The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Opposition's health spokesman yesterday said it "makes no apologies" for handing an $18m contract to a vendor threatened with "far-reaching consequences" by the Public Hospitals Authority (PHA).

Dr Michael Darville, rushing to the defence of the Christie administration's "aggressive healthcare agenda", blamed the present government's "stop, review and cancel policy" for the failure of the integrated healthcare management system (iHMS) deal awarded to Allscripts Healthcare Solutions and its partner, Infor Lawson.

The Progressive Liberal Party (PLP) senator, who was present when the Allscripts contract was signed in 2016, sought to justify the former government's actions by saying that "the experts recommended" the US-based publicly traded company "as the number one choice" for the data-driven transformation of the Bahamian public healthcare system.

But Catherine Weech, the PHA's managing director, told Allscripts in an August 13, 2018, letter it "can find no evidence" to show the US firm had "installed a single operating platform on any desktop device" in the two years following the contract's award despite being paid $7m by the Bahamian taxpayer.

The letter, which has been obtained by Tribune Business, adds further weight to assertions by Dr Duane Sands, minister of health, that millions of dollars belonging to the Bahamian people has been squandered on a deal which has delivered zero value for taxpayers and patients alike.

Mrs Weech, writing to Allscripts' president, Alan Fowles, put the Nasdaq-listed company on notice that the PHA and government intended to "decertify, and possibly rescind" the integrated healthcare management system contract unless the two sides could "re-negotiate terms of a mutually acceptable solution" by August 22 last year.

Dr Sands' revelation to Tribune Business that legal action is likely imminent indicates that the Government, some 15 months later, is now prepared to exercise the options set out by Mrs Weech in August 2018 - a 60-day notice to Allscripts to cure its alleged contractual breaches, followed by termination of the deal and a demand for "a full refund" of sums already paid.

The PHA managing director accused Allscripts of leaving the taxpayer-funded healthcare provider with "a staggering increase in implementation costs" by failing to stick to the terms agreed in both the contract and tender process, with one-third party vendor alone responsible for more than $1.5m in undisclosed expenses.

Noting that Allscripts had failed to address the concerns set out by her predecessor, Herbert Brown, more than one year before she wrote to it, Mrs Weech said: "We submit that the PHA has endured what can only be described as a silent indifference to its plight.

"Further, not only do we have difficulty in accounting for the PHA's almost $7m in payments but we feel that the constant demands for outstanding receivables are unjustified. We can find no evidence or documentation which would support the notion that a single Allscripts module, integration or basic operating platform has been installed within our data centre or on any desktop device."

A position paper sent to the PHA's Board of Directors, which was updated on September 13 last year, suggests that up to $9.1m may have already been paid to Allscripts and Infor Lawson even though Dr Sands branded the contract as "a bust" and said it had "crashed".

This sum, which is higher than the $7m referenced in Mrs Weech's letter, was said to have been split into $6m for software, licensing fees, implementation charges and project management fees related to Allscripts' platform. The $3.1m balance relates to computer hardware, software and infrastructure upgrades said to have been required at the PHA's data centre.

Mrs Weech, meanwhile, urged Allscripts to supply the rationale for demanding "support and maintenance fees" from the PHA given that no element of the integrated healthcare management system was implemented or functioning.

While "the majority of such unresolved issues" occurred before the Minnis administration took office in July 2017, appointing the present Board and management team, Mrs Weech "implored" the US healthcare technology/data services provider to render "invaluable assistance" to get the project back on schedule and contract.

Then, in a blunt warning to Allscripts, the PHA managing director wrote: "Given the position of the PHA as a statutorily-appointed body, should our chairman [Julian Rolle] opt to ask the Board to rescind the Allscripts award of the iHMS project, such actions would invariably trigger a forensic audit, resulting in the country's attorney general possibly appointing a special counsel tasked with conducting a costly, time-consuming, international inquiry into the matter. This could have potentially far-reaching consequences for your organisation."

The contract, which was bid over six years ago in mid-2013, was intended to totally transform healthcare delivery in The Bahamas through the use of electronic records that followed Bahamian patients wherever they went to access services. This would have given providers instant access to a person’s health history, enabling them to better and more quickly diagnose any cause of distress.

However, Mrs Weech said the project's roll-out had been blighted from the start by a "glaring lack of oversight" on Allscripts' part, "significant cost overruns", "unconscionable delays", multiple information technology (IT) issues and vendor "apathy" towards adhering to contractual terms.

She added that "key responsibilities" had been thrown back on the PHA, while the vendor had deviated from the payment schedule submitted in its bid and the agreed timeline/implementation schedule.

However, despite such concerns detailed by two successive PHA managing directors, Dr Darville yesterday stood by the Christie administration's decision to hand Allscripts the contract. He argued that Dr Sands was pushing the issue as a "political distraction" to deflect from the Minnis administration's woes, even though it was Tribune Business that contacted the minister – not the other way around.

Aiming to put the blame and focus back on the Government, Dr Darville said: "Were it not for the minister of health's stop, review and cancel policy, this health initiative could have played a pivotal role in the transformation of the public healthcare system prior to the full launch of universal healthcare by way of National Health Insurance (NHI).

"We make no apologies for awarding the contract to Allscripts, a reputable US medical software company. The experts recommended them as the 'number one' choice. The Allscripts contract was awarded according to all due processes and there is no truth to the claim that the company got special privileges in the bidding process. Contrary to The Tribune's story, Allscripts did not submit their bid late and it was done in accordance with all the appropriate rules of the Board."

The deadline for receiving bids was extended from September 5, 2013, to September 19, 2013, but Tribune Business has in its possession documents showing that the Allscripts proposal was "stamped" as received by the PHA’s tenders committee on September 30 - 11 days after the formal closing.

The PHA Board's position paper bluntly states: "We have yet to receive an explanation from the PHA's tender selection committee as to how an RFP bid - stamped by the tender committee at PHA's corporate offices on September 30, 2013 - was even considered given that the said proposal arrived 11 days after the RFP tender procurement process had closed in contravention of the assessment criteria."

Dr Darville's statement also ignored the detailed concerns expressed by Herbert Brown, the PHA's immediate past managing director, and evidence suggesting that the "experts" who recommended Allscripts were Sanigest Internacional, the architects of the Christie administration's NHI scheme, rather than Santa Rose Consulting which was named in a Cabinet paper.

The PLP senator, though, at last agreed on the contract's initial lofty objectives. "In awarding the contract, we wanted to modernise our public healthcare system to produce a single medical record, improve supply chains as well as improving revenue cycle management services by computerising the administrative arms of the Princess Margaret hospital, the Rand Memorial Hospital and the satellite clinics," Dr Darville said.

"We intended to collect the much-needed operational capital mainly from insurance companies, tourists and expatriate workers who continue to use the public healthcare medical and surgical services, diagnostic and laboratory facilities without being charged or receiving billing in a timely fashion - sometimes years after."