Panorama over budget, not meeting expectations

VICTORIA – BC’s auditor general, Carol Bellringer (pictured), has issued a scathing report after auditing the Panorama Public Health System. “Panorama has been impacted by defects from the start. It is inefficient to use, burdensome to public health staff, and requires ongoing financial support,” said Bellringer.

Bellringer slammed the ministry of Health for mismanaging the project, resulting in a 420 per cent cost overrun for the $115 million project. She notes that when finally delivered by the contractor IBM in 2010, the Panorama public health IT system was plagued with more than 12,200 defects.

Following the SARS outbreak in early 2003, an independent review recommended that Canada invest in a seamless public health system. Panorama, the IT system that government implemented, was expected to improve management of communicable disease outbreaks and immunization programs across the country.

Bellringer acknowledged that, “A complex national IT system such as Panorama is undoubtedly a challenge to build and implement.” But she noted that the project is five years late, incomplete, riddled with deficiencies, and much of the technology may already be out dated.

“Of particular concern is not only a failure to control costs, but decisions that unnecessarily increased costs,” explains Bellringer. “When IBM could not deliver on the original contract terms, we saw no evidence that the ministry considered other options such as contract termination or alternate systems. Instead, the Ministry of Health renegotiated with IBM in a way that transferred financial risk from IBM to taxpayers.”

The audit also found that Panorama does not support public health services across the country, as intended.

The project has not been fully implemented in B.C. and at present, five other provinces/territories are moving forward with implementation.

The audit identifies issues with the ministry’s project management, contract management and leadership. The Office makes three recommendations to improve these practices for future projects, and recommends an independent review to assess ongoing suitability of Panorama. The report is available on the Office of the Auditor General website: www.bcauditor.com/pubs

Some of the findings of the auditor’s report include:

“B.C.’s implementation of Panorama was supposed to be complete in 2009. Today, aspects of the system are in place, but major components are still outstanding. Also of concern is that Panorama is a stand-alone system. This no longer aligns with health authority IT strategies which are shifting towards integrated health systems.”

“To date, the Province has spent approximately $113 million – or 420 per cent of what was budgeted at the project outset – and implementation is still not complete. The Province expected to pay $16.2 million for IBM implementation services, but it ended up costing $73.5 million. B.C.’s ongoing support costs are estimated to be approximately $14 million per year.”

“The ministry agreed to a series of change orders which  de-scoped significant pieces of functionality, changed final delivery dates, and eroded system quality by allowing more serious defects to persist in the system without penalty. These change orders transferred risk from IBM to the ministry and ultimately, to taxpayers. In particular, the ministry took on the risks of increasing costs and prolonging time to fix defects.”

“It is difficult to navigate, complicated, and confusing. It uses clinically incorrect and counter-intuitive terms and different terms for the same function in different parts of the system.It requires excessive scrolling to view necessary information and has a busy display that makes it difficult to view content.”

“The ministry employed a “command and control” leadership style with Panorama. They dismissed health authority concerns around the safety and efficiency of the system and ignored important system issues. This caused delays and led to higher costs.”

“The ministry did not allow some health authorities to consider system alternatives even when it became clear to both the ministry and health authorities that the system was impacting patient care.”

“In the end, the accepted system did not meet user needs, and contained thousands of defects. Significant remediation was required along with the identification of more than 320 workarounds to make the system usable. Premature acceptance of the system led to delays in B.C.’s implementation of the system and increased the overall cost of Panorama to the Province.”