A few days ago the Auditor General in British Columbia released two reports on e-Health in that province.
Here is the initial reporting I saw.
Auditor general says B.C. e-health system progressing slowly, has long way to go
By Camille Bains (CP)
VANCOUVER, B.C. — British Columbia lacked a strategic plan as it embarked on a multimillion-dollar electronic health records project six years ago, says the province's auditor general.
John Doyle said the government was slow to get going on the system because there was no co-ordination involved.
"Key stakeholders such as health professionals were not effectively engaged to ensure the proposed EHR (electronic health records) system would meet the needs of its users," he said in an audit report released Wednesday.
He said that while the government has initiated some ways to involve doctors in planning the project, they have not succeeded.
"Among the reasons for the failure of this effort: unclear goals for doctor involvement, possibly too little compensation offered, and the competing priority of health authorities planning regional (electronic health records)."
The Health Ministry has made some progress after changing tactics two years ago, Doyle said of the project that has also been linked to an ongoing RCMP investigation.
"The new strategy has not been widely communicated and it is too early to assess the effectiveness."
"The work still to be done to complete (the project) is extensive."
Doyle said the ministry's new 2008 strategy included establishing a simpler governance structure that brought together a group of 20 people including doctors, nurses, pharmacists and First Nations.
Lots more here:
http://www.google.com/hostednews/canadianpress/article/ALeqM5jNXEMRBedyK15qxj8GQuz49cS0Ng
This has been followed up by a series of reports – which have probably not really been noticed because of the Winter Olympics that are going on there.
Scathing report details botched e-health plans
Poor planning, a budget that is soaring out of control and delivery that is five years behind schedule plague electronic records program
By Vaughn Palmer, Vancouver Sun
The B.C. Liberal drive for electronic records-keeping in the health care system is behind schedule, over budget, poorly planned and still a long way from realizing any benefits to patients, according to auditor general John Doyle.
Doyle released a report Wednesday that chronicled a list of failings so comprehensive as to raise doubts about whether the Electronic Health Records project could be said to be "managed" in any proper sense whatsoever.
By way of accountability, the almost 60-page report contained a passing mention of one likely blame line for the Liberals: "Turnover in senior management" at the health services ministry and "a sudden change in the assistant deputy minister."
Both references to the ouster, in mid-2007, of the senior official in charge of e-health, over a series of allegations that are still being examined by a special prosecutor.
But it would be a mistake to attribute the EHR failings to a single official, however highly placed.
More than two years after the supposed housecleaning in the health ministry, there remain considerable problems with the Liberal plan to establish a single, province-wide system to allow authorized health care providers to access a patient's complete medical records wherever the individual seeks medical attention.
"There is still a long way to go before British Columbians fully realize the benefits of having an electronic health record," Doyle cautioned in his report.
The auditor-general agreed the project has potential benefits for patients and medical professionals alike. But given the inherent complexities, his report conveys a sense of astonishment at the inadequacies of the planning process and absence of follow-through.
More here:
http://www.vancouversun.com/health/Scathing+report+details+botched+health+plans/2579660/story.html
Next day.
Planning came late to the initiative for electronic health records
The Liberals fumbled the e-health file so badly that regional systems being developed aren't compatible across the province
By Vaughn Palmer, Vancouver Sun
One doesn't need to read too far into the latest report from auditor-general John Doyle to discover why electronic health records should be a good thing for patients and medical professionals alike.
"Why should a lack of comprehensive EHR be a concern for British Columbians?" asks Doyle, in the opening pages of his damning investigation of the provincial government's way-behind-schedule, grossly over-budget and ineptly planned records-keeping initiative.
He then proceeds to answer his own question, using a series of fictional scenarios to illustrate the potential benefits of a thorough system of electronic record-keeping in the health care sector.
Fictional scenario one: "Eric is a senior citizen who has lived in six different parts of B.C. in the last 10 years. He has had X-rays and blood tests and received various prescriptions in several different towns."
Then one day, while our senior is on vacation in the Okanagan, he experiences shortness of breath and is taken to a walk-in medical clinic in Kelowna.
"Currently, Eric's health records exist all over the province, on paper and film. This makes the job of the treating physician in Kelowna especially challenging because she will have difficulty accessing all the details about Eric's medical history quickly and efficiently."
One can readily expand on Doyle's scenario by adding a few more telling details.
What medication has Eric been taking? Has he experienced shortness of breath before, when and to what extent? He might be able to answer himself, were he not stressed and increasingly muddled. His doctor would know, but she's on vacation and her practice is being handled by a stand-in who has never treated Eric.
Point made. Electronic health records could be a positive boon. But that only underscores the significance of Doyle's report, summarized by his discouraging observation that "there is still a long way to go before British Columbians will enjoy the benefits of an EHR system."
The system, which was supposed to be fully operational two years ago, won't be up and running for three years at the earliest. "Once built," adds Doyle, "it will still need to be fully integrated across the health sector and regularly used by health professionals in treating their patients."
