An Analysis of Ontario's Electronic Health Record Project

Project Fiasco: An Analysis of Ontario’s Electronic Health Record Project

A Thesis Submitted to the College of Graduate Studies and Research In Partial Fulfillment of the Requirement For the Degree of Masters of Public Policy In the Johnson-Shoyama Graduate School of Public Policy University of Saskatchewan

by Paul Kostas Havele Bretscher

In presenting this thesis in partial fulfillment of the requirements for a Graduate degree from the University of Saskatchewan, I agree that the Libraries of this University may make it freely available for inspection. I further agree that permission for copying of this thesis in any manner, in whole or in part, for scholarly purposes may be granted by the who supervised my thesis work, or in their absence, by the Executive Director of the Johnson-Shoyama Graduate School of Public Policy or the Dean of the College of Graduate Studies and Research. It is understood that any copying or publication or use of this thesis or parts thereof for financial gain shall not be permitted without my written permission. I is also understood that due recognition shall be given to me and to the University of Saskatchewan in any scholarly use which may be made of any material in this thesis.

Requests for permission to copy or to make other use of material in this thesis in whole or in part shall be addressed to:

Johnson Shoyama Graduate School of Public Policy, University of Saskatchewan 101 Diefenbaker Place Saskatoon, Saskatchewan S7N 5A5

i Project Fiasco: An Analysis of Ontario’s Electronic Health Record Project

Paul Bretscher Johnson-Shoyama Graduate School of Public Policy, University of Saskatchewan

Suggested Citation Bretscher, P.K. Project Fiasco: An Analysis of Ontario’s Electronic Health Record Project. M.P.P. Thesis, Johnson-Shoyama Graduate School of Public Policy. University of Saskatchewan: 2011.

Abstract

Policy failure is a recurring theme in large government technology projects. The Ontario Electronic Health Record (EHR) project is one of the most recent, and high profile, Canadian examples.

The EHR project had two main phases – the design phase (in which the architecture of the system was determined) and an implementation phase (in which the operation of the system was carried out). This study has two objectives: first, to develop a set of frameworks that can be used to understand the design phase and the implementation phases; and second, to use these frameworks to describe and to understand why the EHR initiative was so unsuccessful.

To facilitate an understanding of the implementation phase of a project, a game theoretic framework is employed that classifies technology solutions as either independent or interdependent. When solutions are interdependent, the framework suggests that, in order to obtain the greatest value, the government should exert its authority to ensure the coordination and cooperation of the actors in the system.

To understand the design phase of a project, a framework is developed that links together the nature of the problem with the type of organization best suited to solving the problem. I argue that the complexity, or decomposability, of a problem directly affects the optimal method of a search for solutions, and the optimal means of organizing that search.

These two frameworks are then applied to Ontario’s EHR project to analyze why the EHR project was so unsuccessful. I conclude that decision makers failed to consider the interdependent nature of EHR solutions; instead, they encouraged independent actors to develop their own ehealth solutions, effectively undermining the provincial goal of an interoperable system. I also conclude that decision makers misdiagnosed the nature of the EHR problem, resulting in an ineffective search

ii procedure to locate an EHR solution. These two errors resulted in a policy fiasco tha