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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 20, 2007

The Mess in the West.

About a year ago (22nd June 2006) an entity of the Western Australian (WA) Health Department styled Healthtec conducted a briefing on the forward plans for Health Information Technology in WA.

The briefing was told that this Technology division was established on 1 January 2006 with the role of managing WA Health’s information, communication and medical technology. In doing so, Healthtec intended to lead a significant enhancement of current systems and infrastructure under the Health Reform and Implementation Taskforce HRIT ICT Program (HRIT ICT). This included the replacement program for patient administration and clinical health information systems (HIS).

In the WA Health Operational Plan 06-07.doc – Revision 25 - 28 Apr. 06 there is a section entitled “Ensuring our information and communication technology(ICT) aligns with the Clinical Services Plan“ (section 5.5)

The timeline proposed was as follows:

1. ICT and medical technology master plan completed by July 06

2. Expenditure Review Committee approval of ICT program business case by December 06

3. Release of ICT RFT/Tender by January 07

4. Establish contract form supply of ICT systems by June 07

5. ICT Implementation strategy and timetable endorsed by SHEF by May 07

6. Commenced implementation of ICT infrastructure plan deployment by June 07

A little further research reveals this was already a modified time line.

From the WA Health Clinical Services Framework - 2005 – 2015 dated 21/09/2005 we read:

“3.4 Information and Communication Technology Framework

Supporting the CSF and a number of health reform projects is an Information and Communication Technology (ICT) strategy.

The ICT program will deliver a system-wide integrated clinical information system that will incorporate the public and private hospitals, community health, primary care and mental health sectors. This new system will be progressively implemented across the state and will include electronic patient records, single patient identifiers and provider identification.

The ICT program will engage stakeholders in the development of system requirements for all clinical modules. This process is now almost complete. After further discussions with stakeholders and the completion of the regulatory processes, the Department of Health will proceed to a tender process in the later part of this year” (2005).

Worse we can also note that the Reid Review (March 2004) “A healthy future for Western Australians, Report of the Health Reform Committee, WA Health Department, Perth said in Recommendation 18:

“The Department of Health should progressively implement a system wide clinical information system which incorporates the public and private hospital, community health, primary care and mental health sectors. The system would include electronic patient records, unique medical record numbers and provider identification.”

So, after all the fanfare of the major Health Department Review of 2004 and the other plans mentioned above we find a central element – ICT Implementation - slipping comprehensively and disastrously. I am sure all this would not have been helped by the reported loss of the Executive Director of the Health Technology Area due to some administrative issues. (Not that this departure seems to have resulted in any update of the Health Department Web Site)

See http://www.health.wa.gov.au/tech/home/ (as of 19 June, 2007 where the page seems to be the same as that I saw in June 2006, one year previously).

As far as I am aware we are still to see any completed significant Health IT procurement action. A review of the tenders sought and let by WA Health in the Government Electronic Market (GEM) didn’t locate any likely EOIs or RFTs.

This suggests a total slippage in the Health IT area that is now moving towards 18 months at best and three years at worst. Given the importance of progress in this area this really is amazing level of delay and inaction!

A possible reason for this apparent lack of progress may be found in the following report. The report is entitled “A Report Card on the WA State Health Service” and is written by Gavin Mooney who is Professor of Health Economics, Curtin University of Technology. (It is published as the Social and Public Health Economics Research Group (SPHERe) Debating Paper 1, 2007 – Dated May 2007).

The full report can be found at the following URL:

www.sphere.curtin.edu.au/debates/SPHERe%20Debating%20Papers%201%202007.pdf

The first thing to be appreciated is that Professor Mooney has been at this a while.

“He is recognised as a leading expert worldwide on efficiency and equity in health care delivery. He has over 30 years experience in advising governments in health care planning, including in the UK, Canada, New Zealand, South Africa, Spain, Denmark, Norway, Sweden and Iceland. He has acted frequently as an adviser to the World Health Organisation, and to the OECD.

He has authored or edited over 20 books and has more than 200 articles on health planning and economics.”

