Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Tuesday, May 15, 2007

SA HealthConnect Opens an Appalling e-Health Tender.

SA HealthConnect are at it again – working hard to squander public money as quickly as possible.

On May 8 the HealthConnect SA Released a Tender Seeking a South Australian Care Planning System (SACPS).

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Apology: I am sorry to be posting a lot of detail – but to follow just how bad this tender is it is important to read closely and with the background that can be found at the HealthConnect SA website.

http://www.healthconnectsa.org.au/ - was temporarily unavailable Mon 14 May at 4:47 pm EST. Fixed at time of posting.

For those who want the message without pain the next two or three and last 10 paragraphs will do it!

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Essentially the tender says – as I read it – we are seeking to procure a South Australian Care Planning System (SACPS). We are not sure what it should look like and what functionality it will be able to deliver but it has to be implemented and ready to be evaluated by March 2008. It also has to provide a shared care planning record that is web accessible and that can be used by GPs, Specialists and Hospitals (at least). Oh! – and yes - the money runs out on June 30, 2008 and ongoing operation beyond that time is not guaranteed. As an additional complication for you, our humble responder, we want the system to utilise NEHTA services which are not planned to exist until 2009/10 at the earliest.

What the tender goes on to say is – because we are so vague as to what we want and what is likely to be available, either off the shelf or needing to be developed – we want a fixed price bid that we can negotiate around to come up with something we think is suitable. Also, again because of our vagueness, can tender respondents please come up with a range of implementation and delivery options we can choose from.

Clarity around the decision making to decide how many respondents to negotiate and discuss with – and possibly collect intellectual property from for free – is also not provided as best I can tell!

And to make potential tender respondents really comfortable we then read:

“Because of this, the HealthConnect SA Program is seeking partnership with a preferred vendor that:

Demonstrates an innovative approach to this RFP;

Is able to articulate the vision for the goal-state SACPS;

Is committed to delivering or migrating to standards-based solutions;

Shares the financial burden associated with developing standards-based solutions; and

Recognises the commercial value of partnering with HealthConnect SA.

In responding to this RFP, respondents are requested to identify how such a partnership might work, the benefits envisaged by such a partnership and what would be expected of HealthConnect SA in entering into such an arrangement.”

This is code for “we want you to bear a good part of the cost of getting this thing up”!

Even more fun is an earlier part of Section 3.26 as follows:

“The HealthConnect SA Program expects the goal-state SACPS to be at the forefront of a new generation of ICT systems in the Australia health system. The goal-state SACPS will lead on three fronts:

The extent to which enhanced care planning functions will be available to support health care providers across disparate healthcare settings;

The high levels of interoperability that will exist between the SACPS and other key State and National initiatives; and

The adoption and use of standards and migration of the SACPS in line with developments in the NEHTA work program.”

To help the SA HealthConnect workout what they are asking for the responding vendor to provide a “Gap Analysis” identifying the differences between the possible and the fantasy they have in mind but have not clearly articulated.

Forgive me but this is really just nonsense. But it gets worse. Mandatory requirements are provided in Section 32.9.1

Mandatory Requirements

· Financial viability of the Respondent;

· Health Industry Experience of the Respondent;

· Evidence of proven integration experience with HL7;

· A clear vision for their system architecture;

· Evidence of a history of embracing standards;

· Evidence that a satisfactory governance structure is in place between all participants in the response; and

· Demonstrated project management experience.

That's it! – All the rest seems to be optional and to be responded to on a “here is what we can do” basis.

Also of note is that

“The scope of the initial care planning function set will be determined by:

1) The care planning functionality already available in the respondent's proposed products;

2) Any functionality that can be developed within the timeframes for Phase 1; and

3) Affordability.”

This is saying we want as much as you can provide – but if it is going to cost a lot we might want a bit less.

