Wednesday, December 07, 2016

It Seems Major Government Health IT Projects Can Do Little But Disappoint.

This time we have a Canadian story.
There are many reports on this issue:
First we have:

After $8B spent, e-health records initiative still not complete

Auditor General annual report critical of program to switch to electronic health records
December 1, 2016 by: Sudbury.com Staff
Ontario’s health-care sector spent more than $8 billion between 2002/03 and 2015/16 on various electronic health records projects and related initiatives, but significant components are still not operational, Ontario Auditor General Bonnie Lysyk said in her 2016 Annual Report.
The government had committed in 2008 to providing an electronic health records for every Ontarian by 2015.
“The initiative has certainly advanced since our last audit in 2009,” Lysyk said Wednesday after tabling her report in the Legislature. “However, it is still not possible to say if it is on budget because the government never set an overall budget for it. In effect, we cannot say if $8 billion is a reasonable figure.”
Although an overall strategy or budget is lacking, the province did create a formal $1.06-billion budget in 2010 (which also covered prior periods) for completion of some electronic health records projects under the responsibility of eHealth Ontario. This budget excluded eHealth Ontario’s annual corporate administration expenses.
An electronic health record is a digital lifetime record of an individual’s health and health-care history, updated in real-time and securely available to authorized health-care professionals. 
More here:
There is also coverage here:

$8 billion and 14 years later, eHealth has yet to finish the job

By Shawn Jeffords, Political Bureau Chief
First posted: Wednesday, November 30, 2016 01:11 PM EST | Updated: Wednesday, November 30, 2016 01:17 PM EST
More than $8 billion and 14 years later and Ontario still doesn’t have a working electronic health records system.
That according to Ontario’s Auditor General who tabled her annual report Wednesday. In it, she notes that “significant components” of the system are still not working in 2016 after a government pledge seven years ago to have electronic health records for every Ontarian by 2015.
“The initiative has certainly advanced since our last audit in 2009,” Lysyk said in a news release. “However, it is still not possible to say if it is on budget because the government never set an overall budget for it. In effect, we cannot say if the $8 billion is a reasonable figure.”
More here:
Last we have broader coverage here:

Ontario auditor general exposes litany of government snafus in annual report

Examples include cracked highways, overspending on eHealth records, shoddy Metrolinx oversight of contractors, and a climate change plan that will do more in California than Ontario.
By
Wed., Nov. 30, 2016
Crumbling highways, shoddy transit contractors, $8 billion spent on still-incomplete eHealth electronic medical records, and a climate change plan that will do more in California than Ontario.
Those are some of a litany of government snafus exposed by auditor general Bonnie Lysyk in her annual two-volume, 1,063-page report to the legislature on Wednesday.
The independent watchdog said a common theme throughout her 13 value-for-money audits was government contractors and suppliers screwing up yet still being rewarded with additional business.
“They probably receive more chances than you and I would give them if they were renovating our house,” said Lysyk.
Her audit of eHealth Ontario found the controversial agency’s work remained unfinished some 14 years after the computerized health records program was formally launched.
“The initiative has certainly advanced since our last audit in 2009. However it is still not possible to say if it is on budget because the government never set an overall budget,” she said.
“In effect, we cannot say if $8 billion is a reasonable figure.”
That amount includes $3 billion spent by eHealth, $1 billion by the Ministry of Health and agencies like Cancer Care Ontario, and $4 billion by hospitals, community care access centres and other clinics across the province.
As first disclosed by the Star on Oct. 13, the government was so worried about Lysyk’s audit that it scrambled former TD Bank CEO Ed Clark, Premier Kathleen Wynne’s business guru, to recommend improvements.
In a 48-page report last week, Clark said while eHealth provides‎ $900 million in annual health-care benefits to Ontarians, its mandate should be sharpened so it has “an explicit focus on technology service delivery and to ensure the agency is held to account for delivery” of those services.
The agency has been dogged by problems, including an expense account scandal when private consultants earning $3,000 a day billed taxpayers for $3.99 Choco Bite cookies and $1.65 Tim Hortons tea.
Lysyk found the seven main eHealth projects that former premier Dalton McGuinty’s government deemed priorities in 2010 were only about 80 per cent done — despite a 2015 deadline for completion. Those are now expected to be finished by March.
Health Minister Eric Hoskins said he will soon unveil “the next steps of our digital health strategy that will continue modernizing our system, further improving patient access, connectivity and experience.”
Lots more here:
Here is the link to the relevant section of the report:
Reading the detailed report (which I have to say makes riveting reading) what struck me is that we all really need this Ontario Auditor General to spend three months or so to audit our national e-Health Program.
I think her views would be very useful!
David.

12 comments:

Anonymous said...

David,
This is another gem you have posted !! When you consider that Ontario 's population - of around 14 million comparable to that of NSW and Vic combined and about one third of the total Canadian population (comparable to NSW) ... the comparisons don't stop there ... both NSW and Victoria have invested heavily in the implementation of EHRs and "advanced clinical systems" over the past 14 years with not a great deal to show for it (refer to A-Gs report on Victoria's HealthSmart program and ongoing overspend and under delivery with NSW Health / eHealth NSW implementation program ... not sure how many billions NSW and Victoria have wasted in aggregate over the past 14 years ... but likely to be at least 4-5 Billion in total. The Ontario provincial investment in EHRs is only a part (albeit considerable amount) of the total investment in the Canadian government multi-decade investment in the funded Infoway Program (or the investment by the other Canadian provinces) .... This is similarly teh case in Australia .... add at least 2-2.5Billion (and counting) for the PCEHR / MyEHR bottomless pit and counting !! .... doesn't really stack up as good value or money on any reasonable index of performance assessment in my view.

