Thursday, July 26, 2012

Just Where Does This Move Leave Those Who Signed Up for the NEHRS / PCEHR? In A Labyrinthine Managerial Maze With No One Accountable I Suspect.

This appeared yesterday:

Health Department to outsource PCEHR operations and management

  • by: Karen Dearne
  • From: Australian IT
  • July 25, 2012 3:31PM


THE Health Department wants to outsource its operational and management responsibilities for the personally controlled e-health record system to a single provider.

It has released a tender calling for "provision of project support services" for the PCEHR program, which went live earlier this month despite warnings that the system was unstable and plagued with known bugs.

"Over the next two years, the government will provide $161.6 million to Health to operate the PCEHR and support its gradual enhancement and adoption," the tender says.

"As the systems operator, the department will be responsible for managing uptake, complaints, systemic issues, performance reporting, system integrity and strategic direction.

"Our objective is to identify one provider with the required range of expertise, skills and quality assurance processes that will support the department in its management of the PCEHR program and its new operational role."

The supplier will also have to liaise with a "network of stakeholders" including the National E-Health Transition Authority, Human Services, Accenture and the Office of the Australian Information Commissioner.

"The successful tenderer will be required to assist the department to achieve the objectives of the program: to improve the quality, safety, efficiency and coordination of healthcare by reducing the fragmentation of information across the healthcare sector," the tender says.

Based in Canberra within the department, it envisages a team of two people for high-level program management services, one person to perform contract management services, a business systems analyst and two people for operations management duties.

More details are here:

There is also coverage here:

Aus Govt looks to outsource e-health record management

Summary: The Australian Government is looking to outsource the management of its Personally-Controlled E-health Record system.

By Josh Taylor | July 26, 2012 -- 00:15 GMT (10:15 AEST)

The Department of Health and Ageing has gone to tender for an organisation to support the operation of the Personally-Controlled E-Health Record (PCEHR) system.
The Federal Government's e-health record system was launched on 1 July after two years of planning and hundreds of billions of dollars worth of investment. Although it hasn't been a smooth start for the program, over 3500 people have so far registered for their own e-health record.
The request for tender document, published yesterday, calls for a company to manage the running of the system for just under two years, to at least the end of June in 2014 and starting as soon as the contract is awarded. Up until this point, the government has been managing the operation of the system.
More details here:
This is really a very interesting Tender - for what the Department seems to be asking for is 8 reasonably high level people to work internally in the Department for the next 2 years.
The introduction and what follows is very interesting:

1. INTRODUCTION

From July 2010, the Personally Controlled Electronic Health Record (PCEHR) program has been funded to design, build and implement a national PCEHR system. The system was launched in early July 2012 and will gradually transition into an operational and management phase requiring the external support of a range of project management skill and expertise. The Department of Health and Ageing (“the Department”) is therefore seeking to engage one organisation to provide all the project support services required to assist the Department to manage the transition to and demands of the new phase of the PCEHR program. The Department will not accept tenderers who only tender for part of the required services, as specified in Condition of Participation (f). The Commonwealth may also offer contracts to preferred tenders for specific activities that are being sought under this tender.
-----

4. BACKGROUND

Commencing on the 30th of June 2010 the Australian Government allocated $466.7 million over two years to design, develop and implement a Personally Controlled Electronic Health Record (PCEHR) system to improve access to health information and avoid the proliferation of divergent and fragmented systems. From early July 2012, the PCEHR system became operational with consumers able to create their records either online, by phone or via selected Medicare shopfronts. As the capability of the system expands, Australians who choose to participate will have their health information securely available to them and their approved healthcare providers when and where it is needed. A range of health information will be able to be accessed including a patient’s general health history, pathology and radiology summaries and prescription information.

5. CONTEXT

Over the next two years the Government will provide $161.6 million to the Department of Health and Ageing to operate the PCEHR system and support its gradual enhancement and adoption through the continuation of the PCEHR program. As the systems operator, the Department will be responsible for managing uptake, complaints, systemic issues, performance reporting, system integrity and strategic direction, and liaising with a network of stakeholders which includes the National eHealth Transition Authority, the Department of Human Services, the National Infrastructure Operator and the Office of the Australian Information Commissioner.

6. OBJECTIVES

The objective of the project is to identify one provider with the required range of expertise, skills, and quality assurance processes that will support the Department in its management of the PCEHR program and its new operational role, and will provide value for money.
The successful tenderer will be required to assist the Department to achieve the objectives of the program: to improve the quality, safety, efficiency and coordination of health care by reducing the fragmentation of information across the health care sector through a personally controlled electronic health record. The operation and continued development of the national PCEHR system will enable a seamless transition between health care settings, a reduction in time spent reiterating clinical history or waiting for test results to be located, and a reduction in adverse medical events.

