Sunday, September 26, 2010

This is Not the Way to Go About Things but Despite That There Are Some Hopeful Comments.

This appeared a few days ago.

E-health record tenders out soon

  • Karen Dearne
  • From: Australian IT
  • September 24, 2010 12:00AM

ELEMENTS of the planned personally controlled e-health record system will go to an open tender, with an industry briefing due before the end of the year.

Some details of the $467 million project to deliver electronic patient records "to every Australian who wants one" by mid-2012 have emerged in response to questions on notice since the Senate estimates sessions in May.

It's understood answers from the federal Health Department were on hold during the extended election caretaker period.

"The (Gillard) government's investment over two years will fund the core infrastructure, standards and tools to provide (everyone) with access to a secure PCEHR from 2012-13, if they chose to register for one," the department said.

"The priority projects for initiating the national system (commenced from) July 2010 with the initial focus on working with key stakeholders including consumer representatives, healthcare organisations, providers and states and territories to identify the design requirements.

"These early planning and development projects will build on the work already undertaken through organisations including the National E-Health Transition Authority and will include ongoing consultation.

"Elements of the national PCEHR will be procured via an open tender process and an industry briefing is expected to be held in the first six months of the program."

The Australian Health Ministers' Conference will oversee the development - rather than the Council of Australian Governments - with the AHMC due to consider a specific workplan and resourcing later this year.

With the federal government funding the first two years of the national rollout, "the states and territories are expected to make complementary investments to upgrade their health and hospital systems in readiness for connecting" to the new system.

"This will allow for a carefully planned and staged introduction of a complex operation, and allow governments, industry, healthcare professionals and patients to make the necessary investments and operational changes needed to participate in the national e-health records system," the department said.

"The first two years of funding will allow lessons to be learned and inform further stages of the roll-out. The government will evaluate progress and make future investments post these two years, as necessary, to expand on the range of functions delivered."

The government says the introduction of individual patient records is "a core element of the National e-Health Strategy" adopted by COAG in December 2008.


An initial report on long-term governance arrangements is currently being developed in collaboration with the states, for consideration by the AHMC, which will manage the whole process.

More here:

What is right here is the recognition that some long term governance arrangements are being worked on.

What is wrong here is that The governance arrangements are being developed with the states and presumably the State Hospital Focussed CIO cabal rather than with all the important other stakeholders in the health sector. If that is actually happening, and the track record is not good, so far there has not been much apparent in the public domain.

Also it seems to me that having the AHMC (The Australian Health Minister’s Council) at the apex of governance of e-Health is going to lead - as it has always before - to very diffused accountability. The way you avoid this is to do what is done in the US and UK where a powerful executive is given a brief to get something done, the resources and authority to do it and simply gets on with it. Without leadership and accountability of that sort we won’t get far again.

It also needs to be pointed out that this quote is having the Government play fast and loose with the truth.

“The government says the introduction of individual patient records is "a core element of the National e-Health Strategy" adopted by COAG in December 2008.”

The National e-Health Strategy said there was a great deal to do in all sorts of areas before shared records / IEHR was to be developed - and that it should be done incrementally at a regional level. It was the much later National Health and Hospital Reform Commission (NHHRC) that came up with the PCEHR as the priority.

This paragraph points out just what needs to be done first.

“As a result, national action will focus on four key areas: infrastructure and rules for access and sharing of patient information; stimulating investment in high priority computer systems and tools; encouraging healthcare providers to adopt and use advanced tools, and establishing a governance regime for effective coordination and oversight of e-health activities.”

It seems to me that what should be happening is that we get governance and leadership in place and then ask of them to develop plans for progress and procurements - going out and procuring until all the wrinkles are sorted is yet another recipe for disaster. We have waited for over a decade - a few more months at this stage to ‘get it right’ won’t be a disaster.

I also have to say this nonsense of funding for 2 years and then trying to work out where next? is just a prescription for a disaster. If you are going to do it, do it once, do it properly and so it with fibre, oh I mean commitment!

I really wish some strategic sanity could prevail here rather than the ‘fire, ready, aim’ approach this seems to betoken.

The most recent poll would seem to confirm a lack of confidence about how this is being handled.

See here:



Anonymous said...

This all assumes that the tenders get evaluated and that contracts get let. One wise question at the NASH tender briefing last week focused on this very issue (the asker had been bruised badly, as many of us were, by the aborted Access Card tenders in 2007).

