May 31 2011

AHLTA Is Not Alone, Part II: Ontario’s $1 Billion health IT fiasco

Published by at 8:45 am under AHLTA,Heath IT,VistA

It really pains me to post this kind of stuff, but I fear that we are entering an era of unprecedented Health IT fiascos.  After the $4 billion Department of Defense AHLTA fiasco, (AHLTA is Intolerable), and the $17 billion UK National Health Service fiasco, here is a A scathing report on the eHealth Ontario spending scandal charges that successive governments wasted $1 billion in taxpayer money. Carpet bagger consultants have arrived in full force, with flimsy-if-no experience in the complexities of medical informatics, but a deep, abiding concern for their own income.

The head of the Ontario disaster “billed thousands of dollars for limousine rides… before she resigned from her $380,000-a-year job in June. She was given a $317,000 severance package and received a $114,000 bonus after just 10 months on the job.”  This payment was made for leading the fiasco, not delivering a product.  The Canadian auditor found the agency had fewer than 30 full-time employees but was engaging more than 300 consultants. they also said the effort was “lacking in strategic direction and relying too heavily on external consultations.”

The idea behind eHealth is to create electronic health records for Ontario, something the auditor says could save $6 billion if implemented in every province and territory.  Instead, Ontario “is near the back of the pack” when it comes to electronic health records, having wasted millions on underused computer systems and untendered contracts.

EHealth was set up in 2008 to create electronic health records after Smart Systems for Health spent $650 million but failed to produce anything of lasting value. Smart Systems for Health was quietly shut down last September.

And then there is politics: “the Conservatives and New Democrats complained the agency gave out $5 million in untendered contracts to consultants.   Documents released by the government since then showed the value of those untendered contracts was closer to $16 million, with the biggest ones going to companies the opposition parties say have ties to the Liberal government.”

These kinds of shenanigans are not unique to Canada, of course.  Here is a letter from a group of Wisconsin congressfolk blatantly meddling in VA and DoD internal IT decisions:
Wisconsin reps try to derail VA/Defense open source health records system which happens to be the home of Epic Systems, who hope to provide one of the most proprietary, closed systems in the nation.  Epic denied hiring lobbyists, but a quick search on showed over $1m in political donations from Epic CEO Judy Faulkner and Epic, much directed to the very Congressfolks who took the time to write the letter.  Epic don’t lobby; I guess it’s more efficient just to send cash to their Congressfolks.

This isn’t just about money… Bad health IT software kills people.  When I worked at the VA Loma Linda, I routinely rode in the staff elevator with the gurney of a patient headed towards the morgue.  I would be in meetings when a code blue sounded, and docs would rush out of the room, only to come back breathless, saying, “now, where were we?” This was a sobering and constant reminder of the significance of what hospitals do.  The wrong information, or delays in getting the right information, can kill.  Installing patient software (e.g. the VA’s bar coding of patients for medications) can save lives.

At the core of this – around the world, not just the US – are self-righteous bureaucrats who persist in top-down, centralized, waterfall development, “one-correct-way” thinkers who see their bureaucracy, not the patient, as the center of the IT universe.  We are not creating an “accounting system for disease” as if it is a banking transaction system.  We need to building communities of health, with the individual at the center of the world.  We need to overcome the “failure to communicate” in health care; the Electronic Health Record is but one aspect of a much broader need for transformation in our health care thinking.

I don’t see this shift happening.  Instead, I see self-righteous indignation on the part of the bureaucrats who perpetuated the fiasco in the first place.  It’s as if a carpenter builds a crooked house, and blames his hammer.  All he needs is a another, more expensive hammer, and he’ll build a house twice as expensive.  The US Department of Defense is now on its fourth generation of crooked houses/more expensive hammers, and is in the process of repeating the process all over again, full of self-righteous indignation that VA’s VistA is continuing to evolve while their break-and-replace models continue to fail.  DoD continues to blame “the software” for their failures, oblivious to the fact that they were the ones who perpetrated the fiasco in the first place.  Governments continue to pour money onto the fire, paying for new hammers even when bureaucratic incompetence has been repeatedly demonstrated.

My current Health IT fiasco report card:  I hope this is the extent of the list, but I fear that there are many others to be listed.  Please email me with any links.

UK National Health Service:  $17 Billion

US Department of Defense AHLTA: $4 Billion

Canada: Ontario eHealth System: $1 Billion

(tip of the hat to Joseph Dal Molin for some of these links)



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