Wednesday, August 29, 2012

More Of The Ugly Truth Seems To Have Leaked Out About HealthSMART. It Was Not Run Well!

The following appeared a few days ago.

HealthSMART system cavalier: Vic auditor

  • From: AAP
  • August 21, 2012 2:18PM
THE proposal for Victoria's abandoned $500 million e-health system was cavalier and more of a concept than a properly developed business case, a senior bureaucrat says.
The HealthSMART rollout began in 2003, costed at $360 million under the previous state Labor government, but is fully operational at just four health services across Victoria.
The coalition government scrapped it last May after $500 million had already been spent.
Victorian Auditor-General's Office performance audit director Paul O'Connor said the HealthSMART business case lacked implementation detail.
"I would say it was more of a concept brief rather than a fully written business case in terms of how we are going to implement this," Mr O'Connor told a Victorian parliamentary inquiry into the delivery of major infrastructure projects on Tuesday.
"One of the problems that has occurred in Victoria is that some business cases with very large amounts of money have been quote cavalier perhaps in the way they've been constructed but they've received large amounts of funds and seemingly very little oversight.
Some good reporting also came from The Age.

Auditor scorns 'slack' officials

Date March 21, 2012

Melissa Jenkins

DELUDED, lazy bureaucrats in Victoria don't give ministers the advice they need, and large projects are retrofitted to match political announcements, the state's auditor-general says.
Auditor-General Des Pearson and his colleague Paul O'Connor delivered a scathing assessment of the relationship between the public service and the government in giving evidence to a parliamentary inquiry into infrastructure projects.
They argued no effective mechanisms were in place to stop hundreds of millions of taxpayers' dollars being tipped into dodgy rail and road projects.
Dr Pearson said government agencies were too reliant on external advice and often accept it without scrutiny.
Departmental staff often base their advice around what has been announced by a minister and don't take other alternatives into consideration.
''Often, when we're talking to departmental staff, they are sort of saying 'oh, the government announced' and they're using that as what I call a get-out-of-jail card not to provide frank and fearless advice,'' he told the Public Accounts and Estimates Committee.
More here:
There was also some commentary about a lucky Hospital that got an early installation.

Vic e-health system difficult: hospital

  • AAP
  • August 23, 2012 10:34AM
VICTORIA'S abandoned multi-million-dollar e-health system implemented in just a handful of hospitals was overly ambitious and has not improved patient safety, an inquiry has been told.
The HealthSMART rollout began in 2003, costed at $360 million, under the previous state Labor government, but is fully operational at just four health services across Victoria, including Melbourne's Royal Eye and Ear Hospital.
Hospital chief executive Ann Clark said it would have been better to have different information technology systems to suit individual hospitals but develop a set of common rules so information could be shared.
She said the hospital faced significant complexities integrating HealthSMART with its outsourced pathology system.
More here
Some quotes from the actual testimony of the Auditor General are just wonderful.
“Finally, I thought some contextual considerations were relevant, and again I pose a few questions there. Is adequate benchmarking and baseline data available to underpin the various projects we embark on? The next one is: are we punishing ourselves for cost overruns and not adequately managing expectations? There I relate — and we refer in our written submission — to the research by Professor Bent Flyvbjerg in 2009. Just to refresh your memory, he researched worldwide project outcomes and found for construction project budgets between 10 million and 150 million euros, the norm was a 50 per cent overrun and in IT projects it was up to 500 per cent on the target projects. In quoting that I am not saying it is all right to overrun, but it is a recognition that we are not alone in experiencing this problem. In my reading of his research, there are lessons to be learnt there of key lead indicators and issues to be addressed up-front in what I would call purposeful management.”
and here:
“I am very interested in Dr Flyvbjerg’s research, which you have referenced in your submission. It is quite frightening when you read that this is not just a Victorian phenomena, it is an international phenomena in terms of public sectors’ inability to deliver projects on budget and on time. I am particularly interested in what your views are of some of the propositions that have been adopted in other jurisdictions, specifically having peer-reviewed business cases or costings of projects, like they do in the UK with the National Audit Office. I also note Dr Flyvbjerg’s suggestion that there should be strong penalties, including criminal sanctions perhaps, for those who underforecast the cost of projects. And finally, I would be interested in your general comments around cultural change. What is it? Is it optimism bias? Is it that we have built the wrong political incentives and therefore that leads to the wrong bureaucratic incentives? What, culturally, do you think, would signify the greatest circuit break and give us more legitimate grounds for what you describe as purposeful management?”
The full transcript is here:
I have to say I think the comments are relevant to both HealthSMART and the NEHRS.
I think we may be kidding ourselves if we think that just because it is a Federal Project all will be well.
Reading Professor Bent Flyvbjerg’s 2011 paper in the Harvard Business Review is Highly Recommended - especially for DoHA and NEHTA if they have not already done so!
See here:
Enjoy or cringe!
David.

6 comments:

NK said...

"large projects are retrofitted to match political announcements"

isn't it good that this only happens in Victoria then.

"Departmental staff often base their advice around what has been announced by a minister and don't take other alternatives into consideration"

What, they do what their boss says? He wouldn't be speaking to, like, ministers, or something?

"criminal sanctions ... for those who underforecast the cost of projects"

rofl laughing. yeah, the ministers, yeah, they'll accept that kind of liability, yeah.

(Self-congratulations for passing the robot check eventually. Apparently I am not easily distinguishable from a robot )

Earl Hose said...

"[RVEEH] said the hospital faced significant complexities integrating HealthSMART with its outsourced pathology system."
Right now, I believe, HSU is ramping up industrial action by hospital scientists against another round of "outsourcing" of pathology services.
Would a private pathology company have to take on the burden of porting data from an in-house laboratory system into an integrated system that's capable of displaying all results in the one, cumulative record?

Anonymous said...

@Earl, surely you jest! that would suggest interoperability between pathology system vendors...ho, ho, ho...

Earl Hose said...

Jesting? I did hear galloping hooves, though.
Laboratory systems don't have to be interoperable, and they never will be. However, CDM-Net is supposed to bring all kinds of records, including test results (according to the note in Medical Observer) from disparate sources, onto a single platform. Surely?
KPMG had something to do with the medication management side of CDM-Net. Did they do the pathology part, too?
Precedence Health Care is running CDM-Net, so maybe http://precedencehealthcare.com/about/executive-team/executive-bios/#marienne knows.

Anonymous said...

I have heard of one hospital recently where a new pathology system was ordered but they decided that an HL7 feed was not required. Later they were told otherwise, but by then it had to be added at extra cost.

Andrew McIntyre said...

While some terminology issues are yet to be sorted out, paricularly panel codes, there is no reason for pathology tests in HL7v2 not to be interoperable and if they are not it simply reflects a lack of standards compliance from the labs. The large private pathology companies are reasonable, but not as good as they used to be.

There are no incentives for standards compliance so what else would you expect in an age when managers try and screw down costs. Ignoring standards compliance saves money. We are getting what we deserve from a lack of sensible governance.