Public Accounts — Issue No. 22 — Monday, November 16, 2015 (HTML)

Present: Bruce Ralston, MLA (Chair); Sam Sullivan, MLA (Deputy Chair); Kathy Corrigan, MLA; David Eby, MLA; Simon Gibson, MLA; George Heyman, MLA; Marvin Hunt, MLA; Vicki Huntington, MLA; Mike Morris, MLA; Linda Reimer, MLA; Selina Robinson, MLA; Ralph Sultan, MLA; Laurie Throness, MLA

Others Present: Carol Bellringer, Auditor General; Stuart Newton, Comptroller General

2. The following witnesses appeared before the Committee and answered questions regarding the Office of the Auditor General Report: An Audit of the Panorama Public Health IT System.

The following electronic version is for informational purposes only.
The printed version remains the official version.

REPORT OF PROCEEDINGS
(Hansard)

SELECT STANDING COMMITTEE ON
PUBLIC ACCOUNTS


CONTENTS
Page
Auditor General Report: An Audit of the Panorama Public Health System	791
S. Brown
C. Bellringer
S. Newton

B. Ralston (Chair): Good morning, Members. We’re resuming consideration of the report An Audit of the Panorama Public Health System. We last were here on Monday, November 2, and we’re resuming consideration of that report.

At the point that we adjourned, MLA Hunt had posed certain questions about the implementation costs and a distinction, if one could be drawn, between federal costs and provincial costs. The deputy minister has prepared some slides which appear to respond fairly directly to that.

I’m going to ask Mr. Brown, the Deputy Minister of Health, to present those additional new slides and ask the Auditor General and her staff to respond, should they care to. Then we’ll resume questions at large on the report.

Everyone has a paper copy of the slides, I believe. If you don’t, we can supply some additional copies. But I’d like to get underway. The committee time is valuable.

S. Brown: Okay, thank you. As you said at the beginning, Chair, there were three questions, as we determined them, from the end of the last session. One was: could we provide better details of the national budget, the costs and funding sources?

A second question, which had come slightly earlier in the session, was: what was the thinking behind the changes that were made to the contractual terms in about 2007, 2008, in terms of not moving away from IBM but continuing with them?

The third was: distinct from the national budget, what was the provincial budget, and could I provide some details of what the provincial budget was — the costs? Another key issue was: what were the funding sources? One of the members had asked: had that had a negative impact in terms of access to health services?

We’ve pulled the deck together with some numbers. I do apologize to Carol. If there are some questions on the numbers, we will work those through with Carol outside of this meeting. I thought Carol was getting the numbers in advance. If there are any issues, we’ll clarify those with the Auditor and can certainly make sure any corrections or issues are corrected to the committee.

I also thought, just by way of update, I’d give you an update on some further steps that have been taken over the past two weeks.

One of the challenges which I have — which is not your problem; it’s my problem — with the health sector, with certain standing committees, is that they meet at certain times, so getting together senior people from across the health sector is somewhat tricky.

We continue to have discussions on the Panorama report, following its…. I think it was in August — right? — when we got the report. We have now shared the report with various groups, and we continue to work through. Just to be clear, then, if there are changes to our plan as we go through the next two or three months, it will probably be as late as January before we formally table this report at our leadership council, which is all of the CEOs and senior executive from the ministry. We’ll be taking it through a number of standing committees before we go there, to make sure we canvass two of the committees that it’s going to.

One it’s just arrived at. We have a standing committee on IMIT, which is made up of all of the VPs across the health sector. We started to canvass them on: what steps do they think we should be taking to further address some of the issues that have been raised by the Auditor? And then, as Dr. Kendall raised when he was here, we’ll also be canvasing this with our VP of health services.

Just in practical terms, it takes us about four months to actually get through — particularly this kind of report. Some reports would move faster, but because of the sheer depth and scope of this report, it’s taking us a bit longer to get through.

The piece I just wanted to highlight…. I think it would be implied by Carol, but I just wanted to take it to its next conclusion. Last time when I reported to you, I said we would certainly be doing a detailed business plan, going forward, for Panorama. I think we also talked about the independent review and said that I will be having a look at looking at what products are available across.

We’ll do that on a regular basis. We’ll build that into our business plan. We will also have our expert panel, which we’re going to be using, to actually make sure that’s a credible look across what’s available in terms of additional modifications and add-ons and so on to Panorama. I canvassed that with you last time.

It struck me from something that Carol had pointed out in her introduction…. I think the phrase was, in terms of…. I don’t think it was “excellent,” but it was “outstanding” performance is required in these kinds of large, complex projects. I’ve used the word “excellence” there.

In a conversation I’ve had with our IMIT leads across the health sector, there are a number of issues that I think we need to just get stronger policy framework in place for how we manage IMIT projects — period. This builds on the work that we were doing through the division of linking together under a single strategic project
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branch. But we need to now have some teeth to that to say: “What guidance…?” Carol and I canvassed this over the summer a little bit, where we talked about: what is best practice?

What that is, is an update, just for the record, of some of the pieces that we’re actually looking at.

One of the pieces that I think is fundamental to IMIT, which has struck me from my engagement with a couple of projects, is: if there isn’t a great deal of clarity going into the project about which processes you’re actually going to use IMIT to help you with, you end up in all kinds of difficulties later because you’ve got debate about what the standardized processes are you’re trying to use IMIT to help you with. So we’re going to actually build in, in a much stronger way, clarity about process. Are the processes clear? That was a fundamental issue in this project.

It’s surprising to me, I’ve got to say. I kind of thought that on a public health basis, vaccination schedules and certain protocols around some of the elements which are in Panorama would be standardized, really, across OECD countries. I’ve been quite surprised at the diversity of practices. Without that clarity up front, you end up with a lot of confusion, going forward, about which processes you’re actually trying to standardize.

A second key issue, which is obviously fundamental to this report, is the whole issue about being clear about the objectives early on. I think you would see in a number of projects, not just the Panorama, that the aspirations early on often, then, do not deliver later on. We need to actually, in what is a maturing area, have a lot more discipline about setting objectives earlier on and then working those through in a cleaner way. That also includes costing, because a key issue that the Auditor’s raised is about the increased costs throughout the project.

On the capital build for buildings, there’s a lot more discipline now in terms of how capital builds are done. Generally, with the right procedures, you can stay within 10 percent to 15 percent of the initial budget. Clearly, that was not the case in this project. So I’ve asked the IMIT group to work with Finance. We’ve got to look at some stronger guidelines and policies about the kinds of costing that we do early on.

Then the remaining issues there…. Some of them we did touch on. I’ve used the word “excellence.” I want to look at what’s best practice in governance, project management, and so on.

We’ll be doing a more thorough, basic policy manual, which pulls together various pieces of policy that are already in play, but we’ll actually get that to best practice. With that policy manual, not only will we actually take the business plan and the look at what else is available on Panorama to the expert panel that we’re going to bring together. We’ll also take the policy papers and have those critiqued so that we actually strengthen and make sure we’re building a good, solid policy base going forward.

That was just an update to you, just to be clear. Because I’ve got several more meetings over the next month or so, there may be some further additions and modifications to our plan as we move forward, before it goes for final review by leadership council early in the calendar year.

Now to the actual specifics. The first area that we focused in on was to try to get some clarity on the details of the national budget costs and funding sources.

If you turn to slide 5, where it’s got the national budget costs, you see there, on the top line, the original budget, which goes through the various phases — the planning phase, the procurement phase, the development phase, the test case and then the total.

You see there that the original budget was at $37.82 million. Just to remind, this is the national build. This isn’t the provincial build. This is the national build. Of the $37.82 million, you will see that the allowance for IBM was to build a solution for a fixed price at $27.8 million, with the balance being for other aspects of the national group working through the project.

You’ll see there, in the second line, that a consequence of the decision to move from a COTS to a custom build — so from an off-the-shelf to a custom build — was that the national committee approved a revised budget, which was to total $47.98 million. Then the third line down, the bolded line, shows the actual build cost, which was the $44.44 million in terms of the total build.

