Sunday, May 20, 2012

There Are Some Pretty Profound Lessons Here For Those Who Will Listen. Pity About DoHA and NEHTA Just Pushing On.

The Victorian HealthSMART had the ‘last rites’ administered this week. Here is some of the coverage. First here:

Victoria kills HealthSMART IT project

No more money after June 30.

The Victorian Government has abandoned its statewide HealthSMART IT project, reportedly citing a cost overrun of at least $140 million.
A spokeswoman for Health Minister David Davis' office told iTnews that funding for the project would conclude on June 30 this year.
Four lead agencies - Eastern Health, Royal Victorian Eye and Ear Hospital, Austin Health and Peninsula Health - will continue using HealthSMART, after adopting the system almost a year ago.
However, the other six health services slated to have received the system will be able to make their own choices about the computer systems they require, according to a report by ABC News.
The ministerial spokeswoman said that the Government would also look at alternate arrangements, and set up an expert panel to inform it of next steps.
The state government has considered abandoning HealthSMART as early as February 2011.
More of the saga here:
and here:

Vic scraps HealthSMART system

The Victorian Government has made the decision to scrap its HealthSMART system, which was years overdue and had run hundreds of millions of dollars over budget.
HealthSMART was launched in 2003 and had been designed to run as a single electronic foundation for the state's public health service. The single platform would combine a finance system, as well as patient-management and clinical-applications services.
However, Health Minister David Davis today confirmed that the government had scrapped the continuation of the roll-out of HealthSMART, with the government to now work on a hospital-by-hospital basis, to set up individualised systems.
Davis said the government is determined not to "throw more good money, after bad" and would set up an expert panel to advise it on the best way to upgrade the hospital information and communication technology (ICT) systems.
"In those hospitals where it has been put in place or partially put in place, health services will make their decisions from that position, but going forward, beyond that, health services will be able to examine what is appropriate for their particular service," he said.
The road to the system's cancellation is one littered with blowouts and delays; $323 million was originally budgeted for the system and a deadline for completion was set for the end of 2007.
Lots more here:
Last here:

State government scraps $500m e-health project

  • From: AAP
  • May 18, 2012 1:38PM
VICTORIA'S $500 million e-health system, aimed at creating electronic patient records and prescriptions, has been dumped and will be replaced with a patchwork approach.
Health Minister David Davis confirmed the Government had scrapped a further rollout of HealthSMART, the project to modernise the health system's information and communications technology (ICT).
He said the Government would now work on a hospital-by-hospital basis to set up individualised systems.
The HealthSMART rollout began in 2003 under the previous state Labor government but is fully operational at just four health services across Victoria.
Mr Davis said the Government was determined not to "throw more good money after bad" and would set up an expert panel to advise it on the best way to upgrade the hospital ICT system.
More here:
The thing that should not be lost here is that this is really a very sad and very wasteful outcome.
I reviewed all this in June 2007 (Now essentially 5 years ago) and made the following assessment:
“Under the Health ICT Strategy, the Government was to remove obsolete, aged products and invest in modern proven systems, based on accepted interoperability standards covering hospital administration systems, clinical systems and electronic medication ordering.
Of course that was never going to happen. We now find that – to quote from the HealthSMART website:
“HealthSMART is a $323M technology program operating across the public health care sector funded through the 2003-04 Victorian State Budget. Initially a four-year program, it is now running over six years from 2003 - 2009.
To be frank even this timeline looks more than optimistic. Why do I say this?
First, it seems that with clinical systems HealthSMART has adopted the approach of developing State-Wide Builds of the Cerner Software. Experience elsewhere has shown that this can be very problematic (just look at the UK NHS) – as the users don’t see they are getting the system they need that really suits them – rather they are getting a compromise – to them – state-wide solution.
One only has to see that the State-Wide System is being driven by a committee representing 13 different health systems (from major to minor hospitals and from cancer to paediatric hospitals) with over 40 members to recognise that getting agreement on what is to be done will be both slow and tricky to achieve.
Second if one reviews the time-lines provided in each of the progress reports (Roadmaps as they are called) it is clear that with each update issued the time-lines are extending.
Third my making the choice to implement Cerner clinical applications on top of an iSoft Patient Management System they have greatly complicated the operations of each and have lost many of the key benefits of integration that the Cerner system offers.
This is especially true given their approach is to integrate patient administration, outpatients, emergency, laboratory, pharmacy and radiology (at least) onto a Cerner core repository. I believe this is a plain stupid strategy. The amount of context switching from source systems (lab, pharmacy etc) that many clinicians will be forced into is likely to be both time-wasting and annoying.
Fourth with the some of the system selections made there must be the suspicion that adequate financial due-diligence was not undertaken given the difficulties being experienced at present by iSoft.
Fifth, any Health IT strategy that takes six-seven years to implement in the Public Sector has a high risk profile no matter what else goes well initially.
It seems to me that sadly this strategy is facing some existential threats. I hope it can prosper and deliver but it is looking less likely to me as of late June, 2007.
Full blog here:
A year later we had this:

