Monday, December 20, 2010

What On Earth is DoHA Thinking With This Crazy Tender? It is Utter Madness!

I mentioned this tender last week and said I would have a close look over the weekend. All I can say I am glad I no longer have to respond to ill-considered and incompetent nonsense like this. It is a nightmare that, if the requirements are actually enforced I can’t see many able to honestly respond. The requirement of having to have done this sort of work for eight (yes 8) similar projects leaves me gasping since this is the first PCEHR that has ever been proposed in this form as far as I know!

See here:

(There is also a link to download the tender at the bottom of the post).

The important part of the tender - other than the routinely oppressive Terms and Conditions - is here (Page B9 on)


5.1 Overview of Services

5.1.1 The successful Tenderer will provide all resources, facilities, systems, tools, processes, infrastructure and knowledge necessary to deliver the scope of services specified in the following sections.

5.1.2 The successful Tenderer will provide the following services:

a) develop and deliver a Benefits Realisation and Evaluation Framework for the whole PCEHR Program;

b) design and deliver a program monitoring and measurement capability for the whole PCEHR Program, including eHealth Sites;

c) a deep and thorough analysis and evaluation capability for the whole PCEHR Program; and

d) a complementary research capability to provide the Department with data that is relevant and of value to the build and rollout of the PCEHR Program.

5.1.3 In delivering the services, the successful Tenderer must work closely with NEHTA, the National Change and Adoption Partner, the National Infrastructure Partner and eHealth Sites. However, coordination of all of these activities must align with operational direction provided by NEHTA as the managing agent.

5.2 Benefits Realisation and Evaluation Framework

5.2.1 The successful Tenderer will develop a thorough, detailed, fit for purpose Benefits Realisation and Evaluation Framework for the whole PCEHR Program. The Framework will be mapped and aligned to the project plan described in section 6.1.1 B13.

5.2.2 In developing the Benefits Realisation and Evaluation Framework, the successful Tenderer will:

a) review, build on and operationalise the Benefits Realisation and Evaluation Frameworks developed by The Department and NEHTA (the successful Tenderer will be provided with copies of these documents);

b) sufficiently understand the government’s broader Health Reform agenda to facilitate explicit tracking of PCEHR Program outcomes to Health Reform outcomes;

c) understand and link lessons learnt from other major programs of relevance to the PCEHR Program, for example the National Broadband Network; and

d) where possible, consider state and territory eHealth activity which is of relevance to the PCEHR Program.

5.2.3 The Benefits Realisation and Evaluation Framework will:

a) map the program logic which enables the PCEHR Program objectives to be achieved, both short term (till June 2012) and long term (till 2020);

b) describe how the PCEHR Program fits into other national health initiatives within The Department, including the National Health and Hospital Network reforms;

c) ensure that the benefits of the PCEHR Program align with the broader health policies of the Australian Government;

d) align with the high level PCEHR Program planning and implementation documentation which details expected benefits from the PCEHR Program;

e) include detailed specifications for monitoring and measurement across the whole PCEHR Program;

f) allow for the early capture of lessons learnt regarding all aspects of the design and implementation of eHealth Site projects; and

g) include a clear and concise document detailing the benefits of the PCEHR Program for external stakeholders (including consumers and clinicians) which may be used to inform The Department’s communication strategy.

5.3 Program Monitoring and Measurement

5.3.1 The successful Tenderer will develop and deliver a strategy for monitoring and measuring all PCEHR Program activity.

5.3.2 This work will incorporate the detailed specifications developed as part of the Benefits Realisation and Evaluation Framework (see section 5.2 page B9).

5.3.3 The successful Tenderer will develop software, tools and templates that allow for the effective capture and communication of PCEHR Program information. Tenderers to note: Tenderers should be specific about how they will utilise software, tools and templates for the required services and whether this involves developing new software, tools and templates or customising and applying existing ones.

5.3.4 The successful Tenderer will undertake monitoring and measurement activity using an approved Monitoring Plan (see section 6.1.4 page B14).

5.3.5 Monitoring and measurement services should be informed by, but not duplicate, PCEHR Program management progress tracking undertaken by The Department and each of its partners.

