Is Brown Qld Health's white knight?

By: Suzanne Tindal

CIO profile Ray Brown stepped in two weeks ago as the latest chief information officer for Queensland Health, hoping to bring some stability to a division that has seen a number of faces move through the head technology spot in quick succession.

Ray Brown
(Credit: Queensland Health)

The health department's technology leadership game of musical chairs started in July last year when Paul Summergreene, who had moved over to health in the closing months of 2007 from his CIO position at the state's Department of Transport, left after less than a year in the chief information officer job.

His contract had been terminated, Queensland's Health informed the press at the time. There had been reports that his expenses were being examined, but the department wouldn't comment on the issue.

His position was filled briefly in an acting capacity by the clinically adept Dr Richard Ashby. Ashby had served in several hospitals in emergency medicine and medical administration roles. The Australian Medical Association was pleased of the appointment because of Ashby's clinical experience.

"We have seen millions of dollars in health IT funding wasted over the years in Queensland, so the appointment of a highly regarded senior hospital clinician who is acutely aware of exactly what is required to provide optimal patient outcomes is very welcome," it said at the time.

Yet Ashby didn't remain long, leaving in January to become the executive director and director of medical services at Princess Alexandra Hospital.

A bit of stability in the leadership of the division for the next little while would be a good outcome for the division, so that's what I hope occurs.

Ray Brown

Queensland Health again had to fill the void with an interim appointment, reaching into the ranks of its information division. Brown had been acting as the executive director ICT service delivery since June 2008, before which he had been pursuing an IT career in the Queensland public service, holding senior roles in the Police, Corrective Services and the former Department of Families.

Queensland Health may have hit the jackpot this time. Brown hasn't followed the pattern of leaving after only a brief stint on the job. Instead, he was appointed formally to the chief information officer position last week.

And despite much attention being directed at the leadership turmoil, the CIO doesn't believe that it has damaged the long-term technology strategy of Queensland Health.

Since 2006, the IT gurus of Queensland Health have had a mission: to bring the state's hospitals into the modern world of state of the art clinical information systems. Summergreene's predecessor Sabrina Walsh had primed the way by obtaining funding of upwards of $650 million over four years for e-health initiatives.

Whichever leader was in the hot spot, the e-health holy grail was never out of sight, according to Brown. "The e-Health strategy has stood the test of time and remained sound. Each incumbent of the Queensland Health CIO role has built on the direction and progress of the e-Health Strategy without the need to re-visit significant elements of the strategy or the project artefacts delivered," he tells ZDNet.com.au in an interview last week.

When the CIO started in the role in the acting capacity, it had been his focus and it would continue to be so for the next few years, he says.

Around 20 per cent ($243 million) of the funding first made available in the 2007/2008 financial year had been spent, Brown says. The remaining 80 per cent would be spent by 2011/2012.

So far one of the standout successes has been getting an enterprise discharge summary system up and running, a national first, Brown says. The system sees hospital reports go out to GPs who can use them to service outpatients. Brown says, 55,000 summaries have already gone out from 56 hospitals, with June next year seeing 120 facilities being capable of issuing the summaries.

The e-Health strategy has stood the test of time and remained sound.

Ray Brown

Another win has been getting a new imaging system coming online so that diagnostic images taken in rural locations could be examined and used to diagnose remotely.

Brown is also proud of a statewide mental health system which can now be accessed by all mental health workers. Queensland is the first state to set up such a system, according to Brown.

Looking ahead, of course, the "big ticket item" will be setting up an electronic medical record for Queenslanders. Brown says that Queensland was on track to meet the timeline recommendations made by the National Health and Hospitals Reform Commission, which suggested every Australian should have an electronic medical record by 2012.

"Generally speaking we're pretty comfortable that where we're at today will allow us to actually achieve most of those time frames that are in that report," Brown says.

Yet Queensland Health's outlook doesn't look as rosy as some, having had a later start than some states on creating the records. "At some level I think we're behind some of the other states," Brown admits. He points out that NSW and Victoria had done more work in that area. He stresses, however, that Queensland Health was ahead in other areas, and could catch up on the systems in which it was lagging.

