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, January 25, 2011

Where To Next for the Victorian HealthSMART Program? A Major Clinician Guided Mid-Course Review is Vital!

This program has suddenly got itself into the news.

Yesterday we had this:

Health myki faces axe

Kate Hagan

January 24, 2011

THE state government is considering abandoning Victoria's trouble-plagued $360 million health technology program, with Health Minister David Davis admitting he faces ''a genuine dilemma with 'the myki of the health system' ''.

The HealthSMART program - five years late and $35 million over budget - is supposed to link computer systems in hospitals and introduce processes such as electronic prescribing.

But clinical applications are only partially running in just four hospitals, and doctors say patient safety is compromised by inadequate procedures that causes them to duplicate paperwork, chase test results and compete for access to computer terminals.

In a state budget submission, the Australian Medical Association has called for a further $328 million to be invested on health technology over the next four years, with a focus on providing ready access to patient records, test results and medication details.

AMA Victoria president Harry Hemley said health technology in Victoria bordered on the embarrassing, and ''patients would be appalled at the lack of IT, computers and connectivity between different areas of the health system''.

Mr Davis said the HealthSMART program, launched by the former Labor government in 2003, had been ''botched in its introduction'' and was tens of millions of dollars over budget without achieving its stated aims.

''The new government faces a genuine dilemma with the myki of the health system,'' he said. ''On the one side we have large sunk costs, and on the other a system that has failed to meet expectations.''

Mr Davis said technology was ''a critical part of improving the performance and quality of our health system'', and the AMA's submission would be considered as part of the budget process.

Dr Hemley said many promises had been made about HealthSMART's ability to revolutionise technology in hospitals, but the project had been bitterly disappointing despite hundreds of millions of dollars in investment.

''HealthSMART still has potential to deliver a vastly superior health IT system but it needs to be seen as an ongoing investment,'' he said.

More here:


and here:

Health IT program Healthsmart faces the axe

  • Jessica Craven
  • From: Herald Sun
  • January 24, 2011 12:43AM

THE future of a $360 million program designed to improve care in Victorian hospitals is under a cloud.

The Australian Medical Association has called for an additional $260 million to be invested in the botched HealthSMART program, which is five years late and $35 million over budget.

More here:


This was followed by these today:

System is sick, not dead

Dr Harry Hemley

January 25, 2011

FOR those unfamiliar with computer systems in Victoria's public hospitals, you would probably have to cast your mind back to the early 1990s to realise just how poor the information technology networks are in our supposedly world-class health program.

We're talking paper-based records, people queuing to use the available computer terminals and the difficulty sharing information with off-site colleagues. For patients in our public hospitals, the ramifications of poor IT systems are serious.

The problem starts from the time a person is treated in the emergency department and doctors and nurses aren't able to get access to the person's history of care with their general practitioner.

In the absence of a central health database that stores the history of patients' illnesses, treatments and medications, medical staff have to piece together this information from the patient's own memory in a process that requires trial and error.

On a good day, the patient will have a list of their medications and illnesses but typically their memory extends more to the colour of the tablet and a vague recollection that the name of the drug begins with an N.

Once the patient is admitted, staff on the wards have to queue to use a computer so they can access the patient's hospital records and diagnostic information. When staff are finally able to get on a computer, the system is slow and clunky and crashes all too common.

The lack of connectivity between different areas of the health system means medication lists, tests, scans and other diagnostic tools are often repeated. Health dollars and clinicians' time are wasted chasing results and duplicating services in an already stretched public hospital system.

The quality of care is compromised and patients are at increased risk of mistakes being made in their treatment, diagnosis and prescription of medication.

More here:


and this:

'Too late' to kill e-health program

Kate Hagan

January 25, 2011

THE state government should stick with Victoria's bungled $360 million health technology program because it was finally starting to deliver some benefits, an e-health expert has argued.

Mukesh Haikerwal, who is the federal government's clinical advisor on e-health, said the HealthSMART program had ''a long tortuous history'' but cost savings would not be made by ditching it, only to start again from scratch to build an electronic system to share patient information in hospitals.

The Age revealed yesterday that the state government was considering abandoning the program, which is five years late and $35 million over budget.

Health Minister David Davis said the new government faced ''a genuine dilemma with the myki of the health system''.

HealthSMART, originally due to be completed in 2007, replaced existing financial management systems in hospitals. It was also supposed to introduce clinical systems for electronic prescribing, ordering tests and reporting results to Victorian hospitals, but those programs are now partially running in just four hospitals.

