This is a story about a potential half-billion-dollar health-care services contract, alleged cozy dinners between bidders and bureaucrats, an unusual legal letter and accusations the government’s tender process was unfair.
The planned purchase of a new provincewide electronic health record (EHR) system — expected to cost in the hundreds of millions of dollars — is among the largest public-sector procurements in Nova Scotia history.
The final tender for the One Person One Record (OPOR) project went out in June 2017. Two of the biggest companies in the EHR industry — Cerner and Allscripts — were the only firms allowed to bid, based on results of a qualification round.
A final decision could be announced this fall.
But as government’s 16-month evaluation of bids from the two U.S.-based companies nears a conclusion, serious questions are being raised about the process and whether it will yield the best deal possible for the province.
What is OPOR?
Simply put, OPOR’s vision is for Nova Scotians to have individual single health-care records that could be accessed electronically by health-care providers — wherever and whenever needed — in any part of the health-care system.
OPOR would replace the three existing computer networks in hospitals across Nova Scotia with a single, integrated core clinical information system. Eventually, it’s hoped the project will also connect with a significant number of additional stand-alone, specialized health-care computer applications across Nova Scotia. Many of these systems now can’t talk to each other.
OPOR partners include the Nova Scotia Health Authority, the IWK Health Centre, the Department of Health and Wellness and the province’s Internal Services Department.
But there’s been sharp criticism, including questions about some bureaucratic decisions, regarding the OPOR tender process.
One company left off the final tender, Alabama-based Evident — in relative size, a David to the Goliaths of the sector — has claimed the competition was rigged by members of the health authority to favour the finalists.
Another firm, Epic a growing global giant that trails only Cerner in size — was disqualified in strange circumstances and not allowed to even take part in the competition.
And industry heavyweight Meditech, the current provider of EHR hospital services in much of Nova Scotia, was surprisingly — say industry observers — dropped from the final tender list. That’s unusual, multiple sources say, because incumbent firms are routinely included in final procurement rounds, at least as a baseline for comparison.
Much of the information for this story has necessarily come from unnamed sources. Certain individuals only agreed to speak if they could stay anonymous, as they feared government retribution in one form or another. This article relies most heavily, however, on named sources and authenticated documents and emails.
A TIMELINE OF EVENTS
The story begins with government’s initial approval of the One Person One Record strategy in December 2014.
In July 2015, Keltie Jamieson became the health authority’s senior director and chief information officer, information management & technology. The OPOR project was part of her responsibility.
That same month, RFP Solutions, an Ottawa-based company, was hired by the province as the fairness monitor for the OPOR procurement process. The first stage — what’s called a request for supplier qualifications (RFSQ) — wouldn’t come until January 2017.
In March 2016, Jamieson, in an email, told a member of the Evident consortium of companies that NSHA officials would not be meeting with any potential bidders.
That email plays a key role in Evident’s complaint. More on it later.
In December 2016, the Health Department indicated a tender for OPOR was coming; a call-in was held for prospective vendors. In January 2017, companies interested in bidding were asked for RFSQ submissions to show they could do the job. The deadline was Feb. 17.
Six EHR companies — including three of the biggest, Allscripts, Cerner, Epic, along with Meditech, smaller Evident and smaller yet Harris Healthcare Group — submitted packages.
Epic was disqualified for missing the deadline. Harris Healthcare’s proposal didn’t advance past initial screening.
Proposals from four companies — Cerner, Allscripts, Meditech and Evident — were evaluated and scored by a 32-member selection committee, with representatives from the health authority (10), the IWK (8), Health Department (7), Internal Services (4), Finance and Treasury Board (2) and Transportation and Infrastructure Renewal (1).
The RFSQ had stated up to five companies could be short-listed. But in early June 2017, Allscripts and Cerner were named the only finalists.
That surprised many observers.
This is a major project, likely measured in the hundreds of millions of taxpayers’ dollars, sources said. The final contract could be for a decade or more. The choice of vendor will no doubt impact the province’s entire health-care system for years to come.
Yet government shortlisted just two firms, based only on a 50-odd-page RFSQ submission from all bidders. No vendor systems were seen. That’s stunning, one source said.
ALLEGATIONS OF BIAS
At this point, Evident, one of the companies not shortlisted, cried foul.
The Chronicle Herald obtained copies of the company’s official complaint, the government’s response and the company’s rebuttal letter.
Using the province’s procurement complaint protocol, Evident sent its complaint to the RFSQ contact, Angela MacKenzie, category manager at Internal Services procurement, on Aug. 4, 2017.
It contained explosive allegations of unfairness in the procurement process.