"The forward work program and the way this organisation is structured is probably going to allow us to certainly catch up if not pass some of those other jurisdictions in terms of their e-health agenda," he says.

However, he can't forget that e-health is only good as long as the systems are reliable. Earlier this year one of Queensland Health's datacentres had a train of small problems which lead to some applications going off line.

Brown acknowledges that datacentres are on the agenda at the moment. "We will be migrating all of our production environments over the next four to five years to the new government datacentres that are being established," he said. Those new datacentres, like the Polaris datacentre in Springfield, have at least a tier three rating.

At some level I think we're behind some of the other states.

Ray Brown

There isn't really a planned time for migration, according to Brown. As the department refreshes equipment, the new equipment will be set up in new datacentres instead of in the current ones. The electronic medical record will be established straightaway in a new datacentre.

Along with updating datacentre facilities, Brown will also be looking to make hospitals wireless as the electronic health agenda comes online. The department has recently been doing trials with Cisco to gauge how mobile devices can benefit the health environment.

The results have been positive. Yet in order for mobile devices to have the required affect, older hospitals need to be networked. With only $60 million budgeted this year for all IT infrastructure, this could require an additional line of funding. "That won't cover wireless for the state, that's for sure," Brown says.

This is unlikely to be the only roadblock to Brown's goals in what will be a challenging period of e-health implementation. Yet, most importantly for Queensland Health, Brown at least looks set to remain for a time yet. This will likely bring a little more stability to the department which has seen CIOs pass through too quickly.

"A bit of stability in the leadership of the division for the next little while would be a good outcome for the division, so that's what I hope occurs," he says. And, as mentioned before, he believes in the e-health chalice he has been handed, which could be half the battle.

Make e-health funding priority: AMA

By Karen Dearne

THE Australian Medical Association has called for priority funding for e-health adoption, saying the roll-out should start with e-prescribing and electronic sharing of essential patient information.

E-health is one of seven key areas identified for urgent action, with AMA president Andrew Pesce handing the doctors' Priority Investment Plan to Prime Minister Kevin Rudd and Health Minister Nicola Roxon at a meeting in Canberra.

The AMA wants the Federal Government to assume full responsibility for funding the nation's public hospitals, with the states retaining control over operations and local governance arrangements.

Dr Pesce said the time for talk was over.

"We are offering real solutions to real problems," he said.

"The AMA fully supports the roll-out of e-health initiatives in order to integrate systems, reduce fragmentation and duplication, streamline service delivery and improve quality and safety.

"Priority needs now to go to funding the infrastructure for e-health - especially electronic health records - given that the investment to date has focused on development of standards and technical specifications."

But the AMA rejects the recent National Health and Hospitals Reform Commission recommendation that patients should control their own e-health records, saying medical practitioners should control the electronic sharing of patient information between healthcare providers.

Dr Pesce flagged doctors' concerns over person-controlled health records at an e-health forum last month.

The AMA's action plan for investment includes closing the health gap for Indigenous Australians; boosting patient access to GPs and allied health services; medical training and a restoration of facilities for people with mental illness and sub-acute care.

The AMA also wants to see remote communities wired-up for e-health services such as telehealth and web-based consultations.

And it suggests a new monitoring system, Bed Watch, should be implemented to allow continuous reporting on the number of beds available in public hospitals, and to identify occupancy issues such as access block in emergency departments.

NEHTA releases strategic plan

By: Karen Dearne

THE National E-Health Transition Authority has released a strategic plan repositioning itself as an implementation agency with a role well beyond its present funding to 2012.

"Since its establishment, there has been a misalignment between NEHTA's current direction and the expectations of the various stakeholder groups," the plan says. "As the organisation evolves it is important to ensure a foundation exists for 'what' it has been put in place to deliver."

NEHTA will "co-ordinate and manage the uptake of e-health systems which are of a high priority, interoperable and scalable" nationwide.

