As the regular reader will know I have been on the case of the State Government Health Departments and their rather flawed approach to Health IT for some time now. Previous to yesterday’s article I had done a piece about a month ago reflecting a generalised concern for pretty much each State’s efforts. There were also a number of specific earlier articles as well. These can be found as by clicking on the following links.
The Mess that Seems to be State Health IT. – July 04, 2007
Is HealthSMART as Smart as it Claims? – June 27, 2007
The Mess in the West. – June 20, 2007,
The Children of HealthConnect – How are They Going – Part 2? – December 06, 2006
The Children of HealthConnect – How are They Going – Part 1? – December 04, 2006
The Electronic Medical Record you Have When you Don’t Have One! – September 10, 2006
Useful and Interesting Health IT Links from the Last Week – 17/06/2007 – Recent SA News.
Today we have a new article from Ben Woodhead in The Australian
Stalled hospital plan revived
Ben Woodhead | July 24, 2007
THE West Australian Health Department will try to revive a stalled $335 million public hospital software project next month, as it works to bring an end to a succession of delays.
WA's HealthTEC project is trying to overcome a succession of delays
The department has said it will call prospective system integrators and software providers to an industry briefing in August in the first sign since late last year that the project may be moving to tender.
The project, known as HealthTec, was funded by the West Australian government in 2004 and initial software implementations were scheduled for the 2006 financial year.
The Health Department failed to meet the deadline and pushed back the timetable for the release of tenders to late last year. However, tenders were not released and last December the department deferred the project for at least another six months.
A spokeswoman for the department said it was now planning to brief prospective suppliers on HealthTec in August, but she declined to provide more details of plans for the troubled initiative.
"There's going to be an industry briefing next month on the project. That's all we can say at the moment," the spokeswoman said.
Medical software developers and computer systems integrators have already been briefed on the project at least once before.
…… (read more at the URL above).
Later the article goes on to point out WA is no “Robinson Crusoe” in all this.
What is to be done? I suggest strategies are required to address the following issues:
1. The tendency of the politicians to like announcements of more nurses and new buildings rather than announcing the purchase of apparently not very patient friendly computers and technology.
2. The length of time taken to take Health IT projects from beginning to end that is typically rather longer than the political cycle.
3. The tendency of State Health Departments to come up with grand 10 year strategies that, as the sector evolves, become obsolete long before they are implemented.
4. The frequent perception on the part of many “on the ground” in state run hospitals that they are having a centralised state-wide strategy imposed on them when they had no real input into the development of that strategy
5. The disruptive nature of Health IT implementations which inevitably result in a substantial level of ‘institutional pushback’ – especially from some of the older and more senior staff members.
6. The lack of understanding, on the part of many senior health administrators, of the strongly positive business case for implementation of advanced and effective Health IT.
7. The lack of Health IT skills to the number and depth needed within the Hospitals to make Health IT implementations a relatively low risk activity.
8. The seemingly inevitable delays in procurement and other decision making with often leads to a loss of local momentum and considerable frustration.
9. The strategic uncertainties of project management and resource allocation which are part and parcel of life in the public sector.
10. The not infrequent experience of a less than totally responsive and flexible approach on the part of system vendors when being asked to fit in with local work flows and work practices.
11. The lack of any perceived direct benefit from many systems for many of those at the “coal face” leading to a lack of enthusiasm in adoption and use.
How to address all this – admitting it is really very hard and there are no easy answers?
My approach would have (at least) the following elements:
1. Move the Health IT initiative out of the Health Department into a Central Agency Sponsored Entity that is properly resourced (i.e. don’t skimp) and led, and make it that the Health Agencies and Department have strong incentives to implement based on the compelling business case. This can increase the chance of strategic stability and ensure procurement is conducted properly and appropriately. Steady coherent progress is to be much preferred to spectacular disasters!
2. Ensure there is a coherent roadmap of the overall way forward for both organisations and the State as a whole rather that a restrictive command driven approach to making progress.
3. Provide incentives for implementation at the smallest local level possible and ensure there is a reasonable choice of systems for individual facilities to choose from. No ‘one size fits all’ approach – we know that doesn’t work!
4. Make sure benefits obtained can be retained locally and re-invested in further improvement where appropriate.
5. Have a major communication and education program to ensure all within the Hospital system understand the purpose of the Health IT investment is primarily to save patient’s lives and improve the quality and safety of care.
6. Carefully consider approaches that share risks and rewards with system providers for successful implementations.
7. Only have grand strategies and constraints on local flexibility where such things are needed to ensure the target health system can operate coherently. The use of relevant Standards can help here. Getting this central / local balance seems to me to be critical.
I am keen to have feedback on all this – as somehow we need to evolve a viable and workable new way!