“Evident believes that leadership at NSHA have undermined the process and that a fair and transparent process is not unfolding in N.S.,” stated the complaint. “Cerner and Allscripts both had access to NSHA, which put them in a favourable position to score higher in the RFSQ process.”
The complaint alleged representatives of the two companies named, or of their consortiums, were given access to government officials that Evident did not receive.
It also questioned other parts of the process, including the scoring system to determine finalists and a lack of emphasis on potential economic development.
Alan Haaksma, Evident’s director of business development, was listed as the company’s contact on the complaint. Haaksma confirmed for us that the documents (complaint, government response and company rebuttal) were authentic but had no other comment.
In response to The Chronicle Herald’s questions about the complaint, Evident issued this statement:
“Evident became aware of the OPOR opportunity in 2015 and have built some great relationships with local N.S. companies and individuals within government. We still believe Atlantic Canada has the opportunity to leverage a procurement of this magnitude to develop an entirely new Digital Health Innovation District. Evident is currently making good progress in the region and other sectors in Canada,” the company statement said.
“We trust the information you referenced in Evident’s formal complaint regarding OPOR could answer any remaining questions you might have about our experience in N.S.”
Here’s Evident’s complaint — alleging a huge government health-care tender had been seriously compromised by bias — in more detail.
The complaint names the health authority and, in particular, two of its officials — its chief information officer and its director of clinical applications — as allegedly in a “significant conflict” of interest regarding Cerner and Allscripts.
At the time, Jamieson was the health authority’s CIO and Drae McQueen was its director of clinical applications.
(In August 2018, Jamieson became the authority’s senior director of the One Person One Record program. McQueen left government in May 2018 to become a private consultant.)
“The two NSHA individuals mentioned above have extensive knowledge of Allscripts but have not provided Evident with any access and have acted disingenuously over the last 18 months, so as to appear to have purposely blocked us out,” Evident’s complaint said.
Evident’s allegations of favouritism are based on that March 2016 email from the health authority’s CIO, Jamieson. The email seemed to suggest there was a moratorium on meetings between the authority and potential vendors.
“Although we are not in a formal RFP, we are not meeting with vendors at this time,” Jamieson told Bob Daigle of Nova Scotia-based Mobia Technology Innovations, a member of Evident’s consortium, in a March 22, 2016, email.
“I will pass your name to the team, and they will be in touch once it is ready,” Jamieson wrote.
When contacted by this newspaper, Daigle, Mobia’s vice-president of healthcare and government, said the email — which the Herald obtained from a non-Mobia source — was authentic but had no further comment.
Despite that apparent ban on health authority officials meeting prospective vendors, other companies were getting access to government officials, Evident’s complaint said.
DINNER AT PRESS GANG
For example, the complaint alleged, Jamieson and McQueen were seen having dinner at Halifax’s Press Gang restaurant with a member of Gevity Consulting, which the complaint said is part of the Cerner consortium, in May 2016.
That was less than two months after Jamieson’s “no meetings” email, the complaint said.
Meanwhile, Evident’s complaint and other sources pointed to a series of monthly talks on health-care information technology presented by the health authority — the Let’s Talk Informatics series — as further evidence of allegedly unfair access given to certain potential vendors.
The talks were open. The audience was a mix, with government bureaucrats, including many from the health authority, health-care providers such as doctors, representatives of health-care companies and others, sources said.
According to the Let’s Talk Informatics archive online, representatives of two companies interested in the OPOR contract — Allscripts and Gevity Consulting (the latter was a member of the Cerner consortium, the Evident complaint said) — were featured speakers at Let’s Talk Informatics sessions during 2016.
Evident’s complaint focused on an October 2016 presentation by Dr. Robert Leviton of Allscripts, stating the “Allscripts VP & CMIO started the presentation by thanking NSHA staff for the great evening at the Bicycle Thief and proceeded to promote the Allscripts solution.”
Oddly, the above event can no longer be found in the health authority’s Let’s Talk Informatics’ website archive which otherwise lists sessions back to January 2016. This newspaper has obtained both an invitation to the Oct. 27, 2016, presentation by Leviton, Allscripts vice-president for quality and outcomes and CMIO, as well as his slide presentation, titled The Power of Allscripts.
We asked the health authority about that missing session but received no explanation.
Sources also pointed to other Let’s Talk Informatics presentations, in January and June 2016, by Allscripts representatives. As of Wednesday, those were still listed in the health authority archives, but links to session materials and recordings no longer worked.
Health authority officials had no direct response to questions about who had been responsible for inviting Let’s Talk Informatics speakers or why some links didn’t work.
We reached out to Allscripts, Cerner and Gevity Consulting.
In an email, Allscripts spokeswoman Concetta Rasiarmos said the company “conducts itself in accordance with the procurement rules of its clients and potential clients.”
