The Canadian Auditor General Reviews Health Infoway. Facts are Good!

If ever there was a difference between the spin and what was really said we see it here.

Here is what Infoway said of the review.

Open Letter to Canadians

The Office of the Auditor General of Canada (OAG) has issued its report on our organization, Canada Health Infoway (Infoway), and we welcome their insights and helpful suggestions.

These reports are vital; they provide you with the information you need and deserve to judge how well your tax money is being spent, and they provide useful analysis and advice to the organizations being audited.

What’s in the report

We’re very pleased that the Auditor General found that Infoway, in her words, has accomplished much in the eight years since we were established. While we still have a lot of work ahead of us to achieve our ambitious goals, this audit tells us we are on the right track. It acknowledges that we have been working with “due regard” for taxpayers' money, and that we have sound systems in place for managing projects efficiently.

The Auditor General provides us with important recommendations for making Infoway even more efficient and effective. We accept all of her recommendations wholeheartedly and will implement initiatives to address every recommendation by March 31 of next year – just five months away. In fact, we had already started doing a number of the things the OAG refers to in its report – because we recognized they made sense and felt they were appropriate to implement as soon as possible (Read the full list of recommendations and our responses.).

Infoway and eHealth Ontario

Of course, the Auditor General’s report has drawn extra attention because of the concerns over the provincial e-health initiative in Ontario. While our organization is also involved in helping create electronic health records (EHRs) for Canadians, it is important to understand that Infoway has not had any contracts with eHealth Ontario nor its predecessor, the Smart Systems for Health Agency (SSHA).

That said, we have funded some key projects in Ontario – for example, putting a viewer in emergency rooms throughout the province to provide medication histories for seniors, contributing to a system to help reduce wait times, funding the expansion of telemedicine initiatives. Our primary role is to set the national strategy and standards for EHR systems, aid capable organizations that are developing them, and ensure that all of these systems being implemented across the country will be able to link to one another in the future.

Infoway’s strict rules

Infoway has to operate under strict funding requirements set by the federal government. We fund projects once deliverables have been completed and the standards have been met. Generally, we assign half the funding to the development of a system; the remaining half would be paid only when the system has been developed and demonstrated use levels have been achieved. We believe there is no point investing in technology that is not being used.

Working under these clear policies, to date we have spent just over half of the money allocated to us. The other half of the funds, while earmarked for jurisdictions, will remain unspent until projects are delivered and health care providers begin using the system.

Success stories

Infoway has worked with every province and territory, supporting almost 300 EHR projects nation-wide. The results are improving the quality of health care, reducing wait times, avoiding costly and dangerous errors, improving access in remote and rural communities, and cutting costs for taxpayers. For example:

• We have helped fund systems to transfer X-rays and other medical imaging to digital formats. This will ultimately save up to one billion dollars a year (when fully implemented) and importantly has increased radiologist productivity by 23%, getting patients their tests and treatments faster.
• In British Columbia, we are upgrading and enhancing the province’s existing PharmaNet system which gives pharmacists electronic access to complete health records. Last year, 2.5 million potential cases of drug interactions were avoided that could have led to serious complications or even death.
• In Alberta, the WebSMR system we helped fund has improved post-surgical reporting from a month in most cases to less than an hour 91% of the time. That’s a significant breakthrough in post-surgical care.
• In Ontario, the Ontario Drug Profile Viewer has been implemented in emergency departments in 177 hospitals. This system enables health professionals in emergency departments to instantly access drug information for Ontario’s seniors. In September 2009, the system was used to view medication information over 95,000 times.
• The investments that Infoway has been making in the area of telemedicine are making a substantial impact throughout Canada. In Ontario, Infoway’s support has enabled the expansion of the Ontario Telemedicine Network, through which over 2,000 health care professionals are now delivering care to over 660 rural and remote sites throughout the province.
• All communities north of 60 are telehealth enabled or are in the process of being so. Infoway is on track to get 40% of First Nations communities telehealth-enabled with focus on mental health and drug addiction services.

We’re pleased to say these are only a few examples of how Infoway’s efforts to support EHRs are improving health care across the country. See how EHR systems are delivering tangible benefits to Canadians today.

Why this matters to you

As a taxpayer, you deserve to know that we have been using public funds wisely. The Auditor General concludes that we have made good use of public funds; she also made eight recommendations to further strengthen our reporting abilities, contracting processes and documentation (Infoway accepts these recommendations and has already implemented a number of initiatives in response to the Auditor General’s recommendations; we will implement changes to address any outstanding issues by March 31, 2010).

