The Victorian Auditor-General issued a report card on the Victorian HealthSMART project last week and it did not make great reading.
A sample of the reportage:
Correspondents in Melbourne | April 16, 2008
A $320 million IT program to help streamline Victoria's health system is running late and over budget, a new report has found.
The auditor-general's report says the HealthSMART program will not be finalised as expected by June 2009. The 2009 target was reset from the initial projected completion date of June 2007.
However, the Department of Human Services (DHS) has not yet told the government of any need to revise the completion date, the report says.
HealthSMART is aimed at improving patient care, reducing the administrative burden on health care professionals and easing costs associated with IT in the public health system by standardising information systems.
The department has spent 57 per cent of the project's budget on just one-quarter of the planned installations, and delays in the project mean that it will have to be subsidised by an added $61 million of DHS funds.
April 17, 2008
THE State Government is grappling with another multimillion-dollar computer fiasco, this time involving a major upgrade of health technology systems.
Weeks after a scathing report on the introduction of the myki public transport ticket system, Auditor-General Des Pearson has raised concerns about the progress of the $323 million HealthSMART project.
HealthSMART was announced in 2003 to overhaul mismatched technology running the state's health system and introduce new systems such as electronic prescriptions to improve patient care and combat fraud.
But Mr Pearson, in a report released yesterday, said the original targets were overambitious, it was already two years behind its intended 2007 completion date and likely to slip further.
The report also found the program was already $34.8 million over budget and would need an extra $61 million in running costs, although the Government and Health Department dispute the first figure.
The worst-performing part of HealthSMART was a $96 million "clinical systems" plan to computerise prescriptions and diagnostic services. The report found that of 10 agencies that could use the system, only four planned to do so, and none would likely meet the June 2009 deadline.
The full report – with all its gory detail - can be found here:
I think the issues that have been identified here all stem from the unrealistic expectations of central health IT agencies that one size will fit all and that individual organisations will pay for things they are not convinced they need without considerable encouragement and explanation. This is made even more difficult when some organisations really believe they can get equivalent systems to those on offer at much less cost.
It is clear from the report that the administrative systems have been able to be installed but that the closer you move to the professional users the more explanation, interaction and justification of change is needed, and has not quite been delivered.
This is all not helped by a technical approach that involves multiple interfaces where integrated solutions would almost certainly be both cheaper and more effective as well as a one size fits all shared services model with some applications which always poses challenges to user adoption.
At least Victoria has been open about what it is doing and has adopted a governance model that hopefully will get things finally done right – even if at a bit more cost and a little more slowly than hoped. A serious, consultative, mid-term independent strategic review might not be a bad idea at this point.
To be succinct – as I said when asked to comment on all this:
“There are 2 key issues. One is the difficulty always experienced with clinical systems when you attempt to impose a single state wide solution without gaining "real" clinician engagement and support first. Clinician 'buy in' is utterly critical for success.
The second is expecting hospitals - already pushed financially - to pay a good component of the cost for systems when the benefits are not going to accrue directly back to the hospitals (and users) but more to the health system and patients in general. Distribution of benefits and costs is always a major issue and needs to be done very well to achieve success. A centralised full funding model would be preferable I believe. Remember that politically whenever a hospital makes any productivity / efficiency improvement they don't keep he benefit - they are just expected to do more!
Amazingly we see that in South Australia the same flawed approach is being adopted – but with a distinct lack of openness, compared with Victoria, to boot!
Jennifer Foreshew | April 15, 2008
cio files | David Johnston
WHEN South Australian Health Department chief information officer David Johnston set out to deliver real and tangible e-health outcomes, he was told by many it could not be done.
David Johnston is overseeing a revolution in SA
Joining the SA Department of Health in 2003 from SA Water Corporation, where he was chief information officer, Johnston found the technology division chronically under-funded and "largely ineffectual".
"Years have been spent subsequently by many people preparing detailed strategies, sourcing funding, setting up governance structures and establishing project management capability to enable a major reform," Johnston says.
"Now the rubber is hitting the road, and that is immensely satisfying."
The SA Health Department currently has an integrated $375 million decade-long program that consists of 65 interrelated individual projects, costing between $250,000 and $70 million.
The electronic health records program aims to link all clinicians and patient information.
Establishing the technology base is one component, but building in the proper ongoing management and controls will be a challenge as we deal with over 27,000 staff."
At present, SA Health Department's ICT service has about 150 staff and an annual budget of about $40 million.
From July 1, all ICT functions across the health portfolio will be transferred to direct department control, increasing the staff to about 360 and the budget to about $110 million.
"The difference will be that the operational staff will be coming into ICT services, which means we can then start concentrating on consolidation of duplicated functions," Johnston says.
"For example, we have 17 help desks across health, so there are rather large efficiencies that we need to extract to reinvest in other areas such as information architecture and proactive network management."
The SA Health Department has 40 per cent of ICT staff in support roles, but Johnston expects this to drop to 15 per cent within five to six years. The staff who currently provide break-fix support services will be able to concentrate over time on much higher value-add activities to ensure the use of the ICT systems and infrastructure across health are maximised, he says.
Its rather a pity just what is planned over the next decade is not made public in some reasonable detail and that a centralised model is planned. Those who do not learn from history…..
We can all watch and see how this plays out. Mr Johnston looses contact with his (powerful) users at his peril!