It seems a lot is going on over there in South Australia.
First we had the following news this week:
SA health gets Web-based patient records
Central records should avoid misdiagnosis
Rodney Gedda 13/03/2008 11:16:03
The state government of South Australia will spend $17 million on a Web-based information system allowing nurses and midwives instant access to patient records.
Technology developed by Sydney-based Emerging Systems will be used to integrate patient records across the public hospital system to improve the speed, accuracy, and hence safety of health-care delivery.
The project will add another level to the SA's electronic health records system, careconnect.sa, which aims to link all clinicians and patient information over the next ten years.
Emerging Systems was chosen for the project after its success in developing a Web-enabled clinical information system for medical and nursing staff at St Vincent's Private Hospital in Sydney.
SA Health Department CIO David Johnston said linking nurses and midwives through a patient health record system will allow faster access to patient information and lead to more responsive and informed treatment.
"All major public hospitals will be linked which will help improve areas such as patient care planning, care quality management, [and] workforce utilization of our nurses and midwives," Johnston said.
The Emerging Health Solutions system will be introduced at Lyell McEwen Hospital in Adelaide first and progressively rolled out to 17 public hospitals across the state by the end of 2009.
This project is similar to other e-health information initiatives in NSW and Tasmania.
More at: http://www.computerworld.com.au/index.php?id=1302744744&eid=-180
This news followed hard on the heels of the of the announcement of the outcome of the announcement of the that Pen Computer Systems (PCS), a leading Australian owned Health Informatics company, had been contracted to develop Stage 1 of the e-Health Care Planning System.
More at http://www.healthconnectsa.org.au/Default.aspx?tabid=84
Additionally we also have the following from the SA Health Minister.
Quicker patient record access for SA country hospitals
04 February 2008
The Mt Gambier hospital is set to pilot a component of the multi-million dollar careconnect.sa program allowing health staff faster access to patient records.
The pilot will allow fine tuning of the SA Department of Health’s careconnect.sa clinical information system before it is rolled out to all public country hospitals in South Australia.
David Walshaw, Director of Lower South East Health Services said, “Providing country hospitals with the same electronic patient health record system used by metropolitan public hospitals will contribute to the development of a state-wide integrated electronic health record.”
“The new system will assist medical, nursing and allied health staff make quick, informed decisions on the healthcare needs of their patients. It will also benefit patients as their medical information from across the major public hospital system becomes immediately available to the staff treating them.”
The program aims to improve the quality and safety of healthcare in South Australia by improving the links between hospitals via the clinical information system. Medical staff and doctors will then be able to quickly access critical medical information such as laboratory results, radiology reports, outpatient appointments, emergency department attendances and discharge summaries.
The system also enables electronic distribution of information to a patient’s GP, specialist and other health professional, informing them of the patient’s encounter with the hospital to ensure continuity of ongoing healthcare.
“Accurate information is crucial if patients are to receive the right care at the right time,” added Mr Walshaw. “A key aim of this system is to give healthcare professionals access to patient information safely, securely and easily, whenever and wherever it is needed.
Installing the clinical information system at Mt Gambier is a step forward in bringing South Australia’s country health services in line with the metropolitan public hospitals and it will be a major benefit for staff and patients.
More information is available at: www.careconnect.sa.gov.au.
All this activity would appear to be part of this announcement:
SA funds $375m health IT plan
Ben Woodhead | June 14, 2007
THE South Australian Department of Health is set to launch a $375 million information technology overhaul aimed at digitising healthcare across the state.
SA Treasurer Kevin Foley hands down the state's 2007 budget
The 10-year initiative, which includes 65 individual projects, comes in the wake of intense lobbying from Department of Health IT executives for a systematic approach to upgrading patient information systems.
The $375 million program, which was funded in last week's South Australian state budget, is also designed to dovetail into national electronic health record initiatives.
The budget highlighted an $11.5 million capital injection for patient and nursing administration systems, but the overall 10-year project will allow the Department of Health to upgrade myriad other IT platforms.
