BC Auditor General issues report on Electronic Health Record (EHR) Implementation.

Public

Health professionals not effectively or adequately engaged.

Approach should ensure health professionals, stakeholders and the public are informed.

On February 17, 2010 the Auditor General of BC, John Doyle, issued his report on “Electronic Health Record Implementation in British Columbia” which is available on their website http://www.bcauditor.com

In his report, the BC Auditor General, acknowledges “The development and implementation of an EHR system … is a complex and high-risk endeavour … because of the large investment of public funds” and “because collecting, storing and disclosing information electronically raises concerns about the privacy and security of personal health information”.

Concerns about the privacy and security of personal health information is not covered to any great extent in the BC Auditor General’s report.  However, several issues have been reported on by the BC Commissioner of Privacy and individual orders are available on their website, http://www.oipc.bc.ca/.  The BC Civil Liberties Association also provides information and discussion on eHealth issues on their website, http://www.bccla.org/ehealth.html

BC is one of five Provincial Auditor General Offices that will issue separate reports for their jurisdictions and the Office of the Auditor General of Canada will be issuing a joint summary report in April 2010.

There’s more in the full report than contained in the news release and Executive summary.  Here are some key highlights.

What will the total costs be to complete the EHR?

"The Ministry of Health Services expects to have spent $162 million in capital costs on the EHR initiative by March 31, 2010 and estimates capital costs will reach $222 million
by March 31, 2013, by which time the ministry expects that implementation will be complete."

“As steward of the health care system in the province, the ministry is responsible for reporting on how the needs of the residents of British Columbia are being met and what the outcome is of spending more than $220 million of public funds (less a $110 million Federal reimbursement) on the EHR initiative.”

“This does not include other relevant capital costs, such as the (significant) costs incurred by the health authorities in developing their regional health records. Nor does it include the operating costs of maintaining the EHR once it is built (which the ministry estimates will be $27.4 million a year by 2011/12), or the costs associated with integrating the systems across the health sector and supporting health professionals to effectively use the EHR in treating their patients.”

“Health sector governance structures in British Columbia have not ensured that the EHR initiative stood out from competing priorities. Health authorities are governed by boards, with chief executive officers making decisions about what new systems their organizations will adopt. Provincial funding to the health authorities is mostly for their use as they see fit; they apply funds they receive to priorities they see as most pressing."

“The provincial and regional EHRs have proceeded along relatively separate paths. For example, each health authority and the ministry itself has developed or purchased its own viewer (to display the health information on a health professional’s computer). Duplicated effort such as this likely contributed to delays in EHR progress and missed opportunities for efficiencies" and "to achieve economies of scale".

The Auditor General asks, “What will the total costs be to complete the EHR? Will the funds be available? And, if so,from which sources?”

Privacy and security requirements were not examined.

The report states the Auditor General did not examine “how well the new initiative meets privacy and security requirements, because it was too early in the EHR implementation”.

The report cites challenges ahead including that "new health information systems that give patients direct access and control over their personal health information are becoming more common. Making these systems compatible with the provincial EHR system should become an important goal of vendors. Will these and personal health records be made compatible with the EHR systems already in place?"

And on the challenges of sharing and protecting personal health information, the report asks, "How will the many issues be resolved to facilitate the sharing of information?"

Thus, it may not be too early to ensure the public, health professionals and stakeholders are fully informed and effectively engaged with the plans under development including any concerns related to the privacy and security of personal health information?

Health professionals not effectively or adequately engaged.

“Key stakeholders such as health professionals were not effectively engaged to ensure the proposed EHR system would meet the needs of its users.”

“The ministry did not adequately engage health professionals … from the start to ensure the tools developed meet their requirements.”

This raises questions of what, to date, has been done to obtain medical and other health professional input and how can this be improved?  What is needed to ensure  adequate and effective input on the perspectives of doctors and other health care professionals?

Critical for Ministry to have an open planning process and well-communicated strategic plan.

“A critical role for the Ministry of Health Services is setting the strategic direction for its various health service initiatives. This includes providing guidance and direction for the EHR initiative through an open planning process with a current, comprehensive and well-communicated strategic plan.”

The report includes, “The ministry initiated the EHR in 2005 without having a comprehensive tactical plan for completing this complex and high-risk endeavour.”

“The ministry was slow in developing integrated timelines. The first integrated schedule was not produced until March 2008 - four years into the EHR initiative.”

“During our audit, the ministry had just started planning how to evaluate the impact and outcomes of the EHR initiative. Good management practice would have been to establish how the initiative would be evaluated early in the planning stage and to collect baseline information to measure future results against.”

Approach should ensure health professionals, stakeholders and the public are informed.

“The tactical plan now identifies the internal and external key stakeholders, describes the consultation approach the ministry will follow to confirm the information they need, and sets out the structure the ministry will use to provide it.”

The BC Auditor General appears hopeful of the tactical plan now developed. “This approach should help ensure health professionals, stakeholders and the public are informed of what is being put in place and when it will be available. Given the ministry’s dependence on health professionals and the public to support the EHR system, this is a critical part of tactical planning.”

Extensive work remains, and what benefits will ultimately be realized remains unclear.

The Auditor General reports, “the work still to be done to complete the EHR is extensive. ... There remains much to be done. It remains unclear how electronic health records will be deployed to users and what benefits will ultimately be realized.”

The four recommendations to the ministry were “to finalize its strategic plan, complete a comprehensive tactical plan, enhance its measuring of progress, and report publicly on the outcomes of the EHR initiative.”  And the BC Auditor General has requested updates from the ministry every six months.

Hopefully, the report of the BC Auditor General will further stimulate the approach to ensure health professionals, stakeholders and the public are informed of and effectively engaged in what is being put in place.

Web resources:

BC Auditor General, Electronic Health Record Implementation in British Columbia

Related orders of the BC Commissioner of Privacy

2010-03-08 Order F10-08 – Northern Health Authority
http://www.oipc.bc.ca/orders/2010/OrderF10-08.pdf

2010-03-05 Vancouver Costal eHealth Privacy Investigation Report
http://www.oipc.bc.ca/news/2010Releases/NR-Investigation_Report_IR_F10-02.pdf
http://www.oipc.bc.ca/orders/investigation_reports/InvestigationReportF10-02.pdf

2009-04-30 Provincial Health Services Authority
http://www.oipc.bc.ca/orders/2009/OrderF09-07.pdf
Applicant requested access to records from an investigation into human rights complaints against him.

Citizen Groups

BC Civil Liberties Association - eHealth
http://www.bccla.org/ehealth.html

BC Opt Out
http://www.bcoptout.ca/