Technical Debt eHealth Saskatchewan 26 October 2020 ISSUE: eHealth’s current technical/infrastructure debt must be resolved. As the health care system transitions from paper to digital, health care IT systems require substantial upgrades to meet increasing demand and to ensure patient safety. Over the past five years, funding has remained virtually static. Hardware and software is now out of date. System failures are increasing as is the cost of maintenance. KEY MESSAGES:  eHealth Executive Leadership Team estimates the scale of the infrastructure deficit at approximately $150 million.  To meet current expectations of customers and mitigate unacceptable risks to patient safety, eHealth will require an additional investment of $50 million per year above its historical base budget for the next three fiscal years.  Prior to amalgamation, health regions dealt with IT renewal on an ad hoc basis. Problems were solved through one-time capital allocations, taken from base budgets. Since amalgamation, this no longer takes place.  After several years of limited investment in renewal, eHealth is now in the position of having to assume responsibility for this burgeoning technical debt.  We’re falling further behind; our equipment has a lifespan of four years, and at current levels of funding, it will take 12 years to recycle that equipment.  Equipment can be used beyond its lifecycle. However that increases the cost of support, vulnerability to attack and the likelihood of failure.  A major equipment failure which may disrupt service and risk lives appears inevitable with the current funding model. eH 04-20G - Responsive Records Package Page 2 of 37 Background Analysis  eHealth provides IT equipment and support to roughly 400 health care facilities across the province.  Some of the equipment is so old, automated systems can’t be used to identify the PCs and laptops that are currently connected to that system.  No archival records exist of what’s being used by whom, given amalgamation.  Major outages that impact patient care delivery are increasing at a rate of 25 percent per year.  Close to a quarter of the PCs in the health care system are more than five years old and running on old operating systems. This makes it impossible to apply the latest and most up-to-date security patches.  The Electronic Health Record runs on an Oracle database and has reached the end of its useful life.  This health record is considered to be foundational to the Saskatchewan health care system. It collects and manages patient results, records and documents from multiple points, producing a single health record.  This platform has been in use since early 2010 and the technology we are using is no longer supported.  The Pharmaceutical Information Program (PIP) has not been upgraded since 2015 and requires major updates to maintain stability.  PIP uses several different technologies including Java 7, which IBM will soon no longer be supporting.  Saskatchewan’s Provincial Auditor continues to make urgent recommendations for improvements to the security and reliability of health care IT systems. eH 04-20G - Responsive Records Package Page 3 of 37  The most recent recommendations can be found in the Auditor’s 2020 Volume 1 Report, released on the 23rd of June, 2020, dealing with improved security for portable computing devices  Without significant additional dollars, eHealth is not in a position to address these significant recommendations.  Some recommendations dealing with disaster recovery and business continuity date back to 2007 and remain unaddressed.  Further investment in Core Infrastructure is a vital priority, if eHealth is to transform from current aging regional infrastructure on to a more solid foundation.  An investment of many millions of dollars is required to upgrade and replace key components like application load balancers, compute hardware and communications hardware.  Failure to take these steps will increase the chances of complete hardware failures resulting in the collapse of existing systems.  System failures could include admitting/charting and hospital registration systems, laboratory diagnostics, medical imaging diagnostics, hospital pharmacy systems, contact tracing, vaccine inventory and public health services as well as MySaskHealthRecord.  Limited infrastructure will also delay the possible introduction of new clinical applications in the future.  Our health sector partners continue to demand a solution to inefficiencies in the health care email system. The current email infrastructure supports 63,000 mailboxes in 15 different email environments.  Problems exist with delays in the delivery of email and challenges with duplicate mailboxes. Users are often forced to deal with a long list of incompatible programs and nuisances that cause frustration and waste time.  The current system cannot meet the needs of the health care system and that has an impact on workflow, which can impact patient care. eH 04-20G - Responsive Records Package Page 4 of 37  Demand for more mailboxes and larger mailboxes is causing massive growth in the email system. Additional infrastructure is needed, including more storage, licenses and staffing. From the September 2021-22 eHealth budget submission to Saskatchewan’s Ministry of Health: By the Numbers - Information Technology On-site Technology: o 21,000 desktops and devices o More than 6,000 mobile devices o 6,000 printers o More than 5,000 virtual desktops Network Connectivity: • 2,100 Wireless Access Points Unified Communications: • Approximately 20,000 patients supported by Telehealth • 20,000 phones • Approximately 23,000 Webex meetings quarterly Data Centre: eH 04-20G - Responsive Records Package Page 5 of 37 FOIP 16(1)(c)