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."

Thursday, August 05, 2010

There Is A Serious Lesson Here For all Health Departments – Read Closely!

The following interesting review appeared a day or so ago.

Qld health IT disaster shakes up Australia's government CIOs

CIOs wait for full picture before commenting

Top-level State and Federal Government chief information officers around Australia have acknowledged they are aware of the Queensland Government's dramatic change in IT direction following revelations of widespread problems with the state's IT shared services strategy, but are broadly withholding comment on how the debacle might impact their own initiatives until the full picture is known.

In late June Queensland Premier, Anna Bligh, said the state would abandon its centralised IT shared services model as its exclusive structure for delivering IT services in the wake of the Queensland Health payroll disaster and damaging revelations of widespread problems in associated programs.

Most whole of government public sector CIOs contacted about how issue would impact their own IT shared services initiatives eventually declined to comment, however. After an extended deliberation between NSW Government departments, the office of NSW whole of government chief information officer, Emmanuel Rodriguez, declined to comment on the issue. The office of Federal Government CIO, Ann Steward , issued a prompt statement from the Department Of Finance and Deregulation: "I'm afraid it would be inappropriate for us to provide comment at the moment."



In December 2007 Queensland Government’s IT shared services agency, CorpTech - along with IBM and Queensland Health - underwent a project to overhaul Queensland Health's ageing payroll system. The project was due for completion in August 2008.

It was a disaster of epic proportions when the SAP new payroll system - dubbed the Continuity Project - went live in March this year. Several Queensland health workers received incorrect wages and, in many cases, no wages at all. The bugs were ongoing for each subsequent payrun albeit with relative less errors.

On June 29 the Queensland Auditor-General issued a damning report on the three major Queensland IT shared services projects. The report found that the ICTC project - a consolidation of CBD datacentres, networks and infrastructure - was pushed back by 16 months. The whole of Government email project IDES was rescheduled by 18 months and the Corporate Solutions Program (CSP) - a combined finances and human resources project - completion date was adjusted.

In the aftermath of the Queensland Health payroll disaster and the Queensland’s Auditor-General report, Queensland Premier Anna Bligh announced on June 29 that Qld Premier releases terms for McComiskie review of shared services Queensland Government would disband the IT shared services model and Corptech will undergo a revamp.

“The Queensland Government will abandon the one-size-fits all shared services model as the exclusive model for corporate services across the whole of Government,” Bligh said in a statement. “The whole-of-government IT provider, CorpTech, will be overhauled to better match agency needs - this will include an assessment of which agencies are best served by their own technical services.”

Read the comments of other CIOs here with the full article.


Now while it seems pretty clear the Qld Health Payroll Project was a bit more of a mess than is typical I see that what it was revealing was the more general point that the further you move IT service delivery management from those who need and rely on those services the more likely you are to come unstuck.

Having centralised back-office operations and gaining economies of scale are not major issues unless what comes with that is the loss of control of their day to day work and requirements by the users of any system.

Done well the consolidated back office delivery can work fine – witness such things as the cloud based Google Apps and so on.

The issues come when the solution offered is not fit for the intended use or the intended users, where a far less than ideal solution is imposed on end-users, when implementation is poorly done and unconsultative or when the user feel powerless to get needed change to make their work-life with what is being offered acceptable.

We have a classics of this sort happening with both some of the aspects of the HealthSmart program in Victoria and the eMR roll out to the smaller regional hospitals in NSW – both have which have received coverage on the blog.

The lessons for large scale implementations currently being planned are pretty clear.


1 comment:

Unknown said...

One of our responsibilities is to provide credible alternatives. I believe the national health IT strategy provides a good treatment of the issues at a high level, but leaves plenty of wriggle room for jurisdictions. At least it puts governance issues high on the agenda.

I would say that the real issue in Queensland was one of IT governance, and the lesson here is that centralisation of responsibility for governance magnifies the risks when something goes wrong - as it inevitably will, people being people. I have heard of a different manifestation of IT governance issues in another jurisdiction, where software licensing costs for a major core system are far higher when purchased through the centralised service than when negotiated separately with the vendor - for the same version of the software. That same jurisdiction is "encouraging" their customers to buy through them by suggesting that funds such as infrastructure grants may be at risk. They may actually be withholding such funds, but evidence for cause and effect here will be extremely difficult to establish.

Integration of multiple smaller systems is a high risk and often expensive undertaking - even when there are established standards for message content, which is often not the case. To effectively support this we need at least some large scale centralised infrastructure. I have been arguing for some years that this should focus on identity management and authentication. I happen to believe that this approach will provide us with a credible alternative to the highly centralised approach that state jurisdictions have been following, and provide us with some benefits. This belief relies on experience at a relatively small scale, and to some extent on a realisation that the internet is game changing here. This does not mean that the approach is without risk - there are no guarantees. My reading of the national health IT strategy is that the general philosophy and approach is consistent with my beliefs. The strategy strongly highlights the need for effective governance to be established as early as possible. I agree with this - and believe that the current NeHTA work program starting with the roll out of the IHI is consistent with this. The "personally controlled EHR" is another matter - but this will either work and eventually be absorbed into something larger or will fail and become irrelevant. The attempt to implement it will necessitate the creation of some useful components - providing that IT governance issues are taken seriously.

My particular area of interest is in primary and community health, particularly coordination of care and chronic disease management. Apart from the shocking lack of openness of GP desktop systems, the biggest barrier that I consistently come across in my work is the centralised governance and management of the IT for state jurisdictions. Part of the reason for this is that resources that should be available to support integration or other such activities at the local level are locked away in an inaccessible (to GPs and private allied health providers) bureaucracy.