Audit finds ailing agency all at sea

A highly critical review of Ontario’s e-health agency, Smart Systems for Health, will serve as its guide to becoming a best practices IT organization within a few years, says its chairman and acting CEO.

The review by Deloitte and Touche was described as a good roadmap, and its findings not entirely surprising, in an interview with Michael Lauber of the Smart Systems for Health Agency.

“We knew the agency had issues and we had projects under way to deal with all the matters raised in the review,” says Lauber. “There were no surprises in it for management, but it is obvious we weren’t moving fast enough.”

Deloitte and Touche cites a long list of shortcomings and challenges facing the SSHA. Some are the result of its own failings, but the agency has also been handicapped by a poorly defined relationship with the Ontario Health Ministry, which treats the agency like a division rather than a separate entity.

Adding to its difficulties has been a delay in the implementation of the provincial government’s e-health strategy. The basic role of the organization is to develop an electronic health record (EHR) system for all Ontario residents, which the agency’s clients (150,000 hospitals, doctors, clinics and home care providers) can tap into for all the information they need on a patient’s medical history.

But the EHR system is a long way from being finished, according to the Deloitte and Touche report, which points out delivery and privacy issues to be resolved by the agency and the government. The agency also needs to develop its own business plan, it adds.

Lauber agrees that one reason for the delay in completing the EHR system has been waiting for an e-health strategy from Queen’s Park. The Health Ministry has also complicated the agency’s operation by swinging from micro-management to hands-off.

“Some of that is our fault,” he admits. “They have been paying more attention to us than they should have to. We have to operate more independently and remotely from government.

However, we have to earn the right to do that by being an organization that is well run and doing what the government wants.”

Lauber hopes to negotiate an accountability agreement with the Health Ministry that will better spell out what the two parties are responsible for.

Ontario Health Minister George Smitherman commissioned the review after reports of a lack of progress at the agency, which has received more than $450 million from the government. The minister brought in Lauber, a former CEO of the Ombudsman for Banking Services and Investments, as part of a hefty management shake-up. A new CEO and a chief financial officer for the 300-employee organization will be hired soon, Lauber adds.

When it comes to its operations, SSHA doesn’t want to be re-inventing the wheel and will be buying IT products off the shelf wherever possible and making as few changes as possible to them, Lauber says.

“We are in the service delivery business for the medical community and we have to deliver a product that they can use. The agency has to provide continuous connectivity to the health-care sector. Our holy grail will be a fully interoperable electronic health record. It is being developed and will be forthcoming.”

Among its recommendations, Deloitte and Touche says the agency should be allowed to enter commercial deals within the health sector, so it would not be financially dependent on Queen’s Park. “Without more revenue, we can’t provide all the services that we want to,” Lauber explains. “We can only do what we get funding for.”

He says his vision for the agency is to have it match the IT quality and effectiveness of the major banks. With a new CEO and virtually new board, SSHA will be able to go forward “without any baggage from the past. Our executive team is on board with this objective and we have to motivate the whole organization.”

The agency has set up a change management office, which reports to the board of directors, to implement the review’s recommendations and plans to spend the next six to eight months establishing better relations with its customers in the health-care system, says Lauber.

Since it was set up in April 2003, SSHA has made progress in establishing a secure infrastructure and data centre facilities, the report notes. “However, having deployed this infrastructure, it struggles to deliver stakeholder value and has yet to achieve an acceptable level of maturity in its management and operations.”

Ontario wants greater integration within the health-care system and the agency can provide the required technological delivery system, the report asserts. “There is broad support for a provincial e-health agency to promote integration and economies of scale.”

To make it work would require clarity of direction, appropriate governance and a spirit of collaboration across Ontario’s health sector.

So far, the agency has not developed a good reputation, the report says. “This is a reflection of the nebulous understanding of SSHA’s role and core business within the broader health-care community. Clients and stakeholders do not distinguish the agency from the Ministry, especially since the Ministry acts as funding provider, oversight manager and client.”

Complicating the picture for SSHA are divergent views on what its role should be, the report adds. These range from being strictly a secure infrastructure provider to a full-service EHR developer, integrator and operator.

“The brand and reputation of SSHA can be improved over time, but only through a more disciplined adherence to fewer approved priorities. SSHA can no longer attempt to be ‘all things to all people’ in the e-health sector, and at the same time deliver on key commitments.”

The agency has also wandered away from achieving operational excellence, according to the report.

“The result has been an unfocused array of clients, products and services that reflect a legitimate desire to utilize deployed assets but lack a clear commitment to client service and outcome measurement.”

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