The other side of the eHealth story
Amid the flood of coverage of Auditor General Jim McCarter's report on out-of-control spending at eHealth Ontario — much of it of increasingly hysterical tenor — I received an e-mail from Aaron Blair. Blair's a former employee of Smart Systems for Health Agency, eHealth Ontario's predecessor in the initiative to bring Ontario's health-care community online, and he's troubled by the suggestion that Ontario taxpayers have nothing to show for the seven years and $1 billion invested in the effort.
Calling mainstream media coverage of the issue “sensational and irresponsible,” Blair set out a chronology of Ontario's e-health intiative and outlined in great detail what had actually been accomplished. The list is surprisingly long, though, as even Blair admits, whether it's worth $1 billion is open for debate.
Blair allowed us to reproduce his e-mail in its entirety, which we've done below. Have a read, and tell us what you think.

I am a former Smart Systems for Health Agency/eHealth Ontario employee and have been troubled by the reporting associated to the recent scandal at eHealth. Now, I am not an apologist for any of the activities eHealth are coming under scrutiny for. I, too, found  some of the practices troubling while employed. But by stating that the government has spent $1 billion and has nothing to show for it is sensational and irresponsible. Whether the investments that were made were sound is worthy of debate, but I feel your paper should be reporting the facts of what has been delivered so that the public can make an informed decision about how their taxpayer dollars were spent. That said, as a former full-time employee at SSHA/eHealth, I can tell you first hand that there were many of us working late hours as hard as we could on delivering things that we believe were making a difference in the sector we served and to slight those activities is to undermine the efforts of those public servants and their efforts to date.

 I think the important thing is to identify the chronology of SSHA/eHealth:

 SSHA started as a report in the late nineties entitled Delivering a Smarter System for Health. This report reviewed the distributed model of how hospitals and public health practitioners were spending on IT services in the province. The recommendation was to consolidate the purchasing power of the hospitals via the use of an agency to ensure that the health-care sector was getting the best prices for services and Ontario taxpayers were getting the most for the tax dollar.

By 2002 the Smart Systems for Health Agency was created. It had slightly morphed from the initial report. The mandate at Smart Systems for Health, was in effect, to provide IT services to the health-care sector in Toronto. This would enable health-care practitioners to focus on delivering health care and not delivering IT, which was not their core competency. In addition, it would help consolidate services and enable the future sharing of information and collaboration. Later in SSHAs existence, late 2005, after a provincial election, the focus turned to supporting the delivery of an electronic health record. Smart Systems was never tasked with the electronic health record mandate; it was the IT delivery arm of the Ministry of Health that would deliver on projects that were prioritized by the Ministry of Health through their eHealth Program department.

eHealth Ontario was created to expedite the delivery of an electronic health record in Ontario. It was created in late 2008 and amalgamated the Ministry of Health’s eHealth Program with the Smart Systems for Health Agency. This consolidated strategy and delivery. eHealth Ontario formulated a strategy that was published that set the road map to achieve the direction.

 I’m not going to state the success or value of the philosophies, just the intent. Whether the government was successful at achieving the above and/or whether it was a worthwhile endeavour is worthy of debate.

 That gives a chronology of events at SSHA/eHealth Ontario now it is important to outline what each of those entities produced during their existence.


The Smart Systems for Health Agency


Smart Systems for Health Agency created four product portfolios. These included ONE ID, ONE Hosting, ONE Network and ONE Mail. The governance model of the agency was to create projects and set budgets under the direction of the eHealth Program of the Ministry of Health. This body would be used to approve budgets and provide funding.

·         ONE ID was created to enable Identity and Access Management controls for health-care practitioners so they could create secure sessions when accessing health information.

·         ONE Hosting was created to host and consolidate health-care practitioners’ applications. This would either remove the responsibility of managing applications by health-care practitioners and/or help consolidate health-care practitioners’ data.

·         ONE Network was created to connect all health-care practitioners to a secure network that would help facilitate the exchange of health-care information reliably and securely.

·         ONE Mail was created to host e-mail accounts for health-care practitioners so they could find peers and share data via e-mail in a secure manner.

 I think it is important next to itemize what was accomplished under each product portfolio.



·         A hosted Identity and Access Management System that health-care practitioners and applications used to authenticate and share health-care information. The quantities I’m not certain of, as I didn’t directly work on this portfolio.