More here:


There is also coverage today in the AFR and a few other places.

For those that are interested I have been on this case for a while now:

See here:


and as far back as here:


and here:


There are a few facts that need to be clear:

First the program is way behind time and over budget.

Second it seems that there has been pretty intense resistance to many clinical applications from the clinicians who are expected to use the software.

Third if the program is to continue as it is presently planned there are a few years to go before key clinical functionality will be universally available - and remember this was the key goal.

Fourth non HealthSMART initiatives like PACS have gone pretty well as have a range of administrative and basic operational systems.

The bottom line is that all this should not be thrown out - that would be nonsense. What is needed is a clinician focussed in-depth review to establish what is needed to obtain genuine clinician commitment to adoption and use of what is presently on offer for clinicians - with the live option of starting again - with another vendor - in this domain if the present vendor cannot demonstrate they can deliver what clinicians believe they actually need.

This review needs to be externally facilitated, independent and not controlled by the Program in any way. Clinicians need to know their needs are understood and will be answered.

Indeed they need to know they can veto the whole clinical program, by some reasonable democratic process, unless their legitimate needs are actually addressed.

If this is not done - and fast - the entire fiasco will collapse and lead to much increased cost and time wasting. Having come this far and spent this much it is vital that whatever is needed is done to sort out the area of the program where most of the benefits will ultimately flow from!

I note that even after 1 day it is clear this weeks poll is going to say that right now the Program is a total mess!

The national implications for e-Health also should not be ignored, as they are pretty substantial.



Anonymous said...

Perhaps Mukesh Haikerwal could enumerate (from 1 - 20) exactly what are the 20 benefits he is referring to that the HealthSMART program has now started to deliver.

Anonymous said...

I would not start with the Vendor. I would start with how Healthsmart has been run.

One obvious question that has to be asked is what are the differences in approach between Victoria and NSW? I believe NSW has now more or less finished its Cerner EMR roll-out. Of course we all know there is a vocal group there who do not like Cerner very much, but at the same time I don’t think anyone is seriously suggesting going back to the drawing board.

I worry that a “clinician-led review” sounds great but risks seeing the baby go out with the bathwater. It will bring out the open-source zealots and garage vendors who will whisper in the ear of Government that there is a better way that does not involve “American” software and that they have a solution “currently under trial in one hospital” that “could be easily scaled up”. Then we will be in for another 10 years of going around in circles.

Before worrying about the software I would be looking firstly at the way the project has been managed in Vic and secondly how their funding works compared to NSW in terms of what has to be put in by agencies/areas versus centrally.

Anonymous said...

Tuesday, January 25, 2011 10:23:00 PM said "I would not start with the Vendor. I would start with how Healthsmart has been run."

Would you? Your suggestion infers the root cause of the problems lie with HealthSmart management. MMmmmm.

There is no doubt HealthSmart Management have a great deal to answer for. But let's face the truth - the large vendors (solution providers) promoted their wares well beyond what they were capable of delivering in an acceptable and achievable time-frame.

More than that they (Cerner, iSoft, Intersystems Trak)put enormous sales and marketing resources into selling futures and fresh air based on where their R&D was heading. Indeed, media coverage of recent years has demonstrated quite clearly that the bureaucrats expectations of what they thought would be delivered has been far and away in excess of what the vendors were actually in a position to deliver. The great sales-swan-con has been a masterly exercise in deception.

No-one with any sense of sanity and a semblance of intelligence about them would attempt to pigeon hole every hospital in the state into ONE common software system.

The risk exposure is higher than high and the cost to the health system and the community of eliminating competitive market forces is untenable.

Faults and blame lie squarely in both camps - over zealous bureaucrats and hyped-up vendors.

Minister David Davis should:
(i) freeze the entire project forthwith
(ii) put it into maintenance mode for at least 6 months
(iii) appoint a small core of independent healthIT experts to dig wide and deep, uncover the problems, thoroughly analyse them and report their findings without fear or favour.

Based on those findings then set about preparing a strategic pathway for moving forward out of the quagmire.

Anonymous said...

