Saturday, December 31, 2011

Globe & Mail article on eHealth Ontario scandal in 2009

From the link:

Instead it's the utter failure of the Ministry of Health to create electronic health records, which will ultimately lead to better and more efficient patient care. Horrors have been exposed. Heads have rolled. The “scandal” at eHealth Ontario is over. Or is it?

Let's examine briefly the scandalous activities that took place at eHealth Ontario. The chief executive officer, Sarah Kramer, was paid a decent salary, $380,000, a $114,000 bonus and $317,000 in severance when she was sacked. Ms. Kramer was forced out because she hired consultants – sometimes with untendered contracts – and those consultants were paid market rates of up to $2,700 a day. Most scandalous of all, according to media reports, is that some of these consultants expensed $1.65 for tea and $3.99 for Choco Bites. Finally, Alan Hudson, chairman of eHealth Ontario, resigned, taking it on the neck because other people coloured outside the lines. The irony is that he received no salary or expenses for the ambitious task he undertook – creating a province-wide electronic health record system by 2015.

Without a doubt some stupid things were done in the name of expediency; however well-intentioned some actions, the optics were bad. Ontario's auditor-general can sort out the accounting. But the more important question is accountability to the public on the underlying issue. The true scandal in Ontario is the utter failure of the Ministry of Health to create electronic health records, which will ultimately lead to better and more efficient patient care. Alberta has done it. Nova Scotia has done it (under the skilled guidance of Ms. Kramer, by the way), and most other provinces are well on their way.

But Ontario is an ineffectual laggard that has wasted hundreds of millions of dollars. The Smart Systems for Health agency – the predecessor to eHealth Ontario – spent $647-million and achieved diddly-squat. But, hey, the “leaders” of that initiative didn't bill taxpayers for Choco Bites so their failings never made headlines.

One should not presume to speak for Ms. Kramer or Dr. Hudson, but the likely reason they cut some corners – such as untendered contracts – was in a bid to make up for lost time. Let's be honest: The talent pool of eHealth experts is pretty shallow; tendering would result in pretty obvious results. There has been, as this “scandal” unfolded, much prurient and disingenuous tsk-tsking about the hiring of consultants.

Every government in this country uses consultants, and uses them extensively. There are three principal reasons: 

Consultants can be highly specialized and be hired to complete specific tasks that are beyond the capabilities of government staffers. It's an easy way to maintain the fiction that staffing levels are not increasing, as everyone seems to hate bureaucracy. Politicians can hire consultants that share their political bent and then marvel at their “independent” advice.

There is reason for cynicism but, hopefully, consultants are sought out principally for their abilities.
The reality is the best young talent in the health sector has been drawn to consulting agencies. The Courtyard Group, the consultancy at the centre of the eHealth Ontario “scandal,” is a prime example. By all accounts, it does great work. Yes, the consultants are paid well for it, but governments sign these contracts knowing full well the costs.

Instead of the faux outrage about consulting fees, we should be asking ourselves why the young hotshots at Courtyard, with their master's degrees in public-health administration and PhDs in computer science, are not drawn to public service. It's not just the paltry pay, but the sheer powerlessness of modern public service. In a country where we love medicare – if not worship it – it is paradoxical that those who deliver the service (and it takes more than the front-line nurses and doctors) are treated with such contempt. Ministry of Health employees, with few exceptions, have been transformed into emasculated toadies by their political bosses, whose only “vision” for health care is not irritating the public so they can be re-elected.

There is no incentive to do better. On the contrary, there is much incentive to do nothing and say nothing unless there is a fire to put out. And the health bureaucrats get gag orders for good measure. As a result, the impetus for change and innovation can, seemingly, only come from the outside – from independent agencies such as eHealth Ontario and the consultants they hire.

And when that happens, the bureaucracy reacts. Did anyone wonder why we know that a consultant spent $3.99 on Choco Bites? Because there are ministry pencil-pushers with nothing better to do than examine the meal expenses of contract workers and seethe with jealousy because people such as Dr. Hudson have the Premier's ear. If only that manpower were put to good use, such as making patient care safer, which, ultimately, is what eHealth records will achieve. The horrors have been exposed. Heads have rolled. The scandal is over. Inertia has triumphed.

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