British Columbia's auditor general released a blistering report on the province’s planned $222 million EHR system. A lack of planning from the start is blamed for a lack of results four years into the program. Interestingly, John Doyle, auditor general, criticized the province for focusing on securing federal funds over creating a solid roadmap. Can you say "cautionary tale" for states that have been notified of ARRA funding?

For the states that have been working toward a statewide EHR system and health information exchange, this cautionary tale is not for you. These states have already done the hard work of building the infrastructure and bringing stakeholders to the table to develop policies, to name a couple of the required tasks. For states that jumpstarted their EHR/HIE upon passage of ARRA and even later, learning from our neighbors up north is in order.

States have to turn in their operational plans for HIEs by March 31st. Several months at best is not a lot of time to prepare a detailed blueprint. Doyle dinged B.C.'s government for failing to collect proper baseline data, which are needed to compare health impacts and outcomes post EHR system. He took the province to task for not creating measurable objectives and failing to provide a full cost estimate and develop a way to report progress of the system. The lack of leadership was blamed for duplication and "missed opportunities for efficiencies."

It seems odd to have bypassed such things as creating measurable objectives, but perhaps British Columbia was a latecomer that had to throw something together to get the funding period. Regardless of what happened, parallel efforts to deal with these issues should have been undertaken.

The good news for the states is that under ARRA regional extension centers will be available to provide expertise and other resources. There are best practices out there from front-running states to incorporate. Equally important, there are lessons learned from poorly planned efforts that states can embrace.