Province of Ontario fires eHealth boss Sarah Kramer over spending scandal

As identified in this publication on March 30th, 2009 (related to eHealth Ontario),"If it doesn’t work the first (second or third) time---rebrand and start over. Taxpayers have short memories." So let's be clear... what is being identified today by the National Post as an 'Important step to restore public confidence'---is really the forth time the Province has gone through this step. When will we ever learn?

There's a name for those who do the same thing over and over again and expect different results. Apparently that name is the Ontario Government---as yet another scandal over lavish spending at eHealth Ontario has claimed the career of a top public servant.

The provincial government said yesterday it was revoking Sarah Kramer's appointment as president of the agency in charge of creating electronic health records. Ms. Kramer has been dogged by reports that she has been involved in questionable procurement practices where large contracts -- totalling $5-million -- were awarded without tenders from September, 2008, to January, 2009.

The contracts revealed a tangle of relationships between many senior eHealth officials, including Ms. Kramer, board chairman Dr. Alan Hudson and their former colleagues and associates.

Ontario Health Minister David Caplan said yesterday he was revoking Ms. Kramer's appointment after "many valid concerns have been raised regarding eHealth Ontario."

Calls for Ms. Kramer's resignation had been growing as opposition members accused Mr. Caplan of endorsing the lavish and questionable spending at eHealth Ontario through his inaction. Conservative party researchers obtained details of the contracts through Freedom of Information requests.

Ron Sapsford, Deputy Minister of Health and Long Term Care, will now serve as acting president and chief executive officer of eHealth Ontario.

Mr. Caplan said he asked the board of eHealth to "launch a third-party review of the agency, overseen by a government auditor," and asked for a prompt review by the Auditor-General.

Mr. Caplan said the move was "an important step to restore public confidence in the agency and its mandate of modernizing our health care system."

However, replacing the head of eHealth does not end the scandal for the Liberal government, opposition critics said.

Bob Runicman, the Progressive Conservative party leader, said Mr. Caplan himself needed to step down and suggested Ms. Kramer should repay some of her compensation.

"A so-called resignation on a Sunday afternoon that is clearly designed to avoid public scrutiny is simply not acceptable," Mr. Runciman said in a written statement. "The buck stops with Health Minister Caplan. He needs to quit now, and stop taking the easy way out by assuming he's off the hook with Ms. Kramer gone. If he won't leave on his own, the Premier should show him the door."

He also said Ms. Kramer needs to do more than step down.

"In these especially tough economic times, when taxpayers don't get value for their hard-earned money, it should be paid back," he said.

"We expect the Minister to reveal today the exact amount of Ms. Kramer's compensation package, and whether or not she has been asked to pay back any of her lucrative salary, hefty bonus and extravagant expenses."

Ms. Kramer will get $317,000 in severance pay, but will forego the bonus and benefits stipulated in her contract. According to Caplan spokesman Steve Irwin, Ms. Kramer will be required to pay back some of that money if she gets another job in the next 10 months.

The contracts engaged by eHealth Ontario have been under increasing scrutiny.

Three contracts totalling nearly $2-million, for example, were awarded to Courtyard Group, whose founding partner, Michael Guerriere, worked closely with Dr. Hudson for years. Mr. Guerriere's wife, Miyo Yamashita, was the beneficiary of a four-month, $268,000 contract, as managing partner of Anzen Consulting Inc.

Conservatives released documents last week showing Ms. Yamashita, who as a partner at Anzen was responsible for developing a communications and media strategy, billed eight hours (at $300 per hour) for tasks that included sending herself e-mails and calling herself to ask follow-up questions.

The documents also show a senior vice-president, Donna Strating, was expensing $3 snacks and even cheaper soft drinks even as she earned $2,700 per day.

Other reports indicate Ms. Kramer listed an Accenture Inc. executive as a reference when applying for the full-time CEO job. Accenture benefited from three single-sourced contracts worth $1.3-million, two while Ms. Kramer was advising the board but not yet hired and a third shortly after she was hired in November.