As a Canadian, you deserve to have the best possible health care system – one that is available when and where you and your family need it, that provides high quality care and that does not waste your tax money.

Electronic health records are helping to accomplish all of these goals. When we’ve finished our work, all authorized health care practitioners will have your health information at their fingertips wherever it’s needed. There won’t be any time wasted tracking down your records or repeating tests before you can get your treatment. Potentially dangerous drug errors or inadvisable treatments can be avoided. And the ease and speed of EHRs will continue to reduce the cost burden for taxpayers.

Previous generations built up a health care system in Canada that is the envy of the world. It’s our challenge now to preserve and improve that system, using the power of modern technology. At Infoway, we are proud of our efforts and achievements to date and are completely committed to our goal of better health care for you and your family.

Sincerely,

Richard C. Alvarez
President and Chief Executive Officer

Source:

http://www.infoway-inforoute.ca/lang-en/about-infoway/news/open-letter-to-canadians

Here is what was recommended and the responses – getting closer to reality!

OAG Recommendations and Infoway Responses

The Office of the Auditor General of Canada (OAG) began an audit of Canada Health Infoway (Infoway) in February 2008. The results of the Infoway audit were tabled in the House of Commons on November 3, 2009.

The eight recommendations contained in the report are noted below, along with Infoway’s responses:

Setting direction

1. To ensure Parliament and Canadians properly understand Infoway’s goal, the Corporation should further explain in its public reports what is meant by having an electronic health record available to authorized health care professionals.

Infoway’s Response:

We agree with the recommendation and we will make additional efforts to elaborate on the goal of having an electronic health record available to authorized health care providers in our public reporting commencing with our 2009-10 Annual Report and/or the 2010-11 Corporate Business Plan.

Implementation of electronic health records is a complex task, as is reporting on progress. We have made continuous improvements to progress reporting and will continue to enhance our reporting in the future.

Infoway reports on a regular basis jurisdictional progress to making electronic health records available to Canadians. For example, we provide Members of Parliament and Senators with copies of our Annual Report and Corporate Business Plan. We also post these materials on our website to help ensure the broadest possible distribution to Canadians.

2. Infoway should review and strengthen its management controls over contracting for goods and services to reduce the risk of contract disputes.

Infoway’s Response:

We agree to review and analyze current practices to strengthen management controls. Improvements to management controls related to the timing of contract signatures will be put in place by to the end of the 2009-10 fiscal year.

We do not pay any invoice unless the contract is acceptably executed and the Infoway manager has certified that the product or service has been appropriately delivered by the contractor.

3. Infoway should review its contracting policy with respect to contract amendments and extensions to ensure fairness, transparency, and disclosure to the Board.

Infoway’s Response:

We agree to review the contracting policy with respect to amendments and extensions and to present the proposed revisions to the Board for approval prior to the fourth quarter of the 2009-10 fiscal year.

Infoway’s Board-approved contracting policy was developed to respond to competitive market conditions and the often unique and rare combination of skill sets required to deliver the Corporation’s mandate. The current policy reflects the necessary balance between market competitiveness, the Corporation’s business requirements and due respect for the expenditure of public funds. We are compliant with the current policy related to the tendering of amendments and extensions and the reporting of those amendments and extensions to the Board of Directors.

Funding electronic health record projects

4. To ensure accountability and transparency, Infoway should better document its analyses of project deliverables to support its decision to release funds.

Infoway’s Response:

We agree that there is scope for improvement to deliverables documentation and the Corporation will address this issue immediately. This will build on Infoway’s documentation process and methodology for the approval of deliverables, including the third-party claims verification process that assesses the adequacy and effectiveness of the policies, controls, and systems in place for the management of Infoway-funded projects.

5. To ensure that standards will be properly implemented in the five core systems of an electronic health record, Infoway should obtain from the provinces and territories the results of conformance testing on systems it will fund, and obtain assurance that non-conformance issues, if any, will be resolved.

Infoway’s Response:

On a go forward basis, for new investment approvals, and with the co-operation of the jurisdictions, we agree to work to obtain the results of conformance testing from the jurisdictions on the five core electronic health record systems we will fund in the future and obtain assurance that non-conformance issues, if any, will be resolved.

