British Columbia's Vancouver Island Health Authority regularly paid $365 an hour for a consultant with a company that was at the centre of an Ontario electronic health record scandal last year.

The rate is similar to the one that drew media and political attention in Ontario, contributing to the resignation of that province's health minister, David Caplan. But the official who oversaw the B.C. contract said the rate was used much more sparingly here and was good value.

Between 2002 and 2009, VIHA paid Toronto-based Courtyard Group Ltd. $746,646, according to financial information The Tyee obtained through a freedom of information request. The company provided consulting and professional services for developing VIHA's electronic health records systems and extending it throughout the region.

Numerous Courtyard invoices include $365-an-hour charges, the bulk of them for coaching or mentoring Mary-Lyn Fyfe, VIHA's chief medical information officer. The invoices include descriptions like "review annual performance objectives for last year and develop objectives for this year."

In Feb. 2007, for example, Courtyard billed VIHA for 10 hours at $365 an hour for a "Full day coaching session with ML Fyfe" and "status update meetings with C Claiter." The bill also included $365 for a one-hour phone call with Fyfe regarding "priority setting and regional roll out discussion."

And a July 2008 bill is for eight hours of "Clinical Informatics Coaching." That coaching, one of several such days, cost the health authority nearly $3,000. The name of the consultant who did the coaching is censored from the documents VIHA released.

Fyfe herself meanwhile commands a healthy salary from VIHA. In 2008-2009, VIHA paid Fyfe nearly $200,000, plus $10,000 for expenses, the health authority's records show.

Unique skills win high price

"We've used consultants at that level, but we've used them sparingly," said Catherine Claiter, VIHA's chief information officer.

It makes sense to spend that kind of money for skills that would be hard to develop and keep on VIHA's staff, she said. "It's based on the uniqueness of the qualifications you're trying to get."

The $365-an-hour billings were for work done by Matthew Morgan, she said.

Morgan is a doctor, Courtyard Group partner and an expert in various areas, including developing electronic health records, according to the company's website. Claiter said Morgan was key to assessing the state of VIHA's systems and deciding how to proceed as the authority moved to adopt electronic patient records throughout the Island. "He helped us avoid a multi-million-dollar mistake."

Morgan also helped support and mentor Fyfe at a time when she was moving to an administrative job from treating patients, Claiter said. Morgan did that job and helped Fyfe get to the point where she could perform the needed tasks, she said.

One of the things Claiter likes about Courtyard is they share VIHA's philosophy that contractors should help launch projects without making the client dependent on high-priced help for the longterm, she said.

That's different from what happened in Ontario, where consultants were brought in at $400 an hour for full-time work, or even longer hours, and kept in leadership roles with no transition plan that would get the cost under control, Claiter said.

There were also concerns in Ontario about untendered contracts and escalating costs with little to show for it, she added. "The province was not at all in line with what the expectations of the public were for the spend."

A phone call and email with detailed questions to a Courtyard spokesperson in Toronto were unreturned by publication time.

Claiter, by the way, worked for Courtyard before joining VIHA in 2005, though she said she has few contacts there now. VIHA paid her $173,000 last year, plus $23,000 for expenses.

Too high for broke authority: Dix

New Democratic Party health critic Adrian Dix said many British Columbians will dislike the idea of consultants being paid $3,000 a day by a cash-strapped health authority.

"I think it's high," he said.

"There may be an argument that $365 an hour for a health authority that's cancelling community programs is an appropriate way for them to proceed," he said. If there is an argument, though, it would likely be tough to convince the public, he added.

In July,VIHA announced plans to make up a $45-million shortfall by cutting jobs, selling land, increasing fees and rationing elective surgeries.

The government needs to set standard rates for contractors, Dix said. "There's no consistent way to address these issues."

That was one of the things that struck him when the Ron Danderfer search warrant became public a few months ago, he said. Danderfer is a former assistant deputy health minister with a senior eHealth position who was investigated for allegedly receiving benefits in exchange for government contracts. Contract rates rose "arbitrarily" from $100 to $195 an hour, the warrant noted.

Said Dix, "Lots of things seem to be drawn out of the air. They go up without any rhyme or reason."

Other Courtyard consultants billed VIHA at rates of $230 and $150 an hour. One consultant billed for lengthy days, including several that were as long as 14 or 15 hours. It is unclear at what rate those hours were charged.

The cover letter included when VIHA released the records to The Tyee said the rates varied depending on the consultant providing the service and on what they were doing: "some consultants have more expertise and are costlier than others."

Several sources involved in information technology and management consulting in Victoria said high-level help can typically be found for between $100 and $150 an hour, but that people with very specialized knowledge can sometimes charge more.

In June a health ministry spokesperson said the B.C. government had paid $175 an hour to Courtyard consultants under a separate contract in 2006, a rate he said was normal at the time.

Lump sums paid

VIHA also paid Courtyard lump sums totalling at least $150,000 for work that was not itemized in detail on the company's invoices.

One 2006 bill includes a $50,000 charge explained only as "For professional services provided by Courtyard-Group Ltd."

Another bill from that year includes a $100,000 charge that is described only as "our fee."

The same bill required payment for $9,942.21 for expenses. A heading on the invoice said it was for the "VYSTA Regional Center Implementation" and that it was the "final billing for professional services provided by Courtyard Group Ltd."

Asked about the payments, VIHA's Claiter said, "That's our effort to negotiate well on behalf of the public of B.C."

In cases where VIHA staff knew the project was going to be complicated, they arranged fixed-price contracts that ensured costs would not escalate beyond the agreed amounts. The smaller one was for the initial stages of the project while the larger one involved completing it, she said.

So, what did Courtyard deliver for that $150,000? Said Claiter, "The outcome is a lot of documentation and decisions." The consultants worked on teams with VIHA staff, so there was no particular report or system that can be directly credited to Courtyard, she said.

Courtyard has received work through various processes from VIHA, but the bulk of it was through a 2006 vendor of record competition. Once on that list, the company still had to compete for work that arose, Claiter said. Courtyard is one of six companies that was successful and has received about 17 per cent of that work, a background document provided by VIHA says.

Claiter said VIHA is using contractors much less now, thanks to the global economic recession. Many previously high-priced consultants have been laid off and are looking for work, she said. "Why on Earth would I hire consultants when I can get some of these people onto our payroll as staff members?"