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Electronic health records

eHealth mismanaged in Prince Edward Island, auditor says

CHARLOTTETOWN – Yet another province has delivered disappointing results when it comes to eHealth. This time, it’s in the province of Prince Edward Island, where Auditor General Colin Younker (pictured) found the government’s efforts to create an integrated network were poorly managed. As a result, there have been delays and cost overruns, with a system that’s still incomplete.

The auditor general’s critique was part of his annual report, delivered in April, with 23 pages given over to an analysis of the provincial eHealth project.

In PEI, the provincial government expected costs of $12 million to create an integrated network. That was supposed to be fully funded by the federal government and other sources.

But two years later, the costs had more than doubled to $27 million, with P.E.I. taxpayers being on the hook for $12 million.

Costs have since ballooned to more than $33 million, with taxpayers having to dish out $15.6 million.

Meanwhile, the program is still not fully operational, and the province is expected to spend another $6 million over the next five years on capital costs associated with electronic health records.

“I don’t think we could use the word scandal,” Younker told reporters following the release of the report. “There were problems with planning, governance, oversight and project management especially between 2005 and 2007.”

Most analysts agree that integrated, electronic healthcare systems will lead to faster, more accurate decision-making for clinicians. The problem has been one of translating theory into practice, and building networks that work with the needed interoperability – on budget and on time.

Younker was highly critical of how the Department of Health managed the rollout of electronic health records in Prince Edward Island. In his report, Younker writes: “... the Department of Health did not provide adequate oversight for the EHR initiative.”

A steering committee had been established that reported to the deputy minister of health. But Younker says progress reports were not prepared on the overall project.

In the spring of 2007, Younker said it was clear there were problems with costs and timelines and the provincial cabinet demanded biweekly progress updates.

However, these updates did not include financial comparisons of actual costs to the budget. Moreover, the Department of Health handed out contracts for professional service without going out to a competitive bid, something that is required for contracts over $100,000.

In one instance, payments were made to a contractor but the Department of Health could not provide any contract.

Younker points part of the blame at the constant restructuring at the Department of Health. The implementation was delayed because of an “absence of senior management during the critical start-up phase” when all the regional health authorities were disbanded.

More delays occurred after the information technology section of the Department of Health was eliminated.

In 2008 the province was notified that the operating platform used for the clinical information system was not going to be supported after 2012. Consequently, the province will have to invest $15 million over the next 10 years to migrate the system to a new operating platform.

The auditor general is calling on the province to publicly report information on the progress achieved in implementing the rest of the program, including a comparison of the actual and expected costs. He’s also calling for strengthening of the project’s oversight.

Younker also wants a competitive process to be used prior to the awarding of contracts. The province didn’t only underestimate the capital costs associated with electronic health records it also underestimated the ongoing costs.

The province had anticipated annual operational costs of $3 million with about 24 people supporting the program.

Two years later those costs had increased to $4.7 million with 53 people supporting the program. Those ongoing costs are now expected to hit $6 million.

Posted May 6, 2010