We have acknowledged that there will be variations in systems requirements and thus standards requirements within jurisdictions. Jurisdictions have the mandate and authority to ensure conformance and perform user acceptance testing to their specific requirements. They are most familiar with those requirements and are best positioned to ensure they are met. Some differences are valid within a specification and require no action, whereas some are due to different maintenance releases of a standard used by various jurisdictions largely driven by their timeline for implementation. Despite variances in standards conformance, the use of a standard within a jurisdiction will ensure interoperability within that jurisdiction.

Pan-Canadian interoperability can still be achieved and differences in standards can be mitigated by

• ensuring the same standard is used for cross-jurisdictional interoperability, or
• mapping to accommodate differences in the implementation of the standard. We believe that this is not only feasible but also practical and cost effective.

Reporting on results

6. To ensure Parliament and Canadians have sufficient information about progress achieved, Infoway should report on the extent to which electronic health record systems have been adopted by health care professionals and are compliant with standards.

Infoway’s Response:

We agree with the recommendation, recognizing, however, that solution implementation and availability must be completed before adoption can occur. These major project initiatives often take 24 to 36 months to be fully implemented.

Infoway, in conjunction with the jurisdictions, will endeavour to develop measures on the extent to which EHR systems have been adopted by health care providers. Further, Infoway will work with jurisdictions to develop a standards compliance report.

7. To ensure Parliament and Canadians have sufficient information about progress achieved, Infoway should report on results achieved compared with expected results and explain any difference.

Infoway’s Response:

We agree to report on variances between expected results and achievements related to the electronic health record goal line in our public reporting beginning with the 2009-10 Annual Report.

This will build on the Corporation’s existing reporting on expected results and actual performance in our Annual Report (in the section entitled, Delivering Results: Performance Against Objectives). We provide Members of Parliament (MPs) and Senators with copies of our Annual Report and Corporate Business Plan. Last year, we undertook an initiative (which we plan to repeat annually) to provide MPs and Senators with jurisdictional fact sheets to highlight EHR advancements within their respective region.

8. To ensure Parliament and Canadians have sufficient information about progress achieved, Infoway should report on the results achieved for performance targets established for each core system of the electronic health record.

Infoway’s Response:

We agree with the recommendation. The Corporation will need to finalize its work with the jurisdictions on both data availability and data quality, to ensure that additional reporting will be accurate. This will build on the Corporation’s existing reports on the value, benefits, and advancement that electronic health record systems are delivering to Canadians through our proactive media relations efforts, corporate materials, and the Internet, as well as through hundreds of public presentation and speaking engagements.

Link here:

http://www.infoway-inforoute.ca/about-infoway/news/open-letter-to-canadians/oag-recommendations-and-infoway-responses

And now what were the actual audit findings you ask (my emphaisis):

What we found

• Infoway has accomplished much in the eight years since its creation. Using the funding agreements with Health Canada as a starting point, Infoway developed an approach to providing for compatible electronic health records by identifying the key requirements and components of an EHR and developing a blueprint for the design of health information systems. It consulted widely with partners and stakeholders to obtain their input and support. In addition, it established appropriate governance mechanisms and developed a risk management strategy. It has implemented appropriate management controls for operational spending, although controls for contracting for goods and services need to be strengthened.
• In the 29 EHR projects we examined, Infoway had ensured that provinces and territories designed the projects to comply with requirements such as its blueprint and standards. It had also identified project-specific risks and was monitoring them, as well as other problems that arose during the life of the project. However, Infoway has not obtained the results of conformance testing on EHR systems. This means it does not have sufficient assurance that standards have been implemented as required.
• Infoway has made considerable efforts to report on the progress of the EHR initiative. It reports progress toward its 2010 goal as the percentage of Canadians living in provinces or territories where an EHR is available to their health care professionals. However, it has not reported on other indicators of progress, such as the extent to which completed systems meet requirements for compatibility. Nor does it report on the adoption or use of completed systems by health care professionals, although it considers low adoption rates a serious risk to the EHR initiative.
• As the sponsoring department, Health Canada periodically obtains assurance through audits and evaluations that Infoway is complying with the funding agreements. However, at the time of the audit, the Department still had not fully developed the monitoring framework it approved in 2008 to manage risks associated with such large amounts of funding and to strengthen ongoing monitoring of the Corporation.

See here:

http://www.oag-bvg.gc.ca/internet/English/parl_oag_200911_04_e_33205.html

In summary, the contract controls were not up to scratch, the systems were not implemented to the agreed standards, adoption has been very slow and expenditure is not being monitored properly.

It is hard work to get to the truth with all the spin and gloss!

It would be interesting to see what our Auditor General would make of our five year old NEHTA.

David.