Wednesday, May 25, 2011

Have DoHA Got The PCERH Procurement Back to Front, Ridiculously Truncated or What?

The following appeared recently.

Health shortlists infrastructure tenders

Fujitsu, CSC and at least two consortia of smaller e-health providers are believed to be among those shortlisted for potential participation in the Federal Government’s $467 million personally controlled electronic health record (PCEHR) initiative.

The national infrastructure partner, one of four such partners sought by the Department of Health and Ageing for the e-health rollout, would deliver, integrate and provide continued maintenance for enabling systems including core system infrastructure; operations and call centres; reporting and template servicing; and separated portals for use by both consumers and healthcare providers.

Computerworld Australia believes companies including Fujitsu, Oracle, Microsoft, CSC and Telstra were among those shortlisted for phase two of the tendering process.

It is also believed they were notified both by the department and by others shortlisted earlier in May, almost a month after the initial 12 April date communicated to tenderers. The delay could push back further steps in the roadmap, which aimed to have a final stage 2 panel notified by the end of May and contracts signed by 30 June for beginning of negotiations and implementation talks.

Integration would take place ahead of a build and test phase beginning April next year, ahead of the go live date on 1 July 2012.

A spokesperson for the department said the tendering process was ongoing but refused to verify which companies had been shortlisted.

More here:

http://www.computerworld.com.au/article/387659/health_shortlists_infrastructure_tenders/?fp=4&fpid=1398720840

One never ceases to be amazed at the unreality of the PCEHR Program. Now we find that today (plus or minus a day or two) the successfully shortlisted tenders to deliver the PCEHR Infrastructure are given a few weeks to finalise a proposal and have it back to DoHA. From there their needs to be an evaluation, contract negotiations, announcements and then mobilisation to deliver whatever is to be delivered.

From here you can be sure there will be no final announcement in under a couple of months unless the whole thing is undertaken with careless indifference to the public interest.

We only have to look to the UK to see how the providers of similar services can deliver a lot less than they promised and do it very late. To finalise a delivery contract of this scale in a few weeks is frankly a joke.

This report a day or so ago in the Financial Times in London makes the risk totally clear!

Health records contract ‘holds taxpayer to ransom’

By Nicholas Timmins and Sally Gainsbury

Published: May 23 2011 23:57 | Last updated: May 23 2011 23:57

The cost of cancelling the remainder of Computer Sciences Corporation’s £3bn worth of contracts to install an electronic patient record for some 30m NHS patients could prove higher than to let it run its course, parliament’s spending watchdog was told on Monday.

Christine Connelly, head of the NHS IT programme, said the “absolute maximum” to which the NHS “could be exposed” was more than is left to run on the consultancy’s deal. Figures from the National Audit Office suggest that amounts to £1.6bn.

“We could be exposed to a higher cost” than the cost “it would take to complete the programme today”, she told the Commons public accounts committee.

Lots more here:

http://www.ft.com/cms/s/0/29cbd372-8580-11e0-ae32-00144feabdc0.html#ixzz1NFIgBRMD

We are talking a good deal more than tea money here!

It also needs to be remembered that there is presently only a DRAFT concept of operations for the PCEHR, the applicable standards have not been finalised and there are no actual specification from which a build or procurement of sub components can commence.

The DRAFT Concept of Operations does not even conclude its public consultation period until May 31, 2011. Not long to produce a useful final document also then!

This whole program becomes more and more fantastic as every week goes by!

David.

7 comments:

Enrico Coiera said...

Getting the procurement model right seems to be important, and I hope that the current round of contracts are informed by history. Many of the problems that have brought the English program down stem from signing contracts ahead of clear specifications:

" the speed of procurement meant that the NHS had not prepared key policy areas (eg, information governance), standards (eg, for messaging and clinical coding), and information system architecture (neither enterprise architecture nor detailed technical architecture was ready). Further, the contracts bound suppliers to a vague specification that has cost the NHS around £30 million in legal fees to sort out."

MJA, 186 (1), 2007, p3-4.

Anonymous said...

Enrico Coiera is quite correct and I have no doubt the Department and NEHTA are both very well aware of this.

