Health IT in NSW – Can it Go Much More Slowly?

Health IT in NSW has a long a proud tradition of glacial progress that extends all the way back to the 1980’s. Rather than run through all that history – which will be grist for another article in the future maybe – we should just consider the last few years.

Ministerial press releases make a fun retrospective! The circularity and repetition (a colleague would call it “Brownian Motion”) is just hilarious.

Let’s start in 2001. (My comments in italics)

http://www.health.nsw.gov.au/news/2001/February/02-02-01.html

Electronic health records - better care, your choice

“A SYSTEM of linked electronic health records (EHRs) will significantly improve patient care in NSW hospital patients within two years, the Minister for Health, Craig Knowles, said today.

The Minister today released a report into the privacy implications of the proposed system - Panacea or Placebo? Linked Electronic Health Records and Improvements in Health Outcomes - from the NSW Ministerial Advisory Committee on Privacy and Health Information, chaired by NSW Privacy Commissioner Chris Puplick.

The report explores the scope of electronic health records and how they can be implemented with an assurance of security and confidentiality. Following its release the public is being asked to comment on the recommendations.

NSW is leading the nation in its development of the electronic health record system.
Only patients who actively agree will have an electronic health record.

Mr Knowles said there were many advantages for patients who wanted this service.

"If you need to have multiple admissions to hospital it will be much easier for the treating doctors to have access to your records. This will greatly reduce the burden of repeating information many times and the risk of mistakes about, for example, which drugs a patient is taking, allergies or pre-existing medical conditions which could affect current illness or treatment," Mr Knowles said.

"Health record privacy is our top priority. A unique identifier system will help ensure access is strictly limited to authorised medical staff only.

""Of course, patients will have ultimate control. They can ask for the service, they can stop the service. To ensure the integrity of the system, patients will be able to get information about who has accessed their health records and when," Mr Knowles said.

The first stage of the electronic health record system is expected to start later this year.”

This was the first manifestation of Healthelink. Now six years later it is still in trial in two small areas and all the work done to decide the approach to privacy was overturned in 2005 as I recall. This was announced by the (Health Minister -4) (i.e. the fourth most recent Health Minister).

In late 2001 we had the release of the point-of-care clinical system (PoCCS) which was planned to support the clinical care process by enabling the doctor, nurse or allied health professional to:

· Record care where and when it is delivered

· Review progress and order treatment or tests from any workstation

· Continually review results and outcomes and alter care as required

· Be prompted with alerts and allergies at time of ordering

· Generate a clinical pathway or care plan to prescribe care for the patient's length of stay in hospital

· Monitor progress on the clinical pathway and record variances to analyse outcomes

· Utilise decision support at the time of ordering and on review of clinical outcomes

· Measure patient acuity to determine the intensity and complexity of care required and given

· Generate discharge referrals with automatic population of data from relevant systems e.g. radiology, pathology

The tender closed in February 2002 and after evaluation (which took a while) a selection was made (Cerner) and some implementations were begun in 2003 I understand.

Flashing forward to late 2002 it was all obviously getting too hard – so the retreat was made to paper.

Health Information - For The Record

Wednesday December 4, 2002

Health Minister Craig Knowles today launched the 'My Health Record' scheme, an initiative encouraging people to condense their medical information in one location to avoid confusion, time and expense when seeking medical treatment, and to increase the chances of a faster recovery.

An Australian first, the comprehensive 'My Health Record' booklet is being made available to more than 20,000 people in New South Wales who suffer chronic illnesses such as heart disease, respiratory disease and cancer.

Over the next 12 months, copies will be widely available to all people who frequently receive medical attention.

A centrepiece of the governments $45 million dollar Chronic Illness program, 'My Health Record' is available from local Doctors, hospitals and health centres for free. It includes pages and plastic sleeves where patients can voluntarily record dates and times of GP and hospital visits, diagnostic test results, procedures, medications taken, allergies and emergency contact numbers.

"For the first time we have a far-reaching scheme encouraging people to track their medical history and have the information at hands reach," Mr Knowles said.

"This is invaluable for better health outcomes, especially for people who seek treatment from multiple providers including doctors, hospitals and pharmacists on an ad hoc basis."

Chair of the NSW Chronic Illness Program, Professor Ron Penny, said the scheme was designed to ensure patients receive the most appropriate management of their condition at all times.

"It's about 'getting it right' early and ensuring patients are provided with continuity of care," Prof Penny said.