The province released a notice of proposed procurement for the OPOR project on Dec. 6, 2016, she said. At that point all companies, including Allscripts, “were made aware that they were not permitted to meet with Nova Scotia government officials regarding the OPOR procurement,” wrote Rasiarmos.
Asked whether Allscripts was aware of any moratorium in place as of March 2016, Rasiarmos responded: “Please refer to the timelines above pursuant to when the OPOR terms and conditions and tender documents were released by Nova Scotia Procurement.”
In response to questions about Allscripts presenters appearing at health authority-sponsored events, Rasiarmos said Shaha had been asked by a health authority official to repeat a session he had given at Halifax’s big data conference the preceding fall. Meanwhile, Navqi and Leviton “were offered by Allscripts to support NSHA’s Let's Talk Informatics series as experts in their clinical fields,” she said.
“All Allscripts presenters delivered their publicly advertised informational education sessions prior to the issuance of the notice of proposed procurement (NPP),” on Dec. 6, 2016, she said.
Prior to that date, Allscripts also had meetings with NSHA and other government officials “to discuss health IT, informatics, and general health-care knowledge and experiences,” Rasiarmos wrote.
We received no responses to questions about the above sessions or the allegations in Evident’s complaint from Cerner. Gevity Consulting declined comment.
In the fall of 2016, Evident’s consortium made an unsolicited OPOR proposal to the province. That proposal was rejected. But Chris Mitchell, the province’s chief procurement officer, told the company in a debrief that “our proposal hit the mark” and that he “strongly encouraged us to bid on the upcoming procurement process,” the company’s complaint stated.
We sought confirmation from Mitchell but government’s response — covered below — did not address that point.
That same fall, the complaint said, Jamieson told “an Evident consultant that she is not impressed that ‘a small hospital company’ thinks that they are able to service the needs of NSHA (large teaching hospital).” Jamieson allegedly also told the same individual that “her director of clinical applications comes from a hospital in California where she implemented AllScripts previously.”
We reached out to Jamieson, through health authority communications, to ask about the “no meetings” email and Evident’s other allegations, but received no direct response.
RESPONSE TO COMPLAINT
Evident’s complaint was rejected by the Nova Scotia government.
“Procurement has determined that any potential conflict of interest issues relating to the procurement process have been addressed and that all respondents were treated in a fair, open and transparent manner, therefore the RFSQ will not be cancelled,” Mitchell wrote in a Sept. 26, 2017, response addressed to Evident’s Haaksma.
A procurement review committee studied the complaint, Mitchell wrote. That committee went over evaluation notes and scores for the RFSQ. “No bias or preference was detected.”
A fairness monitor also kept an eye on the technical evaluation consensus process, found it followed proper procedures and that results “reflected the consensus of all members of each evaluation committee,” he wrote.
“The fairness monitor has confirmed that no fairness concerns were observed,” Mitchell wrote.
In an undated rebuttal letter, Evident’s Haaksma said the government’s response ignored many specifics of his company’s claims, including conflict of interest.
“Our competitors had access to NSHA executives. NSHA provided them with a provincial forum (Let’s Talk Informatics) to demonstrate their systems and bolster their value proposition on a provincial level,” Haaksma wrote. “This type of access also provides our competitors with key insights into NSHA’s strategy, putting them in favourable position to respond to the RFSQ.”
The rebuttal stated Evident’s concerns about competitors having unfair access through the Let’s Talk Informatics sessions had been shared with the Health Department’s chief information officer.
“The DHW CIO agreed this was an issue but was not able to stop it,” Haaksma wrote.
Haaksma was likely referring to Sandra Cascadden, associate deputy minister in the department’s chief information office.
We asked the Health Department directly about Evident’s claim regarding Cascadden but received no explanation.
In fact, in response to inquiries to the health authority, the Health Department and the Internal Services Department, we received an email from Internal Services spokesman Brian Taylor conveying the government’s response to all our questions.
His email did not address issues cited in many of our queries. That includes questions about Jamieson’s March 2016 email, speakers for the Let’s Talk Informatics sessions and other specific allegations from Evident’s complaint.
The government spokesman’s email maintained the procurement process, including review of any complaints, was thorough and fair.
That included oversight by a fairness monitor “engaged throughout the entire process, including evaluation,” wrote Taylor. The monitor reported the process “was carried out in a fair, open and transparent manner” and government had acted “with the utmost integrity.”
“The province accepts their conclusion.”
WHO KNEW WHAT?
Were any other companies aware of such a lockdown?
Meditech, the current supplier of clinical information systems at the IWK and hospitals in Nova Scotia’s western, eastern and northern zones, apparently didn’t know.