By way of information, and we’ll come back to this in a couple of slides, around the 2007 period, when the discussion was taking place as to whether to continue with this project, approximately $23 million had been spent at that time.

Of the $23 million, $12 million had been paid in work done by IBM in the first phases of this project, and the balance was on the work that was going on across the various jurisdictions and territories.

The consequence of going from a COTS to a custom build is both in terms of complexity of the work and how much time is required to complete that work. In the report shown by the Auditor, they correctly identified costs in 2009 and 2010 of $10.5 million and $11 million, which are accurate numbers, according to the records I’ve looked at. These, then, got to the Auditor’s number of $66 million.

One of the questions you asked at the end of the last session was: what was the source of those funds that amount, then, to the $66 million? If you turn to the next slide, slide 6, in terms of the final cost of the build, which was $44.44 million, that build was fully funded through the federal government through the CHI. However, because of the additional two years of sustainment, there was the additional $21.5 million.

B. Ralston (Chair): I wonder if I could interrupt. What do you mean by “sustainment”? Do you mean operating cost? Perhaps you could….
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B. Ralston (Chair): Oh, I’ve never heard it used that way before. Maybe I’m unique in that respect. So it simply means operating costs?

S. Brown: The sustainment was cost incurred as the work continued on developing the project. Those would be to do with…. It could be to committees. It could be working with clinicians to actually define now what was required in more detail, work going on in the different regions of the country, as well as just the shared work that was going….

B. Ralston (Chair): I think that clarifies it. I just hadn’t heard the word used in that way before.

S. Brown: Okay. I’m just seeing if I’ve got a list of the kinds of work. That was the kind of work that I was involved in with the piece.

In terms of those additional two years for sustainment funding, there was what I called, in my notes, the normal sustainment activities associated with the development of the project. These included help desk; the packaging of the releases and how they were released to be reviewed by the jurisdictions; minor enhancements; some of the development of standards, because now it was moving to a custom build; any incidents that were occurring in the development, as well as remediating any defects that were found.

Last time, we talked about how in a custom build, you would expect a number of defects being found as they’re testing the different versions. I’ve got a note here saying that in 2009, out of the $10.5 million, about $3 million was used for remediating any of the defects that were coming through the development of the product. Then that dropped to a much smaller number in the 2010 period. Those are the kinds of costs included in the sustainment.

You’ll see that with the sustainment — because this is still at the national level, not the provincial level — those costs were distributed based upon size of province across the various jurisdictions that were involved at that time. For your information, at the time when this was being done, the jurisdictions included Ontario, Quebec, Manitoba, Saskatchewan, Nova Scotia, Newfoundland, Yukon, and First Nations and Inuit health as well as, obviously, B.C. You’ll see there that the source of funding that came from B.C. for those two sustainment years came to a total of approximately $2 million, the rest being paid by the respective jurisdictions across Canada. That builds out, then, the national build.

Our next links in and, I think, links to the work that the Auditor did in terms of the $66 million number and gives you a sense of the sources, then, being for the actual capital build, the actual building of the IT project. That was the Health Canada Infoway — federal. Then the sustainment costs were shared between the different jurisdictions, with B.C. being at $2 million.

B. Ralston (Chair): Mr. Brown, I’m mindful of the time. I’m wondering if you can move to next group, slide 2 on page 7. We’ve given you 25 minutes so far. I’d like to wrap it up fairly shortly so that there is time for members’ questions and a response from the Auditor General. I understand this is complex material, but please help us by being succinct, if possible.

S. Brown: Will do. The question was in terms of: why not go to re-procurement? What was the thinking associated with that?

What we have done, by way of information, is we’ve had staff link out to a number of staff who are retired or who have moved on to different portfolios and, also, looked at any records that we have. What we found was that the shift to the custom development and the decision to carry on with IBM was a unanimous national decision. Therefore, obviously, B.C. also voted in favour of continuing with IBM at that time. That decision was made in Edmonton, and all the individual members involved were asked to vote on it and express their views. It was unanimous.

The actual thinking that went into that was as follows. Number one was what I mentioned earlier, the investment to date in terms of the investment, not only in terms of dollars but in terms of the learning that had occurred, working between Canada and the provider in beginning to try to utilize the COTS product.

The second was that IBM was to be held to a fixed-price contract. In other words, the $27.7 million was not to increase. I should absolutely clarify that there was an additional, I think, about $2.5 million that went to IBM for shared services outside of their fixed-price contract, just for your information on that. I may have the numbers slightly wrong, but it’s approximately $2.5 million.

Because IBM was held to a fixed-price contract, no additional funds were going to be given to IBM for the build. That was considered against going to the runners-up in the procurement process, and it was determined at the time by the national committee that the costs of going now to the alternate providers with the budget spend and the learning would take them back to a starting point that they felt was not a value-add in terms of moving forward.

Then the third factor was that the federal funding at that point was going to finish in 2009. If the feds then withdrew their funding, going back to a different vendor, that would create significant net new costs for the provinces if they were to continue. And there were concerns around the provincial-territorial budget.

Those were the factors that went into it, and then — turning to the next slide — that led to a decision to move
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forward with IBM and also renegotiate the contract. One of the pieces that you canvassed last time was the acceptance. Just to reiterate, we totally accept the critique of the Auditor General that the acceptance was, I think he said, suboptimal, and someone said it was more than suboptimal. But that was not appropriate, and a better job could have been done by that.

The other piece was with respect to the renegotiation of the contract. What occurred at this point was because then the fixed price at $27.7 million was being held to and now there was a custom build which was going to require more work. The committee went through a process of renegotiating some of the scope of the project at that point, which was picked up, I think, in the first part of exhibit 1 of the Auditor’s. So there were some trade-offs in terms of the scope, because now there was going to be more work to actually custom build the product.

The other piece was that in terms of doing that negotiation, there were some benefits accrued to the provinces and territories which were against future costs, as also part of that renegotiation. That was why I mentioned last time, I think, in terms of…. The master agreement and some of the maintenance agreements were reduced by IBM on a go-forward basis to offset future costs.

That is as succinct as it can be, and you can come back and question me further. That was the thinking that went in at the time, in terms of moving forward with IBM.

Then the last piece is with respect to the provincial build of the province, which is starting on slide 10. Now, with the provincial build, there’s the knock-on effect of the decision to actually custom build this product, which would then require more time to consult and deploy and develop the product going forward.

Turning to slide 11, you see there a breakdown of the budget. The original estimated budget for the capital for the province was $44.6 million. You will then see the implementation or operating at $53.97 million over several years. The key point I’d highlight there is what I think I mentioned last time.

When the original project started, all that was forecast was going to be the capital build. Later on in the project, there was a shift in thinking, which is an obvious one when you look back at it, saying: “It’s not just the capital build. It’s all of the costs that will be incurred by developing, deploying, engaging and training the workforce in terms of using the product.”

Those were costs that were not included but then were included and recognized going forward. When I mention that, we now have a total build cost, and that was the $53 million with the HAs. The question then became: what was the $53 million? Did that then have an impact on HAs in terms of health service delivery?

Because it was not included in the original project build, the decision was made to actually manage the costs of the $53.97 million on an annual basis by risk-managing the surplus that the ministry has at the end of each year to pay for those costs. Rather than pushing it onto the HAs, which could then have had an impact on services, the costs were actually assumed by the Ministry of Health. The Ministry of Health managed those by surpluses that occur naturally, on what is quite a large budget, at the end of each year.

Those costs, then, the $53.97 million…. I can canvass these with you in more detail, but they go the range of training, consultation with clinicians, interfaces with existing systems. There’s a whole range of activities associated with those costs, going forward.

B. Ralston (Chair): I’m going to ask the Auditor General or her staff if they wish to respond at this point. Or would you rather hear some questions and respond later?

