box10.gif (1299 bytes)







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 million.

As well, operating costs are pegged at a further $27 million a year and rising.

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 person.

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 endeavour.”

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 way.

“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 for efficiencies.”

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 competing priorities.

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