The second thing to be realised that he is convinced WA Health Department Management is in a state of virtual collapse:

The Executive Summary of the Report makes that clear!

"How is the WA health service now travelling? We have many dedicated, hard working, highly skilled health care workers doing the very best they can for their patients. Yet despite their efforts the people of WA are not getting the health care they deserve.

In the wake of the Reid Review of March 2004, this report reviews some key aspects of the WA health service and argues that most of the problems of the sector are not related to under funding as is often claimed. The causes of the problems lie much more in a lack of concern for efficiency; poor management at a senior level; an obsession with resourcing the tertiary hospital sector and with hospital waiting lists and emergency departments; an all too ready emphasis on keeping the health service off the front page of The West Australian and state TV and radio news bulletins rather than on what the informed public want from their health service; too little concern among policy makers with equity; an absence of any rational priority setting system; a neglect, amounting to negligence, of Aboriginal health; a failure to promote transparency and accountability in resource use; and a too great willingness on the part of health politicians and bureaucrats to listen to the special pleading of the AMA.

Fundamentally, the costs of the WA health service are out of control. The target for expenditure growth, according to the performance indicators of Neale Fong, the Director General of Health, is 5.5 per cent. It is difficult to obtain figures to show what the current growth is but it is more like 9-10 per cent. That is not sustainable even with the current minerals-led boom in the state.

Yet more worrying is that when the Fiona Stanley Hospital opens around 2012, given the lack of budget integrity surrounding the forecast running costs of that hospital, the annual rate of expenditure growth will rise yet further or we will see services being cut elsewhere, especially to disadvantaged groups - in the community, in rural and remote WA and for Aboriginal people. And the minerals boom may well be over by then.

A related but separate issue is that it is so difficult to get any sort of debate mounted on the state of wellness of the health service. Those of us, including this author, who try are criticised for airing our views.”

The summary then goes on to say that the WA Department of Health needs a wholesale overhaul in its management of people, resources, skills and priorities among other things.

It seems clear that the lack of progress in the Health IT area is likely to also be a symptom of the management malaise identified by Professor Mooney. Without improved information systems (which are mentioned in the full report) there is no doubt the difficulties being experienced will continue.

One can only hope both the managerial and technology issues will be addressed soon for the good of all Western Australians. This performance seen here really does suggest that, despite the mining boom, WA is coming a bad last! Its over three years since the Reid Report and as best one can tell zilch has actually happened!

I would love to hear from Western Australian readers who can tell me I have this totally wrong and that all is well!

David.

2 comments:

Anonymous said...

David, I suspect that you (and Professor Mooney) have got it exactly right.

As further evidence of WA public service malaise (incompetence?), a state health agency that applied for, and won, a Department of Health and Ageing grant of $1 million was told by a senior bureaucrat to refuse the funding!

This funding was intended to implement a health information management solution that would integrate health records across practices and deliver specific benefits for disadvantaged patients and their healthcare providers, particularly in remote parts of the state.

The bureaucrat in question felt that better health information management was not "core business" for this health delivery agency (!) and instructed the agency to decline the offer of funding.

Is it any wonder that state health IT services around the country (with notably few exceptions) are a basket case?

Anonymous said...

Thank you for pointing us to Gavin Mooney’s report card on WA State Health Service.

His paper pulls no punches - he says it as it is. Whilst there is much to be concerned about in the system his views are constructive and thought provoking. What I find particularly refreshing is the fact that the heavy hand of politics and bureaucratic face saving has not been able to thrust its will upon the author to curtail his criticism in the interest of political expediency.

This document contains many clearly enunciated and very important messages, equally relevant not just to WA Health but to the entire Australian healthcare system. It should therefore be obligatory reading for everyone interested in improving the way in which health services are delivered in Australia.

………… and congratulations to AushealthIT ……… 200 posts and a growing base of readers.

AushealthIT blogspot readers will relate well to Professor Mooney’s comment “…….. it is so difficult to get any sort of debate mounted on the state of wellness of the health service. Those of us, including this author, who try are criticised for airing our views.”