C. Bellringer: I don’t really have anything to add. We hadn’t seen the slides ahead of time, so we hadn’t talked about it before we got here.

The only reaction I have to it is…. The focus, going forward, I see as a positive thing — the recognition that there needs to be a different way. What we saw in this audit was…. Suboptimal, as you say, is an understatement.

We’ve seen some indication of that in some of the things that we’ve had the opportunity to talk about on other projects that are going forward. So I think there’s…. If it’s done and if it’s done in a real way — I’m not suggesting that I feel it wouldn’t be — the steps that the ministry is taking would certainly get at the heart of the issues that we raised.

B. Ralston (Chair): I’m going to move to questions by members. I had a couple of people who had indicated: David Eby and then Kathy Corrigan.

D. Eby: With respect to the sustainment figures, I noted that, Mr. Brown, you had some notes with some additional breakdown of those costs. I wonder, Mr. Chair, whether those might be provided to the committee, as they have more detail than what we’ve been provided. I’ll leave that with Mr. Brown — to ponder whether they’re willing to release that.

B. Ralston (Chair): I can direct that it be released through the Clerk to the committee, and I’ll make that direction.

With respect to page 11, and that’s the provincial budget and costs, am I correct in assuming — and I do have a follow-up question — that the full amount of the $112.6 million…? The Auditor General says $115 million. This is all provincial dollars that went into this?

S. Brown: Nearly, but not quite. With respect to the capital build, the $44.4 million, the Canadian health information gave us a further $10 million credit — I think it was $10.1 million — against, because the capital build was now higher. So we got a $10 million credit back to us against that $44 million.

C. Bellringer: In terms of the $115 million that we had reported, that is the $113 million — $112.6 million — on the provincial sheet plus the $2 million portion of the national build. That was where we got the $115 million from.

D. Eby: When I look at the old Health Canada website — I’ve asked the Chair, and he has forwarded the link to this around to my fellow committee members — I read that originally, Infoway was supporting the development and the implementation of this public health surveillance system called Panorama.

Actually, when I look at the current project list on the Canada Health Infoway, I see that the government of Manitoba got $6.6 million. It looks like they haven’t used it all yet, only about half of it. It looks like the government of Ontario got more than $27 million. Both descriptions say that the purpose of the project is to implement Panorama, a public health information system. Ontario — $27.7 million on the Canada Health Infoway project list website.

I’m wondering. Ontario got $27 million. Manitoba got $6 million for implementation. Did B.C. get any money, or did we have to front the full cost of implementation because we were carrying this project and it was our fault?

S. Brown: My understanding would be not the latter, but I would have to get a detailed answer for you. I don’t know the answer. My understanding is that we got everything proportionally in line with other jurisdictions. I don’t think there was a neglect on B.C. in terms of getting its proportion of the funds from Infoway. I’d be happy to get the answer and pass it to you through the Chair.

B. Ralston (Chair): I’m going to direct that the link be sent to you and your staff as well.

K. Corrigan: I have two questions. Maybe I’ll just ask them both and then get a response — two questions for now, anyways.

The first one relates to the capabilities that were removed from scope. I note that on page 23 of the report, “National outbreak capabilities: ability to use the system to collaboratively manage outbreaks that cross provincial borders,” and then there are some other ones. The impact, of course, of that one, the Auditor General points out: “The system cannot be used to manage interprovincial outbreaks, the main reason for which the system was built.” On page 35 of the report, it says that if functions like that were to be added back, there would be an additional cost to B.C. and the country.

My first question is — and some of this may be being done now, because I know some of the functions have been added since the report, I guess: how much will it cost British Columbia or the country to provide the functions such as the management of national outbreaks? How much will it cost to add those to the system? I’ll ask that.

My second question is: when the choices were made to not renegotiate…? There was a choice to renegotiation in the change orders without any tangible compensation in return for the significant concessions, the report points out. I’m wondering how public all of this was throughout the process. Was it public at all that these problems were happening?

Secondly — and, I guess, related to that — were the decisions to continue on in any way related to trying to minimize or hide possible public embarrassment at how much this was costing and how far it was behind schedule? Those are my questions.

S. Brown: With respect to your first question, at this point in time, there is no business case and, therefore, no costing on what would actually be required to achieve a full national outbreak capability within the system. The reason for that is…. There are a couple of reasons.

First of all, the Public Health Agency of Canada shifted its role in the middle of this process. They would have been a key player in terms of driving to standardized interjurisdictional data-sharing agreements, and those standards are not in place today.

Canada Health Infoway has done some work on national message specification that could actually facilitate the basis for development of standards. That may be something that comes forward with the new government. It would be the role of the Public Health Agency of Canada, in terms of taking on that piece of work.

What I can say to you, though, Member, is that the provincial functionality is there to the degree that today we are able to share files efficiently between jurisdictions using the platform and, therefore, exchange information in a more structured way than would be possible without.

As we referenced when we were here last time, in terms of ebola, there has been some work done there with ebola in terms of exchanging information, which is actually shaping up and is under review by the health officers across Canada at the moment. It is actually going to be canvassed at a federal-provincial meeting of deputies in
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the new year, probably by spring, in terms of the policies and procedures around managing a national outbreak using the systems that are in place.

K. Corrigan: The Chair said that I can do a quick follow-up on that before we get to the other question. Are you saying the comment in the report on page 23 that says, “The system cannot be used to manage interprovincial outbreaks, the main reason for which the system was built” — that that statement is incorrect?

S. Brown: No, it’s correct, because the actual design goal for the system was to create a national system that could exchange information easily to manage an outbreak at a national level. The exchange of information that is now possible through the system was actually not the full scope of what was set out at the beginning.

But I will say that to my understanding, that was an issue for all the jurisdictions. It wasn’t to do with the actual build. It was the actual jurisdictions, in terms of having the right kinds of standards in place, that could facilitate that kind of an exchange.

With respect to your second question, I assumed that it was public information, but I actually don’t know. I got no sense myself, as we were dialoguing over the last two weeks, to understand that there was this sense of failure that you were picking up then, from the report.

There was a realization that going in the direction of the COTS was just not going to work. The off-the-shelf, which was both a jurisdictional…. It was the jurisdictions who went in that direction at the beginning of this.

That was not practical in the sense of the amount of variance that there was between the different jurisdictions in terms of how they conduct their public health services. If I could say this. When I just mentioned earlier, to a much stronger policy framework around moving forward with these projects in future…. If we’d had done that work back in 2003 to actually look at how the processes across the different territories and provinces enough aligned that you could actually bring in a IT solution off the shelf…. That would have been a piece of work, which I why I emphasize that piece.

As I look at the report and then dialogue it, that’s been a learning. If you haven’t got your processes sorted out, then your ability to actually use an off-the-shelf product…. You’re going to end up doing custom build, which is what happened in this case.

G. Heyman: Mr. Brown, I’m looking at the detailed action plan and response to the first recommendation of the Auditor General, “to commission an independent review of Panorama and other alternative systems to identify the most cost-effective, integrated approach to meet the current and future needs of public health in British Columbia.”

In terms of the action plan, while there is reference to an annual survey of Panorama end users and undertaking an annual environmental scan, the bulk of the action planned is essentially statements about how you believe public health outcomes will be further advanced through ongoing improvements to Panorama and the on-boarding of innovative health information technology applications facilitated through Panorama’s interoperability design.

Perhaps you could explain that statement and the one that follows about the three-to-five-year business plan and help us understand exactly how that responds to the recommendation to conduct an independent review.

S. Brown: When we wrote the response to the Auditor — in early August, I think it was — I had quickly canvassed a number of people in the sector. I was persuaded and then took the step of signing off the response to the Auditor that said we would really focus on building on Panorama and looking to options to add to Panorama, which is what you’ve just read back to me.