7. REQUIREMENT

The successful tenderer will be required to provide personnel with the requisite skill and experience to co-locate in Canberra with the Department, and work collaboratively with the Department, its staff and its contracted business partners. In addition, the successful tenderer will be required to provide a flexible number of personnel to meet a variable workload demand as the requirements to operate the PCEHR system are progressively rolled out.
Here seems to be the core of the staff requirement:
-----
The Commonwealth may offer contracts to preferred tenders for specific activities that are being sought under this tender. The successful tenderer will be required to provide a minimum of the following numbers of personnel with the following skill and expertise to undertake the following services:
(a) Two people to perform High Level Program Management services, that include but are not limited to:
  •  Assistance with determining strategy and its application to the implementation of the PCEHR Program;
  • Integration and coordination of decisions and initiatives within the PCEHR Program;
  • Direction and coherent management of numerous parallel projects and multiple service providers and stakeholders through strong governance models;
  • Monitoring of the overall PCEHR Program and project performance and benefits realisation;
  • Ensuring rigour in the PCEHR Program and its associated projects;
  • Focusing the PCEHR Program and individual projects on delivery of business benefits in time, cost and quality measures, with well-defined metrics that demonstrate success;
  • Ensuring a balance between short term tactical and longer term strategic objectives;
  • Providing well defined statements of work, evaluation plans, requests for quote/requests for tender documentation and contracts, as well as business and technical requirements for third party suppliers; and
  • Ensuring individual projects are aligned within the overall PCEHR
Program thus enabling:
(i) critical dependencies to be established and managed;
(ii) critical path to be understood;
(iii) critical risks and issues to be identified and managed;
(iv) high level administrative and clerical support; and
(v) meaningful reporting against program objectives
Program Management personnel will be required to have skills and experience including, but not limited to: Demonstrated ability in administering Prince2 project management methodology.
(b) One person to perform Contract Management services.
- lots omitted
(c) One person to perform Business Systems Analysis services, that include but are not limited to:
  • Supporting the Department to set the required outcomes and overall business design of the PCEHR operational period;
  • Establish, maintain and support the
(i) Reporting structures and standards;
(ii) Issue/risk management and escalation procedures;
(iii) Status reporting; and
(iv) Resources and cost forecasting of the PCEHR Program.
  • Manage, store and quality assure PCEHR Program and project documentation;
  •  Assess the effectiveness of the policy through the evaluation of Program benefits.
(d) Two people to perform Operations Management services, that include but are not limited to:
  • Supporting the Department to manage uptake, complaints, systemic issues, performance reporting, system integrity, data custodianship, and strategic direction;
  • Ensuring the PCEHR program complies with legislative constraints, to achieve the policy intent.
(e) One person to perform Capability Development services, that include but are not limited to:
  • Establishing long term governance structures;
  • Monitoring and revising as required:
(i) Sourcing strategies for the Department’s operational partners;
(ii) Policies and procedures for contract staff;
  • Provide job descriptions and assistance with the sourcing of additional resources as requested by the Department.
(f) One person to perform Change Management and Continuous Improvement services
----- End abbreviated extract.
So one organisation, eight pretty senior people to take the PCEHR forward. The scope of what these people are meant to do is just staggering and what is more - as far as I can tell there is no associated control of the various activity arms that are in place.
This paragraph is pretty telling:
“As the systems operator, the Department will be responsible for managing uptake, complaints, systemic issues, performance reporting, system integrity and strategic direction, and liaising with a network of stakeholders which includes the National eHealth Transition Authority, the Department of Human Services, the National Infrastructure Operator and the Office of the Australian Information Commissioner.”
So you have all these roles and objectives but have to work through all these other entities and stakeholders.
Frankly this is utter madness. Either you outsource control, budget and staff and ask a contractor to get on with things - with appropriate accountability - or not. This is a seriously half pregnant proposal if ever I saw one.
What is needed is a separate agency to do the lot - properly governed and led - and separate from DoHA, NEHTA and the DHS. Anything else will just implode on itself in confusion and mayhem.
What nonsense.
There is no doubt, however, serious help is needed. The Access To Medicare Services tab still crashes after 2 weeks.
On the matter of yesterday's rather messy COAG meeting it seems NEHTA funding has been shunted off to a committee. It will be interesting to see if the Liberal states are similarly hesitant with the NEHTA funding as they are with the NDIS. Time will tell I guess.
David.

11 comments:

Anonymous said...

David, I agree completely with your sentiments. It looks very much like a project being set up to fail from the outset.

