The cost of eHealth; some insights of what’s behind the Sunshine List

 The annual publication of public employees earnings, affectionately referred to as the sunshine list, has been released. Considering the type of scrutiny eHealth spending is under, there will likely be some public outcry regarding the number of eHealth employees on the list. But before we make too many rash judgments it is important to clarify the sunshine list and what it represents. First, no one who appears on the list is a consultant, these are all full time public servants. In addition these numbers are not salaries they are a combination of salary, bonus and overtime in an annual reporting period. The latter is an important consideration that should not be overlooked.

I will go on record that I was at eHealth Ontario/SSHA for 5 years and in my last year I did appear on the sunshine list, but it was a result of a combination of salary and bonus. Having been at eHealth for some years it enables me to provide perspective on what that list really means, and what it means to Ontarians. And having been at eHealth for five years the largest reason for the number of employees that appear on that list is overtime. This is part of the challenge that the incoming CEO will face.

eHealth Ontario has built two large data centres in Markham and Mississauga. They host numerous health applications. These applications are used by health care providers and as a result their value isn’t typically perceivable by the healthcare consumer. Physicians, labs, etc. all utilize the various applications that eHealth hosts in their data centres that communicate over a dedicated private health network. eHealth employees largely manage this infrastructure, which is no small task.

The new CEO will have the responsibility of growing the eHealth footprint, managing expectations and communicating progress to the public. Again this is a challenge because the public will likely not see the tangible benefit of eHealth technology. Although these applications are designed to improve ER wait times, cancer treatment wait times, reduction in fatalities due to lack of prescription information, etc. The challenge is that these improvements are statistical. If someone is waiting in the ER, or for cancer treatment, or heart surgery for any time waiting is too long. To these people, understandably, it doesn’t matter if wait times have improved statistically. In the worst case, regardless of a reduction in fatalities due to prescription conflicts, if you are a member of that family the fatality is one too many. That’s the side of eHealth that Ontarians are mostly concerned with, and the incoming CEO has a broad task to effectively manage those expectations.

However, equally as daunting, is maintaining that eHealth footprint. The eHealth datacenters have been in existence for about seven years. As most IT experts will attest that duration signifies a need to upgrade hardware, software, replace end of life equipment, etc. The cost to replace, renew and upgrade can sometimes be quite significant, and at times this cost does not generally add perceivable value, it enables the systems to continue performing as expected, but it is a cost nonetheless.

In addition as systems age, and as more demand is placed on aging systems, incidents arise. When incidents arise they can be resolved quickly, or are more involved. I can recall numerous occasions where eHealth Ontario operations staff worked around the clock to resolve incidents, where 72 hours in 4 days was not uncommon. Having been witness to these incidents first hand I can inform the public that the individuals made much sacrifice of rest, family and at times health to try and resolve an incident. These were not ‘cash grabs’. As most health applications are required 24/7 and some systems that have downtime could result in a fatality the eHealth staff take making sure applications are up and running very seriously.

Finally, as mentioned since health applications are often 24/7 the ability to upgrade, maintain, etc. has an equipment and software cost, but there is a labor cost as well. As the systems can only be down for short period they are often done in short maintenance windows in the wee hours of the morning to ensure minimal impact to health care providers.

So what does this all mean? Well when looking at the 2010 sunshine list, look a little further. Architects, directors, project managers, senior managers, presidents, CEOs and vice presidents will usually appear. When you eliminate 10-15% of the number you’ll get a better understanding of the true salaries at eHealth, which in IT you’ll probably find quite standard. Now whether they should get paid less, have bonuses, etc. is another discussion, but it is at least understandable when compared with similar roles, in similar industry the people that appear on that list. One can simply take a look at the various salary comparison tools on workopolis to confirm, which is what most HR firms do to establish pay scales for a particular industry.

Now regarding the other people on that list: when you see terms like Tier 2/3, or support, or operations, and even engineering, I can attest that their appearance on the sunshine list is less to do with salary, and much more to do with spending many hours working around the clock to bring in new systems, upgrade old systems, or resolve incidents. Now this can reflect a larger issue that could be resolved in a number of methods: more staff, could be one solution, but then instead of having one employee at 130K with overtime you have two employees at 80K, overtime will likely be required (though not as much), so inflate that number a little and add the other costs to having that person around (space, equipment, insurance, benefits, etc.). That person might not appear on the sunshine list in the future, but effectively that 130k has been replaced with closer to 200K of cost to Ontarians. You could hire consultants, that would optically reduce the number of people on the sunshine list, but the cost of consultants can be far more to the tax payer as we’ve seen in recent months. Lastly, you could potentially outsource, but that comes with additional costs and concerns which is why in-sourcing is becoming a popular trend. These options will be incumbent on the incoming CEO to evaluate and decide and it is no easy task.

Ultimately the sunshine list will be met with scrutiny in the public eyes. When salaries are made public it is often the case, which is why it is a fairly taboo subject in the workplace. But if one looks a little deeper it can provide insight into the where the money is being spent, and the good news is, in eHealth a lot is spent on keeping the systems current, running and relevant.

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