A Brief for the Australian National Audit Office regarding E-Health

Reflecting on yesterday’s commentary it occurred to me that it may be useful to offer some suggestions as to the rocks the Australian National Audit Office should look under in developing a performance review of Australian E-Health.

In broad terms Performance Audits (Which is the type of audit I feel is needed in e-health) address the following:

1. The existence of, and the suitability of the Information and Communications Technology Strategy that has been or is being implemented.

2. The practicality, quality, project management skills and resource availability applied to ensure successful implementation the project plans.

3. The quality and insight of the Risk Management Plans associated with the project.

4. The business case for implementation of the ICT Strategy being implemented.

5. The outcome of the project in terms of service improvements, financial savings or other relevant evaluation criteria.

6. The degree to which lessons learnt during the project have been disseminated to ensure minimum repetition of mistakes and financial waste.

7. The closeness of the actual delivery of the project and its expected outcomes to those identified in the strategy, planning and business case documentation.

It seems to me that the implementation of e-health, both at a national and state level, has been littered with a range of major projects which have not met expectation (for timing and delivery) and for which there has been very little evaluation made public to foster organisational learning.

First among these must be the HealthConnect initiative. To date there has been a minimum of transparency as to both costs and benefits for this whole program. Despite repeated claims that the notional $128M project is on track and on budget there seems to be very little to show for these funds. A hard look is clearly warranted.

It may be that what is actually required with respect to HealthConnect is a review, in detail, of each of the pilots and implementations as well as the overall strategy. Most important will be to understand what benefits, if any, have been delivered in terms of improved patient care and patient safety.

Second it seems there needs to be an audit of the performance of the governance structures surrounding e-health in Australia. It is no secret that since 1995 there have been a number of reports into the area.

These have included the 1995 Health Communications Network Report, the 1997 House of Representatives Report, the 1998 NOIE Reports such as the 1998/9 Unstoppable Rise of E-Health Report, the 1999 Health On-Line Report, the July 2000 Report to Health Ministers of the National Electronic Health Record Task Force and the 2004 Boston Consulting Group E-Health review at least. In parallel there have also been a range of State Health Department Reports. To date these reports have led to a range of trials which are admitted to have not resulted in any significant national implementation. After all this time the National E-Health Transition Authority has the view that “the momentum for e-health is rising and that the stage is set for Governments to consider a national system of electronic health records". Dr Ian Reineke (CEO, NEHTA - As of April 2006). ANAO really needs to investigate what has gone wrong for over a decade and what is needed to fix things. The opportunity cost of a wasted decade must be assumed to be massive.

Thirdly it has been suggested by Mr Abbott (Federal Health Minister) that the Commonwealth has invested close to $1.0 Billion over the last decade in provision of such programs as the Practice Incentive Program and Broadband for Health. Both these were aimed at improving GP computing. An public audit of the outcomes, learnings and benefits of this expenditure is clearly overdue.

Fourth it seems delivery of benefits from Supply Chain Reform are coming much more slowly than they could or should for the Health Sector. Careful review of the issues here could be very valuable and save real money.

Lastly a strong case can be made for a review of the range of identity and identification programs being sponsored by the Commonwealth which are clearly needing to be rationalised. The importance of the requirements of the Health Sector in this area cannot be underestimated.

Someone needs to be asking just how the NEHTA IHI and IPI initiatives, Minister Abbott’s Health Smartcard, the Access / Smartcard Initiative, Passport ID, the Document Verification System for Attorney General's and Medicare / Centrelink's current ID systems are to be co-ordinated and managed for both efficiency and cost effectiveness.

While not the responsibility of ANAO (but rather the state equivalents) there seems little doubt the procurement processes of Health IT in NSW Health, the Victorian HealthSmart Project, the continuing delays in Queensland Health’s IT implementations and the use of scanned records in Tasmania could all stand careful audit scrutiny.

Clearly there is lots to be done. Let’s hope some one will take up the torch and get all this back on the rails.

What score out of ten do you think these various initiatives would achieve if fairly audited?

David.