A mate forwarded this e-mail to me last week.
-------- Forwarded Message --------
Subject: Notice of Planned EOI Release
Date: Wed, 24 Jun 2020 06:08:06 +0000
From: HSNSW-HealthTechnologyContracts <HSNSW-HealthTechnologyContracts@health.nsw.gov.au>
HealthShare, on behalf of eHealth NSW, plans to release an open Expression of Interest (EOI) for the State-wide Single Digital Patient Record (SDPR) Initiative in Q3 2020.
The SDPR initiative is envisaged to be the vehicle to drive the modernisation and transformation of the NSW Health Electronic Medical Record (EMR), Patient Administration System (PAS) and Laboratory Information Management Systems (LIMS) environments across the NSW Public Health System.
Regards,
G B
Procurement Manager - Software | ICT Strategic Procurement Services
Level 13 Tower B Zenith Building 821 Pacific Highway Chatswood NSW 2067
PO Box 1770 Chatswood NSW 2057
---- End Message (Sender’s name blanked)
Now I am just thinking to myself that we have only just pretty much finished with the most recent decade or so long implementation of the Cerner EMR and would hardly have achieved the planned return on investment (ROI) even by 2025 I would guess.
On the basis of experience elsewhere, to rip out and then replace what NSW has in place must be a 10 year project that would cost many billions of dollars. The business case for such a migration would have to make utterly fascinating reading – given the already huge sunk cost which has not been retrieved and lack of a huge incremental benefit from a new system over the old one, I suspect it would reveal.
I have to say this has all the feel of a sudden outbreak of megalomania on the part of the eHealth NSW team.
Frankly I
doubt it would be possible to obtain a positive ROI before 2035. That concern is only one you could have of this plan including the apparent centralised architecture, technology stasis (i.e. not a major technological upgrade), project scale and so on!
What do you think?
David.
30 comments:
Wonder if NSW eHealth will finally ask for an end to the HI Service relaxation and make mandatory the full and granular implementation of this essential interoperability component?
Insanity is doing the same thing over and over again, but expecting different results.
One must assume that the Health Department and the responsible government Minister have authorised eHealth NSW to plan for the calling of an EOI as part of the Q3 2020 initiative to introduce a Single Digital Patient Record [SDPR] across the NSW Health system.
A decision of this magnitude dictates that the necessary due diligence has been conducted to justify calling for an EOI for a SDPR. It is to be expected that the findings of such due diligence investigations might not be publicly available, as they may be considered commercially confidential, should they expose deficiencies in the systems and services already deployed by incumbent suppliers of the “NSW Health Electronic Medical Record (EMR), Patient Administration System (PAS) and Laboratory Information Management Systems (LIMS)”.
It is not clear from the “Notice of Planned EOI Release” how it is envisaged the SDPR will be “the vehicle for modernising and transforming the NSW EMR, PAS and LIMS”, although no doubt that will be made clear when the EOI is eventually called.
It is unlikely there is any intention to replace or seek alternatives for the EMR, PAS and LIMS systems already installed across NSW Health. However, it would seem eHealth NSW is concerned about the inability of its major suppliers to cooperate with each other to reach some agreement on how best to ensure they each adopt a universal (single) digital patient record. Perhaps they will jointly respond to the EOI when it is called.
Also, it is not apparent where and whether the My Health Record has any place in eHealth NSWs plans. It probably doesn’t.
Nor is it apparent why eHealth NSW and its incumbent suppliers are not embracing the ADHAs National Health Identifiers. These and other such questions must have been considered as part of the due diligence investigations. Hopefully, the answers will come to light soon.
Adding to the questions.....
There's a piece in today's SMH on Telstra's Healthcare business
Telstra Health ready to deliver as it steps out of the shadows
https://www.smh.com.au/business/companies/telstra-health-ready-to-deliver-as-it-steps-out-of-the-shadows-20200628-p556yh.html
"Telstra's foray into the healthcare sector may have slipped below the radar of most investors, but after a close call in 2017 the Telstra Health business is not just alive and kicking but ready to step back into the spotlight."
