Digital health slow to boot up
EXCLUSIVE: Ontario’s push to get patient records online is plagued with bugs Provincial move to electronic records running year behind Few benefits to show for millions spent, critics complain
Ontario’s vision of bringing digital patient records to all Ontarians has been riddled with delays and conflicting agendas, critics charge. They say hundreds of millions of public dollars have been spent over the past five years building technology infrastructure and developing electronic services that have benefited few. An investigation by the Toronto Star
has found that many hospitals in the GTA are frustrated by slow progress towards electronic health records and a lack of guidance coming out of the Ministry of Health and LongTerm Care, and that there is little transparency and accountability associated with a provincewide program — running more than a year behind schedule — to get more doctors online and using electronic systems.
“ Are people frustrated? Absolutely,” said Judy Middleton, chief information officer with the William Osler Health Centre, one of the largest hospital corporations in Ontario. One ministry insider called the government’s e-health initiative a “ widowed portfolio” that has lost its way, while observers from the technology community have described it as a “ Frankenstein” program made up of pieces not talking to each other.
In an interview with the Star, Health Minister George Smitherman recognized that progress has been slow and that some participants, particularly doctors, are growing impatient.
“ We built a lot of highway but we haven’t necessarily built it as part of a co-ordinated transit plan. Where we need to do a better job for the system is to rise up to a more strategic level and assert an agreed-upon vision, and this is the next phase we need to go to,” Smitherman said, hinting changes, such as more accountability, are coming.
Electronic health records have been touted for many years as a way to reduce costs in the health- care sector, dramatically improve patient care and prevent potentially deadly medical
errors. Their creation was a key recommendation in the Romanow report three years ago.
At the heart of the province’s ehealth efforts has been Smart Systems for Health, a littleknown government agency established three years ago to build infrastructure to electronically link 150,000 health- care providers — doctors, hospitals, labs, pharmacists and community care centres. Many have described Smart Systems as the glue that will keep these disparate healthcare providers connected, through a specially built network that acts like the province’s own private and secure Internet. The agency, which employs more than 300 full- time staff and continues to aggressively hire, also runs two data centres 24 hours a day. Smart Systems has also been charged with safely storing the electronic health information of Ontario patients as more medical records go digital. The idea is that every Ontarian will one day be assigned an electronic health record at birth that will follow him throughout his life. The record could track a person’s health history, including allergies, prescribed drugs, past illnesses and treatments. Armed with speedy access to this information, it’s believed health- care providers can work more efficiently and, at the same time, make fewer, potentially fatal, errors. “The electronic record provides a systematic, historic record of every interaction a person has with the health-care system,” according to the Romanow report.
Despite Smart Systems’ vital public role as the guardian of this information, the agency’s public profile remains remarkably low.
Middleton said hospitals are connecting to Smart Systems’ network but there’s not a lot being done with it. She said many hospitals in the province are pursuing their own agendas because of a “ breakdown” in communications with Smart Systems and the lack of a clear government plan. The result is a smattering of hospital technology projects that don’t necessarily share a common goal. An Ontario government review into health capital planning in the province, headed by health- care expert Michael Decter, came to the same conclusion in January 2004, warning that lack of integration between the information and communications technologies in hospitals could lead instead to “ reduced patient care” and “ inefficiencies” in the system. “Some hospital groups are working towards common systems, others are not. The panel found that there are no incentives in place to encourage coordination and integration of systems,” Decter’s report said. Sam Marafioti, vice- president of e- health and chief technology officer at Sunnybrook and Women’s College Health Sciences Centre, echoes that concern. “Smart Systems is our partner but they’re also our biggest concern at the moment,” he said. “ It should move away from technology infrastructure to the sharing of health information for providing patient care. We’re not seeing that shift, quite frankly.” The situation leads Middleton to question how the government agency is spending taxpayers’ dollars. “Smart Systems keeps augmenting their staff, there’s no deliverables, and the salaries are far beyond what any corporate consultants make,” she said. “It’s very discouraging. The money is going into this hole but we’re not seeing results.”
Exactly how Smart Systems has been spending its money is largely a mystery. Since 2001, the agency has burned through $260 million of funds transferred from the health ministry. Critics charge that too much of that money has gone into hiring high- priced consultants.
Three years ago, the Star filed an access to information request attempting to get a breakdown of consultants who have been hired by Smart Systems, the type of projects they have worked on, and how much they were paid. Smart Systems has refused to release the names of many consultants and how long these consultants worked, arguing it has the duty to protect the privacy of these businesses and what it considers sensitive third-party information. The Star’s request is into its second appeal with Ontario’s information commissioner. What is known is that the province’s auditor general took issue with early spending by the health ministry before Smart Systems was officially established as an agency. With no approved budget, ministry staff went ahead and hired more than 65 consultants between October 2000 and March 2002, some being paid as much as $ 2,150 a day. Out of nearly $ 21 million spent on Smart Systems in its 2001 fiscal year, about $ 12.7 million was spent on consultants who were not hired as part of an open and competitive tender process.
“ This practice did not ensure that the most qualified consultants were acquired at the best available price and that all suppliers of consulting services were given fair access and treated in an open and transparent manner,” the auditor general concluded.
Michael Connolly, chief executive officer of Smart Systems, readily admits that his agency was dependent on consultants during its early days, largely because he was starting from scratch and didn’t have the option of recruiting people out of the health ministry. He defends the use of consultants as “ reasonable” and “ appropriate.”
“ We have very quickly transferred the organization from being 100 per cent consultant driven to a primarily internal staff organization,” he said, conceding that this transformation in human resources over the past two years is partially responsible for the agency falling behind schedule.
“ But we’ve subsequently caught up.”
Connolly, a former banking consultant who has been involved in the province’s e- health planning since 1996, says his agency isn’t being given a fair shake, and the government should be bragging more about what has been accomplished than defending against what hasn’t.
“People seem to think that, somehow, in three to four to five years we’re going to transform the health sector,” said Connolly, at the same time praising what work has been done. He points to Smart Systems’ role in supporting telemedicine, such as the 1,700 video- conferencing sessions being handled each month between hospitals and patients who are too fragile or too far away to travel. Then there’s the introduction of secure email for anyone
in the health- care sector that qualifies for it.
Smart Systems is also
behind a new public
health database that
tracks infectious disease outbreaks in the
province, which like other jurisdictions around the world is preparing and planning for a possible flu pandemic.
Dr. Jim Maclean, president and CEO of Markham Stouffville Hospital and a member of the minister’s “health results team,” also has a seat on Smart Systems’ board. He suggests criticisms of the agency may be deserved, but they’re out of date.
“ There’s always a lag between what was and what is,” said Maclean, adding much has improved in the past six months. Echoing that view is John Breakey, chair of the Information Technology Association of Canada’s Ontario division, which often acts as a bridge between government and the technology community. He says Smart Systems is making good progress, given the enormous complexity of its task and the number of players with competing interests. What is clear is that most Ontarians today don’t have a comprehensive electronic health record, let alone one that can be moved around between hospitals and clinics or accessed in emergency rooms.
Noticeably absent are a majority of the province’s 25,000 doctors, many of whom are the first point of contact for patients.
“ We can’t declare success until we have the vast majority of (doctors) automated to some extent,” Connolly said.