Tag Archives: Auditor General

Sensationalism Trumps Rationale Debate

One of my best sources of information is Twitter.  The people that I follow are well read and are constantly bringing interesting articles and documents to my attention. As I skimmed my Twitter feed this morning, I couldn’t help but notice several Tweets about a recent Canadian Business magazine article entitled “The worst-run industry in Canada: Health care”.  The title was so provocative that I immediately clicked on the link to read the article.

To say that I was disappointed in the article is an understatement.  While it raises some very good points, the article did not once put any quantified statistics on the table to prove the contention that Canadian healthcare is the worst run industry in Canada.  By what measure?   Steadily increasing healthcare costs, while worrisome, are not a sign that they system is poorly run.  I expected better analysis from a leading Canadian business magazine.

One point that I do believe merits further discussion and debate is the lack of information with which to analyze health system performance.  The Auditor General raised similar concerns in her presentation to the Canadian Medical Association’s General Council this past August.  In a news conference following her presentation, Sheila Fraser stated that “We don’t know if we’re getting good value for money”.  If the Auditor General can’t make such an assessment, how can Canadian Business magazine make the  assertion that Canadian healthcare is poorly run?

I was also concerned by Senator Kirby’s assertion that “Health care is a service business pure and simple.”   While there is a certain logical appeal to this statement, I contend that the implications of this statement are profound and should be carefully considered.  How do we value extra years of human life, for example?  Do we permit those with extra dollars to spend to receive a different level of service like we do in many other industries?  I don’t pretend to have the answers but I think that the debate regarding the challenges facing our healthcare system are much more profound than articulated in the Canadian Business article.  I am concerned that sensationalism trumped rationale debate in this article.

Mike

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Public Awareness – A Timely Investment

After reading my blog post on Canada Health Infoway’s planned public advocacy campaign, Michael Power, a respected colleague and cherished friend tweeted a comment that I felt I could not adequately address in a 140 character reply.  In what I now fear might have a knee-jerk reaction to defend my opinion, I challenged Michael, a lawyer by profession (which means that he argues for a living), to a public debate conducted on our respective blogs.  As my mother always warned me, be careful for what you wish for, you might actually get it!

In his blog post response, my esteemed colleague attempts portrays spending on a public awareness campaign as a waste of money.  He cleverly attempts to put words in the Auditor General’s mouth by musing whether the she would “consider such a campaign (with television advertising) a good ‘value-for-money’ exercise” and argues that “benefits should be self-evident because hundreds of millions have already been expended over the last decade”.

In this era of financial restraint and a recent history of eHealth scandals, Mr. Power’s arguments are, on the surface, quite compelling.  Indeed, my initial reaction to Infoway’s plans was very similar Mr. Power’s reaction.  However, upon further reflection, I have come to the conclusion that time is right for the type of public awareness campaign that Infoway envisions.  If we are going to spend limited public dollars on digitizing our healthcare system, we (those of us advocating continued investment in healthcare IT) owe it to the public to explain why we feel such an investment makes sense and offer a compelling vision for how a digitized healthcare system will improve healthcare outcomes.

According to the federal Auditor General’s report that Michael Power referred to  in his blog post, Canada Health Infoway was created to “lead the national development of electronic health record“, with the stated goal to “ensure that, by 2010, every province and territory and the populations they serve will benefit from new health information systems that will help transform their health care system“.

As a national leader, Infoway should ( a word that my wife frequently reminds me to use with great care) take a leading role in raising awareness among the main beneficiaries of a digitized healthcare system – the citizens who ultimately pay for and make use of the services that our healthcare system provides.  While Mr. Powers contends that “public reports” be restricted to Infoway’s web site and annual reports, I assert that the Auditor General’s recommendation that “the Corporation should further explain in its public reports what is meant by having an electronic health record available to authorized health care professionals” can be interpreted in a broader sense to include a variety of communication tools including advertising and social media. Public reporting need not be limited to an annual report that few people will read.

A recent report by the eHealth Initiative –  an independent, non-profit organization whose mission is to drive improvement in the quality, safety, and efficiency of healthcare through information and information technology – states that two-thirds of stakeholders reviewing the progress in health information technology and health information exchange initiatives in the U.S. believe that “outreach to consumers about the value of EHRs and HIE is not effective“. While similar data is not available for the Canadian market, I believe that the situation is likely the same in Canada. Doing more of the same, a course of action that Mr. Power seems to recommend, will not achieve different results and is, in my view, an ineffective use of limited resources.

Canada Health Infoway’s public awareness campaign is designed to explain the benefits of a digitized healthcare system in terms that everyone can understand through media to which most people are exposed. Sorry, Michael, but I don’t think that many people are going to go out of their way to visit the Infoway web site or take the time to read the Infoway annual report.  More importantly, perhaps, I don’t think that we should expect them to do so.