Apart from there being no mention of myhr, there's no mention of Tim Kelsey. He was with Telstra between February and August 2016 (it's on his LinkedIn page)
Interestingly there's only one mention of Tim working at Telstra on his Wikipedia page, although the time is not specified.
The question is: Why are both Telstra and Tim so shy about his contribution to Telstra's Health business? After all he was there just before Telstra's "close call"
There's not a lot of transparency in the health care business, especially the various government initiatives. This is a bit surprising given what Wikipedia says about Tim:
"Kelsey has become a leading activist for transparency and digital empowerment in public services."
Kelsey was irrelevant at Telstra. He had nothing to do with Telstra's close call. Telstra got sucked down into the cesspool by Shane Solomon who was given a big fat checkbook to go out an acquire health software without having any real understanding of the stupidity of that approach.
Kelsey was an opportunist who simply used Telstra as a stepping stone into Australia.
I think you're jumping at shadows. The announcement is simply an advance notice of a pending EOI, nothing more.
There is no suggestion of "rip(ping) out and then replac(ing) what NSW has in place"
Where do you get the idea that NSW is looking for "a new system" to replace "the old one"?
What is your evidence that there has been a "sudden outbreak of megalomania on the part of the eHealth NSW team"?
Aren't you being excessively presumptive?
Aren't you being excessively presumptive?
No, the planned EOI, as described in the e-mail, seems like madness to me!
Of course you can differ and you are welcome to! Maybe you can tell us all what the EOI is actually planning to acquire?
David.
What does eHealth NSW mean by Single Digital Patient Record (SDPR)? They already have an EMR. Wouldn't that be the foundation upon which to build the SDPR?
Doesn't NSW Health already have a Single Digital Patient Record Number in place across the state? One would hope so, but if not, why not? And if not, how many different 'types' of Patient Record Numbers are in use in NSW Health?
Hmmmmm...ACT Health went out for something similar I think late last year. One wonders why (since they share a lot of patients) that ACT Health and NSW Health don't work together on seeking expressions of interest for a Digital Patient Record.
And the general public must get confused about the difference between a Digital Health Record (My Health Record) and a Digital Patient Record. Must be hard if you live in regional NSW and have services provided in Canberra and NSW - how many records do you need to check to find your list of medications, test results or allergies?
Good question. "Maybe you can tell us all what the EOI is actually planning to acquire?"
It's all presumption at this stage but I would suggest they are trying to find a way (ie. put something in place) to ensure NSW Health will end up using one, common, standardised (hence the word 'single'), digital patient record.
How that dovetails with the EMR already deployed in NSW and with the MyHealthRecord to which NSW has contributed millions of dollars over the last decade is a mystery, at least it is to me but probably not to eHealth NSW.
Maybe the EOI for a SDPR is nothing more than a brainfart. Maybe they are seeking consultants to help them deliver a strategy to arrive at a SDPR. Maybe, maybe not. Brainfarts are very difficult things to smell out.
https://www.tenders.nsw.gov.au/health/?event=public.rft.showArchived&RFTUUID=643FB2DC-BF29-20DA-8B0D7285480C107F
Tender Details
"Following an industry briefing and initial feedback opportunity between August and September 2019, eHealth NSW is now seeking further industry input into developing a Single Digital Patient Record (SDPR) via a Request for Information (RFI).
The eHealth Strategy aims to create ‘a digitally enabled and integrated system delivering patient-centred health experiences and quality health outcomes’ in NSW.
NSW Health is considering options to develop a SDPR which will provide a holistic, state-wide view of a patient’s health care information. The SDPR will support safe, high-quality healthcare for patients and a more consistent ICT user experience for healthcare providers.
To support development of this strategic initiative, eHealth NSW is now seeking to engage the market through an open RFI. This will help to inform any future business case development and enable industry to offer valuable input into the SDPR initiative.
The RFI will outline the current NSW Health electronic medical record (EMR) landscape and overall vision for the SDPR. This will also include key considerations for future directions and options.
