Federal Auditor General's Report on Canada Health Infoway

Written By Michael R. Whitt, QC

The Auditor General's Fall 2009 Report, released November 3, 2009, included at Chapter 4 a detailed review of the operations of Canada Health Infoway.

The report notes that Infoway is tasked to deploy $1.6 billion of federal funding to encourage and enhance the prospects of a modernization of health records in Canada by the development and adoption of large-scale electronic health record systems in the various provincial and territorial jurisdictions of Canada. To a very large extent, Infoway received passing grades from the Auditor General.

The Auditor General also noted that six provincial and territorial governments were auditing their respective healthcare modernization efforts, and while some reports had been published, a consolidated report is planned for release to the public in early 2010.

There were some instructive recommendations in the Federal Auditor General's report:

1. The publicly stated goal of Infoway to have electronic health records systems “available” to 50 percent of Canadians by 2010 is potentially misleading, given Infoway's stance that “available” does not necessarily mean “used” or “adopted”. The Auditor General suggested that this be clarified.
2. Some tightening of contracting procedures for goods and services was recommended, although overall, Infoway's processes were good. Infoway's contract amendment processes, however, should be tightened up to permit its Board to understand and control amendments which extend the term of tendered contracts or the monetary value of contracts. Infoway's processes were otherwise acceptable.
3. Although no real problems were identified in the audit, a potential for future problems was identified in the lack of procedural requirements to document internal analyses permitting funds to be released. Infoway has agreed to amend its processes.
4. Although on the surface directed at Infoway, the Auditor General recommended that Infoway obtain the results of provincial system conformance testing and plans to remedy non-conforming systems from provincial governments it assists, as a condition of further funding. This is an obvious reference to the very real risk of problematic implementation of appropriate vendor selection and conformance testing being carried out by a variety of provincial governments using a variety of different mechanisms (from procurement processes and “standing offers” from vendors, through to technical systems analyses and tests using sample data sets to assure operability and core functionality). It is an industry concern that those regional efforts to select and control vendors have a high risk of generating problems with primary care providers' acquisition, implementation, and adoption, and do not necessarily end with nationally compatible interoperability (an Infoway goal).
5. Infoway should report annually on the actual adoption of electronic health record systems by health care professionals and whether the systems are compliant with national interoperability standards. The Auditor General believes that this will provide Parliament and Canadians with a truer picture of Infoway's success in achieving its purposes. Infoway has agreed, but with the caveat that adoption is outside of its control, and difficult to measure.
6. Infoway should also report its results achieved compared with its expected results. Again, Infoway has agreed, and has said that the information has been provided in different forms on an unconsolidated basis, but will in future be consolidated.
7. The Auditor General also recommends that the reports of actual versus planned results should be against Infoway's performance targets on each of its five core systems:
   • Registries of providers and patients;
   • Diagnostic Imaging systems;
   • Drug Information Systems;
   • Laboratory Information Systems; and
   • Interoperability of Electronic Health Records systems.
    
8. Health Canada should develop and adopt a better monitoring framework to ensure Infoway is compliant with its funding agreements. Health Canada responded that compliance with this recommendation has been put into place between the close of the audit period and the report.

In all, Canada Health Infoway and its management have been given a favourable report card. This is very encouraging for the industry, as other funding agencies have been the subject of negative audit reports and have generated a public and political backlash, impairing commercial efforts to automate healthcare delivery through new information and communications technologies and systems.