Only last week, iur company received yet another advice (this time from WA Health) that a tender that closed in February 2009 (Enterprise Portal and Interoperability Platform) was not to proceed (all offers were declined) and that the approach has been reconsidered.

Another free consulting exercise with an investment of millions of dollars by the collective eHealth industry and absolutely nothing to show for it. Not even an apology for wasting our time and effort.

How do these state heatlh bureaucrats keep their jobs!

Dr David More MB, PhD, FACHI said...

Indeed, I have also been caught many times preparing bids that have then not proceeded and the IP has just been taken by the bureaucrats.

Thanks for making the point.


Andrew Patterson said...

I've often wondered if perhaps we need a different approach to tendering in 'high tech' areas. Sure, if you're tendering for army boots, or cleaning services, or exam booklet printing etc then the tender process seems like a sensible approach because the government can be quite prescriptive about what exactly it wants.

But when it comes to these high tech 'design' projects where the government has only a vague 'aim' in mind - the entire process seems designed to get sub-optimal results.
1) The tender process disallows contact between the respondents and the real users/stakeholders. As a system architect I can learn more from talking to real users of a current system than any 100 page specification document
2) The tender process requires big up front design and fixed price quoting - exactly at the point where we know the least about the project (see (1)), and counter to everything we have learnt about software engineering in the past 10 years
3) The respondents are doing unpaid consulting/design work and therefore often can't devote the required manpower/expertise to the process.

I think the process should be split - the first stage would be to shortlist consortium/partners based on brief 'vision' for the project and based on the respondents experience in the area. But this stage wouldn't involve any more than vague costings or design (or maybe no costings at all)

The second stage would be a PAID competitive design process between the shortlisted respondents. So "here is $250,000 - spend 3 months and show us what you can do and give us a price estimate". You'd get much more accurate tender costings, you'd get better more fleshed out designs, and even if the project doesn't go ahead the respondents wouldn't feel ripped off.

I realise that there are ways that this process could be ripped off by unscrupulous respondents who go into the process just to get shortlisted - but surely they would get a black mark against themselves eventually.

Am I crazy? Is there some group within government that introspectively looks at the very tender process itself - or do we just do it this way because we always have?

Anonymous said...

Andrew... You are not crazy. We do this because 'this is the way we do things around here'... (and while we do what we've always done, we'll get what we always got). Despite the fact that it doesn't work, and there are no off-the-shelf solutions available for purchase - and no-one really "knows" what they really really "need"... (and the customer would - oftentimes - be well advised to be careful what they wish for). And, it's true. There is room here for the unscrupulous. But no more so than contemporary experiences demonstrate, where we see that whoever has a dinky package, an 'international reputation' and a glossy brochure gets the gig...despite the fact these don't (demonstrably) work. What would happen if we adopted your suggestion, PAID specs and proposals PLUS a 'live demo' ? Evaluated by real time users and purchasers? - and then let the devil take the hindmost? !!! What fun! !!! This really amounts to put up or shut up... doesn't it?

Anonymous said...

To follow up comments by Anonymous of 27/09/10 8:52 and those of Andrew Patterson. What becomes of those ideas, offers, notions and solutions offered by suppliers/experts, but who read the specifications and contract T&Cs (as they are issued by 'our betters') and who instantly recognise these as having been written by those who believe the earth is flat, that there is a Santa Claus and who have fairies at the bottom of their garden? Do providers then proceed to file the 'tender docs' in the bottom drawer of the file cabinet under "D" for "dreaming"? These experts might actually have better ideas - and something more efficient and effective - not to mention scalable - to offer.

If only they were (a) asked (b) heeded
See also Andrew McIntyre's recent posts.

Anonymous said...

I thought the PCEHR was going to be "stored and shared in a network of connected systems" (from the NEHTA site). How can they tender for this? Going the tender route will only result in another NHS.

They need to be getting existing systems to work together. This requires incentives for the users and makers of those existing systems to interoperate.

TT said...

"I thought the PCEHR was going to be "stored and shared in a network of connected systems" (from the NEHTA site). How can they tender for this? Going the tender route will only result in another NHS."

Not sure how you can come to that conclusion at this stage. Just "what" may or may not be tendered by NEHTA or anyone else for that matter remains to be seen in detail, then we can comment on its likely chances of succes and/or how it relates to other models across healthcare (like the NHS)....

btw, for what it's worth there are great success stories in the UK NHS transformation journey everyday, it's not all about IT failures etc etc, so one should not use a paintbrush approach to "anything bad" being like the NHS etc etc....try and stay objective please