$17M scheduling system 'playing Russian roulette' with patient lives, this paramedic warns

On Feb. 19, shortly after the launch of new multi-million dollar scheduling software for Toronto Paramedic Services, an advanced life support crew wasn't sent to a cardiac arrest call near their station — allegedly because a software glitch meant they didn't show up as "on duty" in the system.

Instead, a basic life support crew farther away was dispatched to the call, according to internal paramedic emails obtained by CBC Toronto, which detail numerous alleged examples of glitches in the scheduling system since it launched roughly six months ago.

Now, some Toronto paramedics are ringing alarms over ongoing issues in the $17-million system, which they believe could be routinely endangering patient safety throughout Toronto. And while the city claims the software is safe, "administrative issues" stemming from the software's use by Toronto Paramedic Services have prompted staff to undertake a roughly $100,000 risk assessment this summer, a CBC Toronto investigation has found.

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Launched in mid-February for Toronto Paramedic Services, the software scheduling system is supplied by Kronos Inc., a Massachusetts-based workforce management software and service company.

For months, the system has been "playing Russian roulette with people's lives," said Mike Merriman, who's been a paramedic for 26 years and is the service's current representative with the Canadian Union of Public Employees.

Merriman is among those concerned that the scheduling software is "putting public safety at risk" on an almost daily basis because on-duty paramedics don't always show up in the system, leading them to miss nearby calls.

The internal paramedic emails CBC Toronto obtained outline numerous similar incidents throughout 2017, including:

• On March 23, the Kronos scheduling system did not show an advanced life support paramedic as "on duty." As a result, the team member wasn't sent to several high-priority calls for a period of a few hours, even though he was nearby.
• On April 17, three advanced-care paramedics reported to their station, but due to some kind of error, dispatch only thought two were available. One of the paramedics sat idle for hours, not responding to life-threatening calls.
• On June 1, an advanced care paramedic booked in for duty and went to her post. For more than two hours, she heard multiple calls coming in but was not dispatched to them. When she phoned in to find out why, she was told that she wasn't showing up as "on duty" due to an error in the system.
• On July 4, 11 paramedics were unable to sign into the system and the dispatch centre was not aware they were available.
• On July 6, the system was used to call medics in for overtime and to call in a critical care paramedic for the night shift. It didn't work, and once the paramedic team realized the issue, they called staff members in manually. But in the meantime, there was no critical care coverage for 97 minutes.

Paramedics maintaining response time to calls, city says

A spokesperson for Toronto Paramedic Services confirmed the service is aware of these issues, and has been working with the vendor and the city to "rectify them."

"In the meantime, temporary, manual measures are in place to ensure that these issues do not recur," said Kim McKinnon. Most of the issues have also been shared with Deloitte, the firm conducting the risk assessment, she added.

A spokesperson for the city also confirmed that "frustrating" glitches have occurred, but said there is no cause for public concern.

"There have been some start-up issues and administrative glitches but to be clear, none of these have put public safety at risk," Jackie DeSouza, the city's director of strategic communications, said in a statement.

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"The city's IT staff are working closely with the software supplier, solutions integrator and the city's project team to resolve technical issues as soon as they appear," she added.

Throughout the implementation of the new system, she said Toronto Paramedic Services — the largest municipal paramedic ambulance service in Canada — has "maintained its response time to life-threatening emergency calls."

Software suite, implementation cost $17M

DeSouza said two city divisions — including paramedics and Parks, Forestry and Recreation — are currently pilot-testing the Kronos suite of software.

Parks, Forestry and Recreation has been using a piece of software called Kronos Workforce Central since November 2016 for timekeeping and attendance, and for the scheduling of full-time staff, she said. In February 2017, Toronto Paramedics Service implemented Kronos Workforce TeleStaff, which also encompasses dispatch services.

At least one other city department is keeping an eye on how the pilot projects go. "Children's Services wasn't included in the pilot but we're awaiting the results to determine whether it will be beneficial for us to use in the future," noted the department's spokesperson, Aggie Fortier.

The Kronos software suite, according to both DeSouza and city contract documents, was selected through a Request For Proposal (RFP) process.

The RFP notice issued by the city in 2014 stated that Toronto was already using a customized time, attendance and scheduling solution, but that certain divisions — Parks, Forestry and Recreation and Emergency Medical Services, as Toronto paramedics were previously known — had an "urgent need" to move to a new system due to complex workforce and scheduling requirements.

The paramedic scheduling system used at the time did "not support the operational or auditing needs" of the force, according to the notice.

A contract award document sent to the city's bid committee in March 2015 found the total cost to the city to implement the Kronos system was more than $14 million, including software license support and maintenance costs.

That contract involves Kronos Inc. as the software supplier, with a maintenance contract lasting from Jan. 1, 2017 until Dec. 31, 2020, and includes the "professional services" of Ottawa-based consulting firm Calian Ltd. to implement the project.

But the latest numbers provided to CBC Toronto by DeSouza put the current cost of the project at nearly $17 million, which covers the overall design, development, implementation, software licences, and maintenance.

The goal, she said, is for the new system to be implemented across the organization, "enabling the city to make technological improvements, streamline services, improve productivity and enhance customer service."

'Someone has to be accountable'

When contacted by CBC Toronto, Kronos Inc. stated that the company has a policy of not speaking on behalf of its customers.

"At Kronos, the safety and effectiveness of our software solutions are a priority and focus," said Spiros Paleologos, vice president of operations and general manager for KronosCanada, in a statement.

The company's systems are used by nearly 1,000 corrections, emergency medical services, fire, police, and sheriff departments in North America, including 60 of these in Canada, he added.

Ottawa's paramedic team, for instance, currently relies on the Kronos suite. Sean Cook, the superintendent in charge of scheduling for the Ottawa Paramedic Service, said the city has been using the software since 2004 "without any real incidents."

But both Merriman and Ward 39 Coun. Jim Karygiannis remain concerned about the system's use here in Toronto.

Karygiannis said he is aware of the system issues that have been happening "since day one," and said he plans to meet with paramedics in late August to hear about their safety concerns directly.

Merriman, meanwhile, now questions how much more money will be spent on the outside risk assessment, which DeSouza said was prompted by "the administrative issues with Kronos in Paramedic Services."

'A minute can make the difference'

The city's Information & Technology Division approached its Internal Audit Division in early July regarding an assessment of the system, she said. "Given Internal Audit was not sufficiently staffed to conduct the assessment within the timelines required by Paramedic Services, the city engaged Deloitte, which has expertise in risk management processes."

The first phase will cost $68,000 and will be an assessment and report that evaluates the risks of the city continuing to operate Kronos in Toronto Paramedic Services. The second phase, costing $38,500, will provide "lessons learned from this project and consideration of the root causes of the issues that have been experienced since Kronos was implemented in Paramedic Services in February 2017," DeSouza said.

Money aside, Merriman said his greatest concern is public safety. He said "someone has to be accountable" for the system glitches, which he believes are putting Toronto residents at risk almost every day.

"A couple minutes can make a difference — or a minute can make the difference — if somebody's going to live or die," he said.