It also looks like a project being set up as a curtain raiser to some further steps which cannot yet be declared for the implications of doing so would be untenable.

So what might those next steps be?

1. Build a core capacity of 8 senior people contracted to work inside the Department on an outsourced basis, This keeps them off the Department's head count and arms length removed from the Department whilst remaining inside the Department and under the Department's control.!!

2. The next step is to extend the outsourcing to enable the whole project to be removed from the Department's control and put into the hands of a private sector entity or, as you have suggested, put under the governance of another 3rd party to be established independent of DoHA.

3. This now enables the Department and the jurisdictions to free themselves of any association with, and responsibility for, NEHTA including funding. In other words it opens a way for shutting down NEHTA and transferring the whole project over to the new 3rd party under an outsourcing arrangement.

How close to the mark does that sound?

Dr David More MB PhD FACHI said...

Sounds remarkably close to me!

David.

Anonymous said...

So with Government history and capacity to manage outsourcing arrangements would you as a citizen trust those involved to be working in your best interests –hardly? !! If trust is the premium currency on which the use of this all hinges – it is going to be more money spent for not much outcome or use. So PCEHR may not have been a government strategy of “giving it to google” (health) after all!! Rather it appears it is government setting itself up to “doing a google” (health) – (letting go/adandoning /unplugging).

Earl Hose said...

Looks like a(nother) job for KPMG.

Anonymous said...

Good grief - read the tender properly. These are contractor roles to work within DoHA to help run bits of the PCEHR now that the build is (notionally) finished and the expensive consultants there for the build are finishing up. The roles will all be inside DoHA and probably still reporting through the existing eHealth branch.

To avoid having to establish contracts with a number of different companies, each supplying one or two people, the tender requests a single supplier for all of the roles. There are Canberra body shops who do this for many, many departments and programs already. This is not outsourcing, it is just a bunch of contract roles!

If anything, you should be celebrating that DoHA is NOT seeking to establish either permanent APS roles to run PCEHR (hard to get good permies for this), or set up a new external entity to be the operations arm (service still too immature to cut loose). Or worse still, give it to NEHTA and turn them into NEHA. Or the absolute worst, give it to Medicare and let them try to work out what to do with it...

In summary, a small number of temporary roles to come from the same supplier in support of short term operations needs. A long way short of the breathless histrionics in the media.

Dr David More MB PhD FACHI said...

@ Anon 09:55:00 PM

Sorry - look at the scope of the expectations. This is an attempt at major responsibility shifting I reckon.

Comments more than welcome as to how others read it - and I have read it carefully.

David.

Anonymous said...

It is NOT a "bunch of contract roles" - far from it. This will be yet another exercise in wasting more millions tp obfuscate all and sundry and make sure that yet another of the big 4 is responsible for assuring the next big tick for the PCEHR. Anyone of them that tender will put a nice big price tag on it to make sure their reputation won't be too tarnished, you can bet on it.

Cris Kerr said...

Anon at 9.55pm: ' ... In summary, a small number of temporary roles to come from the same supplier in support of short term operations needs. A long way short of the breathless histrionics in the media. ... '

To continue to do the same as before (even with more resources) invites the same outcomes.

###

David, I agree, and especially with; ' ... What is needed is a separate agency to do the lot - properly governed and led - and separate from DoHA, NEHTA and the DHS. ... '

Anonymous said...

Whatever it is, it will be done badly, based on the record so far. What we really need is an election so we can assign this huge mess to the trashcan where it belongs. A PCEHR repository should be a person controlled repository that is a side benefit of inter-provider communication and not the main game. They are building castles in the air and sooner or later gravity will prevail. The cost of holding this monstrosity in the air will bankrupt everyone and its best to make the call that its not to big to fail, and should not be kept on life support when its brain dead. I am sure some organ donation can occur, but this parrot is pushing up daisies.

Anonymous said...

From the ZDNet article:
"hundreds of billions of dollars worth of investment."
Seriously? hundreds of "billions"? Typo perhaps?

As for outsourcing and contracting from a single source, if that was going to be the case, why didn't they just contract with the major players in that space to begin with 5 years ago and be done with it? Smells a bit like 'not invented here' gone bad to me.

Anonymous said...

So now we will have a group of people who:
* didn't create the policy and can't change it;
* didn't design the roadmap and can't change it;
* didn't design the systems and can't change it;
* didn't fund the work and can't change it.
Desired candidates will have excellent communication skills, a Bachelor of BS, Diploma in PR and prior experience with Spin. No medical or Health IT experience necessary.

Create scapegoat for future blame and deniability for DoHA/Gov.

-Tim C.