Anon above is dead-on, large vendor have always sold based on future products and promised rather than existing capabilities, 20+ years in IT has proven again and again. When I a was leading and Enterprise Architecture group in Denmark tasked with integrating close to a 100 systems we had all the major player showing us carefully crafted PPT slideshows on how their integration products could handle it all with easy, always keen to explain why their competition could not. We had all the RFP's returned and looking good, then without telling them of my plan I setup a meeting with ALL of them in a large boardroom at the same time, each had to present their proposed solution. Needless to say it was amusing to watch them shoot the each other down, as they all knew each others shortcoming better than anyone else. Result? No-one had a solution, but its was in non-public BETA coming Real Soon Now. In the end it took 3 vendor working together and a lot of work and code from our Architects & Devs to get a basic PoC working. I suggest inviting competing Vendors to such an open house forum ... SM in QLD

Dr David G More MB PhD said...

Another good way to sort the wheat from the chaff is to develop scripts that show in action the functionality and capability that is required them and have each provider execute those scripts.

Soon sorts out the real from the 'foil ware'.


Anonymous said...

Dr Harry Hemley, President AMA Vic, said “It's time the Baillieu government stepped up to the challenge and turned the HealthSMART mess around. Most importantly, the Premier should commit to the delivery of medication management systems in all Victorian hospitals by the end of 2012. It's an ambitious target, but the benefits for patient care will be immeasurable. We can't make the necessary increases in efficiency and improve patient care without better IT.”

Delivery of medication management systems in all Victorian hospitals as Dr Hemley calls for will be a futile exercise unless and until a standardised patient eMMR (electronic Medication Management Record) is first established.

Dr Hemley however should understand that the starting point for building the eMMR lies, NOT in the hospitals, but in that part of the health system which lies beyond the hospitals – it lies in the world of primary care. In other words it lies in the community environment not the hospital environment.

Once the community-based patient-centric eMMR has been established with doctors and pharmacists exchanging scripts electronically and writing to the eMMR then hospitals too will be able to prescribe and write to the eMMR and everyone will be on the same page.

It would be helpful for everyone concerned if the AMA actively demonstrated in some tangible way that it was behind the drive for implementing e-prescriptions between doctors and pharmacists in primary care, as this is the most logical point from which build a viable medication management system.

Anonymous said...

Healthsmart snookered themselves from the beginning by hogtying Cerner to iSoft iPM. The Cerner system could have quite adequately handled the patient administration function. But some clever cloggs deemed that patient administration had to be done with a separate system. The horrendous interfacing problems that ensured has significantly increased the complexity of the project, made a dogs breakfast of the user experience and diverted precious resources away from the work required to introduce some flexibility into the clinical aspects of Cerner to make it a more acceptable to Victorian health services.

Anonymous said...

What a dilemma.

iSoft (Australian technology company)grew too fast, bit off more than it could chew, got into trouble in the UK, and is now on the ropes gasping for oxygen and praying for the bankers to step up with life saving funds to help it survive. Meanwhile, HealthSmart continues to hope and pray that iSoft's new product 'LORENZO' will still be the magic oil to fix all our ills.

Cerner, on the other hand, continues to grow in its home market the USA, stumbles its way from pillar to post in the UK with its new product 'MILLENIUM' and continues wrestling with how to adapt its American architected hospital software to fit the Australian health care system.

So. Could "Cerner system have quite adequately handled the patient administration function"?

And, should Cerner have been given sole exclusive software vendor status to all of Victoria's hospitals for patient administration and clinicals?

Or should InterSystems (Trak) have also been offered the opportunity to service Victoria's hospitals with its patient administration and clinicals software?

And who did the 'snookering' here?

Was it the HealthSmart bureaucrats or was it the vendors (iSoft, Cerner and Trak) competing against each other with their hard sell 'we are the only vendor which has the complete integrated solution for your hospitals'. You are?! We are. Absolutely.

Anonymous said...

Vendors oversell because all other vendors oversell.

Good BCats and/or Consultants on the Govt side have the duty to work out who is full of it.

I played this role for a Govt, and I found the vendors will not outright lie but just suddenly lapse into future tense. Where we were suspect on their ability to deliver - we did our best to alter the tender or at a minimum documented that particular conversation to use as leverage later.

I must also say that US companies are a hell of a lot more demanding in terms of vendor and compensation from vendors who do not deliver than in Oz. We tend to pay all our bills on time, rarely from what I have seen hold cash back for non-delivered items and get compensation in the form of discounted customisations.

Trouble is the decision makers here are quite often the ones with the least knowledge and therefore the ones most easily led.

Trouble is anyone can claim to be an E-Health expert where in reality, I am not sure I have met even 1 person who would fit this bill IMHO.

Anonymous said...

