The Mess that Seems to be State Health IT.

This week the Australian Financial Review (AFR) published what amounted to a review of where the Australian States are with their Health IT funding and implementation.

The article was entitled Focus on healthier data links and was written by Renai LeMay.

I would provide the relevant URL, but the current AFR web site is so utterly useless that is simply not possible. For those who subscribe to the paper the article appeared on July 3, 2007 on page 35.

The article opened by setting the scene by pointing out that:

"State health departments are poised to splurge more than $1 billion on new technology over the next few years as they ramp up plans to replace and link core patient and clinical information systems.”

From the article we learn that, most recently, in Western Australia there has been a request for funding from Treasury to replace its state-wide clinical information systems. Interestingly was are also told that the money will come from the $335 million over 10 years allocated by former premier Geoff Gallop in 2004. Clearly the sense of urgency is missing over there in the West. More information on WA is available at http://aushealthit.blogspot.com/2007/06/mess-in-west.html.

Next we learn, that Tasmania's Department of Health and Human Services is planning to issue a tender for new patient and pharmacy administration systems in the 2007 financial year. We can only hope they do better this time than the last time when they went out and bought a large scanning system calling it a patient record system.

We are also told that Qld Health is another leading the spending charge, with the state budget in early June allocating $150.3 million towards Queensland Health's information and communications technology function. It will be a new CIO spending that money as the incumbent has just resigned, no doubt somewhat tired after all that has gone on in Qld Health in the last 2-3 years. (law suits, implementation cancellations etc)

South Australia also gets a mention for is huge 10 year plan. Details can be found at http://aushealthit.blogspot.com/2007/06/useful-and-interesting-health-it-links_17.html

The article the goes on to point out that:

“NSW and Victoria appear to be slightly ahead of the other states when it comes to improvements in core health systems - at least in terms of the amount of money being spent.

NSW Health has already budgeted about $300 million towards the area until 2009, including a $40 million contract for an electronic medical records system awarded to United States-based supplier Cerner in November 2006.

In Victoria, the state's Department of Human Services is implementing HealthSMART, a $323 million technology replacement program slated to run from 2003 through to 2009.” Again I have provided additional detail which can be found at http://aushealthit.blogspot.com/2007/06/is-healthsmart-as-smart-as-it-claims.html

Sensibly the article points out that all these funds (at a bit over $1.0 billion) over between five and ten years hardly amounts to a ‘hill of beans” when compared with the annual public hospital expenditure.

The most recent Australian Institute of Health and Welfare report provides the following figures.

“Recurrent expenditure on public acute and public psychiatric hospitals was $23,991 million in 2005–06, 5.6% greater than expenditure in 2004–05 after adjusting for inflation. Salary payments accounted for 62.1% of total recurrent expenditure in 2005–06, and Medical and surgical supplies accounted for 9% of total recurrent expenditure. The average cost per separation was $3,698 excluding depreciation and $3,839 including depreciation.”

Kindly the journalist (Renai LeMay) had told me of the broad thrust of his planned article and asked for any comments I might have. These were trimmed in the sub-editing process so I provide the original version below:

My comments on all this would be along the lines of:

1. Some states are planning to make considerable investments while some have already made some major investments.

2. Unfortunately it seems that there is not enough learning and sharing of experiences between the States as we keep seeing centralised, one-size fits all approaches being adopted - when experience shows there have been many difficulties, delays and clinical annoyance and alienation when this is what is done.

3. There does appear to be a lack or procurement and project management expertise in many of the projects conducted so far and the States planning to update need to make sure they get high quality staff and advice to have the investments deliver benefits.

4. It would be useful to make sure an appropriate overarching health strategy linked to the health needs of the State is in place as well as well considered implementation plans to deliver the acquired systems on time and budget - with proper risk management in place both financially and contractually. Management of the strategic instability of State Government directions due to the political cycle is also a major risk to all these investments.

All in all this really is a depressing picture with a lack of urgency, implementation delays, procurement problems and so on leading one to wonder what needs to be done to get this right.

I suspect rather more local autonomy and control, within somewhat less constrained product and implementation frameworks, might be a good place to start.

David.