Government & policy

Former CIO Diane Beattie tells her side of story

LONDON, Ont. – Earlier this year, London Health Sciences CIO Diane Beattie (pictured) resigned her position after an internal audit claimed that under her watch, untendered contracts were given to a company that assisted in the creation of the hospital’s IT networks. Her resignation surprised and dismayed many in the Canadian healthcare IT sector, since Beattie has been lauded as an outstanding executive who played a key role in creating one of the country’s leading region-wide systems of electronic health records.

In late October, she provided her view of the events that led to her resignation in an article published by the London Free Press:

By DIANE BEATTIE

Some of you will have read of the ‘scandal’ at the London Health Sciences Centre, a sad story in which I have been involuntarily cast in a starring role. It is the most difficult situation I have ever had to deal with in my professional life. Until now, I have not spoken out or responded, but I believe that the time has come to present the citizens of London with a more balanced view of a tragic and unnecessary saga.

First, let me say with some passion: At no time have I had any personal gain from the business agreement the hospital made with Tom Vlasic and/or The Atwood Group. Over 17 years as a Board member and an executive, I have always tried to work in the best interests of the hospitals and the health system in our community.

There are important lessons in what happened at LHSC in our successful effort to begin the implementation of electronic health records. This transformation is the most important challenge facing our healthcare system – and none is more difficult to achieve.

The absence of comprehensive electronic records of our personal health history leads to errors in diagnosis, treatment and drug prescription. It costs Canadian taxpayers millions of dollars annually in duplication and waste of scarce healthcare resources. People have asked me over the years I have been involved in putting the pieces of such a system in place, “My bank, my credit card company, even Blockbuster allow me to see my records online – why can’t my doctor?”

It’s a fair question, and one we need to be able to give a better answer to soon, if we are serious about improving healthcare and controlling healthcare costs, but it is not a simple challenge.

Banking systems involve you and your bank and a choice of maybe two dozen options. An electronic health record involves you, dozens of doctors, hospitals and specialists, with literally thousands of possible entries. Ensuring that errors don’t get added and that privacy is guaranteed is much more complicated. For example, hand-written, paper-based prescriptions generate thousands of mistakes. It’s a system we must fix!

The number of experts who have the skills to manage these complex high-risk, high-cost systems implementations is very limited. That’s why hospitals like LHSC go outside to find the best experts. The team at LHSC chose an expert with a track record in complex systems. He helped our team deliver the project on time and on budget. No one got paid for work they did not do, and no one – including me – benefited by the choice of consultant we made. The hiring decisions were not made by me alone, as some reports would have you believe.

Until now, no one has said, “a step was missed, I think we should do the hiring another way.” Indeed, our team received awards and praise for their achievements; rare outcomes in the e-health world. The ongoing operation and sustainability of the system is the responsibility of the internal staff of a hospital. Our hospitals and community can be proud of the internal teams - they have the expertise to run the systems.

So why am I leaving a job that I loved and a project that we were close to making a huge success?

I lost the support of the Board as a result of an internal audit. I was profoundly disappointed in the review process. In the preparation of that audit I was granted only a brief interview. The draft and final report were not provided to me. The first time I saw the details of the report was when it was published on the London Free Press website on Sept 19th 2009. Not surprisingly, the report contains, from my perspective, simple but serious factual errors. There must be a step in such a process for the staff whose reputations are at risk to review the document before it goes to the Board. I was not given that opportunity.

Nonetheless, I concluded that it will be better for the speedy implementation of our work if another leader takes it to completion.

There are at least three important lessons of this experience. The public sector procurement process, when the service required is scarce and the need is critical, needs reform. A lowest-cost system designed to deliver sheets, towels, and syringes does not work when you are competing to retain consultants from a small pool. We would not want our hospitals to hire the cheapest brain surgeon, but we demand it when it comes to complex technology. We can’t undertake a long drawn out procurement process. We need to be able to move quickly to decision, to make those choices transparent, and to include factors other than cost as the basis for choice.

Until we have these processes in place the system will work too slowly, and critical projects will continue to be pushed back for years. Failure to change also means there will be other well-meaning, hard-working outsiders whose reputations get attacked - along with the reputations of the public sector executives who retain them - when they try to push hard to implement change and the political winds shift.

No matter what the selection process a “stage and gate” approach to all projects is required. Canada Health Infoway introduced this approach. At each stage of the project we needed to show that we had completed the work agreed to before the hospitals were reimbursed. This meant in our project that any overruns were the responsibility of the project and the hospitals, not the funder. In our case, our expert worked with us to ensure that we were on time and on budget at each stage.

The third issue is the challenge to tradition and traditional practice boundaries that a comprehensive e-Health system involves. The early stages of such a project are widely welcomed.

Doctors and hospital managers like the ability to gain quick access to records, and to be confident of their accuracy and comprehensiveness. Not everyone is as happy when their new responsibility to enter a lot of data quickly and accurately is implemented. The literature indicates that this is a challenge that all projects of this type face. Another constant in major healthcare reform is that when they reach the point of assessing individual performance, pointing the way to changes in practice and professional roles, the resistance understandably peaks. We need to get better at defending the benefits of change to all those impacted by it.

Our projects were made more complex by the ongoing integration of the London hospitals and our community’s healthcare resources. Where deep traditions of independence and autonomy are threatened by change, it is not reasonable to expect everyone to support the path to a shared future. When you add a layer of technological change on top of that anxiety, one that will accelerate and deepen that integration process, you increase the risks any shared project faces. I hope that all the Board members involved in the leadership of our great hospitals are able to move quickly to re-affirm their commitment to the second major milestone of restructuring for London’s Hospital system and to the speedy implementation of electronic health care records. To do anything less would be too high a price for our citizens to pay as a result of this painful episode.

I am confident that London will retain its leadership in this crucial twenty-first century challenge for healthcare in Canada. I wish my successors every success. I can only hope that my experience and scars help them get there faster.

Posted November 12, 2009