When I came to the meeting two weeks ago, I acknowledged that while I’ve now, as I just said…. We go through a process, which is a bit of a longer process, of talking to various people across the health sector. I acknowledged at this meeting that I was going to go a step further than what we’d done in the response.

We’re actually going to take on a much more thorough environmental scan than I had committed to in the response to the Auditor when I wrote in August. I felt, on reflection, the Auditor is making a fundamental point to us, which is: if you don’t know and you haven’t done a competent job of looking at that, then you do not know if there’s an alternate or certain key modules that should be replaced over time.

Part of the commitment I was making last time when I was here is to go further than I’d put in the response originally, to make sure that we do a thorough, competent annual review, as we look out over the next four or five years, to see what’s evolving in the marketplace, and not simply just look at potential add-ons or modifications to the Panorama program.

B. Ralston (Chair): Just before you continue. Given that you’ve said you were revising the action plan and this is a new system that the committee is engaged in, I would appreciate it if you would file a new, revised action plan. The ministry and its action plan will be judged by the committee, and you’ll be invited back, hopefully, in a year or so to report on your progress on the action plan. So if it is revised, it’s probably important that we have that revised version before us.

S. Brown: I’d be pleased to do that. If I could just say, by way of a marker, I think it would probably be around February by the time we’ve actually been through the full
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process internally and gone to leadership council and got sign-off of our game plan going forward.

It won’t be radically different, but it will be enhanced and refined, I think, Chair — what you will see.

C. Bellringer: My understanding of what was presented in the action plan, which was the one that was provided at the last meeting, was different from what was included in our report as the ministry’s response.

I think the action plan…. I mean, unless you’re saying it’s changed since then…

C. Bellringer: I think it is reflecting the most current information and can be used. It’s what we would be using to do the next assessment until such time as it changes.

G. Heyman: The second recommendation calls on the ministry to “review its project management practices to ensure future IT projects are managed in accordance with good practice.” In the action plan, you talk about developing a plan to meet industry standards for project management and develop an action plan to move towards best practices.

I don’t want to revisit all the ground we went over at the last meeting, but it is somewhat concerning that…. In the face, of it the action plan seems logical and sensible, but what’s concerning is that I don’t know whether any elements of this were part of the ministry’s thinking during the planning and execution of this IT project, or an evaluation of this IT project as it developed, or other IT projects or other significant capital expenditures by the ministry.

Are you saying by this that there was no formal attempt to look at industry standards for project management or to determine what best practices were? Or just that people were wrong about their assumptions, or there really wasn’t a thorough project management matrix in place that is consistent between projects?

A follow-up question to that would be for the Auditor General: whether she and her office have a concern that there’s an inadequate approach that’s endemic throughout this ministry for major projects and, potentially, other ministries and if we need to take a step back and take a broader view.

S. Brown: I’ll go first and then hand over to Carol. There are project management practices in place, and there have been over the last ten years, so it wasn’t to be a critique of…. What I think you’ve got is an evolving understanding of the complexity of large-scale IMIT projects. I think the word used in your introduction to your report was there’s a need for exceptional project management skills in terms of some of the complexity, particularly something like this which was a pan-Canadian project.

The project management has evolved. It’s evolved significantly over the last several years, and iteratively. The amount of sophistication now in capital builds, as in hospitals, etc., is radically different than it would have been ten, 15 years ago in terms of how project boards are used, how you use independent.

I think, to the discussions I’ve had with Carol…. I don’t think the IMIT has actually gone at the same pace, or certainly we have not gone at the same pace. We’ve had project management for sure. We’ve certainly used a whole range of consultants and independents throughout various projects. But to the point that Carol made and I took to heart, there’s a need for the exceptional or excellent project management skills.

The ministry was already in progress in terms of going through some improvements and changes, which I think I referenced last time, about consolidating project management under one branch, about being clear when to bring in external. But really, the report from the Auditor did actually do what you’re suggesting, Member. It has actually invited the ministry to say: “Stop, step back and take a fresh look at where exactly you are in terms of your practices, your performance, and make sure you’re doing everything you can to be as excellent….”

It’s why I took a further step in the last two weeks to say that we will take that step and make sure the practices we do have are to the right standard. We will avail ourselves and I will avail myself of some external expertise, which we referenced last time, to make sure that I get a second level look at what’s being recommended, to make sure that we get the right standards in place going forward.

C. Bellringer: I am reluctant to speculate on the broader question, because we have not done a full-blown audit of either the ministry or government as a whole. The best way to conclude on that is: we’ll do another one. We do have Cerner on the list for an audit that we’ll be doing.

The report that we are doing in the spring, on challenges in large IT systems, isn’t an actual audit, so it won’t give you the answer to: is everything in place adequate or inadequate? It’ll be a presentation more of best practices and some of the things that we found in past audits.

B. Ralston (Chair): Given that every ministry has a suite of projects and that’s kind of the nature of government — executing projects — is there an intraministerial agency that sets the standards and monitors compliance with standards of excellence in project management? It would seem that that would be, potentially, a huge benefit to the operation of government and, ultimately, a savings if even one of these projects went a little bit more smoothly.

C. Bellringer: We will look at the governance structure, if you will — the way that it’s managed within gov-
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ernment currently. Perhaps the comptroller general…. I recall at the last meeting the comptroller general pointed out some of the way that the current infrastructure is in place, but he would be more familiar with it than I.

In relation to contract procurement and contract management, there are standards and rules and policies and guidance in place.

In relation to project management, there are project management groups within government that are doing work as far as project management training.

Within ministries, though, the ministries are responsible for managing a number of their spending decisions in determining whether or not they’re meeting their goals in relation to the funding spent or the types of deliverables that are being met as a regular management practice. I don’t believe there is a — financial or other — project management centre of excellence place within government that would review…. I think, in a lot of cases, the ministries are responsible and accountable to their minister and to the Legislature for what they deliver.

B. Ralston (Chair): Given that there’s been a suggestion that standards of project management are evolving rapidly and, presumably, improving, it would seem surprising that there’s no centre within government that would disseminate that information and encourage adherence to higher, evolving standards. Is that what you’re saying, then?

S. Newton: I’d say that on the construction side, as Stephen has mentioned before, there are clear requirements. There is the capital asset management framework. I think, in relation to that, a number of those framework elements could also be used for IMIT projects.

I think the issue with IMIT projects is not necessarily the project management aspect of it. It’s the complexity of the IMIT project itself and the build and understanding some of the elements that need to be put in place in order to plan them effectively — or also determine, as these projects are unfolding, how to deal with changes. On the construction side, dealing with something that’s a little bit firmer, that we know about, is a little easier to do.

I would say it was probably something more along the lines of not necessarily the pure project management piece, which can build off of some of the management frameworks we use on the capital side. It’s understanding the complexity of IT and getting a better handle on that. And there is guidance within government through the OCIO’s office in relation to IMIT projects and project development as well. I think it’s a matter of, probably, a little bit more work on government’s behalf to determine how those parts connect.

S. Newton: Oh, sorry. I apologize for the acronym. Office of the chief information officer.

S. Brown: If I could add, Chair, just as a learning in terms of health which has taken place in the last three years, an additional complexity that health seems to bring to the table is not just the IT piece, but it’s the interface between information technology and medicine.

Because in medicine you’ve got all issues about clinical autonomy and different ways of practising and the colleges, one of the practices that has evolved in the last three years and certainly is being used in the Cerner context is a much firmer linking together of the IT with a medical lead very early on in the process. Trying to get some discipline around what are medical processes and standardized medical processes is key to a successful IT project.

B. Ralston (Chair): Both the Auditor General and you, Mr. Brown, have referred to Cerner. Is that another acronym that I’m missing or not understanding?

S. Brown: Cerner is an IT product that is already in use in the province, in hospitals, for information management within primarily hospital settings, although as the Cerner product develops, it’s actually moving into community as well.

There are several refreshes underway across the province right now on Cerner, which has been identified by the Auditor for an audit in the near future.

