eHealth Ontario, surprisingly wishes to scrap the Diabetes Registration program which it has been touting as one of the few successes that the arms length government agency has had. Expected to cost $46.2 million, the agency has decided that the program is no longer required “because cheaper eHealth software — known as electronic medical record (EMR) 4.1 and developed by 13 different vendors, none of which is CGI — is already used by 9,000 Ontario physicians.” Apparently the contract can be cancelled without penalty to the taxpayers since it was to be paid based on delivery of key milestones. Although there may be no direct penalty in cancelling the contact, the poor planning by eHealth will have direct and indirect consequences to the taxpayers of Ontario.
eHealth Ontario provides critical infrastructure for the provincial health system while OntarioMD provides oversight for the EMR Adoption program. The EMR Adoption program certifies software vendors that their offerings meet required functionality. The functionality required is determined through collaboration of the two organizations. Physicians who purchases a certified offering qualify for up to $27,100 in provincial funding; similar programs exist in other provinces and because they are tied to physician funding it’s almost impossible to do business unless you pass. EMR software vendors do not receive any funding or incentives; it’s the cost of doing business to get your “license to hunt” for as many physicians you can capture. Every few years new specifications are released and OntarioMD and eHealth Ontario would have collaborated on the requirements for diabetes registry integration.
Now that you know the players involved with the registry, I’ll explain why cancelling this contract will have cost Ontario millions (if not billions).
Why it Hurts the Taxpayer: Time = $$$
Cancelling the contract with CGI may not stipulate any financial penalty, but I find it difficult to believe that Ontario taxpayers will be completely off the hook. If CGI actually conceded to payment only when the registry would be completely delivered heads would roll; expect partial payment to the company or a lawsuit that will be funded by the taxpayer.
Even if Ontario would be free from making any payments consider the number of bureaucrats, specialists and consultants to oversee the Diabetes Registry project. There were probably anywhere from 4 – 12 people involved (maybe more) and for the amount of time that the project was in progress, eHealth was flushing millions down the toilet in salaries and consultant fees! The conclusion eHealth made to cancel the project is outrageous and demonstrates the mismanagement of resources at this organization.
“because cheaper eHealth software — known as electronic medical record (EMR) 4.1 and developed by 13 different vendors, none of which is CGI — is already used by 9,000 Ontario physicians.”
The requirements for EMRs to have functionality to manage diabetes is not new with the v4.1 of the specifications; they only detail how data that is collected in those systems should be formatted to transfer it to a provincial registry. Vendors may have had to add additional fields, but the majority of physicians were already managing Diabetes effectively with EMR systems meeting prior versions of the specifications (i.e. several years prior to the registry was announced). eHealth was involved in writing previous versions of the specifications so I’m puzzled that that it took them this long to realize that “hey, doctors can already do this”.
EMR Software Vendors Risk Viability
For almost 5 years, I was the Product Manager for one of Canada’s most successful EMR companies; the company was not huge – maybe around 200 people at the time working across the country. Most Canadian based EMR companies are not very large and conformance testing takes a significant amount of investment. The company I was working for estimated that between 60 – 70% of revenues were going towards provincial certification (not just for Ontario, but for several provinces) making it critical that the ROI be high. OntarioMD announced that the Diabetes data transfer specification would be required to pass CMS v4.1, just as I departed in 2010. I know the company passed its testing, but that may have been wasted effort if the registry is being scrapped. Unfortunately there is no recourse that can be made to OntarioMD to reclaim the investment made to meet a defunct requirement. In today’s unstable economy it could have been more wisely used for business expansion and hiring/retaining employees.
OntarioMD in good faith believed that eHealth would deliver on the diabetes registry and having systems capable of integrating on it instruction would be wise, but its sudden abandonment is going to scar the EMR Adoption program. This move introduces doubt; can vendors afford to build capability for future systems that may not exist?
The only good news out from this story is that eHealth is trying to stop the bleeding, but it’s from a self-inflicted wound. Its purported successes were a smoke screen for a program that actually had no benefit if what is being reported is true. Ontario taxpayers can no longer afford the continued mis-management of this agency and I’m almost convinced that it needs to be scrapped and directly managed by the government. An arms-length health agency with billions of dollars in budget with no direct government oversight is too tempting a target to be abused.