PROVINCE OF ONTARIO UNVEILS YET ANOTHER ELECTRONIC HEALTH DATA PLAN

March 30th, 2009
If it doesn’t work the first (second or third) time---rebrand and start over. Taxpayers have short memories.

To this end, Ontario has unveiled another round; a $2.1 billion strategy that hopes to give every diabetic patient in the province an electronic health record by 2012. Apparently the original $650 million was required to ensure the "right people" are working on the initiative.

The "eHealth Ontario" initiative will also connect doctors, patients and pharmacists electronically to better manage the flow, safety and effectiveness of prescription drugs and cut wait times at Ontario hospitals, the head of the group developing the program says.

"There is a very clear line between investing in information and information technology in these three areas and seeing improvements from a patient perspective," says Sarah Kramer, president of eHealth Ontario.

The 53-page strategy aims to have 65 per cent of the province's primary physicians and two-thirds of their patients hooked up to the electronic medical data by April 2012. The eHealth agency was formed last September after a previous costly and controversial program failed to produce viable health record plans.

The original program, called Smart Systems, had been created in 2002, employed 300 people and wasted $650 million as part of its mandate to electronically link and support Ontario's 150,000 health-care providers. But a 2007 operational review found it was riddled with delays, lacked any accountability and its privacy policies were incomplete.

When the new, restructured and rebranded agency was formed, the province brought in Dr. Alan Hudson - head of Ontario's drive to shorten wait times in key areas. Hudson, who is chair of eHealth Ontario, quickly created a new board of directors filled with Bay Street notables.

Conservative health critic Elizabeth Witmer called Ontario's record on eHealth extremely poor. "(The government) has already invested half-a-billion dollars and we have seen NO results," she said. One might think there would be greater accountability. Or any!? In an attempt to prove, if you throw enough money at something it looks like progress, the new agency says its goal is to have enrolled 100 per cent of physicians and all of their patients by 2015. It also would like to see 65 per cent of medication orders filled electronically in three years with 35 per cent of physicians ordering drugs via secure, electronic prescriptions.

Key to the program, Kramer says, is the enrollment of as many as 800,000 diabetes patients in the province into the electronic record system. Currently, Kramer says, only half of diabetics receive the kind of basic, preventative checkups that can keep them out of hospital by catching common complications of the disease before they cause acute harm. The plan will implement a tracking system that will allow physicians and patients to follow care and alert them when any of those signal examinations are due or have been missed.Both physicians and patients will be able to access this information through the use of passwords.
On the pharmacy side, Kramer says the electronic triangle the strategy will form between patient, doctor and pharmacist will cut back significantly on the frequent mistakes that accompany prescription drug use.

Kramer says the strategy will cut wait times most significantly by keeping diabetics out of hospital. Once the infrastructure and training are in place, it will be easier to bring other diseases into the electronic system. The money, approved by the provincial cabinet in May 2008, will also fund such programs as Ontario Telemedicine Network, which provides over-the-phone medical advice to hundreds of people annually. Dennis Darby, head of the Ontario Pharmacists' Association, welcomed the new strategy. "It certainly will allow pharmacists to provide better patient care," he says.


- - - -

Courtyard Group | Status of Electronic Health Records (EHR) adoption in Canada

STATUS OF ELECTRONIC HEALTH RECORDS (EHR) ADOPTION IN CANADA (View PDF)

With offices in the UK, US, and Canada, the Courtyard Group is an international healthcare consultancy company whose mandate is to transform healthcare by enabling clients to achieve sustainable outcomes. Courtyard has done a number of notable projects across Canada including working on Ontario’s Wait Time Management Strategy.

---

Sarah Kramer, President and CEO of eHealth Ontario Outlines Health Strategy

Sarah Kramer, President and CEO of eHealth Ontario spoke about the future of eHealth in Ontario at HealthAchieve 2008.

She focused on Ontario’s eHealth strategy, its system transformation goals and how the government’s goals will be implemented. In her words,the overall emphasis of eHealth in Ontario is to deliver clear, measurable, transparent results … that improve patient care quality and safety. Click here for the full text of her speech.