C. Bellringer: It’s in our three-year plan. The work so far is at a very preliminary stage. I think it’s about two years into the three-year plan. Size-wise, it’s eight to ten times larger than this. It’s one of the largest IT systems being designed and implemented in the province in health care.

S. Robinson: I have two different kinds of questions. I could just start with the first set and, if there’s time, go into the second.

One has to do around the testing. I’m assuming that, initially, when the contract was signed, there was a plan for how to test the system. Who was going to initially test the system? I do recall that one of the issues…. It’s certainly here in the…. The national product got accepted
[ Page 799 ]
and the use of IBM resources to supplement the testing team was not optimal. That was the recognition.

S. Brown: My understanding is that it was to be the jurisdictions that were to test the system. A decision was made, as we’d come this last time, to use IBM, and all of the issues that the auditors raised about the risks of doing that actually were then present. It would have been the responsibility of the jurisdictions to do that testing.

I assume from my reading of the material that because of the tighter time frame, because of the extension that took place and concern about funding, some decisions were made. With hindsight, we absolutely recognize what the Auditor had said, and said that that was not a good decision to make.

S. Robinson: So it wasn’t the original contract. It was about: “We need to fix this. Our timeline has shrunk. How can we more efficiently test it?”

S. Brown: Yeah, the reading I did was that there was that major course correction, and there was a lot of debate and discussion in the context of the budget and the federal funding. That led to some trade-offs and decisions that were made in that two-year period.

S. Robinson: My next set of questions has to do with the action plan. It has to do around the word “independent.”

In the very first recommendation from the Auditor General, the recommendation was to commission an independent review of Panorama. I don’t see “independent” anywhere in the action plan.

Then, when we go over to the action plan based on the Auditor General’s recommendations for (2) and (3)…. The way to confirm the approach is to engage independent expertise or independent project assurance.

I’d like to understand your perspective on…. Independence for these action items is of value and recognized but not for the very first recommendation, if you can explain the difference.

S. Brown: It was partly, with our original response, how we framed ourselves, with respect to No. 1. The original position that I took once I’d canvassed internally was that there was a sense of confidence that there was not an alternative to Panorama, No. 1. And No. 2, that Panorama with the changes that have been made in the last two years…. As Dr. Kendall said last time, there’s been a significant improvement, so our best strategy is to continue.

That was the original position I took. On reflection, when we were getting ready for coming to the session two weeks ago, I said at this meeting — I probably wasn’t as clear as I could have been — that we would take a much more formal look at what else is available and see what evolves over the coming five years.

Now I will ask the people we engage as independent to give me a second-level look and reflection back to me. I will ask them to make sure that the usefulness of what we do is useful to what Carol says — that it’s done properly, that we take a good look and it’s done in a businesslike way in terms of making those decisions.

V. Huntington: We’ve spoken about the transfer of risk to the taxpayer on the major decisions. Was this transfer of risk made at the national level? At what level, in British Columbia, was that decision made? Did they sort of spread out the risk to all provinces, or was the risk only absorbed in British Columbia? And at what level was that decision made?

S. Brown: It was national. It was a shared risk in terms of the determination of the shifts and adjustments that were made in 2007, I think it was, when the changes were made. I understand that it was at a workup to a meeting that took place in Edmonton, where the decisions were made in terms of how to move forward, both with respect to stay or leave IBM, or to make accommodation for a custom build that was different than what was originally intended. Although, I understand it had already started evolving in that way over the previous year. It wasn’t just a sudden switch and move to custom. That had already, really, begun to emerge, I think, in 2006, if I understood correctly.

The people at that committee would have been at the ADM level, I think. I can check that for you if you want to know the level. It would have been at an ADM or a DM level at that national committee, in collaboration with Canada Health Infoway.

V. Huntington: So it was made at an official level, then, on whether or not the taxpayer should absorb the risk and transfer it from IBM to the taxpayer.

S. Brown: I would assume. I can check on this. I would assume that from that meeting, that would have, then, come back to the respective jurisdictions. But I would have to check on that to see what happened at that time.

It would be normal practice. It wouldn’t just be officials making that. I think what would have come back would have been the question that was raised last time, which was: what was the thinking? That would have been brought back in terms of the trade-offs and thinking that went into why, unanimously, there was a decision to carry on in that direction.

V. Huntington: I would be interested in receiving that sort of timeline of the decision — when and who and at what level it was made. Also, I’ve been interested in the discussion in the report around the issue of ministerial
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command-and-control decision-making and leadership styles. One of the concerns I had was the fact that the ministry appeared to — well, did — dismiss the health authority concerns about efficiencies and patient safety, etc.

It’s a twofold question. How does the ministry see its role in the delivery of health care versus the actual health authorities, which are responsible for that delivery? At what stage does the ministry seem to decide what is best for the patient? At what stage and why does the ministry make decisions that are not approved or acceptable to the health authorities? That’s one.

The other question I had was…. It was a pan-Canadian project that you were looking to. However, in British Columbia, the decision was made at the ministry level to allow some authorities to opt out, others not to opt out. I’d like to know the criteria upon which that decision was made.

S. Brown: With respect to your first question, I would say it’s an evolving relationship. I’d say that early on in the last decade, when this was first implemented by having health authorities, B.C., along with most other jurisdictions, basically had the notion that you could move all operational accountability over to an enterprise like a health authority and that then the government, the ministry, would stay in the back in a steering role in enabling that.

I think the reality of the political context for Health, in a Westminster model, led to the conclusion that the ministry is accountable, at the end of the day, for decisions that are made and is held accountable by the public.

I would say there’s been an evolution over the ten years, where there is much more of a balance now between the health authorities and the ministry. I would say an active dialogue and debate goes on in terms of: what is the role of the ministry versus the role of the health authority?

I would have to make a distinction, though, to something that you said. I would say the ministry would contest that there was a serious clinical risk or that the ministry was actually determining and ignoring the clinical risk. The HAs themselves have a complex relationship with their clinicians, who are under the guidance of their respective colleges, in terms of clinical autonomy and clinical standards. So there’s a dynamic that occurs, just at the HA level, between the health authority administration and doctors, in particular, but also the health professionals in terms of clinical.

What you saw in play here was that dynamic taking place. You’ve got a range of different perspectives, even within the clinical, around what schedules should take place — what vaccination schedules, what dosages. So you’ve got quite a wide, broad debate going on at the same time as you’re trying to move in an administrative direction.

I think the point that we did take from the Auditor’s report…. I would say, personally, that we have made big strides. There is a different tone in the relationship over the last couple of years. I could definitely say, having been there. I can’t speak for the previous, for some of it. There is very much….

We have done quite a lot of work with the HAs to clarify: what is the governance role of the HA? What’s the role of the minister? What’s the role of the ministry? What’s the role of the senior executive teams in the HAs? We’ve done quite a lot of joint work with the boards, with the board chairs and with the senior executives to clarify those roles and really try and use, now, the leadership meeting, which is the officials on both sides. As well, the minister meets regularly with board chairs throughout the year, where there’s some really good dialogue and working together through issues.

I would also say, in all honesty, there’s some push-and-take about…. Sometimes, to be honest with you, it’s like herding cats. We’re all going off in multiple directions, and there’s a need to push sometimes and say: “We’ve got to settle down. We’re serving a population of people, and we need to make some decisions.” So there are some tensions that occur on various issues as you’re trying to work through stuff.

With respect to the second piece of your question, I will have to get that information for you — in terms of the detail of that. I will get the answer and supply it to the Chair.

V. Huntington: Just a comment. Does the ministry not see its role more as a policy forum that would debate with the HAs on an issue that needed consideration, develop the policy, create the regulation and guideline and then watch and enforce the issues rather than make some decisions about those operational matters?

S. Brown: That would be…. You’ve actually captured what we’ve just tried to do over the last two years. We’ve actually tried to position the ministry much more clearly, as you just described it.