Nor can one have much confidence that the Liberals will be able to stick to their current, much-revised schedule, given their ineptitude to date.
For instance, take the matter of the government's relations with the medical professionals who will be generating the electronic records and accessing them on a daily, hourly and perhaps minute-by-minute basis.
.....
Four years into the program for electronic health records, $150 million already spent, and the B.C. Liberals (under prodding from the auditor-general) have finally got around to producing a credible strategic plan.
Monumentally embarrassing for a party that claims to know how to run the proverbial peanut stand.
More here:
And next day
E-health security so lax report was withheld
Publication of auditor-general's findings delayed half a year while Vancouver Coastal tried to plug holes in medical records database
By Vaughn Palmer, Vancouver Sun
When Auditor-General John Doyle and his staff investigated the security of electronic record-keeping at the Vancouver Coastal Health Authority, they found trouble everywhere they looked.
"In every key area we examined, we found serious weaknesses," wrote Doyle. "Security controls throughout the network and over the database were so inadequate that there was a high risk of external and internal attackers being able to access or extract information without the authority even being aware of it."
This for a database containing the sensitive medical records of some 620,000 people receiving residential and home care, mental health, addiction and other services, in 75 community locations across Vancouver and Richmond.
The system is known as PARIS, a cutesy-pie acronym derived from Primary Access Regional Information System. But nothing about it suggested any point of comparison with the fabled city of light.
Some sample findings from Doyle's 30-page report, one of two issued recently on the government's mismanaged electronic health initiatives.
"No intrusion prevention and detection systems exist to prevent or detect certain types of [online] attacks. Open network connections in common business areas. Dial-in remote access servers that bypass security. Open accounts existing, allowing health care data to be copied even outside the Vancouver Coastal Health Care authority at any time."
More than 4,000 users were found to have access to the records in the database, many of them at a far higher level than necessary.
More here:
http://www.vancouversun.com/health/health+security+report+withheld/2590803/story.html
The link to the first report can be found here:
http://www.bcauditor.com/pubs/2010/report9/electronic-health-record-implementation-british-columbia
The second report is here:
http://www.bcauditor.com/pubs/2010/report7/paris-system-community-care-services-access-and-security
An equally awful report from Ontario – the biggest province is here (Oct 2009)
http://www.auditor.on.ca/en/reports_en/ehealth_en.pdf
The key lessons from all of this is that you need high quality program planning, project controls, risk management, leadership and stakeholder engagement to undertake complex projects of this type.
It all looks awfully like something rather closer to home to me.
I leave it as an exercise for the reader to work out what an AG report on NEHTA might reveal now. If they were to worry about that maybe they could make a bit off a positive difference in the next few months.
David.
10 comments:
David, British Columbia should not be compared with NEHTA. BC is a Province as you know, therefore it should be compared with NSW or VIC or one of the other states.
And that makes the lessons learnt invalid how?
I assume you are aware the AG in Ontario and at the Federal Level have also found a range of issues.
David.
“And that makes the lessons learnt invalid how?”
Oh no, it doesn’t make the lessons learnt invalid by any means, quite the contrary. In essence the lessons are the same.
No strategic plan means the first step of doing the hard thinking upon which to build foundations for moving forward does not exist. You have consistently agitated for a strategic plan from NEHTA and later an Auditor-Generals’ review of NEHTA for a very long time. The majority of the health informatics community agrees with you. An Auditor General’s Report on NEHTA would be more than informative. However, at this point in time with so many disasters on the government’s plate Kevin Rudd and Nicola Roxon will do everything in their power to make sure the AG is kept as far away from NEHTA as possible - at least until after the next election.
Let’s get real - with faulty foundations the building will eventually topple. How true is the saying - IF YOU FAIL TO PLAN YOU PLAN TO FAIL. And as another commented “You can't solve a problem you don't understand”.
What we should be worrying about here is how much damage is being done in the meantime. Oh that we could be reassured all is well that NEHTA has ehealth under control (which seems a very reasonable expectation for reasonable people to hold), but without some independent authoritative 3rd party undertaking an audit we will just have to hold our breath and hope and pray.
I know a few 'reasonable' people who may not agree - as Mr Regan said 'trust but verify!'
David.
What was said was ..... that for reasonable people to be satisfied an independent audit is a very reasonable thing to expect should be undertaken. It sounds to me as though you both agree with each other.
Key stakeholders such as health professionals were not effectively engaged to ensure the proposed EHR (electronic health records) system would meet the needs of its users"
I have only one question: how is this possible in 2010?
What manner of people make such decisions, when even undergrads in IT, and certainly who ares studying health IT, know better?
...... "would meet the needs of its users".
The problem here is that most users who are involved in determining whether a system will meet their needs don't really know until it has been developed, tested, implemented and proven. Time and again we see 'representatives (enthusiasts) sitting around the table making the 'decisions' on behalf of the 'users' who when they eventually get close enough to the system find that it doesn't meet their needs. What all this means is that the ivory tower, committee representative decision making is fraught with potholes.
For a manifestation of the last comment look no further than Victoria
Post a Comment