Courtyard Group commends Auditor General's report on eHealth initiative

Courtyard Group today responded after reviewing details of the Ontario Auditor General's report on the eHealth initiative. Courtyard congratulates the Auditor General on a very comprehensive report and welcomes the clarity it brings to a very complex situation.

From the time of the first media stories in the spring of 2009, Courtyard Group has not spoken publicly about its involvement in the eHealth program.

"It was a terribly awkward situation to be in," acknowledged Managing Partner David Wattling, "but we thought it best to let the Auditor General do his work and we cooperated with him fully in that regard."

Courtyard's Work in Perspective

Of the 486 consulting contracts in the eHealth Programs Branch of the Ministry referenced in the Auditor General's report, 37 were held by Courtyard, 28 of which were obtained through competitive bidding processes under Courtyard's Vendor of Record arrangements with the Province. As revealed by the Public Accounts of Ontario, eHealth expenditures paid to consulting firms over the last seven years total more than $288,000,000. Less than 4% of this amount was paid to Courtyard, with several other consulting firms having a much larger presence.

Courtyard Group Authored Successful 2009 Ontario eHealth Strategy

The Auditor General found that the lack of an eHealth strategy ("Consequences of Not Having a Strategic Plan 2002-2008" - page 18) was the principal cause of upwards of a billion dollars being spent with minimal benefits for patients. For many years, Courtyard and its principals were openly critical of the approach taken by the Smart Systems for Health Agency. The Auditor General's report validates Courtyard's concerns and documents the colossal waste that resulted. Courtyard never worked for SSHA.

Courtyard Group is the company the Auditor refers to on page 19 ("The 2009 Strategic Plan"). When the government realized that SSHA was off track in 2007, the Ministry of Health launched a competitive process to select a company to draft a practical eHealth strategy that focused on meeting the needs of patients and their caregivers. Courtyard was the winning bidder.

The plan we developed drew on Courtyard's deep healthcare expertise and international experience in building systems that clinicians find useful to provide better healthcare for their patients. As the Auditor General notes, when eHealth Ontario was created in fall 2008, an eHealth Strategy building on the one developed for the Ministry was completed with Courtyard's support. It was publicly released for comment and finalized in March of 2009 - four months from the creation of the new agency.

This is the reason Courtyard was contracted by eHealth Ontario - to complete the work we had already started under contract with the Ministry of Health.

As the Auditor General states on page 20 of his report: "To its credit, the Plan sets out a number of concrete targets and deliverables on each of the key EHR components. It thus represents a major step forward in crystallizing the government's eHealth priorities and plans, and communicating these to stakeholders."

Courtyard Group has also worked successfully with eHealth Ontario on two of the three deliverables referenced on page 19 of the report:

1. The diabetes registry, which will make patient data electronically accessible to help ensure better care for diabetics; and 2. The ePrescribing and Drug Information system and the successful pilots that have been implemented in the Georgian Bay region and in Sault Ste-Marie.

No Indication of Political Ties

Courtyard has a long-standing, explicit written policy of not supporting political parties. "We work with governments and healthcare providers across Canada and internationally to improve healthcare for their citizens, we do not work for political parties," Mr. Wattling emphasized. The Auditor General stated on Page 11 of his report that, "we were aware of the allegations that 'party politics' may have entered into the awarding of contracts and that those awarding the contracts may have obtained a personal benefit from the firms getting the work-but we saw no evidence of this during our work."

Courtyard Group has over 150 healthcare specialists, many of them physicians, nurses and pharmacists, working on projects to improve healthcare across Canada, the United States and the United Kingdom. We have not and will not obtain work through political connections. We rely on our expertise and our track record to win contracts.

Procurement Practices

The Auditor General in his report acknowledged that Courtyard Group was "undoubtedly well qualified to assist the Ministry on eHealth matters" (page 41), and with respect to procurement concerns, specifically noted that "our observations about procurement practices involving private sector consultants apply only to the actions of public servants. They are in no way intended to pertain to or reflect on any practices that consultants followed or their performance." (page 7)

Much has been made of Courtyard's success in winning new contracts and repeated contract extensions. This has led some to speculate on how we became "entrenched" or why some clients became "dependent" on Courtyard. The answer is very simple. It is the unique clinical perspective that we bring to our engagements. No other company in Canada has a team of 25 health professionals who understand how to design and deploy technology that health practitioners will use. In most of our engagements with government, Courtyard staff were the only health professionals on the team. Lose that perspective, and we risk returning to building expensive computer systems that nobody will use.

We acknowledge that procurement processes have been very poorly managed in healthcare in Ontario. The Auditor's report makes it very clear that procurement problems are endemic to the whole system. However this is neither Courtyard's responsibility nor expertise. We focused on bringing a health professional's perspective to the eHealth effort - the missing ingredient that resulted in so much wasted effort over the years.

"There was a sense of lost time which resulted in great urgency to act quickly. Senior officials were requesting statements of work, approving new mandates and demanding quick deliverables," said Dr. Guerriere. "We did not stop to inquire whether our clients were following applicable guidelines in awarding us work. Clearly in retrospect, we should have."

Courtyard has changed its standard contract terms and conditions to require clients to confirm in writing that they have complied with all of their internal procurement rules before work is started.

Focus on Improving Healthcare for the People of Ontario

There remains a great deal of work to be done. Procurement processes must be tightened up, and Courtyard welcomes that development. It will protect all parties involved in the eHealth effort and ensure that taxpayer dollars are invested wisely. We look forward to participating in a marketplace where the rules are clear and consistently applied to all participants.

Notwithstanding the problems that have come to light in the past several months, the eHealth agenda remains essential to improving the quality and efficiency of our healthcare system. Courtyard is proud of the contribution we have made to the eHealth Strategy and its adoption, and we hope to continue our efforts to ensure that the needs of health professionals and patients are incorporated into the systems we develop in the future.