Tuesday, June 22, 2010
Despite Some Successes HealthSMART in Victoria Does Not Seem to Be Going Well Clinically.
The following article and letter appeared a few days ago in The Age.
June 14, 2010
VICTORIAN hospitals have slammed the state government's trouble-plagued $323 million health technology system - dismissing its benefits as limited and accusing the government of putting hospitals at ''serious risk''.
A series of documents from the networks that run hospitals across Victoria reveal a litany of problems and dissatisfaction with the HealthSmart system, which is running four years late and $35 million over budget.
Health board minutes - seen by The Age - show hospitals being left to meet funding gaps for millions of dollars, with networks writing to Health Minister Daniel Andrews and his department to try to find money for ''hidden costs''.
The opposition and the Australian Medical Association seized on the state government's latest information technology failure, saying patients and doctors were losing out.
''This is the Victorian health system's myki,'' opposition health spokesman David Davis said.
HealthSmart aims to co-ordinate the different computer systems running in hospitals and bring in new programs such as electronic prescriptions to reduce medical errors.
But according to June 2009 documents from West Gippsland Health, the board decided to write to the Department of Human Services expressing its ''dissatisfaction with the system and raising their concerns that it poses a serious risk to the organisation''.
Western Health documents, also obtained by the opposition under freedom of information, show frustration at a $15 million shortfall in capital funding and recurring costs.
And in April last year, Bendigo Health warned of potentially insufficient money to fund the crucial clinical part of the information technology system.
More detail here:
And a letter the next day to the Age.
DESCRIBING HealthSmart as ''myki'' is a misnomer (''Health 'myki' blows budget'', The Age, 14/6). Myki is an inconvenience compared with the dreadful implications of HealthSmart, which affects life and death decisions about patient care.
I have been trialling and analysing the HealthSmart hospital discharge summary electronic interface for general practitioners. A traditional and effective summary is one or two pages. HealthSmart generates an unmanageable 15 or 30-page report.
The formatting is amateurish and critical information about patient care can be buried 10 or 12 computer screens in. GP notations and actions are lost and unrecoverable because of incompatibility with software used by about 85 per cent of general practitioners.
It is already a shameful misappropriation of more than $300 million diverted from healthcare without pre-existing evidence of workability and effectiveness. This reflects poorly on the Department of Health, hospital network chief executives and boards.
Network bosses should be advocating for credible small-scale development with field trials to prove benefits and effectiveness. In other words, applying the same standards to themselves as they demand of healthcare professionals.
Dr Dennis Gration, Tecoma
On this basis I thought a little update was warranted. This, remember, is a seven year program which was to cost $360M.
The program has a good website with lots of information which is very good I have to say when compared with what we see from DoHA.
The site is here:
Of special interest to me was the apparently current timeline document.
This can be grabbed from here:
From all the documentation two things are pretty clear.
First the administrative and payroll side of the plan has got to its goals pretty convincingly –which is very good.
The Community Management Systems and the iPatient (from iSoft) patient administration systems have also gone well and implementation is largely complete.
The second and bad news seems to be that the clinical systems have been very considerable laggards in all this.
We now have the following:
Northern Health 2011
Western Health 2011
Royal Women’s 2011
Loddon-Mallee RHA 2011
Melbourne Health 2011
Southern Health 2011
Eastern Health 2011
It seems what we have here is actually the list of applications that are really very late indeed and are so called ‘post-program implementations’ when clearly they were actually meant to be in program.
Over the years I have had a number of missives in unmarked envelopes from Victoria chatting on in horror about how the clinical systems are being done.
Two key points have been central inflexibility and excessive cost to the target organisations.
It seems there is still some way to go. I wonder will it be possible to do better on the following implementations?
Just today, and after I had drafted the text above, a new article on the issue has appeared.
June 22, 2010
THE Alfred hospital's computer system is so bad that its own doctors are warning it will inevitably lead to ''catastrophic, and perhaps fatal'' consequences for patients.
A scathing letter from medical staff to The Alfred's management, obtained by The Age, warns that the hospital's electronic medical record system is a ''disaster'', with surgeons forced to compete with nursing staff and anaesthetists to access computer terminals.
In a litany of complaints detailed by the hospital's senior medical staff association, doctors claimed they were unable to look at more than one patient record at a time, with some staff urging a return to paper records.
''A number of my colleagues have taken the opinion that the current arrangements and systems are compromising patient safety and that it will only be a matter of time before we see catastrophic and perhaps fatal outcomes arising directly from the issues,'' the June 18 letter from staff association chairman Howard Machlin stated.
The Australian Medical Association said the information technology problem was widespread, with some hospitals woeful at providing basic access to computers.
In the letter, Alfred staff also complained that the software system left doctors looking at a computer screen for information on ''why the patient is sitting in front of them rather than actually looking at, or talking to, the patient''.
Dr Machlin stated that the number of computer terminals and the speed of the system at the Alfred was inadequate, and a particular problem in operating theatres.
A great deal more here:
All this does is confirm just how inflexibility in a clinical program can lead to very sad and frustrating outcomes.
Posted by Dr David G More MB PhD at Tuesday, June 22, 2010