What’s next for CST?

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Mary Ackenhusen | March 30th, 2015

Last week, VCH/PHC/PHSA and Team IBM (TIBM) reached a mutual decision to part ways, ending the contract with this vendor for our Clinical and Systems Transformation (CST) project support. I believe this was the right move for our organization and for TIBM, but I am sympathetic to the sense of loss that some of you may be feeling. TIBM has been on site for over a year, and friendships have been formed. As consultants, we knew their time here was limited, but I understand that having them leaving on short notice must be difficult, particularly when the next step is not yet clear. Adding to the uncertainty, is the resignation of our Chief Information Officer who will be moving on to a new position with Pacific Blue Cross, and the fact that our Chief Transformation Officer, Rebecca Hahn, will be starting her maternity leave in a few months.

What’s the same? ThinkstockPhotos-78779248

This is a lot of change in a short space of time, but there’s also much that remains the same. VCH and PHC remain fully committed to CST, the goals of advancing overall patient care, quality and safety, and the building the project on the Cerner platform.

And I am personally invested in working with all of you on this project for all the reasons you know and believe in: This is our path to efficient and effective quality care and the foundation for a modern healthcare informatics strategy. I can confirm we are committed to building the capability to HIMS level 5+ (something very important to those working directly on the project) as well as making CST work with our community and primary care systems. Both of these things are essential for our patients to experience a single record for all their health encounters – in PHC, PHSA, VCH or the community. This is still our vision.

What have we achieved?

We have spent almost two years doing the ground work to create the clinical content and processes to support the first part of our vision, the clinical transformation in acute care. We have learned a lot over these two years and we will build on that learning. One of the most heartening discoveries I’ve witnessed is the growing expertise and experience of the many staff and physicians who are part of the CST team.  We were novices when we started this project, but that’s no longer the case. So going forward I expect we will be much less reliant on outside expertise.

We also have found that there is a huge passion for this project and a strong drive to get it right. I echo this sentiment that we have to get it right, even if it takes a bit longer, because our clinicians will be using this every day, and our patients are depending on us to deliver safe and timely care.

What’s next?

So where to from here?  As some of you know, the Ministry of Health initiated an external review to provide an objective and independent opinion on the current state of the CST project. The review recommendations, in combination with our own learnings and evolved thinking since the beginning of the project, will be the basis of developing a revised plan to continue the project. We expect to be able to tell you more about this in a few weeks, but I can say at this point that it is our intention to engage our staff and physicians in the project “reset” in a manner that ensures that our clinical needs are truly leading this transformational initiative.

In the meantime, our people currently working on the project will be tasked to continue with the many pieces of work that are unaffected by the departure of TIBM. This is an opportunity to regroup and do some of the work that we never got done due to the fast pace of the project, such as pharmacy supply chain, document imaging, clinical report distribution, laboratory design, and clinical policy work.

What about you?

Naturally some of you who have been assigned to the project may be wondering about what it means to you as individuals. I expect we will actually need to increase our in-house expertise, though, in the short term, as we regroup, we will have to be careful about hiring. Unfortunately, it’s hard to be any more specific until we have confirmed our new way forward and determined the numbers and types of resources we will need.

I have also heard that some of you feel concerned that you have “failed” the project in spite of the huge effort that you put in. I want you to know that feeling goes both ways – I have some of those same feelings in reverse. All of us are very grateful for the work that you have achieved to date, and we will build on this going forward. A project of this size and complexity often has many twists and turns. Our feelings of loss will be short lived as we re-group and begin our re-planning work towards achieving the benefits for patients that motivates us all.

We will be stronger

The best cultures, of which I hope we have one, accept setbacks and are stronger because of them. It would be nice to get things perfect the first time, but organizational literature is full of delayed and even failed large IT health projects. It is not our intention to be added to the list. We have lots of other health systems that have gone before us and we need to take the time to learn why some were amazingly successful and some never got off the ground. Thus, we will be looking to Island Health, North York, and Intermountain Health to name a few of the many that have a lot to teach us.

