. –
Provincial auditor John Doyle (pictured) last month issued a
hard-hitting critique of British Columbia’s efforts to create an eHealth
system, slamming the province for a lack of management and poor
coordination that has resulted in the project running five years late
and far over budget.
Moreover, the release of the 50+ page document was purposely delayed for
six months, the auditor said, after weaknesses in the security of
provincial healthcare databases was discovered. The hiatus was meant to
give planners a chance to beef up security systems.
The original plan for a province-wide eHealth system was launched in
2005 with the target of completion by 2008. The new target is now 2013,
five years behind schedule.
The project was first given a budget of $150 million, with $120 million
coming from Canada Health Infoway and $30 million from the province.
However, the capital costs have soared by nearly 50 percent to a
projected $222 million, with the provincial share growing to $110
As well, operating costs are pegged at a further $27 million a year and
At the same time, Doyle contends that the BC health ministry is still
assessing how much work has been completed so far. As such, the figures
on total budgets may yet change again.
The report notes that some confusion in planning was caused in 2007 with
the dismissal of assistant deputy health minister Ron Danderfer, who was directing
the eHealth effort but became embroiled in a scandal. He was recently
charged with allegedly accepting favours in exchange for providing
favourable treatment to an eHealth contractor.
However, the problems in planning go beyond the responsibilities of one
As Doyle observes in the report, “We expected the ministry to develop
and follow a good tactical plan from the start; one that laid out how it
intended to achieve the strategic goals of an integrated, compatible
provincial electronic health records system.”
However, the auditor and his team found a lack of planning and
direction: “The ministry initiated the EHR in 2005 without having a
comprehensive tactical plan for completing this complex and high-risk
Like many other eHealth projects, there was little in the way of
on-going evaluation or reporting of results. “Good management practice
would have been to establish how the initiative would be evaluated early
in the planning stage and to collect baseline information to measure
future results against.”
But according to the report, “During our audit the ministry had just
started planning how to evaluate the impact and outcomes.”
Duplication of effort and interoperability have also been persistent
problems, with the auditor noting that BC’s six health authorities and
ministry of health have been acquiring IT systems in an uncoordinated
“The provincial and regional EHRs have proceeded along relatively
separate paths. For example, each health authority and the ministry
itself has developed or purchased its own viewer (the part of the
electronic record that connects to, and displays, the health information
on a health professional’s computer). Duplicated effort such as this
likely contributed to delays in EHR progress and missed opportunities
Moreover, according to the auditor, the ministry didn’t adequately
involve the people who would ultimately be using the systems – doctors,
nurses and allied professionals. “Health professionals were not engaged
by original planning processes. Achieving the expected value from the
EHR initiative requires engaging doctors, nurses, pharmacists and other
health professionals from the start, to ensure the tools developed meet
their requirements. The professionals must see the benefits of the EHR
system for their clinical work before they will adopt it.
More recently, B.C. has addressed these problems. The auditor observed
that a streamlined governance structure was established in 2008 that
brings key stakeholders together in one group called the eHealth
Strategy Council. It provides strategic advice to the ministry and
developed the Health Sector IM/IT Strategy for the province.
The eHealth Strategy Council membership includes health professional
organizations (representing doctors, nurses and pharmacists), First
Nations, and key decision-makers.
The 20 members are responsible for providing health system leadership
and not just organizational representation. Expanding both the
membership and the role to the broader health sector should reduce the
risk of duplication and of time and resources wasted because of
As well, “A new Clinical Integration Advisory Committee started in 2009.
The group represents clinical users of the EHR – active health
professionals with eHealth linkages. The aim is to obtain health
professionals’ advice and support on the deployment and adoption of the
EHR and associated policies (related to privacy, for example). It was
too early for us to assess how effectively this committee operates.”
In December 2009, the eHealth Strategy Council published its provincial
Health Sector IM/ IT Strategy, the first integrated, whole health sector
IM/IT plan for British Columbia.
Through the process of developing the strategy, the council members and
the organizations they represent committed to:
• developing a provincial health sector IM/IT strategy aligned with
provincial health sector priorities, identifying key areas of focus;
• aligning IM/IT plans in each organization with the strategy;
• containing IM/IT costs by expanding shared services (reducing
duplication in organizations); and
• ensuring that privacy and confidentiality of health
information are protected.
The new strategy covers the period 2009/10-2013/14, and is to be revised
on an ongoing basis with publication of annual updates. This plan has
been shared with stakeholders and published on the ministry website.
Posted March 25, 2010