Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Thursday, December 13, 2018

It Seems Hospital Digital Health Might Have Been Implemented With Less Control And More Cost Than Desirable In Queensland.

This report appeared last week:

Digitising public hospitals

(Report 10: 2018–19)

Audit objective
The objective of our audit was to assess how well Queensland Health has planned, and is delivering, its digital hospitals program and whether it is realising the intended information-sharing and patient benefits.
The Queensland healthcare system is transforming to meet the pressures of an ageing population, the growing burden of chronic conditions, and changing consumer expectations.

In a digital hospital, processes are streamlined to create a ‘paper light’ approach, integrating electronic medical records (ieMR) with clinic devices, workflows, and processes. An electronic medical record is one of many applications that contribute to a digital hospital. The government has set a target for twenty-seven hospitals to fully implement the ieMR solution by June 2020.

Electronic medical records provide timely, accessible and legible information about patients at the point of care. It also provides the foundation for future transformations in health care delivery, like the ability to gain greater insights and decision support from the system’s data to improve the quality of patient care and operational efficiencies.
Here are the recommendations:

Department of Health and the hospital and health services

We recommend that the Department of Health and the hospital and health services that have implemented the ieMR solution (Note 1):
1. continue to work together to identify the actual cost to date of implementing and operating ieMR. (Chapter 2)
The Department of Health should:
  • use this information to update the Cabinet Budget Review Committee on the actual program cost to date. The information should form the basis for a more reliable estimate of what it will cost to complete the program and of the longer-term costs of maintaining the ieMR solution
  • in consultation with HHSs, consider whether the level of investment by HHSs to implement the ieMR solution is appropriate.
Note 1: The hospital and health services that have implemented the ieMR solution at varying ieMR stages include the Metro South Hospital and Health Service (ieMR advanced), the Mackay Hospital and Health Service (ieMR advanced), the Children’s Health Queensland Hospital and Health Service (ieMR advanced), Cairns and Hinterland Hospital and Health Service (ieMR intermediate), Metro North Hospital and Health Service (ieMR basic), and the Townsville Hospital and Health Service (ieMR intermediate).

Department of Health

We recommend that the Department of Health:
2. completes its refresh of the eHealth investment strategy based on the revised cost of the ieMR program and any impacts it has on the strategy for other programs (Chapter 2)
3. provides the Cabinet Budget Review Committee with:
  • updated timing for the realisation of benefits
  • a balanced assessment of benefits realised (and dis-benefits) across hospitals from all hospital and health services that have implemented the ieMR (Chapter 3)
4. provides greater assurance that it is obtaining ongoing value for money from its ieMR vendor by:
  • investigating options for demonstrating value-for-money pricing, including conducting comparative vendor price analysis where possible
  • assessing and documenting the ieMR vendor’s performance across its service contracts, with input from hospital and health services.
This should occur at appropriate intervals and, at a minimum, before each contract extension decision (Chapter 2).
5. re-visits the governance arrangements for the program as it moves from building, configuring, and implementing the ieMR solution to business-as-usual and optimising the solution 
This should include:
  • re-visiting the focus and roles of the eHealth Executive Committee, eHealth Queensland, and other areas of the department such as the Clinical Excellence Division
  • continuing to obtain an independent review of program benefits periodically. (Chapters 2 and 3).
6. develops and implements an engagement strategy for all current and planned eHealth programs to assess the effectiveness of its engagement with hospital staff and clinicians and the effectiveness of the system implementation (Chapter 2)
This should include:
  • specific actions, performance measures, and data sources to enable the department to assess how effectively the department engages hospital staff and clinicians
  • gathering information about concerns, risks, or dis-benefits that may inform the program about changes or modifications that need to be made to the program.
7. continues efforts to refine the business intelligence strategy and approach, and rollout solutions to hospital and health services to maximise the benefits from the ieMR implementation at each site (Chapter 3)
8. improves the preventative security controls of ieMR user accounts (Chapter 2).
This should include enforcing password complexity requirements and implementing a change management process to educate clinicians on appropriate password settings.

Hospital and health services

We recommend that all hospital and health services participating in the ieMR program:
9. report regularly on their total ieMR project costs and broader costs associated with their digital transformation (separated from ieMR costs) to eHealth Queensland as well as to their own hospital and health service boards (Chapter 2)
10. improve their employee termination processes to ensure they promptly remove an employee’s ieMR access when an employee or temporary staff member terminates their employment with their hospital and health service (Chapter 2)
11. implement a process to monitor whether reviews of inappropriate user access to ieMR patient data are completed (Chapter 2)
12. report dis-benefits to the program so the program can learn from these and if necessary, modify the solution or implementation approach (Chapter 3).
Here I the link:
A summary video is available here:
I have to say the audit has been well conducted and appears to have asked a lot of the right questions. The full .pdf from the link above is well worth a read.
This Fairfax report provides notice of some of the uncertainties.

Queensland hospitals in the dark about future costs of $1.2b project

By Lucy Stone
5 December 2018 — 4:57pm
Queensland’s hospitals still do not know how much it will cost them to run Queensland Health’s $1.2 billion integrated electronic medical record once the controversial project is completed in 2025.
In 2011, the ieMR project was originally projected to cost $600 million, but a 2016 business case showed its cost would blow out to $1.2 billion.
According to an Auditor-General report into Queensland Health’s digital hospital program, tabled in Parliament on Tuesday, the 2016 business case for the ieMR projected savings of $1.89 billion across hospitals from 2015 to 2025 once it was rolled out.
A draft business case this year showed the project’s completion would be at risk if the additional funding was not approved in the 2018-2019 budget.
Queensland Health director-general Michael Walsh said on Tuesday that increased costs were in line with increased scope of the project.
“As we’ve rolled out [ieMR] to hospitals, what we’ve been able to do is learn from each go-live,” he said.
“Hospitals want to maximise what they can deliver as benefits to patients, so they’ve added additional devices to be rolled out, they’ve ensured that there’s training provided to staff and that we’ve increased the scope from either basic, intermediate or advanced in terms of capability that’s rolled out.”
The ieMR project is designed to create a single medical record for each person that will easily be accessed at all hospitals across the state and is being provided by US medical technology company Cerner.
Queensland Health’s hospital network is broken down into several Hospital and Health Services areas under which several hospitals will work, each region managed by its own board and chief executives.
The Auditor-General’s report noted that while each HHS is responsible for their own budget, they had used Queensland Health's business case to create their ieMR budget.
The 2016 business case “significantly underestimated” what it would cost each Hospital and Health Services area to implement the ieMR solution, the Auditor-General found.
Several hospitals have since had to request extra funding to cover more infrastructure and staff costs.
The Auditor-General’s report showed that the cost to date for hospitals implementing the ieMR was unknown because neither Queensland Health nor the hospitals themselves had the necessary software to record and report detailed project costs.
More here:
Basically the summary is that it is costing a fortune, benefits are coming more slowly than expected and some of the forward costs are unknown. This whole thing is going OK but needs tighter control and management.
An audit of this quality of the #myHealthRecord  would be really fabulous!

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