Not sure that Lorenzo will help Healthsmart all that much because under the terms of the original tender process only deliverable products could be tendered, and Lorenzo was only vapourware at tender time.

I would have thought that Healthsmart would have to go to tender again if they want to get Lorenzo up.

Anonymous said...

The original HealthSmart proposal was for a panel of systems to suit the differing requirements of health services in Victoria. So one could have had a choice between a Cerner or Intersystems(Trak) product, or some other system.

Some where along the process that idea was ditched and the eventual single vendor outcome was Cerner for Clinicals and iSoft iPM for PAS, and Trak for a small set of standalone metropolitan community health centres.

Hard to figure how that made much sense.

Anonymous said...

Friday, January 28, 2011 10:03:00 PM said “Hard to figure how that made much sense.”

Giving the hospitals a choice of either iSoft, Cerner or InterSystems-Trak (or at least two of these) would have introduced a competitive element into the marketplace. But that would have significantly complicated the task of having two data centres supporting a statewide system.

Of course one has to ask did any of the three vendor solutions have sufficient functionality to meet the requirements for PAS plus Clinicals plus Community Health?

Absolutely not. Does anyone think otherwise? After all these years is there any evidence to suggest things are any different today?

Bruce Farnell said...

I recall attending a workshop sponsored by the Victorian DHS focussed on eReferral (a topic for another day perhaps) - with at least one presentation on HealthSmart. This was in the early days of HealthSmart.

I posed the question: "Given the software panel concept, what is the role for open-source applications?" I must that the reply was refreshingly short and honest. I quote verbatim - "There wasn't one".

I'm not saying that open-source will cure all of our eHealth ills. Although the dangers of vendor lock-in should not be understated. I question the IT governance of any initiative of this nature that fails to at least evaluate and monitor open-source offerings. For instance, did they evaluate WorldVISTA? I doubt it.

Anonymous said...

Open standards is what is required, as then open source can play.

From what I have seen they have allowed non standard HL7 which includes Z-Segments etc.

If they specified a set of functionality well and insisted on support for Australian HL7 standards in a testable way and built the test harness then anyone could play.

In reality this involves them knowing what they want which is a problem. Instead they get what they are given, which is highly vendor specific and often not compliant. In reality they need expertise in knowing exactly what they want or there will be no interoperability. We have failed to develop the expertise for governments to know what they want and the result is as expected. The naive customer falls victim to the slick salesman and this is the pattern of eHealth in this country. Until we develop expertise and demand standards compliance to well specified tenders the slick salesman will continue to win out.

Another failure of governance due to lack of expertise. We don't want generic managers, we want managers who know exactly what they want and understand the technical details and insist on compliance with those details.

Anonymous said...

HealthSmart did specify HL7 2.4 for the core, but then because no system they selected was at 2.4 they had to adjust to 2.3.1 or back to 2.3 in Cerner's case.

They also eschewed using international standards (LOINC etc) for mapping tables and ontologies and drafted their own.

Makes interoperability a bit of a challenge.

Anonymous said...

Does that mean that going backwards is the way forward.

Anonymous said...

Any commercial health software product that cannot be easily upgraded to move from HL7 2.3x (particularly 2.3.1) to HL7 2.4 obviously has a poor code base and deserves to be named and shamed in the marketplace.

Most decisions to adopt local coding standards are made with little, or no, consideration being given to the fact that an increasingly-significant percentage of the population have health records that span more than one country.

Anonymous said...

Rubbish. A very very very minuscule percentage of the population have health records that span more than one country.

Anonymous said...

Hardly minuscule!! Approximately 25% of Australia's 19 million people were born overseas, not to mention those in the remaining 75% who have spent time living, working and travelling in other countries.

Anonymous said...

Yes - so - what's your point - we aren't developing a PCEHR for people who lived overseas - we have enough difficulty trying to develop one for people who now live in Australia.

Anonymous said...

Tuesday, January 25, 2011 5:17:00 PM said... "Perhaps Mukesh Haikerwal could enumerate (from 1 - 20) exactly what are the 20 benefits he is referring to that the HealthSMART program has now started to deliver."

It is not possible to list 20 benefits that HealthSmart has delivered. Dr Mukesh knows that which is why he remains silent. The great tragedy here is that people who make these inane claims and comments are the ones who are advising the Health ministers. They make these stupid claims, in doing so they demonstrate their lack of knowledge in the ehealth field, and they get themselves appointed to be advisers and perpetuate the problem with more consistently inadequate advice.

