Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Sunday, January 14, 2007

How Many Times Does This Sort of Thing Need to Happen?

If ever there was going to be an independent report that would focus NEHTA’s mind on the need to change direction this is it!

Last week the following article (selected quotes below) appeared in the Toronto Star. The full article can be found at the following URL:


Report slams e-health agency

“Smart Systems is not offering good value to taxpayers, consultancy says”

The agency responsible for Ontario's electronic health infrastructure is poorly regarded in the health-care community, lacks strategic direction, and has not been held properly accountable by Queen's Park, according to an operational review conducted by Deloitte Consulting.

"Given the increased urgency for substantive progress with e-health in Ontario, an aggressive agency-turnaround plan is required," concludes the 100-page report, the outcome of an internal review launched a year ago by Health Minister George Smitherman.”

“The agency, which employs more than 300 people, was created in 2002 and has since received $458 million from Ontario taxpayers as part of its mandate to electronically link and support the province's 150,000 health-care providers.”


“Among the review's findings:

• There has been "little or no meaningful progress" with the creation of an emergency health record for Ontarians, though it was recognized there was "ambiguity" with the agency's role in this area.
• The network designed to link health-care providers is "below standard" when it comes to practices for monitoring performance and security.
• Assessing the agency's performance versus the government's expectations is difficult because "well-defined expectations, deliverables and measurable performance targets have not been established and documented by the ministry for SSHA."
• The Smart Systems' secure email service has fallen well short of expectations, as only a third of the 60,000 accounts that have been installed are being used.
• Though the agency is expected to host sensitive health information, "privacy policies are incomplete and not widely understood" and "many of the procedures necessary to provide guidance and direction have not been developed or are in draft form." In certain instances, "processes are ad hoc, undefined or undocumented."
• Security of patient information was also questioned, as Deloitte said it wasn't clear who was responsible for defining and implementing security controls and technologies. "As a result, sensitive information may not be protected consistently throughout its lifecycle."

A copy of the full report can be downloaded from:


All in all it would be difficult to say the money has been well spent so far.

The Smart Systems for Health Agency (SSHA) was intended to be a provider of connectivity services and standards for the health sector in Ontario, Canada – the largest province in the country with a population of a little over 13 million.

The mandate which the Agency was given in 2002/3 covered the following:

“The mandate at the time highlighted six products to support the priority initiatives identified within the SSHA regulation:

−Managing the private network;

−Providing a secure messaging service and online directories;

−Security infrastructure;

−Physical facilities;

−Voluntary emergency health record;

−Data and technology standards.”

A little later (2004/5) a role in application delivery for the sector was added. All the while the SSHA has been “pursuing a long-term goal of creating a voluntary EHR to allow health care professionals to access patients’ lifetime health histories. To achieve this goal, EHRs will need to connect many sources of information as well as currently independent applications and databases. Establishing electronic connections to allow information from different sources, applications and databases to be shared is the focus of SSHA’s efforts at this time.”

The parallels with NEHTA’s present role and activities are quite uncanny.

The five recommendations from Deloittes to the Ontario Health Ministry (among a large number of internally focussed recommendations) make it clear just what the key problems have been:

• “Finalize and approve the Ontario e-Health Strategy
• Strengthen e-Health program management
• Establish enabling legislation/regulation for SSHA
• Strengthen e-Health privacy policy
• Enhance communication and collaboration between MOHTLC and SSHA”

Essentially a secure messaging environment and a technical infrastructure has been created in the absence of an e-Health Strategy, implementation plan, privacy policy and effective communication with the key clients. Additionally the core role of the SSHA in servicing the health sector has been lost – along with over $A500 million it would seem.

Just how similar does all this seem to the way NEHTA is proceeding at present (developing infrastructure in a strategic vacuum and the like) and how different is the outcome likely to be unless a Deloitte like review is undertaken as a matter of some considerable urgency?

I do see light at the end of this tunnel and it is that of an oncoming train!


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