ONE Hosting


  • Hosting and Management of the iPHIS application: the iPHIS (Public Health Information System) is used as a publication facility when an outbreak such as SARS occurs to give healthcare practitioners all the information required to successfully diagnose, treat and share late breaking developments regarding the disease. This was recently used for H1N1 as well as a recent measles outbreak.
  • Hosting and Management of the ISCIS application (healthy baby and healthy children). This application is used to consolidate birth mortality, defects, disease etc. t is a consolidated model that was once distributed and provides reporting and information to the Ministry of Child and Youth Services. It was deemed successful enough that two more modules were added, Autism and Pre School Language. All three applications consolidate data that was once distributed and remove the IT management responsibilities of the regional offices.
  • Hosting of CMS (Clinical Management Systems) these systems are used by healthcare practitioners to manage their clients, schedule appointments and capture prescriptions.There are three different vendors that are hosted and provide this service to the healthcare community: xWave, Practice Solutions and Nightingale.
  • Hosting and Management of the Drug Profile Viewer application. This application captures patient prescriptions and is available in hospitals and doctors to ensure that medication conflicts are not prescribed or used in the emergency room.
  • Hosting and Management of the Electronic Master Patient Index. This application captures all health card records of Ontarians and over 60 hospitals send transactions outlining what services they have requested in the above hospitals. It is leveraged by the Wait Time Information systems that is hosted by Cancer Care Ontario that automatically routes cancer patients awaiting service.
  • Hosting of the TeleHealth Network. This system enables the communication and sharing of information of healthcare providers across Ontario. It enables hospitals in Northern Ontario to directly collaborate via video conferencing with specialists in Toronto as an example.
  • Hosting and Management of the e Referral application. This application enables healthcare practitioners to electronically refer patients to specialists that have availability for treatment.
  • Hosting of the Ontario Access and Community Care data centre. This provides space and power and services to the OACCAC to deliver IT services to the province.
  • Hosting of University Health Network. This provides space and power and services to UHN to deliver IT services to their subscribers.
  • Hosting and Management of the Oral Health Information System. This application consolidates data of the Oral Health of Ontarians and enables practitioners to consolidate data and reporting.
  • Hosting of the Ontario Case Costing. This provides space and power to the Ministry.
  • Hosting and Management of the Ontario Lab Information Systems. This consolidates data and images of all the privately and publically run labs in Ontario. It enables healthcare practitioners to access this information regardless of location.

This outlines some of the hosting services provided. It is supported by a highly available infrastructure that could withstand a significant disaster. The infrastructure associated to supporting the above includes:


  • 2 Data Centres (1 in Markham and 1 in Mississauga)
  • A large and highly available Storage Area Network.
  • A large and highly available Virtual Machine Infrastructure
  • A large and highly available Local Area Network
  • A large and highly available backup infrastructure
  • A large and highly available monitoring solution
  • Enterprise Reporting Application
  • Corporate Services for SSHA/eHealth Ontario employees
  • A large and highly available PKI infrastructure
  • A large and highly available Identity and  Access Management infrastructure
  • The foundations of a Health Information Access Layer.


ONE Network


  • This built a highly available fibre network that is private and encrypted. This network enables the secure communication between health-care providers.
  • All hospitals and large health-care practitioners are connected to this network.
  • There are over 1,000 physicians that also connect to this network to utilize the shared services available at eHealth Ontario.


ONE Mail


  • This mail infrastructure hosts over 5,000 mail boxes for hospital staff, health-care practitioners and physicians.
  • One Pages is a part of this offering that enables subscribers to look up their peers across the province.


eHealth Ontario


  • eHealth Ontario consolidated the eHealth Program and Smart Systems for Health.
  • eHealth Ontario delivered an electronic health record strategy and roadmap.
  • eHealth Ontario initiated the work for the Diabetes Registry (via IBM)
  • eHealth Ontario initiated the work for a digital imaging solution.

Now, whether or not $1 billion is an appropriate price tag for the above, or whether it is indeed an appropriate investment, is certainly worthy of debate. But I think it is important to not overstate that little was delivered. There was a lot of work that was delivered. The challenge is whether or not what was delivered will greatly contribute to the overall objective of achieving an electronic health record. That said, it’s the above investment that should be debated. One billion dollars with nothing to show is inaccurate, sensational and irresponsible.

I’m hoping that this information reaches the appropriate individuals that can bring it to a public forum to ensure that the appropriate issues are being debated.

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