I think part of the challenge here, in talking to a number of the people involved, was that because it was a pan-Canadian level…. B.C. has got health authorities. Other jurisdictions have got different systems. Trying to hold that together…. In hindsight, you look at that and say: “How could anyone believe you could pull it off at the end of the day?”

I think there was an absolute genuine urgency, because of the SARS outbreak, that that was something that should be tried and was worth doing and would have benefited if we could pull it off. Once you’re at that national level, not only have you got your own local dynamics. You’ve actually got multiple different dynamics that are occurring across different jurisdictions. Trying to hold that together in the context of a single national build was inordinately difficult to achieve.

B. Ralston (Chair): Next I had Kathy again. Is there anyone on this side? Okay. Kathy, then, for a second time.

K. Corrigan: Two questions. I wasn’t able to be here last time, but I looked at the transcript, and there was a bit of a discussion about the amount that IBM was actually paid for B.C. implementation. The report says that IBM was actually paid $73.5 million for the British Columbia implementation, or 450 percent more than the original contract price. If there’s any dispute with that number, then let me know. That’s on page 18 of the report.

I was reading a little bit about Ontario. Ontario’s Auditor General report at the end of last year said that Ontario’s implementation of Panorama was double, so not quite as much of a discrepancy. I guess my questions with regard to that are: why is it…? There was some discussion about this, but I do not understand.

If there is a fixed-price contract no matter what happens — whether or not there was a revised deployment approach, major issues with the national system, and so on — that drive up the cost, why is it that the taxpayers are paying the price for the terrible mistakes and the inability of IBM to deliver the system?

I guess my subquestion to that is: is it partially because British Columbia was taking the lead in this project and apparently had fumbled the ball so badly that there was a bit of a guilt and a willingness to absorb more cost related to this contract than perhaps some of the other provinces?

S. Brown: Okay, I’ll try this. In terms of the $73 million, I would have to confer with the Auditor afterwards, but the numbers I’ve got are is that for the national build, it was $27.8 million, and then for the provincial build, it was the balance, which was the $44.6 million that went to IBM. Those are the numbers I’ve got, but we’d have to confer to just clarify that.

Now, in terms of your question, though, in terms of that build, the $27.7 million was part of the original national build. That was held at a fixed price. With respect to the provincial build, the number that I have is that in the original budget plan for the provincial build, because there were always going to be costs with the provincial build beyond the national build, the original was $27.7 million, which is on the table there on slide 11, and it came in at $44.6 million.

What we’ve got is a $10 million credit from Canada Infoway against that $44 million. But those additional costs, going from $27 million to $44 million, were in part driven, then, by the fact that we had moved to a custom build.

What was handed off nationally to the different jurisdictions was a template core program that now had to have significant work done to it because of the decision by the jurisdictions to go to a custom build, to actually build out the details of some of the custom, unique requirements at a provincial level, which accounts for the extra $10 million. I don’t think, from a provincial point of view, that it was seen as a cave-in or as guilt.

It was actually presented to me that there was a fundamental choice that had to be made. It was abandon the project because a COTS wasn’t going to work or actually take what had been learned from that part of the process and now do a custom build, building out. That, I’d say, is the nub of the decision there around about 2007, 2008.

K. Corrigan: Just a follow-up. Frankly, I’m surprised that we have the report…. You’ve had the report, and the ministry has had the report in some form or another for months and month now. We’re here sitting now, the second day it’s been discussed, and there’s a key number which refers to British Columbia’s costs for implementation in the Auditor General’s report. It says very simply that under the B.C. implementation contracts, IBM was to be paid a combined maximum of $16.2 million on a time-and-materials basis.

IBM was actually paid $73.5 million, or 450 percent more than the original contract price. I find it surprising that you’re not prepared to answer questions about that number that’s been in the report for a long time. That 450 percent has been thrown around a bit or has been talked about quite extensively, is my understanding. Maybe the Auditor General wants to respond to that.

C. Bellringer: Some of the numbers…. The reference to a fixed contract — the only part that was fixed was in the national-build element. The $27.8 million with IBM was the fixed-price piece. There’s no fixed-price component on the provincial side.

I don’t know how you look at it without putting the two together, because you end up with where you stop one piece, the next piece continues. If you stop early, then you have to finish it here. If you stop late, then you have less to do.

Certainly, while we separate it in our report to show the way it ended up, in fact, being paid out, the intellectual conversation around it has to be about the whole.

S. Brown: Can I say to the member…? Carol was just pointing out to me that the $16.2 million you’re referring to links into the $27 million because the Auditor discounted, then, the $10 million off the CIHI number, which was the $27 million we were using, so that’s where
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the $16 million comes in. Part of the challenge we’ve had working together is the tabling of the numbers and how the numbers are accounted for. I think, in essence, we’re not disagreeing with the overall numbers.

C. Bellringer: No. The IBM number of $73 million that we mention in the report would be not just the capital line. It would be where IBM was paid for both capital and service, if you will, so it’ll be showing up on one of the operating lines. We didn’t do it on the same basis. But I think we are working to the same numbers, because the totals are the same as I’ve got.

K. Corrigan: My other question was to follow up on MLA Huntington’s comments about the health authorities. The report says that there was the exception made for Vancouver Coastal Health because they were using PARIS, and they had invested in that system. It looks like an exception was made for Northern Health.

Then it says: “…requests from other health authorities to pursue alternatives…the ministry directed Island Health, Interior Health and Fraser Health to implement all seven Panorama modules.” Did any of the health authorities want to implement the modules?

S. Brown: I think the understanding I have is that the exceptions were made because there had been two builds going on. Now that national had gotten down a custom build, then actually building and linking onto…. But there was a level, and that was reflected in the report in terms of some of the pushing that was done, which was the command-and-control piece about that. There was a level of discipline required to continue moving ahead with the modules as they were being developed — and not that we were going to then, in addition to that, allow for the building of new modules.

D. Eby: One of the questions that I have about this is on the fact that British Columbia somehow was selected to head up this project. It seems to have had implications for us. I think, in reading the numbers — I know Mr. Brown’s going to get back to us on this — it looks like Ontario and Manitoba got implementation money, and we didn’t. As a result, it cost us more.

Also, I think we probably had to lean in. We put so much into this project. We were heading the project. I think it would be strange if we weren’t the province the furthest ahead in implementation, given our leadership role in this.

I fear, and I’d like to hear some comments on this, that we weren’t able to make the decision that was the best for British Columbians but rather the decision that was best for our role as the national leader in a project that went so terribly sideways.

Some of that is informed by the presentation we were given today from Mr. Brown. The key point that stood out to me about why we went to changing the contract and staying on with IBM rather than finding somebody else was that the federal funding horizon was due to end in 2009, and the provinces were not willing to participate without federal funding. Here we were in a situation where a decision was made not because…. Frankly, when I look at that list of bullets, that’s the bullet that convinces me — none of these other bullets. When I look at that one, that’s the one that says: that’s why we kept going with IBM.

Here we have a decision made in a context of federal funding, not necessarily the best outcome for British Columbians, and all of the partners agreeing, “Look. If we stop now, we might run out of money” — the music might stop, and then B.C., stuck in the lead chair of this, trying to sell this thing nationally.

I look at this, and I wonder: would we ever take on a role like this again? I wonder why we were here and how we got here and whether we would put ourselves here again — and whether Mr. Brown or Ms. Bellringer have any thoughts about whether any of that has the ring of truth or whether I’m off on an opposition fishing trip.

S. Brown: I don’t know about your latter question. If I was in the chair, I wouldn’t have had the choice. I would not be putting myself forward to lead a pan-Canadian IT project.

I got no sense, genuinely — when we were dialoguing over the last two weeks, reaching out to people — that there was that kind of pressure on B.C. There was a genuine debate that took place in Edmonton. Each of the jurisdictions, looking to their interests, were debating the pros and cons of: do we continue or do we step away from this project at that time? Each jurisdiction, including ourselves, then did actually vote to continue. It was a unanimous decision to continue. It wasn’t B.C. trying to persuade and cajole other jurisdictions to continue down this pathway.

