Today I attended an ITAC Health vendor information session at which Greg Reed, the CEO of eHealth Ontario, provided an update on the agency’s plans and priorities. While I had hoped that Mr. Reed would make a more definitive statement regarding the agency’s role and offer a clear articulation of the agency’s updated strategic plan, I did walk away with a better sense of the underlying philosophies influencing how the agency operates and the challenges that it faces in positioning itself in the complex Ontario health system.
Mr. Reed continues to demonstrate an unwavering commitment to “getting it right” and steadfastly refuses to assert his own views about the “right” direction for either the agency or eHealth in Ontario. Instead, Mr. Reed insists that he needs to take the time necessary to consult with all stakeholders.
Mr. Reed spoke for just under an hour and then took questions. He divided his presentations into four parts to cover the following topics:
- Update on various efforts to remediate eHealth Ontario
- Observations on what he has seen / heard during his visits across the province
- Update on strategic planning activities
- Musings on eHealth Ontario’s role
Mr. Reed structured his remarks on efforts to remediate problems at eHealth Ontario in terms of the four general areas of concern raised in the Auditor General’s report. He noted that the agency’s analysis identified 84 root causes for the problems identified by the Auditor General. In terns of the four areas of concern, Mr. Reed offered the following update on efforts to address these concerns:
- Oversight / governance – The agency is “almost there” in addressing these concerns according to Mr. Reed.
- Procurement – The agency has overhauled the procurement process so that it is more open and transparent albeit more complicated. According to Mr. Reed, the agency is “just about done” addressing this area of concern.
- Project planning – The agency needs “outside help” and has engaged someone (wasn’t clear whether it was new hire or a consulting engagement) to lead remediation efforts in this area. Mr. Reed stated that he could not identify the person but that an announcement was forthcoming in the near future.
- Strategic planning – Mr. Reed had “hoped to have a plan by now” but that he was still talking to stakeholders to get feedback. As part of this process Mr. Reed indicated that he wanted to engage the audience is a dialog during the question and answer portion of his presentation.
Mr. Reed offered additional insights regarding remediation efforts including:
- The eHelath Ontario leadership team has been “reinforced” with “8 or 9 new vice-presidents
- Significant staffing changes. 150 out of a total staff complement of “800 to 850” employees have left the agency and roughly 200 new employees have been hired. Some of the new hires replace consultants. According to Mr. Reed, there are now 118 consultants working at the agency. This number represents about 12% of the eHealth Ontario workforce, a level that Mr. Reed feels is “about right”.
- Joint planning with Ontario government regarding network and data centre operations. The Ontario government is reusing portions of the eHealth Ontario network for other gov’t department traffic and there are discussions regarding use of an existing Ontario government data centre.
- Working to change the organization’s culture from “command and control” to “more open and transparent” where good ideas can come from anywhere, not just through the chain of command.
Mr. Reed explained that he had spent considerable time “in the field” talking to an “alphabet soup” of organizations. He noted that it quickly became apparent to him that the Ontario health sector was a complex environment which he categorized as “very heterogeneous” in many ways, from process to technology. This complexity will, according to Mr. Reed, make developing an interoperable electronic health record a “daunting task”.
When engaging various stakeholders, Mr. Reed explained that his approach has been “listen, learn, hypothesize ideas, and solicit feedback on these ideas”. It is this collaborative and iterative approach to developing a new strategic plan that is taking more time than expected but which is considered an important ingredient to arriving at the right strategy for Ontario.
There was a palpable change in the room when Mr. Reed shifted his presentation to an update on the strategic planning process. Many people reached for their notepads and could be seen scribbling furiously as Mr. Reed spoke. Mr. Reed opened his remarks regarding strategic planning by stating eHealth Ontario’s overarching goal: Whenever someone in Ontario touches the health system in the presence of a provider want that provider to have much information about the patient as possible, preferably in electronic form. Mr. Reed noted that keeping this information accurate and consistent while also assuring that it is securely protected is a major challenge given the high transaction rates that will have to be supported.
Mr. Reed talked at length about two strategic priorities:
Deliver on key commitments. Mr. Reed stated that it was imperative that the agency deliver on commitments that it makes in order to build credibility. He offered a quick status report on several key initiatives including the Diabetes Registry (a misnomer, according to Mr. Reed, as it really is an application), Drug Information System (procurement expected to start late this year, early next year), and foundation technologies such as registries (client, provider, location, etc which need to be “cleaned up” and turned into a resource that the provider community can use).
Mr. Reed mused about the difference between local initiatives and cross-sectoral projects such as Chronic Disease Management systems that “feel like government work”. These cross-sectoral applications have no economic incentive for a single provider but offer significant benefits to the health system as a whole. Such projects, according to Mr. Reed, are likely best handled at a provincial rather than local or regional level. Since many eHealth projects have more local benefits, Mr. Reed believes that many solutions will come from the provider community working with vendors.
- Drive meaningful use and adoption. According to Mr. Reed, the province is “awash in electronic health records” that range in sophistication and that have been designed to meet local needs. Most of these systems are not “controlled or owned by government”. The problem in driving an interoperable electronic health record is that these systems are not connected in any way and that we have, as a result, a plethora of “information silos”.
Mr. Reed introduced the concept of “natural referral areas” in which providers have an incentive to work together. According to Mr. Reed, there are 4 to 5 such areas in Ontario, most of which are larger than many provinces. Rather than a “big bang” approach that results in a single electronic health record system, Mr. Reed suggested that it makes more sense to develop an interoperable electronic health record within each referral area and link them at a later date. This multilateral approach respects local needs and priorities and potentially offers a way to get personal health records into patients’ hands sooner. By adhering to common standards and working towards a common goal, regional initiatives will eventually converge to create a provincial interoperable electronic health record while providing benefits at a faster pace than a unilateral, “big bang” approach.
To my disappointment, Mr. Reed did not offer a succinct and clear statement regarding eHealth Ontario’s role. Indeed, when asked during the question and answer session how the agency plans to work with the LHINs, Mr. Reed responded “I don’t know”. He did muse on the agency’s role, offering some thoughts, including:
- Need to collaboratively develop an overall architectural framework, with the agency making the “hard decisions when necessary”.
- Need to “draw people into the tent” rather than make pronouncements about how things should work.
- The agency will act as a “strategic investor” funding local and regional projects around the province.
The leadership style is to be a “servant leader” that facilitates dialog and gets the right people in the room for this dialog
Overall, the presentation offered considerable insights into the philosophies and guiding principles but was a little short, I felt, on definitive statements of where to next and how we will get there. Perhaps Mr. Reed is right that more consultation is needed but I think that, at the very least, more definitive timelines as to when a new strategy will be in place and a succinct statement on the role of the agency are needed to set expectations and to drive discussions to a conclusion. What are your thoughts on what Mr. Reed shared today?