Thursday, 8 October 2009

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 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.

Saturday, 3 October 2009

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.

Friday, 2 October 2009

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.