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Cerner to take charge of BC EHR project

Terry LakeVICTORIA, BC – Cerner will replace IBM as the lead contractor in the $842 million electronic health record integration project in British Columbia. The system, known as the Clinical + Systems Transformation project, is intended to modernize and integrate the clinical systems used by caregivers at Vancouver Coastal Health, Provincial Health Services Authority and Providence Health Care.

IBM left the project earlier this year after a dispute with the BC Ministry of Health over the strategy and approach needed for the project, which was running behind schedule.

The Vancouver Sun reported that Health Minister Terry Lake (pictured) is hoping the arrival of a new contractor to replace IBM will help resolve challenges plaguing the 10-year information technology project.

While IBM was chosen through a tender process, Lake said Cerner was given the contract without tender. IBM has already been paid about $72 million for a few years of work. Getting out of the contract with IBM four months ago cost taxpayers at least $150,000 in legal fees and $40,000 in mediator costs, The Sun reported.

Lake said health authorities will have their own employees working alongside Cerner contractors to build a system that satisfies all.

Lake said some of the delays relate to how to roll out the system. VCH sought a gradual start-up, while others wanted one in which hospitals start using the new software on a single pre-determined day.

“The PHSA folks thought this big bang approach was good. You light up everything all at once. But VCH was concerned about that,” Lake said. To get all parties on the same page, Lake installed an assistant deputy minister, Sabine Feulgen, as project board chair, to be the government’s eyes and ears.

Lake said Feulgen had experience with big projects in her former job with the Treasury Board and he’s confident she’ll be able to monitor the project. In the past few months, Lake also instructed health authorities to reduce the “burn” (spending) rate on the project while Price-Waterhouse Coopers worked out a new governance model.

“There will be more accountability and clearer lines of authority,” Lake said, referring to the PWC model.

About 200 workers, including contractors and health authority staff, have been working on the project for a few years, but about 70 were laid off or reassigned in the past few months. The project completion date is now estimated at 2024 and the first health facility is expected to go live with the new system in autumn 2016.

Two external reviews of the digital medical record platform revealed “areas of significant concern,” according to a memo by Vancouver Coastal Health CEO Mary Ackenhusen to Health Ministry deputy minister Stephen Brown and other top officials.

A separate assessment of project risks reviews by McKinsey and Co. and North York General Hospital in Toronto led VCH to recommend pulling the plug on IBM, and Ackenhusen concluded the “project requires immediate action to reduce the risk of failure.”

“We have a collective duty of care to our patients and the public to maintain the focus on a safe and high-quality implementation while doing all that we can to reduce unnecessary risk,” she wrote.

The McKinsey report states that while progress has been made on the project, there are “potential key risks” including lack of transparency, lack of clarity on objectives, unclear measures for success, inadequate involvement by doctors and other health providers, and insufficient understanding about how to deliver a megaproject on time and on budget.

The North York General consultant’s report said there were too many consultants rushing the design and build process, and too few internal computer information systems experts with a long-term vested interest.

“The risk is that once the project is live,” the report said, “the knowledge of design considerations and build techniques are lost. Those left to support the system are lacking fundamental understanding of design decisions, rationale and knowledge of system build for maintenance purposes.”

A briefing note written by PHSA CEO Carl Roy to the government says PHSA, Providence Health Care and Vancouver Coastal Health have been using different information technology systems, all of which are “at varying stages of obsolescence.”

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2 Comment responses

  1. Avatar
    August 20, 2015

    It would be great if PHSA considered an open source product (VistA comes to mind) as the basis of an EHR platform rather than relying on EHR vendors to fix their problems for them. It’s been said that Health Authorities don’t know what they want in a health platform and Vendors are lining up to sell it to them. A “blueprint” for future health care (2014) is doomed to fail because the tools and needs of the system will long change by then, committing the purchaser to a never ending cycle of paid consultants who have a vested interest in continued dependancy (vendor lock). Cerner and Panorma are in the business of selling the same product over and over again (subscription model). Open source health care applications are a one time development cost for a lifetime of use. It’s like aspirin in a heart attack though; it does as much good as the $2000 clot busters, but is often overlooked because there is no expensive industrial promotion campaign.

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    • Avatar
      November 11, 2015

      I would like to interject with this comment (no offense Dr. Figurski as you are the ones who need to make it work). Cerner has no EMR affiliation in the B.C. marketplace outside of acute care facilities so I hardly think it is fair to blame them when no MO has any Cerner software EMR installed and that is where the focus of practice should be (but I agree Panorama is a disaster and a B.C. money suck-hole). Maybe you should move to NHA where we give you all of your acute facility results via electronic distribution into almost any EMR qualifies (13 province wide) and it is a free service for our providers :). We are also moving, and already currently have EMREMR>, sharing of primary care with acute care with interoperability and a forerunner in Canada on this initiative (including Panorama).

      The real iniative has to come from the health care authorities to enable the interoperability and hopefully the EMRs will keep up.

      I feel the biggest problem is EMR vendors design software based on what they “think” clinician needs are and don’t follow productive workflows. If we could solve that feeding the appropriate data in to the EHR isn’t even an issue.

      While it isn’t open source ( I think it is one time $85), as that is an obstacle in interoperability with HSAs, I invite you to check out MOIS which was an EHR non-profit designed by a Family Physician, and the original programmer, aimed at the MO and clinic workflow and for providers.

      http://www.unicharts.com/?gclid=CO7fnouLiMkCFYphfgodznQDtA

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