Tom Bowden said...


As someone with quite a lot of experience in Canadian e-Health (we have a business there and I have consulted to Infoway), my view is that Ontario like many other provinces, regions, states and even countries is trying to do something unachievable. Attempting to boil the ocean is one way of putting it.

If a fraction of that sum were applied to joining up day to day healthcare delivery they might have a platform upon which they could build "middle out" to create a fully networked healthcare system over time.

The past decade has been largely wasted - tilting at windmills.

Terry Hannan said...

David and Anonymous, I am in total agreement with what you have posted and the views expressed. I can add very little to what has been written by both of you. I would like to add that the Canadian system and the UK systems provide important lessons of "what not to do" with national eHealth records. This knowledge should encourage the Australian developers to look 'outside our own backyard' for both successes and failures in this field. This posting reminds me of the paper by Lucien Leape (of To Err Is Human authorship). His paper in 2005 was titled "Five Years After to Err Is Human. What have we Learned?"
Answer: very little in most situations.

Bernard Robertson-Dunn said...

If I could add my agreement.

Tom said: "Attempting to boil the ocean is one way of putting it."

Another is "We know the answer and the PCEHR is it!" No, wait a minute "My Health Record is it!", No, hang on, "ADHA is it!", "Maybe eHealth is it!"

Whatever the answer, technology on its own isn't it. In fact the IoT is going to make it much worse.

Anonymous said...

Someone should have told Shane Solomon before he set up Telstra Health to show us all how to do it.

Anonymous said...

In response to the first comment to this one - it may be true that not much has been done in Victoria, but anyone claiming the same is true in New South Wales either has not done the research or has some kind of axe to grind. There must be 100 hospitals now with EMR and an increasing number with EMM as well. You may or may not like the system chosen, but you can’t run the “waste of money” argument.

Dr David More MB PhD FACHI said...

Can I say I agree it is important to separate NSW and Victoria. Having (sadly) been in RNSH recently I can testify they have a pretty good system that is working pretty well.

I blogged about my experience in mid August.

Re the Victorians and myHR is am much more in agreement all is not well!

David.

Bernard Robertson-Dunn said...

Re NSW health. Have a look at these links. I don't know how current they are, but their intention and scope is way beyond MyHR.

AFAIK none of these systems are patient accessible or controlled.

Electronic Medical Record
http://www.ehealth.nsw.gov.au/programs/clinical/emr-connect/emr
over 100 hospitals are using the basic eMR and 100,000 people now have access to the eMR state-wide.

HealtheNet Clinical Portal
http://www.ehealth.nsw.gov.au/programs/clinical/healthenet/healthenet_clinical_portal
The HealtheNet Clinical Portal is a secure database that provides NSW Health clinicians with immediate access to patient information which resides outside of the hospital's electronic medical records (eMR). This includes recent medical information from other NSW Health Local Health Districts and information available in the My Health Record.

Electronic Record for Intensive Care (eRIC)
http://www.ehealth.nsw.gov.au/programs/clinical/eric

eRIC is an electronic system that integrates data every minute from bedside monitors, ventilators and specialised equipment in one configuration for Adult, Paediatric and Neonatal ICUs using evidence based best clinical practice.

eRIC has been designed and configured through extensive consultation with a wide variety of NSW clinicians working within and outside the ICU.

Once implemented across 43 ICUs of NSW, eRIC will be the largest system-wide ICU clinical information system in the world.

Dr David More MB PhD FACHI said...

Bernard,

These systems are all largely internal Hospital Systems to be used by Health Department Staff and clinicians. They are nothing to do with the myHR mostly other than providing discharge summaries for it.

David.

Bernard Robertson-Dunn said...

David,

I know. But are they not the systems that actually deliver health car value? The government has never explained what value the MyHR has or even could deliver. And I mean value, not benefit.

Your original post quoted "An electronic health record is a digital lifetime record of an individual’s health and health-care history, updated in real-time and securely available to authorized health-care professionals." So I assumed the context was point of care systems to be used by service providers.

IMHO, the MyHR is the wrong solution to the wrong problem. And an expensive solution at that.

Dr David More MB PhD FACHI said...

Barnard,

I don't understand your point.

Number 1 and 3 are crucial operational systems for Hospitals - and are vital for care these days.

No 2 provides information from hospitals to local GPs - again important.

David.

Bernard Robertson-Dunn said...

David,

I wasn't making a point, just providing references to NSW systems, as per this post:

"In response to the first comment to this one - it may be true that not much has been done in Victoria, but anyone claiming the same is true in New South Wales either has not done the research or has some kind of axe to grind. There must be 100 hospitals now with EMR and an increasing number with EMM as well. You may or may not like the system chosen, but you can’t run the “waste of money” argument."

Sorry if I was unclear.