NSW Health is seeking input regarding solutions, services, and experiences that your organisation can provide to support this direction. This is expected to include key products, services, approaches, costs, options and lessons learnt from previous experiences.
NSW Health is seeking to engage with both Local and International Vendors, Health Care providers, and other experienced providers who can assist on this journey. "
It doesn't define (maybe the briefing did) "a digitally enabled and integrated system delivering patient-centred health experiences and quality health outcomes"
This is the holy grail of Digital Health and is about as vague.
Thanks Bernard that makes it pretty clear. I wonder why they don't want to use Cerner's patient EMR!
Especially after having spent a decade or so getting it in place?
David.
@3:35PM Maybe they want a 'nirvahna' solution not an antiquated legacy system The grass is always greener on the other side
What does eHealth NSW mean by Single Digital Patient Record (SDPR)?
Maybe they are building something for one person
This is good old government procurement at work. They will be at a P10 OoM level ( that is 90%chance of it being wrong). Will be 3-5 years before this becomes more than a cost of doing business for the large vendors. This is one reason why the Government ends up implementing the latest technology from a decade ago.
Good someone is thinking about end of life system replacements in ten years. FHIR will have been superseded by then.
@1:15 PM "Hmmmmm...ACT Health went out for something similar I think late last year. One wonders why (since they share a lot of patients) that ACT Health and NSW Health don't work together on seeking expressions of interest for a Digital Patient Record."
NSW Health is huge by comparison with ACT Health. The latter has its own views on how to acquire and deploy a Digital Patient Record and they would have no interest in waiting for NSW Health to get its act together.
Both of them will do their own thing. It will be very costly exercise for both health departments, as well as for the vendors like Cerner, InterSystems, EPIC, AllScripts, DXC and possibly a few others.
@5:23 PM "Cerner, InterSystems, EPIC, AllScripts, DXC" are all big US health software vendors. Do they have the SDPR that NSW Health needs or wants? Where in the world today does a SDPR actually exist?
Although with NEHTA and the ADHA Australia has tried to build a SDPR (the My Health Record) these efforts have been a dismal failure. America hasn't done any better with its attempts to develop a SDPR eventhough the companies listed above have made a lot of noise about their 'EMR' systems.
What then does this tell us about the eHealth NSW EOI? Is it hoping to find a solution hidden away somewhere that no-one knows anything about? Or is it hoping that by some miracle one of the American EHR will be suddenly be transformed into a SDPR?
Seems it is not just Health - NSW govt seeks input on next cyber security strateg. Just as we have national strategy and huge new investments intended to improve coordination. Guess this new national cabinet will be as unifying as COaG
@10:17 PM The reality is the big boys have deep pockets and they will fight it out among themselves. Functionality is not the main issue when it comes to selecting / finding / choosing a SDPR.
What counts is the relationship each vendor establishes with the decision makers, and how well they can be seduced to exercise the levers of power in one vendor’s favour over its competitors. The power influencers’ egos determine that big projects, big budgets, big companies, are the only way to go to ensure project longevity for all.
Each of the big boys has an EMR, each will re-brand it to become a SDPR and sell the story to ensure it complies with what eHealth NSW wants to see and hear. Sometimes an ‘alliance’ will be built with a local software developer to flesh out the EMR’s functionality until the sale has been concluded, the contract signed, and the first down payment made.
Then the helpful little local developer will be squashed into oblivion. Splish, splosh, splash, splaaat.
Why is so much energy being expended by so many government bureaucrats and health departments all over the world on wanting to implement a Single Digital Patient Record?
I am sure there are many reasons some valid some less so - police freeze $7.8m in assets linked to alleged public service fraud
The reason "so much energy is being expended", not to mention the enormous amount of money being spent, is because it seems the advocates of a SDPR (let's call it a 'cradle-to-grave' record of every health event in a person's lifetime) is what is needed. Some describe it as the holy grail.