"It's an example of how we can reduce pressures on the health system by ensuring patients avoid unnecessary admissions and benefit from coordinated health care.

"Importantly, patients will no longer need to repeat their medical history over and over."

Mr. Knowles said almost one in five people admitted to NSW public hospitals (in 1999/2000) suffered chronic conditions including cancer, heart disease, asthma, arthritis, stroke and diabetes.

The admissions equate to 36% of total public hospital bed days, and cost $1.1 billion.

"'My Health Record' is a simple, cost effective program focussing on managing illness before it develops into a crisis," Mr Knowles said.

Obviously handling the information electronically was just too hard so this seemed like the next best option. Time moves on and suddenly we see Healthelink re-launched! (3 years later)

Minister launches Healthelink to put health records online

16 May 2004

NSW patients and parents of children in medical care will soon be able to log on to the internet and view their comprehensive medical histories following the signing of a contract to establish two pilots for an electronic health record system for NSW.

Minister for Health Morris Iemma, today announced the commencement of the groundbreaking $19.4 million program to put patients' medical records online.

The Health e-link will for the first time in NSW give GP's, specialists, emergency department clinicians and allied health workers online access to their patients' detailed medical histories and to the most up to date information on their treatment and medication.

"The Health e-link system will make our health system safer and more efficient, by making sure that clinicians all have access to the same information about their patients' medical histories," Mr Iemma said.

"Tests won't have to be repeated unless absolutely needed, nor will patients and carers have to recall from memory all aspects of care they received in the past.

"This new system means that whenever a patient visits the local doctor, the emergency department or a specialist all members of the health care team will have access to the same records.

"Illegible and incomplete hand written medical records can lead to mistakes being made and these are removed in Health e-link," Mr Iemma said.

The Minister said the system, which will be piloted at the Children's Hospital at Westmead and at Maitland and Raymond Terrace in the Hunter, will also provide patients with unprecedented access to their own medical records.

The electronic health record will include information on:

• Family history
• Allergies and alerts
• Medical and surgical history
• Procedures performed (pathology and radiology)
• Diagnostic results
• Multidisciplinary care plans

"In our health system, care is often not delivered by a single clinician," Mr Iemma said.

"Currently medical records are mainly stored physically in separate systems across hospitals, emergency departments, GP clinics, community health and outpatient clinics, diagnostic units and specialists' rooms," Mr Iemma said.

"So a clinician only has access to medical records that are physically stored in their own rooms and access for patients is extremely limited.

"The Health e-link system will allow clinicians and patients to log on and see all of their medical records, ranging from GP visits, prescriptions issued, blood test results, x-rays and hospital discharge notes," Mr Iemma said.

The Health e-link will likely result in:

• Greatly enhanced co-ordination and timeliness of care
• Less likelihood of adverse drug reactions due to unknown allergies
• Fewer diagnostic tests being unnecessarily repeated

Mr Iemma said that a consortium led by LogicaCMG, and including Orion International and Healthlink, had been selected to work with NSW Health to commence the pilot with a view to deliver a state-wide electronic health record system.

The first groups to participate in the pilot are

• Children aged 0 -15 accessing the public health system in the South Western Sydney, Wentworth and Western Sydney Area Health Services
• Chronic disease patients in Maitland and Raymond Terrace

Mr Iemma stressed that Health e-link has in-built security systems to ensure patient privacy and confidentiality.

Information will be password protected and each patient will have a unique patient number, individuals would only be able to access their own personal information.

Participation in the pilot will be voluntary.

The NSW Health e-link project is also a trial site for the national electronic health record system, HealthConnect, along with Tasmania, Queensland, South Australia and the Northern Territory.

Mr Iemma called on the Federal Government to make a genuine commitment to funding this program in NSW, citing the fact that Tasmania and South Australia have received generous grants as a result of Medicare Plus negotiations in the Senate, but not NSW or other states.”

Of course, as is well known, somehow the consent rules changed and rather than opt-in an opt-out approach was adopted. Of course, after another two years and now up to Health Minister – 2 the trial gets announced again – now five years after the initial launch!

Trial of Electronic Health Records

23 March 2006

Healthelink, the first NSW pilot of a revolutionary electronic health records system to improve patient care and speed up treatment, begins in the Hunter today.

NSW Minister for Health, John Hatzistergos, said the project will involve the secure collection and storage of eligible patients’ health information from Maitland Hospital, John Hunter Hospital, East Maitland and Raymond Terrace community health centres.

