Sunday, September 25, 2011

The Troubles In Qld Health (QH) IT Really Seem To Be Building - QH Seems To Be Ignoring The Lessons of History!

Last week I reported on some issues the Opposition was raising with the Government regarding the procurement of the planned Hospital Information System for Qld Health.
Here is the link.
At the very least from a political perspective this certainly seems to be a story that is keeping on giving!
At the earlier post I had not seen this press release from the Opposition health spokesman.
Tuesday, 20 September 2011 15:14

Labor's $182m health IT contract suspect

The State Opposition fears a repeat of Labor's health payroll debacle is looming with internal State Government emails raising serious questions over how a $182 million health records IT contract will be awarded.
Emails obtained through an Opposition right-to-information application have revealed senior Queensland Health bureaucrats made requests to the author of a Gartner market analysis report that may have excluded competition for the multi-million dollar integrated electronic medical record system (ieMR).
LNP Shadow Minister for Health Mark McArdle said Paul Lucas, who was Health Minister at the time, must make a full explanation of why he signed off on this procurement strategy.
"An email between senior bureaucrats reveal Queensland Health had contacted the "Gartner author" to make changes to the "market scan report"," Mr McArdle said.
"By narrowing the scope of the market analysis after the draft was circulated, potential competitors may have been unfairly excluded from bidding for the ieMR platform contract."
Queensland Health is currently in contract negotiations with Cerner Corporation over the procurement of an integrated electronic medical record system, worth a reported $182 million in 2011-12.
"We should be opening the ieMR tender up to domestic and international competition to ensure we get the right platform at the right price for the taxpayer, and to avoid repeating the mistakes of the health payroll system," Mr McArdle said.
"This approach is unspeakably stupid by a Labor government that has already given our health workers a $220 million failed payroll system."
There are already reported concerns in both New South Wales and Victoria over the performance of Cerner platforms in their hospitals.
Mr McArdle also said he received a letter from LNP Candidate for Stafford Dr Chris Davis today, refuting claims by Health Minister Geoff Wilson that Dr Davis supported Labor's approach to procuring the eMR platform. (Letter attached)
"Dr Davis is a man of principle and believes a well functioning e-Health program, just like a payroll system, is an essential part of our health system," Mr McArdle said.
"The Bligh Labor government has adopted a blinkered approach to pursuing a single product, corner cutting the tender process with a poorly defined business case, which may end in disaster for patient care."
The latest revelations support a string of leaked documents showing Queensland Health's IT system was plagued with problems, with 'extreme' risks of poor patient care and reduced Federal funding for health services.
A leaked Queensland Audit Office report also found Queensland Health at odds with the independent auditor over recommendations to increase accountability and transparency of the troubled IT program.
"The Bligh government is the greatest risk to getting our health system back on track as the IT crisis spreads from payroll to patients," Mr McArdle said.
"We have never seen such gross mismanagement and a total failure of leadership in a portfolio than we have seen in Queensland Health under Labor.
"A CanDo LNP Government will be open and transparent and get action on the basics."
Download attachments:
The release is here:
This was followed by these reports in the Courier Mail.

Queensland Health eyes software system despite red flags

QUEENSLAND Health is poised to sign a multimillion-dollar contract for computer software similar to that labelled "defective" by an IT expert who audited its use in southern hospitals.
University of Sydney's Professor Jon Patrick said electronic medical records systems built by Cerner Corporation for the NSW Government crashed frequently and risked patient safety.
A similar Cerner system installed by the Victorian health department also has been plagued by glitches and is five years behind schedule.
"I don't think there's any reason for optimism that they can be improved," Prof Patrick said.
Leaked internal documents have surfaced detailing problems already looming within Queensland, as bureaucrats negotiate with US-based Cerner to build a $243 million electronic medical records system in Queensland hospitals.
Technical information for the proposed Cerner system and existing IT platforms that it must work with was "often incomplete, not-comprehensive, inaccurate and out-of-date", a leaked position paper found.
Another email addressed to chief information officer Ray Brown, released to the State Opposition under Right to Information laws, warned of the increasing need to document potential risks "even if we can't find the resources to remove them" in case of disaster and patient death.
"The no-surprises rule may be applicable and would help in a Coroner's Court," the clinical adviser wrote.
More here:
And then this:

Queensland Health's new electronic medical records system already year behind schedule, leaked documents reveal

QUEENSLAND Health's controversial new electronic medical records system already lags almost a year behind schedule, leaked documents reveal.
Internal timelines show a "gold build order", indicating the software was configured and ready for rollout, and should have been issued last December.
But months later, the troubled department remains locked in contract negotiations with Cerner Corporation as technicians battle potential system risks.
In a further blow to QH, which had tried to keep the platform's cost under wraps, more leaked reports show the spend will hit $194 million by next June.
Chief information officer Ray Brown this week scrambled to show the hi-tech system was on time and budget, after a series of damning reports in The Courier-Mail.
He insisted the gold build was "prototyped" last December and said a subsequent risk assessment took several months "as we were extremely thorough".
But his office was yesterday unable to say when the Cerner contract would be signed, allowing the software to roll out across Queensland hospitals.
Health Minister Geoff Wilson said: "I make no apology for taking a few extra months now to ensure a strong result and save time in the long run."
More here:
Mark McArdle MP
Shadow Minister for Health
LNP Member for Caloundra
24 September 2011

Auditor-General called to investigate Labor’s $182m IT program

The Bligh Labor Government’s troubled integrated electronic medical record program has been referred to the Auditor-General.
Shadow Minister for Health Mark McArdle yesterday wrote to the Auditor-General asking him to step in and conduct a full audit of the health IT program to ensure future patient care is not placed at risk, and taxpayers’ funds are not wasted.
“Labor Health Minister Geoff Wilson has lost control of his department’s IT division – and the result is a massive waste of taxpayers’ money,” Mr McArdle said.
“These are the same people that gave us the controversial health payroll system that squandered $220 million of Queenslander’s money, and now Labor’s got patients’ records in their sights.
“It’s time we had an urgent independent audit into the program.”
This week there have been revelations that the proposed medical record program is over 12 months behind schedule – and more disturbingly, the $182 million contract may have unfairly excluded potential competitors from bidding.
“The medical record system Queensland Health want to purchase has already been subject to criticism for its pitiful performance in New South Wales and Victoria,” Mr McArdle said.
“People want the truth not more deceitful spin from Geoff Wilson and his army of taxpayer-funded media advisors.”
Mr McArdle wrote to the Auditor-General asking him to examine whether the ieMR program had been open to market competition, whether approval was given by the Minister’s office, how much the program had spent to date and the estimated future costs, and whether the program was open and accountable.
“Queensland can’t afford for another expensive Labor IT bungle like the health payroll system,” Mr McArdle said.
“We need to act now and undertake a full audit.
“Only a CanDo LNP Government will be cut waste and be open and accountable,” he said.
---- End Release.
While all the political attempts to score points and seek advantage is always a great spectator sport there is actually a serious issue which needs addressing - and soon.
It is clear that the substantial hospitals in Queensland (and they have some of the biggest in the country) need their core information systems replaced and there is no political issue on this point - the old ones being at their life’s end - indeed they genuinely reached beyond that point years ago!
The key issue is how this replacement - and hopefully significant upgrade - should be achieved.
I have to say the colour drains from my face when I read about ‘gold build’ contracts and state-wide rollouts!
It really seems to me that there is a risk with all this that Queensland is again trying to replicate a state-wide implementation approach that has been shown to cause a great deal of pain and frustration in the southern states.
Frankly to approach large complex teaching hospitals with other than a totally locally managed implementation process where the vendor and the hospital work together to implement a system that suits the client (the large hospital NOT the Department of Health) is just very stupid and very, very risky.
It really does not matter which of the major vendors is chosen (indeed in the very large hospitals, as long as the hospital is happy having more than one is hardly a disaster) as long as they are allowed to use their own implementation methodology directly within the target organisation and work unconstrained to obtain implementation success with that organisation. This way the politics, structures and workflows can all be properly addressed and the chances of success rise exponentially.
(Note: the above does assume selection of any vendor (single or not) has been with full input from clinicians and administration at all levels - and agreement the system will do what they need as well as appropriate technical due diligence etc. has been undertaken.) 
Any ‘gold build’ will not fit the Royal Brisbane and PA anywhere near as well as a local implementation done directly with the vendor and the hospital jointly. Sure it costs more initially - but the long term costs and pain are certain to be lower.
Bureaucrats know nothing about Health IT implementation in large complex organisations compared with HIT providers and the major hospitals (anything more than about 200 beds) should work directly with the vendors to get the success they both want as painlessly as possible! They simply do not need a Health Department in the middle messing things up!
I really don’t understand why we refuse to learn this basic lesson - to our ongoing cost!