It's a lose-lose situation all round.

Anonymous said...

Translating between the various HL7 variants is perhaps not that difficult, the change in syntax is known and can be accommodated.

It is the semantics of the data elements in message that is the real problem for interoperability. Getting agreement on the use of current working standard coding schemes and ontologies appears to be difficult in Australia, without the complication of various bodies drafting/dreaming up their own or modifying existing standards to suit themselves.

By contrast the US appears to be allocating resources to rewarding those who make existing technologies and standards work to achieve 'meaningful use' and letting this activity drive standards development.

Anonymous said...

“The US appears to be allocating resources to rewarding those who make existing technologies and standards work to achieve 'meaningful use' “

So who is obstructing making existing technologies and standards work in Australia to achieve ‘meaningful use’?

For example, it seems that eprescriptions and medication management have been identified by Government as the highest priority ehealth application to address the issue of adverse drug events, medication errors and hospital admissions caused by medication mismanagement. eReferrals is also often nominated as a high priority application.

If there are application vendors who have existing standards compliant solutions that can demonstrate ‘meaningful use’ why on earth are we not allocating some resources to drive them forward?

So the question we should be asking is who is obstructing, preventing, hindering progress in regards to ‘meaningful use’?

Is it the government?
Is it the bureaucracy?
Is it Medicare?
Is it the software vendors?
Is it NEHTA?
Is it all of them?

Anonymous said...

I think the answer is that all of them are hindering progress in different ways due to a combination of conflicting vested interests, politics and ignorance.

Each of these three elements need to be considered against the above questions before we can find answers to inform us how the obstacles can be overcome.

Anonymous said...

As far as the 'software vendors' are concerned you need to break them down into individual elements and then examine the vested interests and the politics behind each.

For example, it is meaningless to lump Cerner and Best Practice and MediSecure and Medical Director under the same umbrella. Each is quite different from the other. Even so, the same scrutiny needs to be applied to each and every other software vendor individually. In doing so it should become clear who uses existing standards compliant solutions which can demonstrate 'meaningful use' and who doesn't.

That is a good starting point.

Anonymous said...

"Yes - so - what's your point - we aren't developing a PCEHR for people who lived overseas - we have enough difficulty trying to develop one for people who now live in Australia."

Silly me I thought we were working towards improving health outcomes for all Australians - must of missed the caveat about it being for resident citizens only.

If the solutions to transferring info from Hobart to Darwin or from the private to public sector - do not solve the problems of moving from Canberra to Munchen ....we might as well give up now and just throw the entire thing to the private sector (which I sometimes think may not be a bad idea).

Anonymous said...

Yes, silly you. If a system is developed which works in Australia it obviously will be available for Australians to access when living overseas.

I have no issue with that. What I did take umbrage at is the pathetic way that you attempted to justify development based on the number of people who live overseas. You need to get a little more focused and realistic rather than raise distracting red herrings to the core issue.

Anonymous said...

"I think the answer is that all of them are hindering progress in different ways due to a combination of conflicting vested interests, politics and ignorance."

I think ignorance is the overwhelming problem. Unfortunately many of the people making the decisions in the health bureaucracy regard e-health policy as just another facet of health care and have little experience or exposure to the complexity of the topic. Not helped by IT people/advisers who view it as a technical or engineering project and not the complex social interaction system that e-health represents.

Can hardly blame the vendors, their task is to sell something that they think the buyers want - they go out of business otherwise.

So if we want something better it is up to the buyers/regulators to lead by example and set the agenda with coherent strategies, and realistic expectations to encourage the vendors

Anonymous said...

“I think ignorance is the overwhelming problem” said Wednesday, February 02, 2011 8:30:00 PM
I agree with you - ignorance is the great destroyer.
It is a very difficult problem to overcome.

Usually the ignorant people are ignorant because they don’t want to learn. And if those people are decision makers in authority with a modicum of power having their egos massaged by advisers who position themselves as ‘experts’, but may in truth be relatively ignorant, the problem becomes almost insurmountable. All too often today individuals hide behind the ‘expert’ moniker and in so doing conceal their ignorance in the process of giving advice.

However, having said that let us not avoid the painful facts of life by saying “one can hardly blame the vendors”. Bollocks to that.

The vendors don’t cooperate and don’t collaborate with each other. Some through ignorance, some through insecurity and fear, some through sheer bloody mindedness. As a consequence one can definitely blame the vendors. They are as much a part of the problem as is ignorance. But the difference between ignorance and vendors is that whilst it is very difficult to do much about the former it should not be all that difficult to do something about the latter – but it is.

