The following rather long letter arrived – by post – in an unmarked envelope – last week.
The impassioned three page letter (scanned) can be accessed here.
http://moreassoc.com.au/downloads/SH%20Letter%20Jan%2031%202008.pdf
(Note the file is about 3.0 Megs and takes a few moments to load even on a broadband link)
While it is hard to know the exact truth behind all these claims enough of the thrust of what is being said makes very good sense, and to me the broad points ring true.
The three articles cited can all be found on the e-Health-Media Website.
The URLs are:
http://www.e-health-insider.com/news/3427/full_lorenzo_benefits_expected_2012
http://www.e-health-insider.com/news/3364/csc_fined_%C2%A35m_for_late_delivery_of_pas_systems
and
http://www.e-health-insider.com/news/3351/cameron_says_nhs_it_must_be_local
Leaving totally aside the specific claims being made about the respective Health IT Vendors (which may or may not be in any way justified) there are a few generic points being made which I believe need careful consideration and discussion by those managing HealthSmart.
The first is that to have even a small number of individuals sufficiently concerned to write to the State Auditor-General (and simultaneously express concerns for the job security for speaking out) strongly suggests there are some serious communication and consultation problems in the HealthSmart programme.
The second is that, as the UK Connecting for Health Project has learned at some cost, rigid national or state implementations virtually inevitably incite major resistance. This is almost certainly due, in my view, to the fact that despite apparent homogeneity within the various entities in these Health Systems, there are in fact wide variations in work practices and processes. To not recognise and adapt to these – as a centralised implementation approach does not – is perilous indeed.
The third is that if a ‘best of breed’ application selection approach is adopted then effective seamless interfacing and integration is vital. This does not seem to have occurred here.
Fourth you cannot expect hospital staff to work to implement one system while being told in that in a few years time you will have to do it all again when the new model arrives. This guarantees staff alienation.
On the basis of this letter I suspect HealthSmart needs to quickly smarten itself up (pun intended) and look to start effective discussion and dialog with those involved.
I think the Department of Human Services (DHS) should treat this letter as a ‘sentinel event’ and that it should prompt a careful review of what is happening that is creating this level of concern among some of its employees. Additionally, for people to be nervous about alerting DHS to problems, for fear of retribution, is a very, very sad state of affairs.
I look forward to the odd comment from those south of the border in Victoria.
David.
4 comments:
Sorry, not surprised at all. Disappointed of course, but not surprised. While I question their assertion that regional solutions are the better way to go, I can fully believe their fear of persecution. QH is exactly the same, patently stupid and blatantly ill informed decisions have been made in order to satisfy political front page objectives.
Medicos have not helped, having a naive appreciation of the complexity of what is to be achieved and demanding instant technology solutions. An enterprise scale integrated system is NOT the same as an Access database.
Lastly, IT cannot automate and integrate a thousand different ways of doing things, it will fail due to cost and complexity. Any attempt to push an eHealth agenda at whatever level will continue to fail unless it goes hand-in-hand with a service reform agenda at the same level.
Good luck, like my southern counterparts I'm burnt out...
Whilst anonymity is to be discouraged, sometimes, sadly, it cannot be avoided. This appears to be one such instance.
Those who choose to speak out can often be labeled - trouble makers - but more often than not they do so to see wrongs righted, knowing that they would pay a very high price and be pilloried in the stocks in the market square if they spoke up without the cover of anonymity. This very sad state of affairs reflects the progressive deterioration of the health system culture over the last decade or more and it is likely things will not change for the better in the foreseeable future.
The question therefore that needs to be asked, first and foremost, is whether this ‘anonymous’ document is kosher. Industry experts agree the facts as presented are pretty close to the truth. That being the case the issue becomes one of ‘what should be done?’
Q. 1 Should a line be drawn under HealthSmart and start again?
Q.2 Should the Director of OHIS be replaced to allow a more ‘open’ and ‘flexible’ culture to be brought into play?
Q.3 Should the strategy be ‘opened up’ to allow other vendors to provide ‘competing solutions’ to drive HealthSmart forward?
None of these questions should be too difficult to answer using a modicum of nous.
The inordinate delays in delivering Lorenzo will now become even greater due to the extraordinarily difficult task ahead of IBA in digesting its ‘takeover’ of iSoft’. Lorenzo will be a long long way off, and the only way to increase the chances of earlier delivery is to bring some serious commercial imperatives into the market - that means competition.
The Brumby Government would be very well advised to say “enough is enough - get on with HealthSmart and at the same time open up the market to competition - give hospitals the flexibility of choice - this system or that system or even a third system.”
Only then will the ostrich(es) in the DHS pull their collective heads out of the sand and only then will IBA (iSoft) understand that it must deliver or be displaced.
This is the only way forward that will satisfy the majority of stakeholders, benefit patients and all taxpayers, serve the Government’s best interests, and create a vibrant competitive health ICT marketplace within the State of Victoria.
The letter to me appeared to backing another horse and is a bit of a powerplay no doubt backed by a mifcfed vendor.
My only comment is iPM is a step on the path towards Lorenzo and not a different product. My experience has been in implementations in private hospital settings.
Also iSoft is already in the Community setting as the ACT Health solution so it would be interesting to hear if iPM has been a success or dud? To say it hasn't be tried in community settings is disingenious.
Just released Auditor General's report presented to parliament today (Wednesday 16th April).
http://www.audit.vic.gov.au/reports__publications/reports_by_year/2008/20080416_healthsmart.aspx
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