I do not put that mission front-and-centre because it leads one down the wrong path. It is possible that one day a 'cradle-to-grave' record might evolve, but not through pursuit of that goal as the primary objective today.
There are many smaller steps that need to be taken first and that is where time, money and resources should be directed. The problem with doing so however, is that the 'many smaller steps' are not understood by the advocates of a SDPR including big vendors. They cannot see how the 'smaller steps' make up the 'whole', and even more importantly they cannot see how to make money from that approach.
Let's be clear what Single Digital Patient Record is:
It's a record of what the health profession thinks about a patient and the medical treatment the patient has received. It is a collection of subjective symptoms, tests (usually static), opinions and hypotheses based upon the skills, experience, biases and training of a variety of health professionals.
It is not a record of the health status of a patient or of the social determinants of their health.
Many people will not have a SDPR for a variety of reasons, some of which will be related to socio-economic status.
Those with a SDPR may end up getting better or preferential treatment so, like the legal system and much of technology, the social divisions between the haves and have-nots will be amplified.
Be careful what you wish for.
So are you saying a SDPR is a good thing or not, and if so - Why is it?
I like your description of a SDPR Bernard, being ".... a record of what the health profession thinks about a patient and the medical treatment the patient has received."
That's the easy bit.
The hard bit is designing the record architecture, structuring the record so that it is flexible, clear and easy to use (which includes data entry and retrieval), fitting it seamlessly into the clinical workflow without imposing any additional workload on clinicians, all the while ensuring it is seen as a trusted source of a patient's clinical information, and always remains timely, relevant, accurate and secure.
@5:24 PM "The hard bit is" ....... spot on, succinctly put summary.
"So are you saying a SDPR is a good thing or not, and if so - Why is it?"
I'm not saying anything about the value of a SDPR, I'm only pointing out what it is.
Like many things, its value depends on your perspective. If you are a hospital health professional, you have to have as complete a record as possible of the status of the patient and the treatment being given. If you are that patient, you are probably more concerned with your condition and the effectiveness of your treatment.
If you go to see a GP, it is a good idea for the GP to have a record of their interaction with you - which is what GPs have always kept. The GP's record will be different from that of a hospital because they have different interactions. In hospital, the interaction is continuous. A GP's interactions are more discontinuous. Interactions with a specialist are probably even more discontinuous.
This raises the question - can a SDPR meet the requirements of all three professionals? By trying to meet the requirements of all three, will that reduce/destroy the value to all three?
I would suggest that whatever the pros and cons of a SDPR, putting the patient in charge of content and access control will totally destroy its effectiveness and reliability to all three professionals.
It is highly likely that the states are fully aware of this fundamental flaw in myhr. This is why NSW and the ACT (and potentially others) are looking to (re)develop their own, internal health record systems.
Yes, that all makes a lot of sense. It's not surprising My Health Record is so useless, it doesn't fit anywhere in the scenarios you have described. What a huge waste of taxpayers money
Have you ever wondered why so many clinical experts threw up their hands during the supposed consultation phase of the PCEHR? There was probably little agreement as to what the PCEHR would do. That's because they all had different and competing requirements.
Instead of recognising that this and re-examining the original concept (a virtual patient record that joined up existing data repositories that everyone, including patients, who would have control over access, would use) the project mangers soldiered on blindly.
When they couldn't join up existing data repositories, (they couldn't solve the interoperability problem) they soldiered on mindlessly. When IBM could deliver NASH because the requirements didn't make sense, they soldiered on steadfastly.
We now have a system that meets nobody's requirements but which is surrounded by a cloud of misinformation, exaggerations and misleading claims, mostly predicated on what what was promised not what was delivered.
The old adage "Those who fail to learn from history are doomed to repeat it" is as true now as it ever was.
Unfortunately there are some who lived through the history but still don't realise what really happened, because they have strong opinions based upon belief, not informed reality. Tim is an example so are some ex NEHTA people who have moved on to other areas and are making the same mistakes all over again.
As they say, you can always tell a zealot, you just can't tell them much.
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