I think you’re correct. I don’t know about the weight of the various factors, but it has been expressed to me several times the point that you have picked up on. Halfway through the project, with a commitment from CIHI to continue funding and to bring a substantive amount to get to the national build core components…. That was a key factor, with the unknown factor being: what would happen after 2009?

Perhaps — and I don’t know, because this is pure speculation — if it had been a 2012 date, there could have been a different weighing up of the factors. But in the context, that was one of the factors that played itself out.

I can absolutely say to you I’ve seen nothing that actually presented itself as though this was B.C. on the hook; B.C. was leading this.

My understanding, in terms of becoming the chair originally…. Dr. Kendall said to me that because we had a system in place — it’s referenced in the Auditor’s report; I can’t remember what the acronym stands for — iPHIS, which was a provincial system…. There was some expos-
[ Page 803 ]
ure and experience of trying to actually implement an IT solution. That seemed to play a role in terms of B.C. being asked to take on the co-chair role early on in the project.

Anything I’ve been told, I didn’t see it as: now we were championing and leading this. It was very much the full responsibilities of co-chairing and organizing meetings, but not in a sense of a bigger ownership, or guilt associated with that.

D. Eby: This is a challenge, Mr. Chair, in that obviously Mr. Brown wasn’t there. I do appreciate his best efforts at what he’s seen, anyway.

Had B.C. pulled out of this thing, the whole thing would have gone down the tubes. This was our project that we were leading. There was surely additional pressure on British Columbia to continue, given that without us, who would take the lead? I can’t imagine anybody, any politicians signing off on…. “Oh, we’ll take that over from British Columbia. That sounds like a great idea.”

S. Brown: I think that subsequent to that, with the 2008 crash, New Brunswick pulled out. I’ve not been left with the impression that everyone was tied in. It was very much a decision to stay and be part of, and at that point, everybody decided. A year later, I think because of some of the provincial impacts that occurred because of the 2008 crash, some of the jurisdictions either scaled back or made other determinations to suspend their engagement. I think it was New Brunswick that did that.

D. Eby: Well, I mean, certainly it wasn’t my impression that I wished to leave that everybody was tied in. My impression that I wished to leave was that B.C. was tied in, that we had extra pressures to stay and other provinces didn’t. Other provinces appear to have held off on implementation fairly significantly in comparison with British Columbia. Other provinces, you mentioned, pulled out entirely, and other provinces still seem to have gotten federal money for implementation that we didn’t get.

The impression I wish to leave is not that everybody was sort of tied in, in the same way. The impression I wish to leave, the one that I get from these materials, is that we were pressured to stay in, in a way that other provinces weren’t. We had less leverage to go to the federal government and say: “Give us some money for implementation. This thing’s a mess.” We were stuck there.

C. Bellringer: I won’t answer whether I think they should or shouldn’t have. The one comment I will make, though, is a lot of what we were able to see after the fact was, some of it, from conversations. The minutes did support a very active B.C. role. I would suggest that the minutes weren’t complete, though. A lot of the discussion that we’re hearing about from…. People would tell us the history of what had occurred. We were not able to see that in the minutes. We didn’t see something to the contrary, but we didn’t see it fully documented.

Especially in the event that B.C. takes a national role in something, I would suggest that any, in particular national, decisions be very carefully documented so that you can go back and demonstrate why a direction was taken at a point in time.

B. Ralston (Chair): Doubtlessly, this is the push and pull of a federal estate where provinces initiate in coordination with the federal government and other provinces. I wouldn’t want to see, again, the message coming here that we would want British Columbia to relinquish a leadership role in an important public health initiative.

My sense would be that British Columbia’s role in the SARS outbreak in 2003, where the SARS virus genome was sequenced here in British Columbia very quickly, may have provided an incentive to consider national leadership in some of these public health outbreaks. But that’s probably speculation on my part.

However, I do have a question. I put myself on the list, having exercised the prerogative of the Chair for a broad comment. On page 37, part 2, “Why Did Things Go Wrong?” — and Mr. Brown, you alluded to this in some respects when you said that dealing with the health authorities was somewhat like herding cats — the language here that’s used in the Auditor General’s report is quite strong and quite cutting.

“From the project outset, the ministry employed a ‘command and control’ leadership style. Numerous letters to the health authorities from senior officials, including the Minister of Health, stated that implementation of Panorama in accordance with the ministry’s schedule was not optional. In fact, the health authorities were told at a meeting with the ministry that if they did not implement Panorama, they ‘would not get another dime’ — for public health IT — ‘for another ten years.’ The ministry perceived the health authorities to be resistant to change. When health authorities tried to raise concerns around the safety and efficiency of the system, they were often dismissed and/or painted as troublemakers and warned to stay quiet.

“This had a silencing effect on joint ministry–health authority committees such as the provincial executive steering committee. Members stopped speaking up, which the ministry interpreted as agreement with their approach. In reality, some were afraid that doing so would put their jobs at risk. The ministry’s discounting of health authority concerns, combined with fear among health authority staff to raise concerns, resulted in the ministry missing or ignoring important issues. This caused delays and led to higher costs.”

That’s a very sweeping indictment of the managerial practice of your ministry. You’ve alluded to it, but I’d ask that you confront those comments directly.

S. Brown: I would repeat again that in the last two years, we’ve done a lot of work on governments and
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interface between ourselves and the health authorities, between boards and minister in terms of it, but there is a fundamental challenge to delivering services in any jurisdiction. You’ve seen various situations of this across jurisdictions. You’ve seen Alberta attempt to go to a single health authority. B.C. has always, over the last ten years, strongly valued the role of the regional health authority being closer to the needs of their community.

In terms of a global budget and in terms of services to the population, we canvass regularly in the House and through the media the desire to create a system of care for B.C. that works across B.C. while, at the same time, creating space for the individual, the unique response at a community level.

From a management point of view, I don’t believe there’s a single formula. There’s an accommodation and debate that takes place about where to actually settle that on any given day. I would say that it’s the same struggle for the HAs. You see on a given day where they’re trying to get some standards across the region, and then at a local level, you’ve got the diverse range of opinions about what should be happening with services.

I don’t want to make it an excuse, because I really think we’ve tried to work about how you have good professional relationships and good debate. But the health system is an inordinately complex set of relationships that occur between ministry, health authorities, clinicians, unions. There’s a level of tension that arises, and sometimes things are said, and issues are resolved. But I would say we have tried to confront the issue. We acknowledged to the Auditor that that has got important consequences if we get it wrong.

Certainly, this will be one of the issues that we’ll be visiting when we dialogue this at the leadership council in a couple of months’ time to make sure that we are continuing to go in the right direction. I believe we are, and I believe there’s been some learnings.

It’s not just about the IT project. It’s learning about, to what the member said, what the relationship is between an HA and the ministry and how best to define that relationship in the context of broader government.

B. Ralston (Chair): Well, I don’t think you’ve really grasped the nettle here or answered the question directly. I mean, what is being said here is that systemically, the management style and practice of the ministry in its dealings with the health authorities is command and control, intimidation, silencing criticism and, therefore, not having a constructive dialogue and, in the end, driving up costs. Do you reject that? Is it happening now? You haven’t answered that question directly, if you’ll forgive my comment.

S. Brown: I would say that it’s not happening now, to my knowledge. I’d say we’ve done significant work, which is what I’ve said, in terms of working that relationship. But at the same time, are there dynamics that occur in terms of moving ahead with projects that are complex and big, with multiple facets? Yes, there are dynamics, the same dynamics you see play out at a community level, of different people with different interests. Then you try to push ahead to make certain decisions which, at the end of the day, you think are the best decisions.

Is the tone and some of the tone that occurred…? Has there been the issue of certain issues not coming forward, potentially? I can’t say that’s not the case. But I’d say there’s been some serious work underway to actually address that issue.