5.3.6 Monitoring and measurement services should ensure the capture of baseline data that:

a) draws on existing sources of information available; and

b) obtains further information necessary to allow a full program of baseline monitoring.

5.3.7 In developing the baseline the successful Tenderer should note the following current tendering activity (released on Austender on 12 November 2010) that may produce information of value once the work is complete:

a) RFT148/1011: Consultancy to evaluate the electronic health (eHealth) readiness of Australia’s allied health professional sector; and

b) RFT 149/1011: Consultancy to evaluate the eHealth readiness of Australia’s medical specialist sector.

5.4 Analysis and Evaluation

5.4.1 The successful Tenderer will provide analysis and evaluation services including an interpretative capability of the information collected under the Monitoring Plan (see section 6.1.4 B14).

5.4.2 Analysis and evaluation services will met the following needs:

a) scheduled analysis and evaluation that provides regular tracking and associated feedback to the Department on the PCEHR Program against the Benefits Realisation and Evaluation Framework on a quarterly basis;

b) unscheduled analysis and evaluation needed to meet the short term needs of The Department and NEHTA in various forms from time to time; and

c) analysis of trends that may impact on the development and rollout of the PCEHR Program including PCEHR system uptake by consumers and clinicians, the level of eHealth interactions between clinicians, and any improved health outcomes for patients.

5.4.3 In relation to eHealth Sites, the Benefits and Evaluation Partner will evaluate:

a) how effectively the sites have deployed and tested the eHealth infrastructure and standards in real world healthcare settings;

a) how effectively NEHTA’s foundations are informing the development and rollout of the eHealth Sites and allow for further enhancement and rollout of the PCEHR Program;

b) whether eHealth Sites have been set up for success and how effectively they are operating under standard project management criteria, for example:

i. governance processes are suitable and effective;

ii. the project is appropriately resourced;

iii. the project is tracking to scope, timelines and budget;

iv. effective and transparent issues, risks and configuration management processes are in place;

v. quality management processes are in place;

vi. there is regular and clear reporting and communication to key stakeholders; and

vii. the various parties are working together effectively towards a common goal;

c) stakeholder support and uptake (both consumers and clinicians);

d) outcomes and benefits including, but not limited to, the following clinical outcome measures:

i. improved health outcomes for consumers, in particular people who have the most contact with the health and hospital system (for example people with chronic and complex health conditions, older Australians, Aboriginal and Torres Strait Islander peoples and mothers and their newborn children);

ii. improved self-management for consumers, in particular people who have the most contact with the health and hospital system (for example people with chronic and complex health conditions, older Australians, Aboriginal and Torres Strait Islander peoples and mothers and their newborn children);

iii. increased access to healthcare and information for both consumers and clinicians;

iv. improved coordination and continuity of healthcare; and

v. improved quality and safety of healthcare;

e) the impact on clinical practices including ease of use of the system, effectiveness and cost effectiveness, changes in roles and relationships with health professionals (both with other health professionals and consumers);

f) impact on workplace efficiency and flow; and

g) impact on workplace education and training.

5.5 Research

5.5.1 The successful Tenderer will provide a research capability which ensures that national and international experiences and learnings relevant to the PCEHR Program are captured and communicated to the Department.

5.5.2 The successful tenderer must undertake a preliminary scoping study to ensure that the objectives of research activities are clear and that research activity is aligned with the needs of the PCEHR Program.

5.5.3 Research will include the following:

a) desk studies that gather published knowledge and learnings from around the world (incorporating international learnings already known to the PCEHR Program);

b) an understanding of what relevant research is being undertaken that may impact on the PCEHR Program, for example the Primary Health Care Research and Information Service (PHC RIS) and the Australian Primary Health Care Research Institute (APHCRI) websites are useful information sources for current research projects;

c) a capability to answer research questions developed by the Department as the PCEHR Program progresses through sourcing data from existing studies and undertaking research that is relevant to the build and rollout of the PCEHR Program; and

d) a capability to undertake targeted testing and modelling (for example economic, benefits and workflow) either "on-site" or in a controlled environment.

The other important part, as I see it, is here where the actual program is defined.