The timetable provided in section 32.5 is also a stunner:

“As such, the following timeframes for the SACPS are envisaged:

Issue of the RFP – Tuesday 8th May 2007;

Deadline for RFP responses Tuesday 12th June 2007;

Evaluation of responses and identification of preferred respondent by Friday 6th July 2007;

Detailed negotiation phase including an agreed scope of work and award of contract by the 17th August 2007 or earlier where possible;

Phase 1 implementation must commence as early as possible in the period between 17th August 2007 through to 31st March 2008 - based on implementing an agreed set of care planning functions. This timeframe is to allow for as much operational use of the SACPS by participating providers and consumers prior to a project evaluation occurring;

A project evaluation some time between March and June 2008;

Formal support mechanisms commencing July 1st 2008 under the business model agreed during the negotiation phase; and

Phase 2 – Further functionality scoped and rolled-out post July 1st 2008, subject to securing ongoing funding.”

This says you have from August 2007 until March 2008 to have something going (7-8 Months) before it will be evaluated and a decision made as to whether funding will continue from elsewhere.

What is more amazing is that nowhere is it stated how many practices, specialists, hospitals and so on are to be connected, using the system etc for the evaluation to take place.

Lastly we have the costing. The responder is asked to provide the following cost breakdown:

Implementation

Base Package Licence Costs

Gap Analysis Costs

Software Customisation / Modification Costs

Third Party Software Costs

Base Software Package Maintenance Costs

Training Costs

(identify training courses and their number)

Other Costs / Alternative Costs

(provide a breakdown of costs)

Project Management Costs

Implementation Costs

Interface Development Costs

(including testing and commissioning)

Data Conversion / Migration Costs

(including acceptance testing costs and conversion process)

Documentation Costs

Travel Expenses

Total Implementation Costs

Ongoing Recurrent Costs

Hosted Service Costs

Software Maintenance / Support

Interface Maintenance / Support

Third Party Maintenance / Support

Other Costs / Alternative Costs

(Provide a breakdown of costs)

Total Ongoing Recurrent Costs

Total Project Costs

These costs are not required for just the initial first year but for the next seven years!

So any provider who tenders is meant to provide an unknown scope of solution, reaching an unknown number of users, in a strategic vacuum with undefined functionality, but provide fixed costings for the next seven years.

There is also another and more subtle issue with all this. The tender makes a great fuss about all the NEHTA directions and standards but fails to really recognise the need to use HL7 in the list of Standards to be complied with and does not mention CDA R2 as a record format – rather than the older and virtually unusable, in my view, CIP standards. It would seem vital that at the moment of issue any tender issued by SA Health would be totally up-to-date on NEHTA directions given it is a core member. One really wonders just how much input NEHTA has had in shaping all this?

Also of interest are the following:

1. Just what approach is being taken to manage patient expectations regarding the privacy of patients – a key factor in the success of all Shared EHR initiatives. While the tender says those involved in the procurement will conform to the Health Department's Code of Fair Information Practice, just what will happen to patient information is not stated.

Regular readers will recall we have yet to hear just how privacy compliant OACIS is in South Australia. I have asked twice and the silence has been deafening!

2. Just how a design of the SACPS will ultimately be made conformant to final NEHTA Shared EHR requirements given they are presently not at all well defined. The amount of re-work required must be impossible to estimate and cost at this time

3. The prospective providers are not asked to address a Migration Strategy from the current OzDocOnline Trial to their solution. Is it assumed all that data will be lost or is the outcome of the tender less uncertain than it may appear?

4. This tender is weeks late in its release – originally promised for March 2007 – that is part of the reason the timelines are so silly. The writers can’t project manage and now the providers have to suffer and evaluation has to be truncated..what a joke!

This really is the most laughable public Health IT tender I have ever seen and I have seen some bad ones. Anyone who spends any time to respond to this rubbish is out of their mind I believe and deserve all the pain they get..and it will be a great deal.

What should be done is easy:

1. This tender should be withdrawn before anyone spends money responding to it.

2. The review of the Care Planning Trial needs to be completed and the lessons learnt.

3. Working with clinicians and users a real set of functional and requirements needs to be developed.

4. A new tender with all the appropriate attributes, reasonable timelines and clarity of purpose should then be released after review by NEHTA and DoHA.

As always it seems we have plenty of money to waste getting it wrong, but are not prepared to spend a little more money and take a little more time to get it right!