B. Ralston (Chair): My question, then, would be also to the Auditor General. In the follow-up audit or the follow-up on the implementation plan, the action plan, is there any intention to further pursue this issue?

C. Bellringer: One of our recommendations — the fourth one, I believe…. We did make a recommendation that the ministry review its current leadership practices and develop a collaborative leadership strategy.

The information that came to us was certainly in the context of this project, so we didn’t make a conclusion across the ministry as a whole. We made that recommendation around future IT projects. We did identify a project within the three-year plan, again, to look at leadership issues within the Ministry of Health so that we could determine whether or not there is something systemic going on or, if there was, that it’s been remedied.

K. Corrigan: Following on some of the recent questions, we have on page 37: “In early 2014, after hearing concerns about the Panorama system and its impact on the region’s immunization rates, the Fraser Health board of directors ordered an independent study of alternatives. The ministry directed Fraser Health to cancel this study shortly before it was to be completed.”

In the action plan, the recommendation from the Auditor General was that there be an independent review of Panorama commissioned: “Commission an independent review of Panorama and other alternative systems to identify the most cost-effective, integrated approach.”

I would also point to the Auditor General’s comments just a few minutes ago that it was surprising to find, when we were taking a leadership role nationally, there was nothing in the minutes that would really indicate exactly what was going on in terms of negotiations and so on. There seems to be nothing publicly that I can find. I’ve done some Google searches, in preparation, and was trying to find out what the progress report was.

This all, to me, seems to point to a determination to keep, along the way and maybe even continuing, this under wraps and as quiet as it possibly can be. I guess my question…. It is a bit of a challenge. Is that not the case?
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Why were there no public reports in all of those years that would have indicated to the public and the taxpayers that there were problems with this process? And there were problems. It’s very clear from the report. I guess, most immediately, why is it that the recommendation to do an independent review has been rejected?

Now, I know the ministry has said…. Your comments are that it’s been decided that Panorama is probably the best system, so you’re going to look at it. But I think that repeatedly, various agencies or boards or individuals and the Auditor General have said that there should be an independent look at this. I would add that it should be public. I’m wondering why there is this sense that that is not the way the ministry wants to go.

S. Brown: I think I tried to answer that earlier in the sense that we determined that there was not a product that was available right now. On reflection, I made a step two weeks ago to say that we would do a formal look on an annual basis. That will be public going forward, and it will be reviewed by some independent experts who we’ll bring together to look at the broader set of issues that were brought forward from this report, which will be part of subsequent report-outs on this process.

With respect to the minutes, because of the questions that were asked at the last session, I have had chance to look at some records myself — probably not to the same degree, in any shape or form, that the Auditor did, but that’s why I acknowledged that I think we need to get some clearer policy standards for ourselves about what kinds of record-keeping we do.

There are lots of records for changes that I was able to see in terms of change orders. But in terms of the questions from the members about what the thinking was, we need to look at how we actually record that so that it’s clearer, particularly for something like this, which is a multi-year project — so that if it’s looked at a number of years later, there’s some level of clarity as to what was the thinking at the time.

K. Corrigan: Was there any public reporting from the time that the contract was first signed through to, up until this report? Was there any public reporting on what was happening with the Panorama system?

S. Brown: The Auditor may know the answer to that. I do not know the answer, but I will check into that. I will, through the Chair, get an answer to you.

G. Heyman: To your response to the first Auditor General recommendation for the independent review, which you’re not doing. You are planning, as you’ve said, to undertake an annual survey of Panorama end-users and an annual environmental scan to evaluate other compatible public health products.

My question is twofold: one, are you planning to consult with the Auditor General’s office or anyone else on the parameters for the survey and the scan?

My second question is to the Chair. I would ask that the Chair request both the parameters as well as the results of at least the first survey and scan be submitted to the committee. I’ll have a follow-up question after.

S. Brown: With respect to the first part of your question, I’d be quite pleased to consult. We’re working on a number of…. We actually worked through audits in different kinds of ways, and we’ve engaged the Auditor early on in the process with the Cerner. I’ve got no issue with any advice the Auditor may want to give me in terms of sharing what we’re doing and any thoughts she may have that might better strengthen the process.

B. Ralston (Chair): As to the other request, I think in terms of reporting back to the committee on the progress of the action plan, Mr. Wall, who serves the committee, has noted that request. That will be something we can pursue when the report comes back.

G. Heyman: On the fourth recommendation regarding the review of leadership practices and moving away from the command and control model — I know from personal experience that it takes quite some time to both change organizational culture and even longer to change the belief system of people transitioning from one organizational culture which, for wont of a better word, they felt constrained by to one in which they believe there is more openness.

My question is: are you planning to commission any outside body to survey or interview staff, at some point, to see how they’re perceiving the changes in organizational culture — whether they believe it’s actually taking place and whether it’s having an impact?

S. Brown: To be honest with you, no, not at this stage. I’ll just let you know we’re doing another piece of work. We’ve got the HA-ministry one, which is what you’re raising, which is a key relationship. But the other key relationship is: what is the relationship between ministry and health authorities and professional groups like physicians, nurses and so on? There’s other work that’s going on in terms of: how does that engagement look?

We’re having active discussions around: what is the role of clinical autonomy versus being part of an organization, and how do you balance that off? It would be premature, to be honest, in my judgment, to do anything by looking at reviewing that right now.

What I can say, generally, is that there’s a lot of work going on with various groups — dialogue with the nurses for sure; dialogues with the colleges; dialogues with
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Doctors of B.C.; as well as the work that I referred to between the HAs and the ministry, where we’re really working to clarify roles in decision-making and the processes associated with that.

At a given point in time, that might be a very good piece of advice to take, which is to actually then evaluate if we are making the right kind of progress in what is a very complex culture.

G. Heyman: I look forward to hearing more from you about how this is progressing, as well as any additional steps you decide to formally take in the next report.

What I’m going to suggest, and I’ve conferred briefly with the Deputy Chair, is that this be adjourned. There are a number of answers that Mr. Brown has offered and that will be forthcoming.

Then the management subcommittee of the committee will schedule the next meeting, the reconvened meeting, of this particular consideration of this report.

At this point, we don’t have any further meetings of the committee scheduled, so the subcommittee will be meeting and making that decision shortly, I think.

S. Sullivan (Deputy Chair): For the comptroller general, we’ve heard that there are processes that have to be gone through for getting a proper response. We see that not everything is in place, because certain meetings had to take place. I was wondering if you could consider how much time we need to give between the moment that a report comes out to when we call a ministry in for a meeting. Perhaps we can discuss that at a subcommittee level.

B. Ralston (Chair): I think that’s probably something that we could take advice of the subcommittee, which consists of myself, the Deputy Chair, George Heyman, and Mike Morris. We’ll consider that as well. I think that’s a good suggestion. Thanks, Sam.

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Chair:	Bruce Ralston (Surrey-Whalley NDP)
Deputy Chair:	Sam Sullivan (Vancouver–False Creek BC Liberal)
Members:	Kathy Corrigan (Burnaby–Deer Lake NDP)
	David Eby (Vancouver–Point Grey NDP)
	Simon Gibson (Abbotsford-Mission BC Liberal)
	George Heyman (Vancouver-Fairview NDP)
	Marvin Hunt (Surrey-Panorama BC Liberal)
	Vicki Huntington (Delta South Ind.)
	Greg Kyllo (Shuswap BC Liberal)
	Mike Morris (Prince George–Mackenzie BC Liberal)
	Lana Popham (Saanich South NDP)
	Linda Reimer (Port Moody–Coquitlam BC Liberal)
	Selina Robinson (Coquitlam-Maillardville NDP)
	Ralph Sultan (West Vancouver–Capilano BC Liberal)
	Laurie Throness (Chilliwack-Hope BC Liberal)
Clerk:	Kate Ryan-Lloyd

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