Ad hoc project management, out-of-sync application development and a revolving-door C-suite hamstrung Ontario’s electronic health records initiative, with taxpayers footing a bill of $1 billion for a system that the national EHR body ranks behind every other province in terms of progress, according to a report from the province’s auditor general on Wednesday.
And eHealth Ontario is still paying $72 million a year to maintain a network with an average peak usage of 16 per cent of available bandwidth, according to Auditor General Jim McCarter.
“Ontario taxpayers have not received value for money for this $1-billion investment,” McCarter said in a release.
One reason: The applications are trailing the infrastructure. McCarter noted that by March 31, 2007, $400 million had been spent on building the EHR network and connecting the health-care community, but only $100 million had been spent on the applications. “As well, the medical community can use few of these applications as yet because most have yet to be completed,” McCarter reported. “Work on the applications should have proceded more in tandem with work on the network, but the timing of application development was out of sync with the spending on IT infrastructure.”
McCarter also questioned the upfront planning process for eHealth Ontario and its predecessor, Smart Systems for Health Agency.
“Such planning should have included identifying all of the resources — staff hours, consultant hours, and other costs such as equipment and software — needed to complete the projects and a strategy for procuring them in the most economic and efficient manner,” McCarter wrote. “Instead, resource needs were all too often identified and filled on an ad hoc basis … Further, those needs were usually met via costly short-term consulting engagements that often were continuously renewed.”
It was those costly consulting contracts fueled a public outcry this spring and summer, eventually costing CEO Sarah Kramer her post. Ontario Health Minister David Caplan resigned Tuesday on the eve of the auditor general’s report. Premier Dalton McGuinty replaced Caplan with MPP Deb Matthews.
The revolving door C-suite door — Kramer’s appointment in October 2008 was the fourth leadership overhaul in the initiative’s history — also contributed to project delays, according to the report.
“Each of these overhauls brought with it its own period of transition where progress on the initiative’s objectives was slowed or, at times, halted,” the report says.
“With each such change there is a price to be paid ini terms of lost time, little perceived benefit for the costs incurred during the transition period, weakened employee morale, and loss of stakeholder confidence in the organization.”
With applications delayed awaiting direction from successive new regimes, the network itself is largely idle. The auditor general estimated that of 4,178 circuits, only 116 had peak usage of more than 70 per cent of bandwidth. The agency pays $90,400 a month to operate those circuits. It also pays $2.5 million a month to maintain 1,386 circuits with no or virtually no traffic, according to the report.
eHealth’s two data centres, with an estimated 1,300 servers and 3,500 clients, was prone to service interruptions. in the firts half of 2008, there were five major service disruptions, which a consultant’s review blamed on lack of standards and operational processes, a lack of meaningful metrics to monitor performance and an aging (built in 2002) network core.