The following interesting piece appeared on ZD-Net a few days ago.
SA Health plans statewide e-health records
By Renai LeMay, ZDNet.com.au
05 January 2010 05:23 PM
South Australia's health department has put the finishing touches on detailed plans to replace its complex network of electronic health record systems with one integrated platform to serve all patients.
The state late December and this week went to market for the Enterprise Patient Administration System (EPAS) component of what it described in tender documents as "Australia's first fully integrated statewide electronic health record system", dubbed careconnect.sa.
South Australia's move comes as other states are also gradually unifying their disparate electronic health record systems into single platforms under the top-level guidance of the National E-Health Transition Authority, an organisation set up by the state and federal governments to oversee the process.
In some cases, records will need to be transferred from existing paper-based systems.
In tender documents, SA Health said the ultimate goal of careconnect.sa — slated to be completed by 2017 — was to establish a "personal, web-based entry point" for patients to access information integrated from various sources.
"There will be no more confusion as to which system holds which information; there will be one fully integrated information system and that will be careconnect.sa," they added. The goal of implementing the platform will be an improvement in the quality and safety of health care in the state.
As part of the integration, SA Health said it had centralised ICT governance and services within its operations.
Some of the functions EPAS will fulfil will relate to scheduling, patient registration and discharge, bed management, workflow management, clinical decision support, clinical documentation and electronic document management. In addition, SA Health will require various additions to its platform, such as a patient billing system and emergency department management.
More is found here:
The article also mentions that there has been a tender for an Enterprise Patient Master Index to support the very broadly scoped EPAS.
With these newly developed tenders I thought the documentation would provide some useful insight into how the NEHTA certification approaches were being implemented and what NEHTA related requirements were included.
I was also interested to see how the lessons of NSW and Victoria in terms of mega implementations had been absorbed to reduce implementation risk.
Sadly I have to report the information is amazingly thin on the ground.
In the EPAS Full Statement of Requirements we have NEHTA mentioned:
Page 18 – in the glossary of terms NEHTA is defined.
Page 64 – we find in the requirements:
“5.8.1. Secure Messaging
NFR3901
SA Health wishes to provide a messaging facility for EPAS Users that will enable them to communicate online, through the system, with other EPAS Users. What support does the system provide for this messaging?
NFR3902
Describe how your solution can be configured to cater for different message formats, especially for inbound e-referrals and outbound discharge summaries.
NFR3903
Ability to support messaging to other secure messaging systems such as Argus and Medical Director.
SA Health will follow the secure messaging guidelines issued by NeHTA.”
Later in the section on futures we find (page 69):
5.11.4. Future Standards
NFR5701
Describe your organisation’s policy for adopting future medical and ICT standards. Make particular reference to expected NeHTA standards.
And that is it. Not a single mention in the pro-forma response I could find.
As far as the Enterprise PMI Tender we have no mention at all.
Given the “huffing and puffing’ from NEHTA about certification and compliance I find this outcome passing strange. Maybe it is all to happen with a nod and a wink?
As far as the second issue of implementation approach is concerned the news seems to me to be very bad indeed.
It seems that over seven years SA Health plans to integrate and implement a huge system to service the needs of all their hospitals and that this will be a ‘single instance’ for the whole SA Health System.
I simply do not believe such an approach makes sense when one considers the operation, functional and workflow differences between the Flinders Medical Centre and some tiny community hospital in the north of SA.
A third issue is the EMPI Tender.
Page 7 describes what SA Health is planning:
“3.4. ENTERPRISE MASTER PATIENT INDEX (EMPI) INITIATIVE
SA Health aims to fundamentally improve the quality and safety of healthcare in South Australia by providing leadership in health reform, policy development and planning. Toward this end, SA Health’s vision is to implement an integrated electronic health record as a part of its careconnect.sa initiative.
The multiple, standalone systems used by SA Health lead to duplicate patient records being created, including creating duplicate Patient Administration System (PAS) identifiers due to a lack of a sophisticated system for searching and matching of patient records and a centralised single state level patient identifier. To achieve and maintain a single health record for each person, we wish to combine these duplicates and prevent future ones from being created by incorporating an EMPI that all relevant systems can use to manage a single patient index across SA Health in real time.
It is widely accepted that the ability to authoritatively identify patients is fundamental to the safe and effective delivery of care. SA Health therefore plans to go to market to find and purchase the most appropriate, world class EMPI product for use by all SA Health applications.”
The project objectives are as follows (page 8):
The key objectives of the EMPI Project are:
· To implement an accurate and accessible single authoritative source of patient identity data;
· To implement a single authoritative reference source of accurate address data, for Sector-wide use;
· To potentially implement an accurate and accessible single authoritative source of provider identity data; and
· To implement quality driven management across all identity data to enable improved data quality within the operation of the proposed new EMPI Service.
This work will:
· Efficiently provide a single unique identifier for each patient, (provider), facility, organisation and address to be used throughout the Sector; and
· Enable improved electronic information sharing and collaboration in an environment where privacy and security requirements are met.
I leave it as an exercise for the reader to figure out what NEHTA initiative this most reminds them of (Hint: The HI Service) and for the reader to figure out just why this is being acquired when the NEHTA HI Service is to go live essentially before the SA procurement is complete.
I am sure there are better ways to create an effective Health IT infrastructure for SA Health than seems to be on the table here. I would be curious to know just what external advice was sought given the scale, implementation risk and probable cost of this proposal.
We can all admire vaunting ambition when we see it, but I suspect a slab that is very much too big to be safely chewed has been torn off here!
It is also quite clear SA Health has effectively ‘thumbed its nose’ and NEHTA’s plans, presumably because they do not feel they will have any impact in the foreseeable future! This is all really very odd. I look forward to aggrieved comments from those in SA explaining how I have got it all wrong!
David.
2 comments:
Interesting analysis - I don't work for SA Health.
'thumbed its nose' implies some explicit thought and experience. Ignorance is the more likely background.
That said, this is an internal infrastructure that I have assumed they will connect to NHI, HPI, and IHI infrastructure when that is in place... but realistically they need to do things before that is ready and probably need to do things that that is not intended to do - matching up internal systems, etc.
But a lot of the background must surely be the contract with CSC to be the Systems Integrator for this project. And that must surely be key to the future - the product they decide, and no doubt the obscene amount of money that goes into this project on top of the $120m+ spent on OACIS which would seem to be acknowledged as a waste of money and ready for replacement.
I guess it's very much a case of "we can't wait for NEHTA we've been waiting long enough". It might also be a harbinger of things to come - how much longer will SA continue pouring money into NEHTA? The GFC plus the impending costs of this new wizz-bang statewide all-in-one development could mean that SA will want to withdraw from its funding obligations to NEHTA! How much does SA contribute I wonder. Let's say of the 50% for which the jurisdictions are responsible SA probably has to contribute around 10%.
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