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As the Obama administration presses ahead with plans to implement electronic medical record systems in the nation’s hospitals and physician practices, it would be wise to take note of a costly tale from north of the border.
The Canadian province of Ontario was embarrassed this week when its auditor general – the person charged with making sure the public’s purse is being spent wisely – issued a report saying $1 billion had been squandered on an e-health initiative.
Auditor General Jim McCarter accused the province’s health officials of showing favoritism in awarding contracts related to the huge IT project, which in the end has left Ontario “near the back of the pack” in terms of efforts to implement electronic health records in relation to other Canadian provinces.
“Ontario taxpayers have not received value for money for this $1 billion investment,” McCarter concluded in releasing his 50-page report on the initiative.
Fallout from the report has already begun. The province’s health minister David Caplan resigned this week and the former head of the eHealth agency which was overseeing the project resigned in June.
The Ontario e-health initiative began a decade ago with a very clear goal in mind – to create a secure, private electronic health record for the lifetime of every Ontario resident. Ideally, healthcare professionals would use the system to deliver services more efficiently and effectively to patients.
The goal may have been simple but the implementation was not. Among the findings in the auditor’s report:
• Of the $1 billion spent so far on the e-health initiative, $800 million was spent to build a computer network for health-care providers. However, the computerized network is significantly underutilized because of a “dearth of available applications.” Less than 1% of the network’s bandwidth is being utilized.
• Even though few organizations are using the e-health network, it is costing the province $72 million annually to operate it.
• Contracts were awarded on the project without asking for competing bids and the auditor general identified a number of examples of clear favoritism.
• There was a heavy and in some cases almost total reliance on consultants. By 2008 the eHealth agency had less than 30 full-time employees but was engaging more than 300 consultants.
Clearly the Ontario eHealth initiative is another example of scope-creep and a government IT project allowed to run amuck. However, it goes without saying that it provides very real lessons for the Obama administration as it looks to pump some $19 billion in federal stimulus dollars into implementing electronic health record systems.
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