Government & policy

Infoway passes muster with auditor general

OTTAWA – Earlier this month, Canada Health Infoway received a generally positive review from the auditor general of Canada – albeit with several criticisms and suggestions about how the agency could improve the way it operates.

According to auditor general Sheila Fraser’s report, Infoway has “accomplished much in the eight years since its creation.”

That’s a far cry from an October review of eHealth Ontario, where the provincial auditor general concluded that a $1 billion investment in healthcare IT had delivered little of value.

Infoway Inc. has already received $1.6 billion in federal money since 2001. Another $500 million promised by the Conservative government last January has been put on hold while Health Canada carries out “due diligence” on whether the money will be spent wisely.

Fraser (pictured above) noted some problems that Infoway has experienced in setting and achieving goals. For example, Infoway has said it will ensure half the population has an electronic record by the end of 2010, and everyone will have one by 2016.

But Fraser observes that just because an electronic record has been created does not necessarily mean it will be used. “Infoway officials told us that having EHRs (electronic health records) ‘available’ does not necessarily mean that they are being used or that they are compatible across the country,” says her report, which cites the corporation for “failure to be transparent.”

“For example, the Alberta drug information system is available to healthcare professionals, but Infoway’s internal reporting indicates that the project has been on hold for about one year because the system is not using the pan-Canadian standard required to fully achieve the project’s adoption targets. Quebec’s client registry is also available for use, but Infoway’s project status reports indicate that the project is facing a significant risk related to the implementation and use of the system.”

Fraser also says Infoway touted its success in creating electronic health records for 17 percent of Canadians by March this year - without also acknowledging this was 11 percentage points short of its goal.

According to the report, “Infoway provides no indication in its Corporate Business Plan or Annual Report that it has fallen short of expected progress, and it does not explain the reasons for the shortfall.” The agency says that it will start explaining the variance in expected results and actual achievements in its next annual report.

Infoway has established itself as a standards-setting body, to ensure that systems across the country are interoperable. However, according to the auditor general, Infoway doesn’t know if the systems it has sponsored actually meet its technical standards.

According to the report, “In the 29 EHR projects we examined, Infoway had ensured that provinces and territories designed the projects to comply with requirements such as its blueprint and standards... However, Infoway has not obtained the results of conformance testing on EHR systems. This means it does not have sufficient assurance that standards have been implemented as required.”

The report finds fault with the way Infoway hands out contracts. Contracts worth $50,000 or more must be awarded only after a competition, but there have been no restrictions on contract amendments.

Fraser cites the example of a $144,000 competitive contract that was amended five times, raising the total value to $726,000 - with no competition for the amended amounts.

“This practice is not conducive to the fair and transparent awarding of contracts and it raises questions about the appropriateness of Infoway’s contracting policy.”

The report also found that in a sample of 35 contracts, 13 were signed only after the work had begun.

Infoway says it accepts all of Fraser’s recommendations about improving contracting and transparency, and says new rules will be in place by March next year.

“We’re exercising due regard in managing taxpayers’ money,” Infoway’s president and CEO, Richard Alvarez, told the Canadian Press.

“We’ve embraced those recommendations. We’ve put several of them in place already and we will basically have the rest done by the end of the fiscal year.”

To Infoway’s credit, the auditor general’s report is positive about the agency. “Overall, we found that Canada Health Infoway is exercising due regard in managing funds from the federal government to achieve its goal related to the implementation of electronic health records (EHRs) across Canada,” says the report.

“Our examination of EHRs shows that Infoway has set a good foundation for the work it is doing by applying appropriate governance mechanisms to carry out its mandate and objectives.”

Posted November 12, 2009