Without using terms like “electronic health record” or “drug information system” or “Picture Archiving and Communication Systems”, the Infoway public awareness campaign uses simple vignettes that powerfully convey how a digitized healthcare system will make personal health information readily available when and where it is needed.  Equally important, this campaign dramatically portrays the limitations of the current paper-based systems and the corresponding impact on patient safety that these limitations impose.

Educating the public on the benefits of a digitized healthcare systems is, in my view, clearly part Infoway’s mandate and is one mechanism that Infoway can use to drive greater interest in and significant adoption of various electronic healthcare systems.  Unlike Mr. Power, I do not believe that the benefits are “self-evident”.  How can the public be expected to understand what many of never seen before?  Only when the public believes that timely and complete information is an integral part of the diagnosis and treatment process will they support (and perhaps even demand) continued investment in healthcare IT.

The Infoway public awareness campaign simply yet dramatically illustrates how lack of information can delay or even impede vital healthcare interventions.   The various elements of the campaign will, I believe, leave people wondering why the same technology that they see used in other industries isn’t readily available to the professionals in whose hands they place their health and, in some cases, their lives.   If the Infoway campaign can get Canadians to take a greater interest in the manner in which healthcare is delivered in this country and get them thinking about the challenges of delivering care with information recorded on pieces of paper, it will have delivered considerable value for the money invested in this campaign.

Mike

PS – After this blog post was initially published Infoway sent the following data point from their most recent public opinion survey:

Infoway Public Opinion Chart

Deja vu all over again

Having just finished reading the BC Auditor General report, I was intrigued to see a Tweet last night regarding a recent Auditor General report on Canada Health Infoway.  Digging a a little deeper a I found a Feb 20th Globe and Mail article about a “new audit” that found “Health Canada handed out millions of dollars to a national eHealth agency without properly accounting for how the money was spent”.  As I read the article I had this strange sense of deja vu, as though I had seen many of the audit findings before.  Also, I found it strange that a “new” Auditor General report would be released when parliament was prorogued.   So, I went to the federal Auditor General’s site and found what appeared to be the report referenced in the article.  It was released  November 3rd, 2009.

http://www.oag-bvg.gc.ca/internet/English/mr_20091103_e_33273.html

I make no secret that while I have some reservations about the way that Infoway operates I support the concept of a national eHealth agency and I strongly encourage the federal government to release the $500M earmarked for Infoway.  This support notwithstanding,I firmly believe in the need for honest and open debate about eHealth plans and priorities.  Indeed, this need is the basis for this blog and lack of transparency is one of my key complaints about Infoway.  In that light, I do question whether an audit report released last fall is really “new”.  Now, I’ll give the Globe and Mail the benefit of a doubt.  Perhaps there is another more recent report that I missed.  If so, could someone point it out to me as I’d like to read it.

Mike

Postscript – updated 26 Feb 2010

I did some more digging around and found the internal audit referenced in the Globe & Mail article; you can find it at:

http://www.hc-sc.gc.ca/ahc-asc/pubs/_audit-verif/2009-20/index-eng.php

In addition to the comments noted in the Globe and Mail article, the audit also notes:

  • Overall, Canada Health Infoway Inc. has an effective management control framework in place surrounding the administration of grant funds.
  • Approved expenditures were related to the Scope of Work and Outcomes as defined in the Funding Agreements.

I’m all for shining the light on all government spending.  But, lets share both the good points and bad points and highlight overall findings in addition to picking on specific detailed issues.

Failure is an Option

One of the life lessons that I have tried to teach my kids is the value of learning from your mistakes. I frequently remind my daughter of Thomas Edison’s famous quote when, after numerous failures in developing an electric light bulb, he was asked if he was ready to quit.  Edison replied

“I have not failed. I’ve just found 10,000 ways that won’t work.”

Another quote that I have shared with her and even printed a copy to hang above her desk is from Winston Churchill

“Courage is going from failure to failure without losing enthusiasm.”

More recently, I was struck by President Barak Obama’s view on failure:

“Making your mark on the world is hard. If it were easy, everybody would do it. But it’s not. It takes patience, it takes commitment, and it comes with plenty of failure along the way. The real test is not whether you avoid this failure, because you won’t. it’s whether you let it harden or shame you into inaction, or whether you learn from it; whether you choose to persevere.”

I was reminded of my many discussions with my children about failure and mistakes when I read the federal Auditor General’s report on Canada Health Infoway.   Although I wholeheartedly support and endorse Canada Health Infoway, I have long felt that they don’t  share failures or anything less than positive news.  Given the number of investments that they are making it is not reasonable to assume that they will all be roaring successes and, given the statistics on IT projects across all industries, we can expect a number of failures and only partial successes.  How are we communicating these lessons learned from these failures?  In this current era of eHealth “scandals” no sane person would want to risk media attention by admitting that IT project for which they were responsible had failed.  Too bad.  If we want to get the best return on our investments I think that we need to openly share all lessons learned and to admit, without fear of recrimination, when something goes wrong so that other can benefit.  Failure is indeed an acceptable option provided that we learn from it.  Otherwise, we have squandered our investment and have not generated any value for the money spent.

Mike