Vic rethinks e-health

Karen Dearne | September 30, 2008
VICTORIA is ruling a line under its patchy HealthSmart IT rollout, and has returned to the drawing board with plans for a new whole-of-health ICT strategy for the period 2009-2013.
When the now-$427 million program began in 2003, it was hoped that the ICT refresh and rebuild across the state's public hospitals, rural alliances and community health providers would be complete within four years.
But in April this year, Victoria's auditor-general Des Pearson said HealthSmart had been overly ambitious in its targets, and was at least two years behind schedule.
More than half of the original budget had been spent with only 24 per cent of the planned installations complete.
The audit office found that HealthSmart had failed to get the cornerstone Cerner clinical system working at any of its sites, and had replaced only one of 10 HOMER hospital systems which were obsolete when the program began.
Mr Pearson said the project judged most at risk, but with the greatest potential benefit, was Cerner's Millennium suite of e-health records, appointments scheduling, diagnostic services, results reporting and e-prescribing applications.
A $79 million deal with Cerner was signed in March 2006, but costs had risen by $17 million to $96 million in 2006 - the biggest price blowout so far, the audit office found.
More here:
And of course we had the always bad sign of the program director leaving (smart people know when the jig is up and it is not working and that one should go before being sprung):

HealthSmart boss resigns

17 September 2008 08:52 PM
The public servant in charge of Victoria's mammoth HealthSmart electronic health initiative has resigned for what the state's health department today said were personal reasons.
Fiona Wilson had led the troubled project since mid-2003 in her capacity as the director of the Office of Health Information Systems within the Victorian Department of Human Services. However a spokesperson for the department told tonight that Wilson had grown weary of the regular commute from Auckland where her partner resided.
More here:
Full blog here:
As it is when the staff are complaining vociferously!

Monday, February 11, 2008

Southern Health (Victoria) Staff Speak Out on HealthSMART.

The following rather long letter arrived – by post – in an unmarked envelope – last week.
The impassioned three page letter (scanned) can be accessed here.
(Note the file is about 3.0 Megs and takes a few moments to load even on a broadband link)
While it is hard to know the exact truth behind all these claims enough of the thrust of what is being said makes very good sense, and to me the broad points ring true.
Full blog here:
The bottom line here to me is what went wrong were 2 fundamental issues:
1. The failure to recognise the complexity of the large organisations and allow them enough autonomy. This just led to push back and eventual failure.
2. A range of poor technical and implementation decisions - a key one of which was not to listen closely to the experience of the vendors who had been engaged.
Looking back my comments from 5 years ago look pretty prescient and sensible.
All I can say is I hope we don’t also continue to push on and waste money for 5 years on the equally flawed NEHRS which is getting even greater ‘push back’ in my view.


Anonymous said...

Suckers. The rest of us knew it was a lemon and resisted being pushed into it. ......... You gotta feel sorry for ...

"the four lead agencies - Eastern Health, Royal Victorian Eye and Ear Hospital, Austin Health and Peninsula Health - who will continue using HealthSMART, after adopting the system almost a year ago."