Someone needs to put a stop to this – and soon! (NEHTA maybe)?

David.

9 comments:

Anonymous said...

Oh dear - how sad. They clearly want to get somewhere fast, but poorly conceived tender requests usually only delay things further. Those you would like to respond will either not respond or offer an alternative sensible response - such as doing the requirements first - and they are likely to be culled. Only silly tenderers are likely to make it past the cull for this one, and then....well the Cheshire cat said it very well in his response to Alice in Wonderland:

"Would you tell me, please, which way I ought to go from here?"
"That depends a good deal on where you want to get to," said the Cat.
"I don't much care where –" said Alice.
"Then it doesn't matter which way you go," said the Cat.
"– so long as I get somewhere," Alice added as an explanation.
"Oh, you're sure to do that," said the Cat, "if you only walk long enough."

Anonymous said...

David,

A couple of further points:

1. SA Health/HealthConnect commissioned and paid for the development of a statement of requirements/functional specification for care planning a few years ago. It was largely the work of a competent health sector technology provider and an active, knowledgeable, IT literate member of one of the Adelaide Divisions of GP. It seems to have been abandoned in this process!

2. The SA Health HealthConnect program operates independently of the SA Health IT program (the CIO David Johnston is a peer of HealthConnect's David Filby) and this is clearly evident in the structure and wording of this tender.

What a mess!

Anonymous said...

Jobs for the Health Connect boys and girls I suspect. Anonymous as any self-respecting contributor in this space might be.

Anonymous said...

As Her Majesty would say "I am not amused".

What would The Hon Tony Abbott MP, Minister for Health and Ageing say?

Aaarrhhh?
or
Enough of this?
or
NEHTA where are you?
or
I wish that More fellow hadn't written me that letter. Have I replied to it yet? I do hope so.

Anonymous said...

I guess they some spare funds to lock away before the end of the Financial Year. Get the money committed now is probably the policy.

The Shadow said...

The funny thing about this is that the only people likely to respond to these kinds of RFIs are those who know the targets are impossible and who will simply milk the funding and end up walking away from a mess (albeit with some cash from Joe Taxpayer)

Anonymous said...

Yes Minister.

What a mess indeed. Now what was it you said back in June 2005? ! When?

http://www.computerworld.com.au/index.php?id=1737192765&eid=-6787

“E-health put on notice
Health Minister Tony Abbott has put federal health IT bureaucrats on notice saying he expects tangible results within a year, specifically functioning electronic health records and accompanying smartcard system - or heads would start to roll.

"I am sick of trials and studies and working groups," Abbott said.

"I want patients to see a difference in 12 months. If patients do not see a difference, we will have failed," Abbot said, adding he was not prepared to be "held hostage" by a never-ending chase for the latest and greatest IT solutions.

"For too long we have tried to achieve too much. The best is the enemy of the good."

Of course Minister.

Whatever you say Minister.

"We will have failed".
or - "I will have failed".
or - "They will have failed".
At lease someone will have failed.

Karen said...

I think that your judgements are harsh. I do not think it such a bad thing that this tender acknowledges the state of e-health in this country - we do not have all the answers - in terms of functionality, architecture, integration and standards implementation. So why should they pretend that they do and try to prescribe a solution.

To me, this tender says, we have some money, we want to do something, we need to demonstrate benefit quickly (as any good project should) before further committing, we have some ideas on how it should work but we are seeking the expert opinions of the market to guide us by providing options for solutions.

Nothing wrong with that.

Or should we all just sit around waiting for the answers to be given to us before we do anything?

Aus HIT Man said...

Hi Karen,

If you are a State Government with money burning a hole in your pocket and you don't know how to specify what you want / need the is a correct non-money wasting way to do this.

You develop an initial Expression of Interest and get input from the market, vendors and other stakeholders on what is needed and what might work. Then, when you know what you are doing you issue your formal tender.

There is no reason not to move forward but there is also no reason to move forward wastefully and stupidly when there are well established processes that avoid such risks.

Sorry, on this you are simply wrong in my view. As Government you do it properly and prudently or not at all!.

David.