Background
eHealth Ontario is the marriage of the Ministry of Health and Long-Term Care’s e-Health Program and the province’s Smart Systems for Health Agency (SSHA) under one banner.

Three key e-health priorities have been identified for the next few years including a Diabetes Registry, an e-health portal to centralize health information on an easily accessible web site, and e-prescribing which will eliminate hand written prescriptions and reduce medication errors.

The ultimate goal of the e-health strategy is to create an electronic health record (EHR) for all Ontarians by 2015. An electronic health record will provide patients and providers with the ability to access, share and use health information. It will improve health care delivery, increase patient safety, reduce ER wait times and create a more effective health care system.

QUICK FACTS
* eHealth Ontario will work with the Office of the Information and Privacy Commissioner/Ontario to ensure the protection of personal health information;
* The Ontario government created SSHA in 2003 to improve patient care through a variety of initiatives, including network hosting and secure e-mail.

RESPECT, TEAMWORK AND COLLABORATION

By Michelle DiEmanuele, President and CEO of Credit Valley Hospital

Hospitals are huge and can be intimidating institutions, not just for the patients, but for a new CEO such as myself. I am quite frankly overwhelmed by the amount of teamwork and collaboration that exists here at Credit Valley and beyond our doors with our health-care partners. This is great news, for if we are to move forward with our quest to deliver patient and family-centred care and to ensure equitable and sustainable access for all, we must forge even stronger relationships. And we’ll do so if we make teamwork, collaboration and partnerships our top priorities.

Gone are the days when hospitals competed with one another for scarce financial resources in order to duplicate programs and services at each facility. What’s critical is the idea of mutual respect - within the hospital and broader health-care environment recognizing the significant role each facility, each program and each individual plays in the overall delivery of good patient care. It is critical to maintaining that community connection and understanding as we build and reform the system.

The spirit of cooperation has been accelerated through design and demand of the various regional health systems across the country. Even before the formalization of such systems, there have been many informal and spontaneous examples of co-operation among health-care facilities. I’m hugely impressed by these initiatives that often begin at the community and grass-roots level.

Here at The Credit Valley Hospital in Mississauga, Ontario, we are working closely with our neighbouring hospitals and other health-care partners to offer our patients more comprehensive and coordinated services, each through our own regional specialities. The patient experience is further improved because in many instances, they no longer have to travel to Toronto or Hamilton or other larger centres for their care, reducing their travel costs and anxiety.

In order for this collaboration to work, we have all put new resources into making sure our patients are being informed and navigated appropriately to find the care they need, where and when they need it. It’s not always where they thought they might get it. In fact, it may not even be in a hospital environment. That’s asking a lot of our patients. Doing our best to make the move between facilities and caregivers as seamless and painless as possible is paramount to a good patient and family-centred experience. One way we do that, is through the REACH web portal.

The collaboration initially between six physical hospital sites in Peel and Halton regions (Credit Valley, Halton Health Care and William Osler Health Centre) means all of our clinicians have instant access to patient health information stored electronically at any of the hospitals through a secure network called REACH -- Rapid Electronic Access to Clinical Health information. The web connectivity is growing between more hospital sites which will allow even more physicians to access clinical data from disparate systems through one unified view. This allows physicians to easily review their patient’s records, lab results, cardiology images, diagnostic (PACS) images, transcriptions and progress reports. Because the ehealth record shows their patient’s entire health history, important information such as medication allergies will be revealed even if the patient inadvertently forgets to mention the allergy at the time of a visit to any of the health facilities on the REACH network.

Within our own four walls at Credit Valley, the team approach to problem solving has made significant improvements toward patient and family-centred care, most recently in our regional cancer centre. Cancer patients have spent seemingly endless time between appointments for tests and treatment in the same building. The Stream Team, made up of oncology doctors and nurses, clerks, lab, pharmacy and information systems with input from staff, patients and volunteers, set out to redefine their patients’ experience. They charted every step, every process, every wasted minute and after several months, they had streamlined ten processes to seven and decreased the patients’ waiting time by almost two hours! Nurses and doctors collaborated on patient assessments; volunteers took on responsibility to ensure patients moved smoothly from one process to the next and now, there’s the potential to see even more patients each day.