Anonymous said...

There is something unnerving about watching health bureaucrats being seduced by the siren's call yet again.

Anonymous said...

This needs to be writ loud and often:

"Frankly to approach large complex teaching hospitals with other than a totally locally managed implementation process where the vendor and the hospital work together to implement a system that suits the client (the large hospital NOT the Department of Health) is just very stupid and very, very risky."

and also:

It would be advantageous for all major hospitals throughout the nation if at least two different vendors were able to offer their systems to major hospitals for the hospital to choose which system and which vendor it wanted to work with.

Anonymous said...

To the above one should add that the complexity of the health system dictates that a standardised system from one vendor to service an entire state exposes everyone to unnecessarily high risk - patients, clinicians and agencies.

Anonymous said...

It also serves to create a monopoly for one vendor, eliminate the essential elements of competition so necessary for a health vibrant market and embed a culture of arrogance and complacency in the successful vendor.

Anonymous said...

GOLD BUILD! Hello .....

GOLD BUILD is the vendor's description. It make the prospective customer feel they will receive the top shelf product. It makes them feel really special. And the GLITTERING GOLD that is meant to flow to the vendor makes them feel really good too!!

Anonymous said...

Yes, the use of the term 'Gold Build' struck me as pretty crass, perhaps they meant Pyrite Build.

Jim Cocks said...

Oh dear here we go again!
Bear in mind that this is only one component of an entire suite of products - I wonder if, like the HR/Payroll fiasco, they are proceeding along the same project management model that implemented a core system without any sort of parallel run or testing.

Aside of the many scalability issues that surround Hospital and Health services systems, the state health bureaucrats (I declare an interest I was one of them) seem to labour under the delusion that they can control the demand characteristics of the public health system - the reality is that the medical practitioners are the first point of patient contact and eventual admission and subsequent treatment. The clinicians (and many others) therefore need to have substantial input into the development of suitably customised workflow models for patient administration - this in turn dictates the structure and intensity of local user training and change management, THE essential component of any successful PAS implementation.

Anonymous said...

Might be time for an FOI on the report on FirstNet in NSW commissioned from Deloitte by the new Minister which has still not been released several months after it was finished. One suspects that if the report was really bad we would have heard about it by now - so the new Minister could be seen to “fix” things...
Anyway, it would be good to hear what they had to say.

Paul Fitzgerald said...

I understand that the FirstNet review is complete and is not pretty. (there was certainly some scathing comments at HIC a few weeks ago) Qld Health seems to labour under the misapprehension that an EMR can be rolled out like Homer (aka HBCIS) was 20+ years ago. I am surprised that the other vendors are not screaming blue murder about this - like some did a few years ago after the HealthSmart decisions.

Anonymous said...

Of course the other thing that happened at HIC was a demo by Jon Patrick of his own alternate "system". To say the audience was underwhelmed would probably significantly overstate the enthusiasm of the reception. As has been said before, if the alternative is vapourware, people are still going to buy Cerner, like it or not.

Anonymous said...

This is nothing of a surprise - Cerner have been trying to get into Q'health for at least 5 years. Their ploy was always to use their Radiology contract at PA Hospital as the way in and avoid a public tender. They have a real strong supporter in a well known doctor at PA who wanted the Cerner solution prior to Trak Health. Truth is it will fail - there is no way Cerner can deliver a solution to Q'Health and replace so many inbedded departmental solutions that are state wide. Whilst this is clearly a 'back-door' deal it will flop. And as a foot note, if any governement thinks that spending $180M plus without the need for a market tender is OK - they too will fall. Problem is, will Cerner get ink on the contract before the election ?