This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
Sunday, May 20, 2012
There Are Some Pretty Profound Lessons Here For Those Who Will Listen. Pity About DoHA and NEHTA Just Pushing On.
The Victorian HealthSMART had the ‘last rites’ administered this week. Here is some of the coverage. First here:
The Victorian Government has made the decision to scrap its HealthSMART system, which was years overdue and had run hundreds of millions of dollars over budget.
HealthSMART was launched in 2003 and had been designed to run as a single electronic foundation for the state's public health service. The single platform would combine a finance system, as well as patient-management and clinical-applications services.
However, Health Minister David Davis today confirmed that the government had scrapped the continuation of the roll-out of HealthSMART, with the government to now work on a hospital-by-hospital basis, to set up individualised systems.
Davis said the government is determined not to "throw more good money, after bad" and would set up an expert panel to advise it on the best way to upgrade the hospital information and communication technology (ICT) systems.
"In those hospitals where it has been put in place or partially put in place, health services will make their decisions from that position, but going forward, beyond that, health services will be able to examine what is appropriate for their particular service," he said.
The thing that should not be lost here is that this is really a very sad and very wasteful outcome.
I reviewed all this in June 2007 (Now essentially 5 years ago) and made the following assessment:
“Under the Health ICT Strategy, the Government was to remove obsolete, aged products and invest in modern proven systems, based on accepted interoperability standards covering hospital administration systems, clinical systems and electronic medication ordering.
Of course that was never going to happen. We now find that – to quote from the HealthSMART website:
“HealthSMART is a $323M technology program operating across the public health care sector funded through the 2003-04 Victorian State Budget. Initially a four-year program, it is now running over six years from 2003 - 2009.”
To be frank even this timeline looks more than optimistic. Why do I say this?
First, it seems that with clinical systems HealthSMART has adopted the approach of developing State-Wide Builds of the Cerner Software. Experience elsewhere has shown that this can be very problematic (just look at the UK NHS) – as the users don’t see they are getting the system they need that really suits them – rather they are getting a compromise – to them – state-wide solution.
One only has to see that the State-Wide System is being driven by a committee representing 13 different health systems (from major to minor hospitals and from cancer to paediatric hospitals) with over 40 members to recognise that getting agreement on what is to be done will be both slow and tricky to achieve.
Second if one reviews the time-lines provided in each of the progress reports (Roadmaps as they are called) it is clear that with each update issued the time-lines are extending.
Third my making the choice to implement Cerner clinical applications on top of an iSoft Patient Management System they have greatly complicated the operations of each and have lost many of the key benefits of integration that the Cerner system offers.
This is especially true given their approach is to integrate patient administration, outpatients, emergency, laboratory, pharmacy and radiology (at least) onto a Cerner core repository. I believe this is a plain stupid strategy. The amount of context switching from source systems (lab, pharmacy etc) that many clinicians will be forced into is likely to be both time-wasting and annoying.
Fourth with the some of the system selections made there must be the suspicion that adequate financial due-diligence was not undertaken given the difficulties being experienced at present by iSoft.
Fifth, any Health IT strategy that takes six-seven years to implement in the Public Sector has a high risk profile no matter what else goes well initially.
It seems to me that sadly this strategy is facing some existential threats. I hope it can prosper and deliver but it is looking less likely to me as of late June, 2007.
VICTORIA is ruling a line under its patchy HealthSmart IT rollout, and has returned to the drawing board with plans for a new whole-of-health ICT strategy for the period 2009-2013.
When the now-$427 million program began in 2003, it was hoped that the ICT refresh and rebuild across the state's public hospitals, rural alliances and community health providers would be complete within four years.
But in April this year, Victoria's auditor-general Des Pearson said HealthSmart had been overly ambitious in its targets, and was at least two years behind schedule.
More than half of the original budget had been spent with only 24 per cent of the planned installations complete.
The audit office found that HealthSmart had failed to get the cornerstone Cerner clinical system working at any of its sites, and had replaced only one of 10 HOMER hospital systems which were obsolete when the program began.
Mr Pearson said the project judged most at risk, but with the greatest potential benefit, was Cerner's Millennium suite of e-health records, appointments scheduling, diagnostic services, results reporting and e-prescribing applications.
A $79 million deal with Cerner was signed in March 2006, but costs had risen by $17 million to $96 million in 2006 - the biggest price blowout so far, the audit office found.
The public servant in charge of Victoria's mammoth HealthSmart electronic health initiative has resigned for what the state's health department today said were personal reasons.
Fiona Wilson had led the troubled project since mid-2003 in her capacity as the director of the Office of Health Information Systems within the Victorian Department of Human Services. However a spokesperson for the department told ZDNet.com.au tonight that Wilson had grown weary of the regular commute from Auckland where her partner resided.