3.1 All of the work undertaken for the PCEHR Program needs to align with the Government’s commitment, as defined by the Minister for Health and Ageing on 11 May 2010:

Australians will be able to check their medical history online through the introduction of personally controlled electronic health records, which will boost patient safety, improve health care delivery, and cut waste and duplication.

The $466.7 million investment over the next two years will revolutionise the delivery of healthcare in Australia.

The national e-Health records system will be a key building block of the National Health and Hospitals Network.

This funding will establish a secure system of personally controlled electronic health records that will provide:

· summaries of patients’ health information – including medications and immunisations and medical test results

· secure access for patients and health care providers to their e-Health records via the internet regardless of their physical location;

· rigorous governance and oversight to maintain privacy; and

· health care providers with the national standards, planning and core national infrastructure required to use the national e-Health records system.

A personally controlled electronic heath record will have two key elements:

· a health summary view including conditions, medications, allergies, and vaccinations; and

· an indexed summary of specific healthcare events.

Implementation of personally controlled electronic health records

Personally controlled electronic health records will build on the foundation laid by the introduction of the Individual Health Care Identifiers later this year. Under this, every Australian will be given a 16-digit electronic health number, which will only store a patient’s name, address and date-of-birth. No clinical information will be stored on the number, which is separate to an electronic health record.

Implementation will initially target key groups in the community likely to receive the most immediate benefit, including those suffering from chronic and complex conditions, older Australians, Indigenous Australians and mothers and newborn children.

Subject to progress in rolling out the core e-Health infrastructure, the Government may consider future investments, as necessary, to expand on the range of functions delivered under an electronic health record system.

Reforms to take health system into 21st century

A national e-Health records system was identified as a national priority by the National Health and Hospitals Reform Commission and the draft National Primary Health Care Strategy. It was also supported by the National Preventative Health Strategy.

The Government’s reform plans in primary, acute, aged and community care also require a modern e-Health infrastructure. It is a key foundation stone in building a health system for the 21st century.

A personally controlled electronic health record will not be mandatory to receive health care. For those Australians who do choose to opt in, they will be able to register online to establish a personally controlled e-Health record from 2012-13.

And to really be amazed - here are the benefits to be expected:

I leave it to the reader to assess just how many of the benefits listed here are likely to be realised in the time allowed for this contact - (about 18 months). The short answer will be pretty much none as the system won’t even begin enrolling clients until then!

Lastly, it is important to note that without Global experience in the area you can forget about bidding:

8.1.1 The Tenderer must provide in its Tender up to eight (8) project sheets demonstrating its corporate track record in delivering benefits realisation and evaluation services to programs of a similar nature, size and complexity.

Please stand up any Company who has evaluated the implementation of 8 national PCEHR systems when there has never been one implemented?

Oh, they want a fixed price for the work to be done in the first 3 months and an estimate of each quarter after that. A bit of a trick since as a bidder it is not even clear just what ‘it’ is.

Really the desire for money is going to have to be pretty intense to try and fake your way into this ill-defined absurdity!



Anonymous said...

"In delivering the services, the successful Tenderer must work closely with NEHTA, the National Change and Adoption Partner, the National Infrastructure Partner and eHealth Sites. However, coordination of all of these activities must align with operational direction provided by NEHTA as the managing agent."

This is an amazing recipe for achieving nothing and being able to blame no-one with nobody actually doing any work (the 3 Stooges would love this skit)! "Partners" everywhere!

This could actually backfire significantly on DoHA. They seem to be admitting they have no idea, and that they have no trust in NeHTA having any idea either!

Hmmm........ this could actually be very interesting.

Anonymous said...

"The requirement of having to have done this sort of work for eight (yes 8) similar projects leaves me gasping...."

8 similar projects you say
You're a rock star David
Maybe you should apply for the tender

But then again you do seem to be somewhat short of breath and somewhere out of touch. The real world is actually past your front gate!!!

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

Pity you are not game to use your actual name if you think I am out of touch. That way we can see how far you are out of touch as well, or not.


Paul Fitzgerald said...

this is akin to expecting an 18 year applying for their first job to have deep industry experience! Another job for the big consultancy firms who will provide a nice bound document full of "motherhood and apple pie" and charge multi-millions for the privilege. And then we can have a pilot to see if anything proposed might possibly work! Lovely to see the taxpayers cash being wasted yet again.

