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Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Sunday, November 29, 2009

NSW Health, Cerner and Professor Patrick. Where To From Here?

It is now clear that there is an issue with the implementation of Cerner FirstNet in at least some NSW Hospitals and that at least some of those using the system are pretty unhappy with the present state of play.

The following article rehearses the present state of play.

Health department accused of censorship

NATASHA WALLACE HEALTH

November 28, 2009

THE University of Sydney removed from its website an extremely critical essay about a new multimillion-dollar emergency department IT system after pressure from the NSW Health Department. .

Doctors, nurses and administrators at four area health services heavily criticised the system - which tracks patients - as posing an ''unacceptably high risk'' to patient safety because it was so slow, cumbersome and inefficient.

Some hospitals have boycotted Cerner FirstNet and reverted to paper to record clinical notes because it is too difficult and too time-consuming to retrieve critical patient information from the system, the essay said.

''In a number of cases we know senior clinicians have shut down the use of FirstNet within a few days of it coming online,'' it said.

This flies in the face of the recommendation last year from Peter Garling's inquiry into public hospitals for full electronic medical records to improve efficiency and patient safety.

The essay, by a medical IT professor, Jon Patrick, said several hospitals also reported it ''doubled the delay'' before emergency patients were first seen by a clinician.

He also said the Cerner contract proposal suggested it was giving a ''cheap price'' on the proviso of a ''speedy finalisation of the contract'' which left NSW Health with such an ''incredibly tight schedule'' it stymied proper clinical consultation.

The essay was published late last month but NSW Health asked that it be removed, Professor Patrick said on his website. The university then published it again two weeks later.

More here:

http://www.smh.com.au/national/health-department-accused-of-censorship-20091127-jwwm.html

There is also very comprehensive in depth coverage of the issue here:

Academic claims NSW Health censorship

By Suzanne Tindal, ZDNet.com.au
27 November 2009 02:26 PM

A professor at the University of Sydney who wrote a scathing essay about NSW Health's implementation of a Cerner system within emergency departments has accused the government of pressuring his institution to take the essay down, which it did, if only temporarily.

“One would have thought that Cerner was aware of the failure of the contract to specify the necessary reporting module and so it appears to be a form of gazumping.”

Professor Jon Patrick

"Version 4 of this essay was temporarily withdrawn on Friday, 23rd October by the university following a complaint from NSW Health," Professor Jon Patrick said on the Health Information Technologies Research Laboratory website. He believed the university was correct to investigate the complaint and didn't consider it at the time as an act of censorship.

Much more here:

http://www.zdnet.com.au/news/software/soa/Academic-claims-NSW-Health-censorship/0,130061733,339299731,00.htm

The most recent version of the paper / essay on the issue (all 23 pages of it) is found liked from here:

http://aushealthit.blogspot.com/2009/11/new-release-of-jon-patrick-essay-on.html

To me the issue around all this is not what has gone on to – date, but what must be done to now ‘pull the fat from the fire’.

First a few disclaimers:

1. I have known Jon Patrick for a number of years, have had many discussions with him on informatics matters and have no reason to believe he has anything other the most principled and honest reasons for raising this issue – despite one or two rather nasty assertions made in the comments sections on the blog (Anonymously not surprisingly!)

2. I have known the Cerner Corporation and many people who work for it (up to and including the CEO Neal Patterson) for a period that now extends over 20 years. I have also (not recently) done paid work for Cerner in Australia and reviewed Cerner implementations many years for NSW Health many years ago.

3. I have done paid work for some Cerner competitors over the years.

4. I worked in NSW Health for almost 20 years as a clinician and so on.

A few basic facts are:

1. Cerner is a highly successful global provider of Health Information Software company who – as their web site says:

“Working together with more than 8,000 clients worldwide, Cerner is solving healthcare's many challenges by making sure the right people have the right information at the right time. Building on our clinical expertise, we are finding new and innovative ways to deliver value to our clients.”

The basic facts are here:

http://www.cerner.com/public/Cerner_3.asp?id=27165

2. Cerner seems to have met difficulties at least in NSW, Victoria and the UK when instances of their software have been customised for a large number of organisations. This has not as often been the case when they have worked with single organisations both in Qld and the UK and of course in the US.

3. The possibilities for the cause of the present set of complaints are legion (could be NSW Health issues, Cerner issues, internationalisation of software issues, local workflow or cultural issues, technology provisioning issues and a range of other possibilities - or a bit of each!)

The only thing that is crystal clear to me is that there is much more darkness than light both about how things are going, what the root causes of any issues are and how they can be addressed.

Looking as an outsider it seems to me what is needed is the input of a genuinely dis-interested expert in Hospital Information Systems (preferably with a good knowledge of a variety of HIS implementation from around the globe) to review (with no options ruled out) the NSW process and plans and consult with all stakeholders to define a way forward and have NSW Health implement what is recommended.

Sadly NSW Health does not have a great track record of undertaking such introspection and then actioning what is needed but we can all hope.

There are a lot of reputations on the line here – as well as the credibility of the NSW Health eMR agenda, and indeed the national e-Health Agenda, to get this right – and it needs to be done properly, transparently and openly. All involved could learn from what might be discovered.

We are well beyond the time when ED staff should need to bring their own laptops to work to manage data entry because the systems provided are so bad!

I wonder will anyone listen?

David.

3 comments:

Anonymous said...

Hospitals in Victoria should be ever so grateful to Jon Patrick for highlighting the problems NSW hospitals are experiencing with Cerner.

We have tried to explain to the Minister and to the bureaucrats in charge of HealthSmart that a one size-fits-all Cerner solution sitting in a centralised data centre is totally impractical. We have written numerous letters, we have had so so many meetings, we have been subjected to implementation planning studies, we have pleaded on our hands and knees to anyone who will listen, and we have got nowhere. HealthSmart continues to filibuster insisting all hospitals must implement Cerner. The bureaucrats don't want to know. They've made a decision, they tell us our representatives on the steering committee approved - so we must all live with it regardless is there view. Don't rock the boat we have a state election coming up.

Anonymous said...

Instead of spending millions of dollars on Cerner systems, NSW/VIC/QLD govt. should look for developing the inhouse system for hospitals

Anonymous said...

Having worked on the failed Cerner implementations in the UK I believe the basic issue lies with it's implementation model as highlighted by David. Cerner corporately operate well (or at least better) on single site stand alone implementations.

They have not (or rather did not here) recognise that their model would not succeed across a multi site implementation. While theoretically the product could and would suit such a model with appropriate and necessary modifications, they resisted and steadfastly persisted with that which they were familar, to the detriment of all.

I would also make the observation that some of their 'success' arises from the onward selling of consultancy services made necessary only by the need to maintain it's overly complex proprietary solutions. There is a resistance to training external organisations in to achieve self reliance.