Chief executive Peter Fleming said the 2009-2012 plan outlined how NEHTA would fulfil its mission in relation to delivering the National E-Health Strategy adopted by the Council of Australian Governments last December.

"We have considered our future work program based on the (Deloitte) strategy and other important work completed this year, including the National Health and Hospital Reform Commission recommendations," he said.

"As a result we have produced our plan to clearly show our stakeholders the directions we are taking to drive the adoption of e-health."

The four priorities echo program outlines produced by the organisation since its creation as a not-for-profit company owned jointly by all state and federal governments. These are to urgently develop the essential foundations required to enable e-health; coordinate the progression of the priority e-health solutions and processes; accelerate the adoption of e-health, and lead the progression of e-health in Australia.

However, the 46-page document contains little new information, and lacks clear action plans or timelines, with most of the real work scheduled post-2012.

While the Deloitte strategy recommended establishing a fresh, independent, national e-health body to handle investment, implementation and regulatory functions - potentially leveraging NEHTA's assets - NEHTA says it is "in a unique position to drive the e-health agenda" within Australia.

"NEHTA has an overarching sense of the landscape of e-health, both nationally and internationally," it says. "This places us in a strong position to orchestrate key activities and inform key decisions."

In January, Mr Fleming told The Australian a number of large-scale production pilots would start this year but so far there has been no major announcements.

Fleming heads medical e-data project

By Karen Dearne

AUSTRALIA's new e-health boss, Peter Fleming, has a solid technology background and a long-held vision for electronic reform of the health sector.

Mr Fleming, appointed chief executive of the National E-Health Transition Authority yesterday, said he intended to deliver a system that would have "major benefits for the entire nation".

Most recently National Australia Bank's technology and business integration general manager, Mr Fleming previously spent five years as chief information officer of health group Mayne, with oversight of its pharmaceutical business.

"In my time in Mayne we saw the real benefits of being able to move transactions electronically," he said.

"It was a vision that we always thought - once it could be done at a national level - would provide tremendous benefits in removing duplication and also in enhanced patient care."

Mr Fleming replaces Andrew Howard, who has been acting chief executive since the sudden departure of former chief Ian Reinecke in April. Dr Reinecke's resignation followed criticism of NEHTA's structure and lack of consultation with outside stakeholders, contained in a review by Boston Consulting late last year.

The shakeup led to new blood on the board, including the appointment of Australian Securities and Exchange chairman David Gonski as chairman.

Mr Gonski yesterday announced Mr Fleming's appointment, saying the board would work with him to "meet the challenges of the national health agenda".

Although Mr Fleming is not well known in e-health circles, it is understood he was chosen for his experience in large commercial projects.

He started his career at Coles-Myer, where he spent 17 years in the IT department before moving to Colonial Group for seven years and rising to chief information officer.

At Colonial, Mr Fleming was involved in installing a new banking system for the State Bank of NSW. Aushealthit blogger David More said Mr Fleming's biggest challenge would be "coming seriously to grips with a health sector that is severely frustrated by the lack of progress" in e-health.

"He should be stepping back and thinking reflectively about how the authority should interact with the rest of the sector, after its deep disconnect," Dr More said.

"It will be incredibly difficult to attract the levels of investment NEHTA seems to be contemplating without a demonstrable cultural change and improved relations with other stakeholders."

Dr More also warned that the corporate command culture may not sit well with the "professional democracy" of healthcare.

"A difficult implementation in a commercial organisation where the CEO can just tell people to do stuff is very different from this situation," he said.

Meanwhile, NEHTA's board and the Council of Australian Governments are awaiting a comprehensive national e-health strategy being developed by Deloitte. The report is due in a matter of weeks.

Mr Fleming said it would be premature to talk about the strategy, as he had yet to read the draft documents and meet the consultants.

"I need to spend some time understanding the plans and the work done to date, but I really want to work with the team to build a solid action plan for delivery," he said.

"That will obviously mean a huge amount of work with all of the key stakeholders to ensure a common approach." Mr Fleming said he would "certainly be very keen" to speak to the health IT industry and clinicians.