What pisses many of us off most of all is that Bruce Ryan who jumped ship a few months ago knew it was a lemon of a strategy but never once did anything to support those of us who were calling for some leeway to modify direction.

Victorians and their health agencies have all paid a very high price for this stupid one-size-fits-all statewide healthIT strategy.

Anonymous said...

Lorenzo, Lorenzo - where for art thou?
(we have been waiting a long long time...)

Anonymous said...

is there a definitive list of what is REALLY installed and live. And what makes Queensland Health think that they will have a different outcome rolling out Cerner? Is this not the definition of insanity?

Anonymous said...

No it’s not insanity. There are perfectly good reasons for why Queensland Health is doing what it’s doing. Once understood it enables you to makes sense of things. You just have to stop thinking that it is about better health outcomes or that it’s using tax payer’s money (and you might be appropriately outraged by the waste, contractor nepotism etc).

Anonymous said...

Yes this situation can be attributed to those involved. Specifically a certain individual clinician(s) who have been actively seeking to secure the funding and means of procurement for Cerner for his/their hospital for years. Those advising the CIO realised this and have literally done anything and everything = code named project mango. This included seeking to secure Cerner off the NSW ICT Panel, then when this didn’t work, they concocted a process (using a Gartner market report) to ensure there was a limited tender to only one provider(Cerner). All this has been to keep such clinicians onside in an effort to keep those advisors and the current IT department executive in power.

Anonymous said...

"What pisses many of us off most of all is that Bruce Ryan who jumped ship a few months ago knew it was a lemon of a strategy but never once did anything to support those of us who were calling for some leeway to modify direction."

Lets not forget the architect - Fiona Wilson, who brooked no alternative view or critisim.

Anonymous said...

In regards to the failure of the $500M HealthSmart strategy Anon 5/22/2012 06:22:00 AM said "Lets not forget the architect who brooked no alternative view or criticism."

A sobering thought when contemplated in relation to the $500M already spent on the PCEHR.

The reality of life is that big projects like this take on a life of their own where it becomes politically too embarrassing to change course so the politicians soldier on pouring in more money, $33M then $233M then $50M (all in the last few months) blind, deaf and dumb to the possibility they have a failed project on their hands.

Anonymous said...

No argument that Healthsmart has not been well run and that big projects are hard and prone to failure. But does anyone seriously think that everyone doing their own thing, with very little money allocated, is actually a recipe for success? We may see a few portals deployed in Victoria like Verdi and Infomedix, but who will have the money or capacity to deploy a true transactional EMR with CPOE and device integration, etc?
Queensland has been mentioned here, but not NSW. They copped a massive bagging over the Firstnet part of the Cerner deployment, but the fact is they’ve still managed to get CPOE into dozens and dozens of hospitals.
I’ll make a prediction that in ten years from now, those hospitals in NSW will have a much more functional EMR than most places in Victoria.
Tell me I’m wrong.

Anonymous said...

re anon "I’ll make a prediction that in ten years from now, those hospitals in NSW will have a much more functional EMR than most places in Victoria.
Tell me I’m wrong"

yes, they may, but at what cost. Qld Health is now talking about another 250M to fix payroll - I reckon I could build a new one for half that - and I KNOW I can implement a level 4/5 HIMSS EMR in the whold state of Qld for less than $50M TCO over 5 years! NSW and Vic would be a bit higher, but same product. Cerner is likely to be that amount for just one hospital. But will a little, local guy get a go - not bloody likely!
I won't publish my name so David doesn't get upset with me for "advertising"! :-)

Anonymous said...

I heard a rumour a couple of months ago that Fiona Wilson had resurfaced up at NSW Health in charge of all their clinical programs.
I thought someone was pulling my leg at the time, but a mate of mine in Sydney swears it’s true. Can someone from up north please put a HealthSmart survivor out of their misery and confirm or (hopefully) deny?

Anonymous said...

Well it *may* just be someone with the same name, but I guess those attending this conference will find out:

Anonymous said...