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Tuesday, July 24, 2007

Why is State Hospital Health IT in Such a Mess?

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

http://www.australianit.news.com.au/story/0,24897,22122716-24169,00.html

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!

David.

5 comments:

Anonymous said...

You are becoming quite 'sophisticated' with your use of links back to earlier blogs and associated comments.

I wondered as I read what BCG would make of it all and whether they should be put on the job of looking at each of the State healthIT scenarios ................. then I thought ............ too hard, even if it is a humongous consulting assignment.

In the end - economic rationalism bit me in the bum ............

- Let market forces prevail.
- Every disaster equates to new opportunities.
- Everyone involved in failed projects learns what not to do until they get promoted beyond their level of competence.
- Let market forces prevail.
- Every disaster equates to new opportunities.
- Everyone involved in failed projects learns what?

Anonymous said...

You might be right about letting market forces do their work. In the 9 July article by Nancy Ferris reported in govhealthit.com (http://govhealthit.com)
- Leavitt protests health IT bill - we read that the “Bush administration reasserts its position favoring market forces and not subsidies”.

It seems the Health and Human Services Secretary Mike Leavitt disagrees with measures in the health information technology bill currently under consideration in the Senate for creating grant programs to spur health IT adoption. His view is that the most appropriate and efficient ways to achieve widespread use of health IT are through market forces rather than through direct subsidization of health IT purchases.

JohnS said...

Health IT initiatives are often constrained by beaucracy not only in the government circles but can also be from within hospitals who are competing with their own agendas.
One key element is to apply a strategic but pragmatic phased approach and not from the beginning create the holy grail. A government making a 10 year plan in Health IT is nonsense. It must create a well funded (not only $s but competencies too) vision so that the plans can evolve.
Got to go ... too busy to write more

Anonymous said...

David,
I am in agreement with most of your solutions to this very difficult issue of how to modernise healthcare to bring them up to a level of IT sophistication that is even remotely approaching that of other industries. I have more than 20yrs in the health sector and in my current role is to sell and implement IT solutions into Healthcare.
I would like to strengthen your solution list to add more emphasis and detail around the importance of the implementation approach with regards to people and process. There is volumes of evidence to suggest that the technology plays only a minor part in the success of or the extraction of business value from IT in general. And considering that Healthcare has a magnitude difference in the complexity of it’s supply chain compared with most industries, it is no surprise that the failure rate of IT is healthcare is so huge, and has been so for 15yrs or more.
Consider this :
• 10% of the value of IT is derived from purchase an integrated system with rich functionality and ensuring the software allows for flexibility of design
• 90% of the value of IT is derived from implementing best practice processes and persuading people to change
• 90% of project failures are due to neglecting the human factors of the project
So has anyone got it right in health ? Is there an approach or organisation that has proven track record ? Now you must excuse me if this sounds like pushing a particular brand, but yes, there are organisations who can point us in the right direction.
IBM a year ago or so bought the leading Health IT implementor in the USA, Healthlink Inc. If you look into their history over the last 15yrs of their existence is quite impressive. They have :
• Been rated first in KLAS (independent USA health IT “ratings” agency) for clinical and back office implementations 2004, 2005, 2006
• 2500+ completed projects
• 1100+ clients
• Clients and projects are 100% referenceable
• 600+ consultants, 60% of consultants with more than 16 years of relevant healthcare business, clinical, and IT operational experience
Reusable assets include :
• An implementation methodology Prolink and a process mapping tool Promap.
• Within Promap they have 4000+ vendor specific healthcare workflow maps, 4,500+ healthcare vendor-specific design decisions, 4,500+ process templates and client specific process maps, sub-process and workflows.
• Benefits Knowledge Base used to define and measure business metrics before/after implemenatation to demonstrate ROI. This contains 1,000 + citations, 200 standard metrics and Best practice content
People may argue well “that’s the USA and they are different”. I would say that people issues and healthcare provider issues are the same the world over. In Australia we need to change our approach to health IT completely and learn from the successful lessons of others. De-emphasize the focus on features and functionality of the software, the technology is not the main game. Healthcare IT simply cannot be delivered as a technology project from top down – this has never and will never work.

Aus HIT Man said...

I must say I find it very hard to take any issue with what you say - especially the last point!

David.