"I'll be looking at the long-term strategy and the best way to do that," he said. "It's an exciting challenge, and the potential benefits for the nation are part of the attraction."

Mr Fleming does not take up his new post until September 29, but he hopes to attend some of the e-health sessions taking place in Melbourne this week.

Michael Legg, president of the Health Informatics Society of Australia - which is holding its annual conference this week - congratulated Mr Fleming.

"We look forward to working closely with him to put in place the infrastructure Australia needs to address the critical shortage in health services that we're going to have," Mr Legg said.

iSoft trims workforce

By Karen Dearne

GLOBAL restructuring by iSoft will lead to job cuts in service delivery in some regions, including Australia and New Zealand, despite the company posting a 137 per cent rise in net profit to $34.7 million last week.

iSoft executive chairman Gary Cohen says a possible 70-100 IT positions may be lost in Britain - or around 10 per cent of the British workforce - but the overall impact would be offset by plans to add up to 50 new sales and marketing people to drive business growth.

According to Britain's E-Health-Insider, iSoft plans to reduce its frontline staff headcount from 193 to 131 through redundancies, and merge the support and technical teams into a single unit.

But Mr Cohen told The Australian that the restructure was "not about cost-cutting".

"This is about tailoring our operations to changed market dynamics, particularly in the UK where the old business was very focused on servicing the National Health Service's IT reform program," he said.

"While we're still working alongside CSC on those contracts, we're moving into a growth mode at the same time and for that the organisation requires a different set of skills.

"So this is about growing our businesses. We're currently a company with revenues of $600 million, and we want to more than double our size in the next three to four years."

Mr Cohen said a process of "bottom-up consultation" on corporate culture change and upskilling has just begun in the Australian and New Zealand operations, as well as in its Malaysian, Middle Eastern and Indian offices.

"While we're not looking at the same sort of restructuring as in the UK, the Australian operation equally needs to align its workforce to the dynamics of the market, and obviously with what's happening at both the state and federal level we're upskilling our competencies and looking to bring on higher-calibre personnel," he said.

"In that process, there may be people whose skill sets don't fit the new model, but we're still evaluating the situation and working through how best to achieve those outcomes."

Mr Cohen said no decision had been taken on likely job losses, but agreed there would be "people who are left behind".

"Let's be very clear, we are driving a cultural change in our company," he said. "Every industry and company needs from time to time to reshape and reposition itself.

"The overwhelming majority of our employees are totally motivated and focused on the future.

"Inevitably there will people who feel they don't fit in any more, and people who we think no longer fit, and that's a conversation we are having within parts of our organisation around the world."

In a statement to the Australian Securities Exchange this week, Mr Cohen said expected to "see more efficiencies come through from further restructuring of the UK business in the current year".

"We'll also continue to focus on building up our sales and marketing: under its previous ownership the company had become too reliant on the NHS connecting for IT program rather than building its own sales teams."

iSoft is also banking on changes mooted by Britain's opposition Tory party, that would allow local health services to deal directly with IT vendors such as iSoft, which holds 60 per cent of the English market.

Leaked details show modest costs for e-health

By Karen Dearne

NATIONWIDE electronic health infrastructure will cost a modest $1.5 billion over five years, or $2.6 billion over a 10-year rollout, according to leaked funding details.

Federal and state ministers have kept tight wraps on costings and timetables since agreeing last December to adopt the National E-Health Strategy, prepared by Deloitte.

The $1 billion to $2 billion range "represents a relatively modest investment" when compared with the total annual health spend of $90 billion, with $60 billion coming from all levels of government.

Deloitte found that "tangible benefits" from implementing the e-health strategy "are in the order of $5.7 billion in net present value terms over 10 years".

Annual savings from a fully integrated system "are estimated to be about $2.6 billion in 2008-09 dollar terms".

The leaking of financial information and costed work programs on David More's AushealthIT blogger website appears to reflect growing frustration with the lack of progress on e-health.

Last month, medical and consumer groups told the National Health and Hospitals Reform Commission they were astonished it had failed to put information technologies at the heart of reform plans.