I believe leadership happens at every level within an organization that values and respects the roles of every individual – not just the caregivers – but the patients and families we are here to serve. I saw that first hand as I worked alongside the men and women cleaning stretchers in our emergency department; as I sat beside the charge nurse who was more like an air traffic controller as she juggled patients, personnel and stretchers throughout her shift. I believe the role of leadership is to create the conditions for success not just in terms of the hospital, the system or even the government. Everything we do, every decision we make, should be prefaced with the question, “what’s best for the patient?” This isn’t easy. It’s takes a sense of respect for everyone at that table and the courage to push the traditional boundaries and norms to embrace innovative solutions. But without that respect, the kind of changes our hospitals need will be too slow for what our patients deserve – and increasingly, demand. Respect, teamwork and collaboration have and will make the difference in elevating patient care.

Is that respect there? You bet. Having re-entered the health-care sector, I’m humbled daily by the unbelievable dedication on the part of doctors, nurses, clinicians, and administrators who put their patients first in a system where that isn’t always easy.

---
Michelle DiEmanuele is the President and CEO of the Credit Valley Hospital in Mississauga Ontario.

Read Original Article.

PROVINCE OF ONTARIO INTEGRATES ELECTRONIC HEALTH ACTIVITIES UNDER ONE AGENCY

TORONTO, Sept. 29 | McGuinty Government Appoints Dr. Alan Hudson as Chair of eHealth Ontario

The Province of Ontario has appointed Dr. Alan Hudson as the Chair of eHealth Ontario, a restructured agency responsible for all aspects of eHealth in Ontario including creating an electronic health record for all Ontarians. eHealth Ontario will bring together the Ministry of Health and Long-Term Care's eHealth program and the province's Smart Systems for Health Agency (SSHA) under one banner.

Three key eHealth priorities have been identified for the next few years including a Diabetes Registry, an eHealth Portal to centralize health information on an easily accessible web site, and ePrescribing which will eliminate hand written prescriptions and reduce medication errors.

Dr. Hudson - who is leading the government's efforts to reduce wait times in emergency rooms and for key procedures - will chair the Board of Directors for eHealth Ontario, which will have individuals from the broader health, business and information technology sectors.

"This is an exciting time for eHealth in Ontario," said Dr. Alan Hudson, Board Chair for eHealth Ontario. "Combining thought leaders from the Ministry and Long-Term Care and the broader health sector means we now have the expertise to make electronic health records a reality for the people of Ontario."

The ultimate goal of the eHealth strategy is to create an electronic health record (EHR) for all Ontarians by 2015. An electronic health record will provide patients and providers with the ability to access, share and use health information. It will improve health care delivery, increase patient safety, reduce ER wait times and create a more effective health care system.

"eHealth Ontario will enable us to transform Ontario's health care system as we know it," said David Caplan, Minister of Health and Long-Term Care. "With its broad mandate, eHealth Ontario will deliver a comprehensive, patient-focused, secure and private electronic system that will improve the way patients receive care."

QUICK FACTS
- eHealth Ontario is mandated to work with the Office of the Chief Information and Privacy Officer, Ministry of Government Services, to ensure that the protection of personal health information.

- The Ontario government created SSHA in 2003 to improve patient care through a variety of initiatives, including network hosting and secure e-mail. The agency has created the foundation for many of the eHealth activities underway today.

BACKGROUNDER
The McGuinty government named Dr. Alan Hudson, Lead of Access to Services/Wait Times with the Ministry of Health and Long-Term Care, as board chair of eHealth Ontario - a restructured agency responsible for all aspects of eHealth in Ontario including creating an electronic health record for all Ontarians.

Also named as board members are J. David Livingston, President and CEO of Infrastructure Ontario; Matthew Anderson, CEO of the Toronto Central Local Health Integration Network; Heather Sherrard, vice-president of clinical services at the University of Ottawa Heart Institute; and Ken Deane, Assistant Deputy Minister, Health System Accountability and Performance Division, Ministry of Health and Long-Term Care.

---
Read original article.