"Electronic health record systems will provide health care professionals with the medical patient information they need, when they need it,” Mr Hatzistergos said.

“This will make a big difference for patients and health-care staff - providing instant access to a patient’s records without having to contact their GP or wait for paper records to be retrieved.

“The Electronic Health Record has exciting potential: to unclog delays in the system and improve safety for patients.

“The information will be displayed in an electronic health record accessible by the patient and participating healthcare providers.

“That means, for example, that an emergency department specialist could quickly access a patient’s care details from other public hospitals or community health centres – giving them more information to provide better care.

“It also means that when the patient later visits their GP, the doctor can access vital information from the hospital about their treatment and condition. Hospital discharge summaries and patient test results will also be accessible through the system,” Mr Hatzistergos said.

“This is the first stage of the trial, in the next stage GPs will also be able to enter patient information into the system as well as being able to view records from hospitals.

Healthelink will initially be available for people aged 65 years and over living in the Maitland and Raymond Terrace areas – postcodes 2320 to 2324.

"Privacy and security have been a key focus during the development of the system and will continue to be our highest priority in the trial.

“All patient information will be held in a secure password-protected environment and in accordance with health privacy laws.

“This Healthelink pilot is completely voluntary, anybody who does not wish to take part will be able to opt out easily.

"The revolutionary pilot will test how well the Electronic Health Record will assist doctors and nurses in real-life healthcare situations, and we hope to learn from its use here in the Hunter,” Mr Hatzistergos said.

For a range of health information, go online to www.health.nsw.gov.au

Well that is a far as the Healthelink saga goes so far – the trial has been underway for 15 months and tenders have been called to evaluate what we got for the $19.5 million. (This is to be completed by the end of 2007) Of course in the mean time HealthConnect has largely vanished and broad implementation of Shared Electronic Health Records – under NEHTA’s guidance – is not seemingly proceeding apace with a business case not due until 2008 or 2009.

Moving back in time just 10 months we note that despite the 2002 PoCCS tender there have been some delays and problems. To fix this a new tender was released. The background is as follows

“In February 2002, the Department issued a Request for Tender (RFT) for a Point-of-Care Clinical System (RFT IT-135). As a result of this tender, Cerner Corporation’s Millennium software was made available to Area Health Services (Area(s)) via a period purchasing deed of agreement. A number of Areas are currently implementing the Cerner Millennium product.

The purpose of this tender process (RFT IT-190) is to evaluate current market offerings with a view to selecting a second EMR solution in order to provide remaining Areas with an alternative EMR product thereby providing a competitive environment.

The Department is conducting this tender process (RFT IT-190) to evaluate Tenderers capable of supplying the required EMR, that are willing to enter into a period contract with the NSW Department of Health for the implementation of an EMR in a number of the NSW Area Health Services in line with the requirements of this RFT.

Potentially four Areas could be seeking EMR implementations through the period contract arrangements resulting from this RFT. These are South Eastern Sydney Illawarra, Hunter New England, Greater Southern and Justice Health” (Quoted from 2005 Tender).

Here is the press release

Patients to benefit from online access to medical records

30 May 2005

Public hospital patients across NSW will have access to state of the art Electronic Medical Record (EMR) technology after the NSW Government today announced a call for tenders to expand the roll out of the EMR system, Health Minister Morris Iemma said today.

"The Electronic Medical Record is a foundation stone of our vision for how we will harness technology to improve patient care," Mr Iemma said.

"The Electronic Medical Record system will give clinicians online access to diagnostic tests for their patient carried out in hospital, regardless of whether as inpatient, outpatient or in emergency.

"From this base we aim to build a network that will ultimately allow consolidated test results to be accessed online from any authorised PC location across the state.

"So if a patient is admitted to Prince of Wales Hospital Emergency Department, their clinician will be able to access diagnostic test results done previously at Nepean Hospital or even Wagga Base Hospital.

"Improved access to clinical information can help reduce delays and give medical professionals the information they need to deliver the best possible care to patients," Mr Iemma said.

"This will be a significant boost for frontline health services delivering better access to a patient's clinical information wherever they are in the health system," Mr Iemma said.

"The system will also allow electronic charting making it easier for treating clinicians to detect trends in diagnostic results."

"NSW Health is looking to secure state-wide EMR coverage, and to do this it is seeking a second provider for point-of-care clinical system to those Areas that currently have not had a provider appointed," Mr Iemma said.

