Public health IT system defective, way over budget, says B.C. AG

B.C.'s auditor general is blaming a lack of leadership inside the Health Ministry for massive cost overruns and thousands of defects plaguing the province's public health IT system.

In a damning report issued Thursday morning, Auditor General Carol Bellringer slammed the ministry 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. 

"The project is five years late, incomplete, riddled with deficiencies, and much of the technology may already be out date," concluded Bellringer in her report.

"Of particular concern, is not only a failure to control costs, but decisions that unnecessarily increased costs," wrote 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."

Panorama was originally intended to be a nation-wide system to enable the sharing of data on immunization, communicable diseases and other public health outbreaks across all provinces and territories, following the SARS outbreak in 2003.

B.C. was picked as the province to lead the development and implementation of the program with the contractor IBM, and received $44 million from the federal government to get it off the ground.

Bellringer made four recommendations as a result of her investigation, including a review of the entire Panorama project, and reviews of how the government manages, contracts and leads future major IT projects.

'No other system'

The government response to the findings, which is included in the report, acknowledges the project faced challenges, but defends it as an effective tool that has already been upgraded and used to manage immunization programs.

"To effectively manage outbreaks and detect emerging disease threats, public health officials must be able to track data across the whole province. Panorama allows us to better protect the public, through information and tools we've never had before," said an additional statement issued by Health Minister Terry Lake after the report was released.

"Though it is not perfect, public health experts across Canada agree there is no other system that can provide the comprehensive solution that Panorama provides. With this in mind, we will not pursue alternative systems," said Lake

Report findings

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."