To read the mainstream press, you’d think that Ontario’s health system didn’t receive a penny of value from the $1 billion spent on developing an electronic health records program by eHealth Ontario and its predecessor, Smart Systems for Health Agency. A typical headline on the release of Auditor General Jim McCarter’s review of the program read, “$1 billion squandered.”
“That would not be true,” McCarter told IT World Canada in an interview on Thursday, the day after the release of Special Report: Ontario’s Electronic Health Records Initiative. “A lot of the money was well-spent.”
That said, Ontario’s EHR megaproject has hardly been a success so far, measuring by the metrics that matter.
According to McCarter, on-time and under-budget aren’t significant measures of success if the results don’t serve the user. And Ontario’s EHR program — ranked by national co-ordinating body Canada Health Infoway as last among the provinces in terms of progress — “clearly does not meet the needs” of the medical user, McCarter said.
The network built under the SSHA regime is mostly unused, largely because the applications to run on it haven’t been completed. The ruckus raised over out-of-control spending on consultants cost eHealth Ontario CEO Sarah Kramer her job in the summer, while Health Minister David Caplan resigned on the eve of the report’s release.
“On a complex project like this, you’re going to need some outside expertise,” McCarter said. But consulting on the EHR initiative was largely ad hoc. Without oversight and clearly defined, concrete deliverables, “things can get out of hand,” McCarter said.
McCarter said the program is salvageable, with improved strategic planning, time frames for deliverables, and tighter oversight. “You need an approved strategic plan,” McCarter said, which eHealth Ontarion now has — seven years after SSHA began work on the initiative.
“I think we need to develop electronic health records,” McCarter said.”It’s a job we have to get on with.”
How would you fix eHealth Ontario? Comment on our Enterprise Insights blog
Getting on with the job means establishing an enterprise architecture team, wrote Awel Dico, enterprise architect with Bank of Montreal, on IT World Canada’s Enterprise Insights blog.
“If proper enterprise architecture (including business architecture, information system architecture, and technology architecture) have been done, then such a mismatch between applications/services and infrastructure technologies wouldn’t have happened,” Dico wrote. “Good enterprise architecture could have provided end-to-end guidance and governance to the whole project.”
The enterprise architecture team “should be able to tell all that it takes to do the job,” he wrote — develop strategy, target architecture, create a road map and develop principles and guidelines for both business and technology on which the project’s governance would be based.
It’s also important to leverage whatever legacy the $1-billion investment leaves behind, reusing it in a new way, Dico wrote.
Robert Sciuk, principal, director of technical services and lead consultant at Control-Q Research, wrote that while Dico offers some broad-stroke solutions, “nothing short of a wholesale purge will put this situation right.”
“Far too many within government believe that an Oracle server and a .Net desktop constitute an ‘architecture,’ and it seems that the primary requirement for a consultant these days is the ability to navigate the ‘culture’ and submit an expense form without coffee stains rather than to demonstrate any deep technical competency,” Sciuk wrote.
Sciuk believes flags should have gone up when an MD, Dr. Alan Hudson, was put in charge of the project rather than someone with an IT background.
He also wrote that eHealth Ontario could have learned from other jurisdictions that have EHR systems in place.
“Numerous jurisdictions have gone before Ontario, and done this successfully,” Sciuk wrote. “Is the Ontario (Ministry of Health) so embued with NIH syndrome (“Not Invented Here”) that they cannot look to the U.S. and other countries for what has proven effective? Survey the landscape, steal the best practices, and implement what others have done before.”