More at http://www.australianit.news.com.au/story/0,24897,21903727-16123,00.html
A bit more is available here:
SA Health gets bio smartcard
Ben Woodhead | July 03, 2007
THE South Australian Department of Health will lock down its patient information systems with smartcards and biometric technology as part of a 10-year, $375 million computing and communications overhaul.
The $375 million 10-year overhaul will link hospitals and community clinics
The department is likely to award contracts for the first major component of the initiative as early as August as it works towards building an integrated information technology platform for the state's public hospitals and community clinics.
SA Department of Health chief information officer David Johnston said the core objective of the 10-year strategy was to streamline access to crucial patient and medical information by making systems available online.
"The broader strategy is to web-enable as many applications as possible using an open-standards, open-systems philosophy," Mr Johnston said.
"Using portal technology and combined biometric and smartcard authentication, users will be able to access integrated information that may reside in multiple transaction systems."
To achieve the goals of the undertaking, which will be dubbed careconnect.sa, the department will complete 65 projects priced between $250,000 and $70 million.
Mr Johnston said most of the projects fell in the $5 million to $30 million range, but he declined to reveal individual budgets.
"We aren't going to release the budgets for individual projects as that would severely compromise our commercial position," Mr Johnston said.
"It ranges from minor projects such as rolling out a common helpdesk and technical knowledge management system through to creating major state-based hospital systems for areas such as nursing, patient administration and operating theatres."
Projects that will get under way in the first year of the multi-year program include patient administration and nursing administration system installations that were flagged in the 2007-08 South Australian budget.
Other projects slated for year one include client identification, web services, pharmacy management and operating room information system upgrades.
More at http://www.australianit.news.com.au/story/0,24897,22005021-16123,00.html
With all this going on I thought it would be interesting to understand what the SA Health Departments Health IT or Health Information Strategy said – especially since it was a 10 year strategy – which in my experience have a risk of getting seriously derailed after a year or two. Of course it is also sensible to see what is planned so some level of accountability can be applied to Government and the bureaucracy.
The man who has all this information at his fingertips is the SA Health CIO (David Johnston).
According to the SA Health Department Organisation Chart for January 2008 he has charge of the following:
• Information strategy
• Coordination of national strategies
• State-wide project implementation
• State-wide project procurement strategy
A search of the Departmental Web Site reveals a SA Health Strategy (2007-2009) (12 pages) but no mention of an information strategy.
Fortunately the 10 year SA Health Plan (2007-2016) has a small paragraph or two!
“Improving information technology
New information management systems are fundamental to improving the delivery of health care services in the future. Over the coming years, we will develop information technology to allow health service providers to have appropriate access to patient information – with the consent of the patient.
For example, this will allow a GP to have access to the same information as doctors and nurses in a hospital, or will enable a diabetes nurse located in a GP Plus Health Care Centre to book an appointment for a patient with a podiatrist at a hospital site or another health care clinic.
Access to patient information will also reduce the need for duplication of medical tests and reports. This investment will further reduce the pressure on hospital emergency departments, GP clinics and will help reduce waiting times for specialist appointments.”
Hardly a strategy!
Similarly the very infrequently undated careconnect.sa site does not help much (dated 2006).
http://www.careconnect.sa.gov.au/Default.aspx?tabid=1
“Welcome to careconnect.sa
As part of the State Government’s Health Reform, careconnect.sa is about improving communications for patients, doctors, nurses, midwives and other health care professionals within the health system by streamlining and interconnecting information systems.
The careconnect.sa program aims to improve the quality and safety of healthcare in South Australia and as a consequence improve efficiencies across the health system by connecting hospitals, health professionals and the community towards the development of a public-sector state-wide integrated electronic health record.
The first critical initial component of careconnect.sa has been the implementation of the clinical information system called Oacis. This has been developed and installed across our eight metropolitan public hospitals.
