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September 3, 2009

David Caplan, Ontario dollars down the drain

The Canadian Charger

CaplanBefore Sarah Kramer was removed from her job on June 7, amid a spending scandal, Ms. Kramer had approved about $4.8 million in untendered contracts, spent $51,000 on office furniture and received an $114,000 bonus, on top of her $380,000 annual salary.

Sarah Kramer took over as the CEO for eHealth Ontario on November 3, 2008.

Kramer said this new agency would play a critical role in achieving the Ontario government's overall health strategy of building a safer and sustainable healthcare system that offers improved patient care.

Ehealth Ontario was created by the Ontario’s Liberals in September 2008 with the merger of Smart Systems for Health Agency (SSHA) and the e-health program at the Ministry of Health and Long Term Care. SSHA started operating in 2003.

Creating a Diabetes Registry; establishing an e-prescription system to eliminate hand-written prescriptions and reduce medical errors; developing an ehealth portal to allow physicians and patients to securely access information they need; and overseeing the development of a province-wide electronic health record system by 2015, that will improve healthcare delivery, increase patient safety and reduce emergency room waiting time, were key priorities Ms. Kramer cited when she started her new job.

Kramer hired two consultants who live in Alberta and an executive assistant for $1,700 per day.

The two Alberta consultants were listed as senior-vice presidents and commuted to Toronto on a regular basis at a cost of $1.5 million per year for flights, salary, accommodation and per diems. However, Ms. Kramer is convinced she got good value for the taxpayers' money spent.

“I do think I got value for money and the way I know is everything that we wanted to get done got done on time, on budget, and in many cases much better than we hoped could be done,” she said, without getting into specifics as to what the agency has actually done.

Ontario Health Minister David Caplan (MPP for Don-Valley East) claimed the agency has been hard at work; citing two pilot projects for ePrescribing- a system that electronically sends prescriptions to pharmacies as its sole completed project.

He added that eHealth staff is working on a diabetes registry slated for 2012 and a comprehensive electronic record system which should be operational in 2015.

Despite this vote of confidence from Health Minister Caplan, Dr. Alan Hudson, Chair of eHealth Ontario's board of directors resigned on June 17.

The same day, the McGuinty government appointed Rita Burak as the new Chair of the board. The government press release states: “Ms. Burka's considerable experience includes a number of progressively senior positions in the Ontario Government including Secretary of the Cabinet and Clerk of the Executive Council and Deputy Minister of Agriculture, Food and Rural Affairs.”

In an effort to get things moving at eHealth Ontario, the Liberal government appointed Rob Devitt the new interim CEO, on August 5, replacing Ron Sapsford, the deputy health minister, who was appointed CEO on June 9, after Ms. Kramer was dismissed from the agency.

Mr. Devitt, currently president and CEO of Toronto East General Hospital, is slated to take over immediately and will fill the role until the end of the year, while the board searches for a permanent CEO.

Meanwhile, as the consulting firm PricewaterhouseCoopers examines eHealth Ontario's books, under the management of an internal government auditor, the Progressive Conservatives are calling for Ms. Kramer and other eHealth officials to appear before a legislative committee to explain their spending decisions.

Auditor General Jim McCarter plans to unveil the results of his investigation into eHealth and its predecessor SSHA's spending in a December annual report.

SSHA, armed with a mandate to create an electronic healthcare system for Ontario in 2002,  reportedly spent $647 million and accomplished nothing before it was disbanded in 2008, in the wake of a damning operational review by Deloitte and Touche LLP.

The total spending for SSHA and eHealth Ontario is now $839 million and eHealth Ontario has recently published a strategy that outlines its $2.133 billion plan over the next few years.

Information about eHealth’s specific accomplishments is scarce.

In an email response to a request by The Canadian Charger for the agency’s accomplishments, Heather Brown, a communications advisor at eHealth Ontario sent the following:

eHealth Ontario Accomplishments

·Unveiling Ontario’s first comprehensive, published eHealth Strategy.

·Launching an ePrescribing Program -- the first in Canada with pilot projects in The Group Health Centre in Sault Ste. Marie and the Georgian Bay Family Health Team in Collingwood.

·Partnering with OntarioMD to roll out Electronic Medical Records in Primary Care Physicians’ offices throughout the province.

·Launching an initiative (the Baseline Diabetes Dataset Initiative) to measure the current state of diabetes care in Ontario, providing physicians with information needed to improve their patients’ care.

·Establishing diagnostic imaging networks across Ontario so that images are available digitally, resulting in faster turnaround times for patients.

·Developing an electronic system to store images from hospital CT scanners for neurosurgical and neurological care to improve patient access to care in the case of urgent head trauma.

·Managing the Drug Profile Viewer which is in use in all Hospital Emergency Departments across Ontario, helping health care providers quickly identify and prevent harmful drug reactions and provide more informed emergency care.

·Establishing the major network service provider for telemedicine in Ontario, enabling over 42,000 clinical consultations in 2008. 

It’s telling that with the exception of the first point, and the possible exception of the last two points, the rest of the above listed initiatives are in process; none have been completed.

Realizing that without specific information, such as how many patients in Ontario are currently being served by these programs, by how many doctors and how many hospitals, in how many communities, The Canadian Charger asked for these details in a follow-up email.

Ms. Brown replied that she was trying to get answers to these questions and she would be in touch soon.

A couple of days later, Ms. Brown sent an email with some further clarification as follows:

The ePrescribing Demonstration project is limited to two sites, in Sault Ste. Marie and Collingwood area, and its purpose is to understand the impacts of electronic prescribing (i.e. "paperless prescriptions") on the workflows and processes of physicians, nurse practitioners, pharmacists and patients so that we can obtain lessons learned for the design and rollout of the eventual province-wide solution. So it's not a pilot in the traditional sense. It's limited to the 2 sites only, not more extensive than that.

Also, some of the expected benefits of ePrescribing (decreased medication errors, better coordination of care between physicians, nurse practitioners and pharmacists) can be realized early on by 80,000 Ontarians. 

The technology solutions used in the two project sites are not prototypes of the eventual provincial solution, although they do demonstrate several of the key elements and concepts of the eventual ePrescribing solution. 

The regulatory colleges (OCP, CPSO and CNO) support the Demonstration projects and their objective is to learn about the regulatory issues of ePrescribing and the possible solutions to those issues, so that they can put in place the appropriate regulatory framework for ePrescribing in Ontario .

OntarioMD is a subsidiary of the Ontario Medical Association which acts as their eHealth arm. Their main product is the OntarioMD.ca portal which gives physicians tools, research, information etc. 3,300 primary care physicians (covering 25% of Ontarians) are already using EMRs already for their patients. Patients don't have access, just their physicians.

[Baseline Diabetes Dataset Initiative (BDDI)] has recently completed a test phase with 11 primary care physicians and approximately 1,300 of their patients living with diabetes. Lessons learned during testing will inform the development of a strategy to deploy the BDDI to approximately 9,000 primary care providers across Ontario. As indicated in the eHealth Strategy, BDDI will begin rolling out to 25% of PCPs (Primary Care Physicians) in September 2009.

This was the sum of eHealth Ontario's accomplishments.

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