The problem is that they are in a panic and have lost all semblance of objectivity and clear logical thinking. They know they have been going round and round and round in circles for years now and still have little to show for their efforts; except a very large depleted bank balance and hundreds of employees in NEHTA and elsewhere who are worried that when the music stops they will probably lose their jobs.

However, they can take some comfort they will probably be safe and secure in the knowledge that the UK has now got itself in so-deep that it has stated that the cost of cancelling the NHS program is prohibitive as the NHS could "be exposed to a higher cost" than the "cost it would take to complete the programme today" - even though there is absolutely no evidence that could be achieved with another injection of 1.6 billion pounds sterling!

Australia has pretty much reached the same end-game stand-off. The bureaucrats will convince the politicians they now have no option but to surge ahead (surge is a popular word in the American lexicon of recent times for - let's go into battle and finish the job until we can find a way to withdraw gracefully).

The final point to make here is that no-one will be surprised to learn that the decision makers from on-high have absolutely no idea what to do about how to extract themselves and the health system from this mess of their own creation. They cautiously admit to that in private. This leads to the desperate and gullible (DOHA and NEHTA) being prey to the white knights in shining armour (large vendors and consultants)riding up to the castle gates to save the day.

We have seen it all before, many times over. It is being played out in the UK right now and is being played out here before our very eyes.

This inexplicable scenario to which David and Enrico refer is designed to shift responsibility for the mess across to these big infrastructure partners on a grand scale, in the desperate hope that they might be able to deliver something that the bureaucrats can only hazily envisage through their clouds of confusion, indecision and inexperience.

Contracts will be written, responsibility for delivering outcomes will be transferred, the lawyers will insert every which-way-out clause, the vendors will deliver less than they promise and charge increasingly more as time goes by to do so (as has happened on a grand scale in the UK). The small local health software developers, eager to prove they can deliver acceptable, working solutions quicker and more cost effectively will continue to suffer till they whither away.

Back to front, ridiculously truncated, cart-before-the-horse sums it up. Who cares?

Anonymous said...

Originally Medicare Australia (then the HIC and IBM’s biggest customer) coveted ownership of the national ehealth record turf through being the centralised infrastructure provider.

Now Computerworld reports the contenders for the national infrastructure partner are – Fujitsu, Oracle, Microsoft, CSC, Telstra. However, Computerworld astutely observes that it is unclear as to whether the national infrastructure partner would come from the private sector.

If Medicare Australia is awarded the job then IBM will be the big winner. A PPP public-private partnership perhaps!

Anonymous said...

It is really sad to read about such a monumental waste of our money, with commitment for even more, where there is no direct or indirect benefit to actual health care. In fact the risk of harm due to incomplete and unreliable PCEHRs is of real concern. And as a specialist involved in high risk patient management I find a lot of the concepts scary. Not being able to correct errors or directly add critical information is nonsensical.

The political and operational risk of PCEHR is extreme and it is hard to understand why they are persisting in the current financial climate.

Tom Bowden said...

At the risk of sounding smug, I think readers may be interested in a system we have just gone live with during the past month in New Zealand.

'Care Insight' allows the ED staff member seeking an emergency patient record to send an online enquiry to the patient's general practice or pharmacy and obtain an electronic 'emergency record card', from the GP's EMR. The patient's GP or pharmacy is ascertained via polling using the Health Identifier to locate relevant information.

This has only been deployed in a relatively small region thus far but the early results are outstanding. Wihin three seconds the ED clinician has up to the minute patient information to hand; meds, allergies, recent history, test results are all there. It also means that the role of the GP's EMR as the primary source of a patient's medical information is confirmed.

We anticipate further uses but for the moment are focused upon getting the security and privacy aspects just right.

Demand for the system is significant with four other regions awaiting installation.

The cost? A fixed fee of $80 per practice per month with no set up fees. It should be live right across New Zealand in about 12 months from now.

Anonymous said...

Tom, where is the GP's EMR stored? Is it on the PC under the GP's desk, or in a cloud system somewhere?

Tom Bowden said...

either or, trend is towards hosted EMRs but this is working in both modes. NZ GPs have a high dependency on their systems and tleave their servers on 24x7. In our trial region all but one EMR is locally hosted, usually in a secure location within the practice.