Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Tuesday, December 02, 2008

NSW Health Sets New Benchmarks for Chaos and Risk.

I have to say the 1100 page Enquiry into Acute Care at NSW Health makes riveting reading.

The report can be browsed in exquisite detail having been downloaded from here:


While not able to read the whole document as yet I have browsed the sections on IT and Communications from the main report.

There are a good forty pages of reading to be had here –as well as some coverage elsewhere and 250+ citations:

Section 14 -Clinical records & information technology

Importance of clinical records

Patient’s medical history

Observations of the patient

Record of treatment

Requirements for clinical notes

Failings of current clinical notes

Clinical notes presently in use

Lack of searchability

Illegible handwriting

Missing time, date and author details

Inability to check entries

Inability to prompt action

Confusing alterations

Incomplete notes

Limited ability to share records with other health professionals

Lost records

Storage and retrieval burden

Inability to collect data

A defective system

Interstate and overseas experience in health information technology

Training of health professionals



Allied health

Further training required

Information technology currently in NSW hospitals

Existing examples of electronic medical record in NSW

New electronic medical record being introduced by NSW Health

A variety of systems

Lack of support staff

Onerous password procedures

Inadequate hardware

No off-site access

No access by other health providers

Limited rural access

Clinician’s views

The way forward

Electronic medical record

Electronic prescription systems

Funding of health information technology

Secure Broadband Network

Implementation of electronic medical record

Experience in implementing FirstNet

Lessons to be learned

Privacy concerns

Electronic Health Record

What is concluded is summarised in the Executive Summary and in the following press reports.

NSW Health IT in disarray

Karen Dearne | November 27, 2008

SPECIAL commissioner Peter Garling has prescribed a massive dose of IT to fix NSW's troubled public hospitals, and recommended a watchdog oversee e-health.

He has demanded the provision of critical infrastructure, hospital and community information systems and a statewide e-health record system within four years - not the present eight to 15 year timeframe for completion.

Mr Garling, who has spent 10 months inquiring into the state's acute care services, said he has "accepted the overwhelming evidence" new models of clinical care "can only be achieved if NSW Health adopts a whole new approach to IT".

He has proposed a future IT program including essential upgrades and new systems that will cost more than $705 million, on top of the $315.5 million currently committed to projects scheduled until July 2011.

"The risks to safety and quality of patient care occasioned by delays in the introduction of an up-to-date IT system throughout NSW Health cannot be over-emphasised," Mr Garling said. "It is not until the implementation of key projects that NSW will actually have an electronic medical record for all patients that is integrated across the system.

"In my view, insufficient funds are allocated to IT to get it up to the standard needed in an acceptable timeframe."

To achieve his goals, Mr Garling has called for an independent Bureau of Health Information -- separate from NSW Health -- to be established to access, interpret and report on all data relating to safety and quality of patient care; this information is then to be regularly re-issued to individual units.

More here


and here:

Sick NSW Health IT prescribed $700m

NSW special commissioner Peter Garling has prescribed an aggressive 4 million investment strategy to cure NSW Health’s sick information technology systems, in a landmark review published late yesterday.

“Whilst much of the work undertaken in NSW public hospitals is “high tech”, its record-keeping system is a relic of the pre-computer age. - Peter Garling S.C.

“What currently exists is a largely paper-based system with significant variation from clinician to clinician, ward to ward and hospital to hospital,” Garling said in his comprehensive three-volume report on NSW’s health system released yesterday.

“Whilst much of the work undertaken in NSW public hospitals is “high tech”, its record-keeping system is a relic of the pre-computer age,” he said. NSW Health’s IT operations are in general led by departmental chief information officer Mike Rillstone, although each area health service also has its own CIO.

The commissioner has recommended a “one-off injection” of 4 million to remedy a system that had been bogged down not just by paper, inconsistent documentation and illegible handwriting, but also substandard hardware, incompatible software and inadequate broadband connectivity.

“In my view, insufficient funds are allocated to information technology to get it up to the standard needed in an acceptable timeframe,” Garling said.

A lot more detail here:


Before making a few comments I must say I was amazed to note that the ever secretive HealtheLink project is due to be fully rolled out in 2016. That has to be sufficiently far off to have everyone involved to very relaxed about meeting the deadline.

What strikes me about this report is how much better it could have been had a real e-Health expert been involved. The document is really terribly context free. A special clinical advisor could also have made a vast difference.

The suggested extra spend of $700 M seems reasonable – but I doubt – with the best will in the world – and even with stunningly great project management – it can all be done in 4 years.

What seems also to be missing is a process reengineering imperative to maximise the value from the IT spend.

This could have been a much more useful enquiry – but it sure lets one be clear where the issues are!



Anonymous said...

Extraordinary revelations. Thank you for highlighting this frighteningly frank report. There is no way NSW health will get an injection of the funds called for by Garling for the foreseeable future. As for a 2016 rollout of HealtheLink !!!! Speechless is the word for it. Speechless.

How much money has been spent on the HealtheLink Project to-date and how much more is to be spent on it between now and 2016?

Trevor3130 said...

You mention project management here, David, so I wonder if Australian Standard for Corporate Governance of Information and Communication Technology, AS8015 (=ISO/IEC 38500), is relevant, also. http://www.infonomics.com.au/CGITExplained.htm
There is an audio of Infonomics' Mark Toomey linked in an article in iTWire by Tony Austin where part of the mp3 is transcribed.

Anonymous said...

This is all very sad. By world standards Australia has an excellent health system and Garling says so in his opening comments. What is so so troubling about all this is that there is an abundance of evidence around which substantiates increasing investment in healthIT. Garling's Enquiry serves to highlight so many problems and underwrite the need for more investement directed towards SYSTEMS, PROCEDURES and IT.

But the controllers of the purse strings point to the enormous sums which have been invested to date. And they argue with some justification that they can point to far too many controversial project failures and poor outcomes to warrant any more big scale investments in healthIT. How then do you convince them to provide the funds so badly needed for IT in order to fix the problems in the face of such controversy.

Will IT fix the problems or are they more deeply seated in the way our system is managed? Are major reforms to the entire health service delivery structure where we should be focussing first up? We could computerise the existing system, but in the old adage - computerise a mess and what do you get? Another mess!

Anonymous said...

Garling has pulled no punches. If the public were able to digest his report 'punch-by-punch' they would be horrified. That may, just may, be the beginning of the revolution.

The driving force to do something to address the problems, and to keep on doing something - not just stop when it's done- but to keep on pushing for incremental improvements all along the way is ................ WHO?


NO. It's not the politicians, and its not the bureaucrats, and its not the service providers, nurses, doctors, managers, and bureaucrats.


So how do we help the patient to rise up, in support of Garling, and say enough is enough, it is time to fix the system and to fix it now.