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

Wednesday, June 27, 2007

Is HealthSMART as Smart as it Claims?

It is funny how things come back to haunt you. In the 2003/4 Victorian Budget an allocation of aadditional funding of $138.5 million was provided budget for a Health Information and Communication Technology (ICT) Strategy to roll out an integrated approach to the implementation and ongoing support of business applications and their underpinning technical architecture.

The full cost of the Health ICT Strategy was estimated at $323.5 million. This included $138.5 million over four years provided in the 2003–04 budget, with the remaining funds to be contributed by hospitals and existing information and communication technology funding from the Department of Human Services.

The additional funding is as follows:

Health ICT Strategy (Additional Funding)

2003/4 18.5M

2004/5 38.0M

2005/6 40.5M

2006/7 41.5M

Total = 138.5M

This means that had things gone as planned the investment would have been finished a day or so from now and all would be wonderful – Health IT wise – in the great Southern State.

Under the Health ICT Strategy, the Government was to remove obsolete, aged products and invest in modern proven systems, based on accepted interoperability standards covering hospital administration systems, clinical systems and electronic medication ordering.

Of course that was never going to happen. We now find that – to quote from the HealthSMART website:

“HealthSMART is a $323M technology program operating across the public health care sector funded through the 2003-04 Victorian State Budget. Initially a four-year program, it is now running over six years from 2003 - 2009.”

To be frank even this timeline looks more than optimistic. Why do I say this?

First, it seems that with clinical systems HealthSMART has adopted the approach of developing State-Wide Builds of the Cerner Software. Experience elsewhere has shown that this can be very problematic (just look at the UK NHS) – as the users don’t see they are getting the system they need that really suits them – rather they are getting a compromise – to them – state-wide solution.

One only has to see that the State-Wide System is being driven by a committee representing 13 different health systems (from major to minor hospitals and from cancer to paediatric hospitals) with over 40 members to recognise that getting agreement on what is to be done will be both slow and tricky to achieve.

Second if one reviews the time-lines provided in each of the progress reports (Roadmaps as they are called) it is clear that with each update issued the time-lines are extending.

Third my making the choice to implement Cerner clinical applications on top of an iSoft Patient Management System they have greatly complicated the operations of each and have lost many of the key benefits of integration that the Cerner system offers.

This is especially true given their approach is to integrate patient administration, outpatients, emergency, laboratory, pharmacy and radiology (at least) onto a Cerner core repository. I believe this is a plain stupid strategy. The amount of context switching from source systems (lab, pharmacy etc) that many clinicians will be forced into is likely to be both time-wasting and annoying.

Fourth with the some of the system selections made there must be the suspicion that adequate financial due-diligence was not undertaken given the difficulties being experienced at present by iSoft.

Fifth, any Health IT strategy that takes six-seven years to implement in the Public Sector has a high risk profile no matter what else goes well initially.

It seems to me that sadly this strategy is facing some existential threats. I hope it can prosper and deliver but it is looking less likely to me as of late June, 2007.

Clearly I am not the only one who has noticed there are a few issues:

http://www.theage.com.au/news/national/health-revolution-stalls-over-mass-funding-blowout/2007/06/23/1182019436711.html

Health revolution stalls over mass funding blowout

Jason Dowling
June 24, 2007

AN UPGRADE of the health system's computer network — which the Government says will "revolutionise" the way hospitals and surgeries deal with patients — has blown way over budget and is years behind schedule.

The upgrade program has cost $363 million so far — $40 million over budget — and is two years behind schedule. It also has been scrutinised by auditors amid allegations of conflicts of interest involving a contractor employed by the Department of Human Services.

…… (see URL for full article)

The stories of contract irregularities, budget blow outs and compulsion of clinicians etc bode very badly indeed.

I suspect that by the time 2009 rolls around I will be seen to have been quite prescient – time will tell.

David.

1 comment:

Anonymous said...

As someone who was (marginally) involved in the original bids to Treasury, then continually involved in the process as an agency level project manager until 12 months ago, I have many stories that I could tell if it were not for a stringent non disclosure agreement.

I can give my opinion on the strategy, however, as I have to the people responsible for the implementation. The single minded and dogged pursuit of a centralised approach continues to be problematic.

I am out of time right now, but will post some more considered remarks later.