Ontario auditor general Jim McCarter has concluded that after almost a decade of time and $1 billion in funding to create a province-wide system of keeping Electronic Health Records, “Ontario taxpayers have not received value for money for this $1-billion investment.
“McCarter’s 50-page Special Report, released today, which examines efforts by the Ministry of Health and Long-Term Care and its agencies to create an EHR system of computerized medical records for all Ontarians, described its efforts as “lacking in strategic direction and relying too heavily on external consultants.
“The recently created agency responsible for this task, eHealth Ontario, was found to be awarding contracts without an open competitive process. McCarter also found evidence of “questionable procurement practices” in the Ministry and at the Smart Systems for Health Agency. Allegations earlier this year that eHealth awarded contracts to certain companies without giving other firms a chance to compete were “largely true,” as were allegations of “favouritism” in the awarding of such contracts.
For instance, one firm that bid 500 per cent more than the next qualified bidder was invited to bid again, the only company offered such an opportunity, and, after lowering its bid significantly, won the contract. Another firm that was awarded untendered contracts on the first phase of several projects was awarded many subsequent contracts worth about $7 million to work on successive phases of those projects.
There was a heavy, and in some cases almost total, reliance on consultants. By 2008, the Ministry’s eHealth Program Branch had fewer than 30 full-time employees but was engaging more than 300 consultants, a number of whom held senior management positions. The recent replacements of the eHealth Ontario board chair and CEO mark “the fourth such overhaul of leadership at eHealth Ontario and its predecessor” and each of these overhauls brought with it its own period of transition where progress on the initiative’s objectives was slowed or, at times, virtually halted.
Widely used in the US and elsewhere, EHRs promise to deliver health-care services more efficiently than using paper files. All 10 provinces and three territories are working to create EHR systems, which one study says could save Canada’s health-care system $6 billion a year. Ontario is near “the back of the pack” in the development of EHRs compared to the other provinces, according to the report.
The Auditor General’s report found that of the $1 billion spent so far on the EHR initiative, $800 million was spent by the SSHA primarily to build a computer network for health-care providers that is expensive to operate and significantly underused, mainly because of a lack of available applications. Specifically, it is costing $72 million annually to operate the network, and users, on average, are using less than 1 per cent of the network’s available bandwidth (or system capacity), with peak usage averaging only about 16 per cent of available bandwidth.