It will be worth it

I am sincerely enthused that we have this opportunity to take a pause and regroup.  It will never be an easy project, but it will be one that we can all be proud of. Thank you so much for the blood, sweat, tears and the many long hours that you have put into CST so far – it is my goal to make it totally worth it in the end, both for you and for our patients.

If you have any questions, feel free to post them to this blog and I will do my best to answer them.  I know there are lots of rumours and chatter so please take the time to tell me where your concerns lie.

About the Author

Mary Ackenhusen
email iconmary.ackenhusen@vch.ca  

As president and chief executive officer of Vancouver Coastal Health (VCH), Mary Ackenhusen leads the largest academic and tertiary health authority in British Columbia. She is passionate about engaging staff and physicians across VCH in building new models of health care that have potential to be more cost effective and better allow all of us to be more productive, to the benefit of patients and their family members. Mary is an advocate for constructive, two-way communication and through the Up for Discussion blog, invites all members of the VCH community to share their comments, questions and new ideas. View all posts by Mary.

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2 comments on “What’s next for CST?

  • Mike Gix says:

    Hi Mary,

    I have difficulty imagining the scope of this CST project, much less any of the intricacies of its design, or the many thousands of person-hours that must be going into the groundwork, planning, and implementation. Even a tech-know-nothing like myself can agree that an integrated electronic health record is a worthy and overdue project. My concern is that while the CST initiative is mandated by the Ministry of Health, the costs of the project have to come from our yearly operating budgets (also a M.O.H. mandate). Is this project setback yet another financial hit to our health service, already strained from growing demands and funding that is not keeping pace?

    It was a little over two years ago that VCH announced the conclusion of contract negotiations to work with IBM as partners in CST. The VCH press release* which announced the $188 million deal reported that vendor selection and contract negotiation took nearly two years. Does this mean that we are now set-back nearly four years in the CST build? And how about the money paid or committed to IBM?

    In the fiscal year ending Mar. 31st 2014, VCH paid IBM Canada $11.5 million for goods and services. This number is from the VCH 2014 Audited Financial Statements (Schedule G) found on our website. Was any of this CST related? Have we paid IBM more in this most recent fiscal year? Did we get value for money spent?

    For context, VCH front-line staff have this year been exhorted to examine all of our work processes and supply practices to find ways to “save a dollar a day”. Leadership in Vancouver Community have really taken this to heart. At my worksite jobs of valued and loyal VCH employees who have served and supported clients well for years are being contracted-out to save pennies on the cost of a client’s meal.

    Considering the costs of this recent split with Team IBM on the partnership path to CST, are we maybe being “penny wise and pound foolish”?

    Thank you for this discussion.


    Mike Gix

    * http://www.vch.ca/about-us/news/news-releases/news-release-archive/2013-news-releases/lower-mainland-health-organizations-to-implement-a-single-patient-health-record-through-clinical-and-systems-transformation

    • Mary Ackenhusen says:

      Thanks Mike for your question. As big and complicated as this project is, I find it interesting that yours is the first question!

      First, yes the costs are coming from our operating budget. I don’t know the history of why, but this is the same for all the health authorities I believe. While MOH grants capital for buildings and equipment, IMIS projects come from the money that health authorities are able to carve out of their operating budgets and convert to capital.

      The project “setback” is really a needed course correction in my mind that will likely save us money in the long run. In making the decision that we did, various options were compared on both a financial basis as well as the quality of the project. I believe that the decision that we took will increase the likelihood of VCH achieving the benefits of this complex implementation (reduction in medication errors, etc) at the lowest cost. A worst case scenario if we had continued with the project without correcting some of the issues would have been a failure and project write-off of substantial dollars. Many other health jurisdictions have followed this unfortunate path. Though on the surface it looks like we’ve been with IBM for four years, they have actually only been on site for about 2.

      We have paid IBM per the terms of the contract and no more. There
      has been real value in the work that they performed for and with us – even if we did disagree on the path forward leading to the end of the relationship.

      I am glad that you remind me of how careful we are in our spending in the operations of our healthcare system as I too am very conscious of
      the need to be equally tight about our spending on consultants, etc. Everytime I see an ask for $100K, I think “that is one nurse for a year” before I make my decision.

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