Mr Iemma said that online results reporting is already being used by Sydney West, Sydney South West, the Children's Hospital at Westmead and Central Coast and would be extended to Northern Sydney and Greater Western Area Health Services by early 2006.

This second call for tenders will see this technology rolled out to the remaining Area Health Services.

The Minister said that privacy and security will be assured as each clinician is given a unique identification and password to access the system.

Preserving system integrity and patient privacy are critically important aspects of the project and NSW Health will take all necessary steps to ensure patient confidentiality is maintained.

Roll out of the software will be managed through HealthTechnology, the new shared IT services agency established as part of the restructure of the state health information management and technology function.

As we now know the second tender got nowhere!

Electronic Medical Record Tender Closes with no vendor meeting all requirements

09 February 2006

NSW Health today announced that it would review its options for its second Electronic Medical Record (EMR) solution after concluding that no single product presented in the tender could meet the defined requirements to a satisfactory level.

NSW Health's Chief Information Officer, Michael Rillstone, said that while he was sympathetic to vendors, who had put in a significant effort, it was important that NSW Health move forward with its EMR program with confidence that the needs of Area Health Services would be met with minimal disruption to front line health services.

"A number of the clinical information systems presented were currently under development and while these may yet meet NSW Health's requirements in the future, at present they represented too high a risk on a number of fronts.

"We only have one chance to get this right. Health is a complex environment, and that does not mix well with high-risk software implementations, as we have seen in the past.

"Nine responses were received. A comprehensive evaluation found that no single product could meet to tender requirements to a satisfactory level," said Mr Rillstone.

The EMR is aimed at providing an information system that will enhance the health care of people attending NSW public hospitals. It will allow statewide coverage of clinical information systems with the goal of making comprehensive information available to treating clinicians, no matter where a patient enters our health system.

Mr Rillstone said that key modules of the EMR strategy have already been rolled out over the past three years into two Area Health Services and the Children's Hospital at Westmead.

The selection of a second vendor was preferred because it provided a more competitive environment with alternate product options. However, this approach represents no advantage if it comes with significantly higher implementation risks.

"Sound health care and clinical decision-making is enhanced by timely access to quality information.

"For example, having the test results of a patient in hospital quickly integrated into their treatment notes so that treating clinicians can consider the results in the context of the patient's overall condition and current therapies to make timely decisions," Mr Rillstone said.

The Chief Information Officer said it was important to understand that NSW Health remained committed to delivering an EMR and that improving the quality and timeliness of patient care and providing support to busy clinicians as they care for their patients was a priority.

While the current second EMR tender outcome is a setback, work has begun immediately on reviewing the options for moving forward aimed at minimising any delay.

And to come full circle we now have an article in the Financial Review telling us the following – and revealing just how long it has taken to work out what to do after the failed tender:

http://www.misaustralia.com/viewer.aspx?EDP://20070720000019155824&magsection=news-headlines&portal=_mis&title=NSW+e-health+system+to+log+on+in+2008

NSW e-health system to log on in 2008

Renai LeMay

The Australian Financial Review | 20 Jul 2007 | Information

The NSW government's $40 million computer project to eliminate paper patient records in public hospitals is gathering speed.

NSW Health's area divisions are currently ramping up preparations for the project, with implementation of US health giant Cerner's technology scheduled to take place from early next year.

The project, in the works since 2002, will give NSW's 84,000 medical staff electronic access to millions of patient clinical records and test results across more than 180 public hospitals.

It is one component of the $300 million that NSW has allocated to public e-health until 2009.

The South-Eastern Sydney & Illawarra Area Health Service (SESIHS) will be one of the first divisions within NSW Health to try the technology. The division's chief information officer, Jean Evans, told The Australian Financial Review that St George Hospital in the Sydney suburb of Kogarah would be the first to receive the new systems in March next year.

Sutherland Hospital will follow soon after, with the division to implement the new computer systems within all of its 19 hospitals by the end of 2008.

"We're not the only area, but we're the first one to go with the full functionality," Ms Evans said. The entire state-wide system is due to be completed in 2009.

….. (see the full article at URL above)

I think it is fair to say that the progress in all this can only be characterised as glacial and essentially incompetent. It simply should not take this long to get reasonable Health IT Support into our major hospitals.

I really wonder how all these slow-coaches sleep at night considering the number of preventable clinical errors and deaths they are failing to prevent by moving at their present snail’s pace!

David.