Marc Lajeunesse, enterprise sales lead with Meditech, based in Westwood, Mass., said it’s his understanding such a lockdown on contacts began in December 2016, when the province notified vendors of a pending RFSQ.
Meditech had been meeting with government prior to that time the same way as with any existing customer, said Lajeunesse, not to discuss OPOR specifically. But he noted normal conversations with clients about health-care technology’s evolution would tread similar ground.
“We didn’t discuss the project itself. So we never had conversations to the effect of, ‘There’s an RFSQ coming, this is what we’ll be looking for,’” said Lajeunesse. “We, as their existing vendor, and as with all of our existing customers, have conversations with them as to the general way forward. So the general way forward with our customers essentially matched what was requested in the RFSQ.”
Harris Healthcare did not respond to our calls or emails.
Another company unaware of any moratorium in March 2016 was Epic, one of the world’s biggest electronic health record firms.
Then again, Epic officials say, they had no idea Nova Scotia was even considering such a significant project until a third party alerted them in late 2016.
“We actually got a phone call from somebody in Canada who said, ‘Hey, this thing got released. We’re hopeful that you guys are responding.’ So we had to go out and find the RFSQ,” Jackie Gordee, a vice-president at Epic, said from the company’s headquarters in Verona, Wis.
“We are one of the largest, top-ranked vendors in the industry, as well as across the globe, so it seemed rather strange that they wouldn’t have at least said, ‘Hey, by the way, this is being released.’” said Gordee. “There wasn’t even any kind of head’s up that it was coming. They probably would have continued on without us had not a third party called us and said it was available.”
Epic has scored an impressive number of contract wins in Canada in recent years.
What happened next was just as unusual.
Epic’s RFSQ submission was couriered to the building where Nova Scotia procurement is located a couple of days before the Feb. 17 deadline, but the courier took Epic’s package to the wrong office.
Epic was unaware of the mishandled delivery, Gordee said. The courier had confirmed the package was signed for upon delivery.
When people in the office where Epic’s package was mistakenly delivered realized the error, they tried to contact procurement, Gordee said. “The ladies calling had actually opened it by mistake and said they called (procurement) multiple times and left voice messages.”
Gordee was told they never got a response.
Finally, those same people physically delivered Epic’s package to procurement. But by then it was past the deadline.
When Gordee became aware of what had happened, she said she spoke to the RFSQ contact person (Angela MacKenzie), arguing there was ample evidence the package has been delivered to the right building on time but events out of Epic’s control prevented it from getting to the right office by the deadline. Given the circumstances, Gordee asked that Epic’s submission be accepted.
Gordee said MacKenzie told her she’d have to check with legal counsel.
The next thing Gordee said she heard came in the form of a legal letter from the provincial Justice Department, addressed to all six prospective vendors. Signed by senior solicitor Michael T. Pugsley, it stated Epic had failed to qualify according to the RFSQ’s rules and that the province intended to file an application with the Nova Scotia Supreme Court seeking a ruling to that effect.
Has Gordee ever seen a similar letter?
“Never,” she said. “This one actually was very unsettling to me because it was sent to all of the other vendors, versus interaction just directly with Epic.”
Other industry sources also say they’ve never seen such a legal missive sent to all vendors in a tender process.
“It was an announcement to all of the other vendors, which seemed very strange,” said Gordee. “I don’t know why that would be of interest to all of the other vendors, or why it should be so public in this way.”
Gordee said Epic replied to acknowledge Nova Scotia’s decision and that it hoped they could work together in future.
“The whole idea of legal, you know, the Department of Justice legal services division, sending letters to us and to all the other vendors, basically calling out Epic, (that we’d) failed to submit in the way that they had said was needed to be in compliance, knowing it was in the building and that people tried to call them, was unfortunate.”
This newspaper checked court records but found no evidence government lawyers ever filed the application that Pugsley mentioned in his letter.
Pugsley’s letter went to all bidders, Taylor, the government’s spokesman, wrote in an email, “as notice of a pending court application by the province to get a ruling on whether the late bid was out of time.” The province didn’t proceed because the vendor withdrew its bid, “making it no longer necessary.”
According to Epic officials, the company took the province’s legal letter as a formal notice they had been eliminated.
Back to Meditech.
Asked if the province had ever indicated it had any problems with Meditech’s products or services here, Lajeunesse replied, “Nothing that I would qualify as a complaint. Normal business practices regarding software issues, administrative issues, escalation, etc.”
Multiple industry observers told the Herald that incumbent companies are routinely included in final round of tenders for big health-care software procurements.
That Meditech, which has information systems in many of the province’s hospitals, wasn’t included seemed odd, they said.
Asked about not being shortlisted, Meditech’s Lajeunesse said he had no comment.