NB’s implementation of an EMR scores low marks

FREDERICTON – A report released by New Brunswick’s Auditor General, Kim Adair-MacPherson (pictured), says the province’s program to computerize the offices of physicians performed poorly. After eight years (2012-2019) and over $26 million invested, less than half of eligible doctors adopted the provincial system.

“The complex delivery structure, unsustainable business model, and oversight failure by the Department of Health were some of the reasons why the program failed,” Adair-MacPherson said.

In July of 2012, the Department of Health contracted the delivery of the Electronic Medical Record program to the New Brunswick Medical Society (NBMS). NBMS partnered with the consulting firm Accreon and formed a private company by the name of Velante Inc. to undertake implementation and operation of a single-vendor EMR program.

The complex delivery structure was not in the best interest of New Brunswickers and weakened the department’s governance and oversight of the program. The department did not effectively monitor the EMR funding to mitigate risk to the taxpayer and ensure compliance with funding agreements, the Auditor General said.

The report found the department failed to intervene in 2015, when there were clear signs the program was in jeopardy but rather continued extending deadlines and providing more funding for four more years. The single-vendor approach was terminated in 2019, when the government moved to adopt an open (multi-vendor) market model.

The auditor general made seven recommendations to the Department of Health to address the weaknesses identified in the report in the areas of contract structure, program oversight and accountability for public funds.

Problems cited in the AG’s report include:

• EMR solution has never been fully integrated with the Electronic Health Record
• Integration work neglected as efforts were focused on meeting enrolment targets
• Responsibility for integration work was not clearly defined
• Lab integration, a desired essential component, was significantly delayed
• EMR Program failed to meet its intended outcomes
• After eight years and over $26 million, less than half of 800 of eligible physicians implemented the Provincial EMR
• Physician implementation never met Canada Health Infoway (Infoway) target
• High initial cost of EMR was a deterrent to physician enrolment
• Instances found where physicians were paid to implement the EMR system
• Incomplete EMR clinical data does not benefit population health management
• New Brunswick has one of the lowest EMR adoption rates in Canada
• Provincial EMR business model was unsustainable from the outset

The auditor-general’s recommendations include the following:

• Structure contracts to maintain oversight and hold parties receiving public funds accountable.
• The Department of Health, as part of granting program funding, should assess the financial health of third-party funding recipients and their ability to achieve the desired results within agreed funding levels, and exercise periodic reviews of records as per the terms of funding agreements.
• The Department of Health should intervene and take timely corrective action when there are indicators of program failure such as: not achieving project deliverables; missing key deadlines; and incurring funding shortfalls.