Dr More, a clinician and health IT expert, said he hoped today's federal budget would deliver a "substantial boost" for the health sector. "But I fear we may be disappointed," he said. "Really, $300 million per annum is small beer in terms of the whole health budget."

Dr More said the costs and benefits contained in the full Deloitte report had been available to all state and federal health bodies for more than six months, "and it is quite wrong in my view that the public does not get a chance to debate the merits" of the proposals.

The strategy identifies four key areas for investment, including foundational activities ($370 million over five years), e-health solutions ($630 million), change and adoption ($470 million), and governance ($30 million).

Big-ticket items include a national e-health solutions investment fund ($500 million over five years) and care provider incentives ($400 million).

In particular, Deloitte called for the present National E-Health Transition Authority to be disbanded, and a fresh e-health entity with a governing board and regulatory powers established.

To date, only a brief executive summary of the Deloitte report has been released, even though the strategy was endorsed by the Australian Health Ministers' Conference as "a practical framework".

Patients may have to foot e-health bill

By: Karen Dearne

PATIENTS may have to pay for their own electronic health records, with the key healthcare reform body urging the federal Government to mandate "person-controlled" systems commercially available from providers like Microsoft and Google.
"We believe that the rapid development of new IT applications required across the health sector to give people the opportunity to have an electronic health record is best undertaken by commercial IT developers in an open competitive market," the National Health and Hospitals Reform Commission (NHHRC) said in a supplementary paper released today. While tech-savvy patients are increasingly keen to manage their own medical records, public agencies worldwide have opted to maintain control over health information-sharing systems to ensure confidentiality, technical security and data quality. But in an unexpected turnaround, the NHHRC said "every Australian should be able to choose where and how their personal e-health record will be stored, backed-up and retrieved", and that the record should be "at all times owned and controlled by that person". Instead of providing a national health IT infrastructure, the Government's role should be "to regulate privacy and technical standards", and allow the market to come up with products that suit both consumers and healthcare providers "By 2012, every Australian should be able to have a personal e-health record," said NHHRC chair Christine Bennett. "The Government must legislate to ensure the privacy of a person's e-health data, while enabling secure access to the data by the person's authorised health providers." To thwart likely objections from doctors over sharing information contained in their patients' records, the NHHRC wants the payment of public and private benefits to health and aged care services "to be dependent upon the provision of data to patients, their authorised carers and other health providers, in a format that can be integrated into a personal e-health record". Microsoft has previously told the NHHRC it was feasible to establish an affordable, consumer-controlled e-health record nationwide within one year. Its HealthVault web-based platform has been designed to allow people to collect, store and share their own medical information with doctors and family members. The commission's interim blueprint, released late last year, has been criticised for its failure to put information technologies at the heart of planned health sector reform. While today's paper said the nationwide adoption of individual e-health records would return between $7-$9 billion in economic benefits from increased productivity and reduced adverse events over 10 years, the federal and state governments have baulked at providing the necessary funding. But the NHHRC believes there is no need to finance patients for the creation and maintenance of their own e-health records. Instead, it calls for public funding for "an appropriate social marketing strategy" to inform consumers and health professionals about the significant benefits and safeguards of the proposed new approach to e-health. It also calls for significant funding and resources to help doctors move to the new arrangements. "Engaging private and public healthcare providers to invest in IT systems and infrastructure, change work practices and participate in personal e-health records will be critical to success," the NHHRC said. "Vendors must ensure their systems are compliant with national standards and can receive and send data with patient consent and appropriate authentication." AushealthIT blogger David More warned that the NHHRC approach was "unbalanced" as it over-emphasised the role of the personally held record "and fails to recognise the importance of the provider's records". "In my view, the person's own record needs to be adjunctive to the records, and systems, used by each health professional to optimise the care they deliver," Dr More said. "The care provider needs information of known provenance and trustworthiness from external sources such as referring doctors and labs. "As well, the benefits case for health IT rests on clinical decision support provided at the point of care, and that is not recognised clearly enough in this approach."