So I would confidently argue that the vendors carry most of the blame because they have the power to fix the problem.

Anonymous said...

In our competitive western society the vendors are not meant to collaborate and cooperate with each other of their own volition, that would lead collusion against the buyers.

Vendor competition is one of the ways we drive innovation, and get value for money.

The buyers have to set the framework and standards and do the collaborating and cooperating with the vendors.

The most positive vendor relationship is where there is some level of trust, and the relationship is mutually beneficial to both parties.

We have way to go in Australia before the standards and framework are in place to provide a competitive environment that engenders innovation, but at the same time ensures that it is relatively easy to 'mix and match' vendor products.

Indeed many state health departments have set up exclusive arrangements with single vendors, hardly the way to encourage innovation or generate price pressure.

Anonymous said...

Vendor competition is one of the ways we drive innovation, and get value for money.

True. So, if I understand what is being said here it is that we need to develop a model which:
(a) will work in our competitive western society
(b) will ensure vendors remain competitive
(c) will reward vendors who are prepared to collaborate
(d) does not encourage collusion.

Does anyone have a problem with that?

Anonymous said...

"The vendors don’t cooperate and don’t collaborate with each other"

You need to make it profitable to do so, and even then I would question whether such a move would squash innovation.

Who has made a bigger contribution to e-health in the world today - Govts or Private Enterprise?

The Govt should be the keeper of the standards, ensure national infrastructure keeps pace, ensure their own Govt health care patch is on the path to an electronic system.

The Govt can not construct this, and the sooner we get our heads around E-health being a benefit for the next generation, rather than an election promise.

Exec Summary - The Govt is hopeless at doing, Vendors are money hungry wolves ....truth is in the middle.


Anonymous said...

Friday, February 04, 2011 7:26:00 PM said "You need to make it profitable to do so". Of course you do, no-one would disagree with that.

However, to suggest that "such a move would squash innovation" is quite wrong. A flexible business model which rewards vendors, is profitable, and encourages collaboration but not collusion, will drive innovation,

Surely you can see that.

Anonymous said...

An the only thing that works in that setting is well defined and tested standards compliance.

Currently any player with a significant market share effectively defines their own standard. Labs will test messages against MD and make sure it works even it has to be non-standard. This is holding the landscape down to the lowest common denominator, which is quite low.

The role of governance is to specify testing and compliance programs to avoid abuse of market power and allow competition and innovation but they do no have the ability or knowledge to actually do anything sensible, as the PCEHR so strongly shows!!

Standards based strict message compliance testing is what we need for interoperability. It leaves vendors free to innovate so long as they can spit out compliant data and consume compliant data, which is what interoperability actually is.

Anonymous said...

And adopting widely used current standards is a good place to start - surely.

Anonymous said...

'And adopting widely used current standards is a good place to start - surely'

I agree and stop calling me Surely.


Anonymous said...

I have been following these comments with interest as I, unlike most of you from what I can garner, actually work with TrakCare - the community health "dumbed down" version of the wider application. Buried in these comments are insignificant references to a major health infrastructure delivering multiple services to the community post exposure ton the Victorian public hospital system - their backbone - the 23 community health centres around Victoria. Do not under estimate the impact that the expenditure has on these DHS funded agencies who must magically make the costly maintenance fees appear out of thin air - we are not-for-profit organisations that rely on government funding and some income from our client fees. Do not sweep us under the carpet when considering the impact of the dissolution of this project - one we have invested hundreds and thousands of dollars in - not only in a fiscal sense but in human resources - there are of course some major areas of functionality that we desperately need to provide patient-centric care (a basic fundamental principle).

Where are the original business requirements specifications? Which industry representatives were part of the vendor selection process? Why did community health get a souped-up statistical reporting system vs a patient-centric client management system?

When you think of HealthSMART don't just limit your views to the acute sector. Cast a thought to the thousands of clinicians who work in the community health sector - working in self-management techniques, early intervention into chronic disease, diabetes management, mental health and well-being, crisis support - far too many services to mention - working to reduce the ER presentations in the acute sector.

And this was a MANDATED system with very little evidence of community health consultation. The larger percentage of development resouces are dedicated to the acute applications leaving very little left to develop key requirements of community health.

Next time you see a disadvantaged member of our community consider that they are probably being supported by the very services we provide.