It is the intention of the Department of Health to build on this foundation to deliver the first Australian fully integrated health record within a 7-10 year timeframe.
Some of the careconnect.sa next steps include linking up South Australia’s public country hospitals, mental health and community services, and creating central state-based hospital systems for areas such as nursing and midwifery, patient administration and operating theatres to enable a single view of patient information across a wider spectrum than clinical information alone.”
So what does all this add up to:
As I see it we have both SA Health Department and HealthConnect SA pursuing apparently different and un-coordinated strategies (apparently reporting to different people and servicing different clients – GPs vs Hospitals etc) and we have claims of commercial confidentiality concealing (for no good reason) what is planned.
Both NSW and Victoria have been able to develop and release Health IT Strategies without commercial harm – SA did in the past – and now the shutters seem to be up.
Equally obscure is the system being offered to SA Health by Emerging Systems Pty Ltd. To quote the apparently relevant page from their web site.
“Emerging Health Solutions
Introducing Emerging Health Solutions, a web-enabled point of care clinical information system that enables quality care.
----- End Quote
See http://www.emerging.com.au/esweb/eswebDADAServlet?sid=258075CIT&page=44ONC
No further information on health solutions or experience seems to be offered although some of the staff are listed as having health sector experience and backgrounds.
A tiny bit more detail on the solution would have been interesting given the (very large) size of the contract.
Without disclosure there is no accountability and without accountability waste (especially in 10 year programs) is virtually inevitable.
SA Health should be much more open in all this. Some good things may be going on in SA and clarity would be very valuable for all those interested in e-Health in OZ.
David.
10 comments:
Just out of interest, David, what would you ask Emerging if they agreed to an interview?
It doesn't look as though NEHTA has had much input into any of this, which leads one to ask:
"what of value could NEHTA have contributed to these developments in SA?"
David - why don't you phone David Johnston and interview him for your blog. Then we will all have clarity.
This sounds more like soundbite than substance. If you look at http://www.myphr.com/resources/phr_search.asp for example it will indicate how many PHR solutions are ALREADY out there. To spend $17m to reinvent a wheel nut is simply... well nutty! Especially as MedicAlert who are HQ'ed in Adelaide and have a great relationship with the Department are listed as having a PHR solution for its clients. If I wasn't an SA tax payer I'd laugh, instead I'm crying... Where is the due diligence here? Has the department evaluated any of the PHR solutions? Has the Department even bothered to pop downstairs and talk to MedicAlert about their solution?
You say the “the 10 year SA Health Plan (2007-2016) has a small paragraph or two!” ………… but that is …. “Hardly a strategy!”
Maybe they will be able to get some assistance from Tassie following last Saturdays call for an E-Health Strategy Development and Management RFT.
The Tasmanian RFT is a great opportunity for NEHTA - to bring its presence to bear - before the horse has bolted.
http://www.myphr.com/resources/phr_search.asp
Good point. Very interesting site. I counted 40 individual products available to purchase as an Internet Service. Surely there must be something in that lot worth considering. Sooner or later one or more will cast their eyes this way. It would sure beat trying to do it all from scratch. As you said - that's nutty.
It's refreshing to see a new Australian software vendor emerging on the scene. Goodness knows - we badly need some new blood. Obviously SA did not enter into a $17 M contract with this new health vendor with its eyes closed - Emerging's relationship and track record with the health funds would have been reassuring.
I don't think it's all that nutty because the sort of PHRs listed in the myphr.com directory don't provide any coordination facilities between the different health providers. In SA we want to have nurses, physios and others feed information into a common EHR that can be accessed by all. We think we've chosen a good path and we haven't seen anything demonstrable elsewhere in other states to suggest we should be getting an already developed package.
Just 2 Comments:
1. If anyone wants to comment - on or off the record the blog allows it and I will happily publish longer articles that have some reasonable relevance to readers.
2. It would be my view there are other ways to solve what SA wants to do than developing a new system. Its a big world out there and the task is hardly rocket science.
David.
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