Hercules said...

As I understand it, a bunch of people who believe they have a good idea of HOW to do something, but not WHAT it is they need to achieve will, as the "managing agent" provide some kind of operational direction.

In applying for this, a company runs the risk of having a "managing agent" that isn't sure what the outputs needs to be, asking for you to measure them (!), while supported by two companies who are (as yet) unknown to you, and group of "wave 2" sites who have put together some bids in a very short space of time for some limited finance. Coupled with the need to also provide some open ended work. Not overly attractive.

Perhaps the most interesting thing here is the use of purals and singulars.

There will be multiple eHealth Sites.
There will be ONE National Change and Adoption partner.
There will be ONE National Infrastructure Partner.

It is this last one that surprises me a little. I believe that the supplier of the HI Services is considered to be A national infrastructure partner, so this sentence could be read to indicate that they are THE infrastructure partner.

Whether it is CSC, or another organisation, it certainly looks like there is no intention to put this out to multiple companies.

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

Hi Hercules,

Nice articulation of the risks!

You could go broke doing this!


Anonymous said...

Hercules - that is consistent with previous statements.

NEHTA will be looking for four delivery partners: A national infrastructure solutions partner (to provide the detailed design, build and integration); a change and adoption partner (to develop a strategy to encourage uptake); a benefits realisation partner (to develop and manage an assessment and evaluation framework), and an external delivery assurance adviser (ongoing oversight of the project).

Which would indicate one company to build all of the PCEHR. A pretty enormous project.

Anonymous said...

It's a desperate play by the Departmental public sector bureaucrats to remain 'relevant' in the face of increasing evidence that pockets of e-health developments by the private sector are rapidly gaining traction and spreading ubiquitously across the landscape with successful working systems progressively emerging.

It is also abundantly clear that the Department has not heeded one iota any recommendations made by Deloiite, by KPMG, and by Booz through the many onsultancies that have been undertaken over the last two yeas at significant cost to the public dollar.

The size, scope, breadth and depth of this tender exceeds all rational informed comprehension. It is so burdened with multiple high-risk factors as to make it totally unmanageable, to the point that it cannot go off-the-rails because it is impossible to ever get it on-the-rails in the first place. Put another way, it is doomed to failure even before the tender closes.

No competent CEO would ever permit their organisation to waste time and resources preparing and lodging a tender response in the form required. The most competent of CEO's would instruct their organisatin to lodge a formal statement of 2 pages (max) indicating why they will not be responding.

The Department should withdraw the tender and go back to the drawing board before it is too-late. Whether or not the Prime Minister, the Treasurer, the Finance Minister and the Health Minister can comprehend this remins to be seen.

Anonymous said...

It's much worse than utter madness when you look more deeply. How many of these discordinated and dysfuntional multi-million dollar initiaties do we need? The more we have the more confusion reigns down upn us.

The Health & Hospitals Fund has upto $1.2 billion to spend in the next ?6 months with some percent of that to be allocated to ehealth, an additional $467 million is also available from DOHA on a PCEHR, and in addition we should also add NEHTA's budgeted spend.

This begs the question if NEHTA is not doing so WHO is coordinating all this expenditure to ensure we get value for money?

The question is WHO?

Does the Health Minister know?

Tuly said...

As a medico with practical experience in IT and eHealth I would just add comment regarding the practical medical considerations that make the tender and its aims frought with considerable problems.

The health IT industry will need to recognise that IT solutions will not fix a health industry paradigm (pvte, ngo and govt) that no longer works in a world of chronic care and ageing. Collaboration between health and IT professionals needs to be undertaken in the understanding that innovative health solutions need to develop at the same time as IT solutions come on line to facilitate those innovations.

Health leaders need to grasp and address the need for paradigm shifts in the way we practice medicine. There is a real danger that we will have IT driven solutions for the wrong problem.

Anonymous said...

It doesn't look like the Industry briefing day on 17th January added much:

Anonymous said...

How can IBM bid on and win a tender they basically spec'ed up in the first place? Why go to tender? Why not just give it to them considering how much money you already spend on all their consults to prep for it?

I'm sure they will do their best to BLOW the budget out.