$96m medical IT system useless: whistleblowers

By: Nick Miller

A NEW $96 million computer system for Victorian hospitals that promised to cut down on dangerous medication errors will be almost useless when it goes "live" this year, insiders say.
Other new computer systems that handle finance and manage patient records are plagued with serious problems that take days, even weeks, to fix.
And in a further embarrassment for the years-overdue $360 million HealthSMART program, a hospital chosen by the Government to be a flagship "lead agency" — Ballarat Health System — has quit the project because it could not justify the expense.
An anonymous letter from "health-sector employees" sent to The Age says the Cerner clinical systems, intended to cut down on mistakes in doses or combinations of medicines, is being rushed into hospitals — with none of the medication functions working — so the Government will not be embarrassed before next year's election.
"The whole reason for this system was to introduce electronic medication," the letter says. "But next year is an election year and we must hit the agreed dates. This means the system will be almost useless when first live."
Documents released to The Age by the Department of Human Services under freedom of information, and the department's own website, confirm that when clinical systems go live at the first two hospitals late this year, they will not include its most significant functions.
These include ordering pathology tests or medical scans, medication management for emergency patients or inpatients, and "decision support" functions that cross-check drugs and doses.
Leaked reports show other new HealthSmart systems are highly unreliable.
In the last quarter of 2008, the reports showed serious problems with the "PCMS" system, which tracks patient records, books operating theatres and warns doctors of a patient's particular allergies or chronic health problems.
As of December, the system was used at five health services, including Northern, Frankston and Royal Women's hospitals.
Hospitals also reported major problems with the FMIS financial software that runs budgets, purchases, accounts and assets at seven hospitals, including Box Hill, Northern, Frankston, Monash and Peter Mac.
Ten hospitals were targeted for the Cerner clinical system, with Eastern Health, the Royal Victorian Eye and Ear Hospital and Ballarat Health Service as "lead agencies". The Age's FoI documents say Ballarat is "unlikely to proceed given costs included in business-case".
One hospital CEO told The Age he "will be very surprised if it stacks up", as the system cost hundreds of thousands of dollars to run each year.
Another senior Victorian health IT expert said most hospitals would never take up the software. "No one likes using it because it's s---," he said. "It's totally inflexible."
A Health Department spokesman denied all the allegations, without giving any detail.
A spokesman for acting Health Minister Lisa Neville denied that hospitals were being pressured over HealthSMART to avoid embarrassment before the election.
Opposition health spokeswoman Helen Shardey said it was vital that Victoria's hospitals got a modern IT system, but the Government was failing to deliver one. "It's a massive cost to health services, and it seems the timing is being driven by the next election rather than the best clinical care," she said.

Rudd Govt to abolish patient privacy

By: Suzanne Tindal

The Australian Medical Association (AMA) has slammed draft legislation brought forward by the Federal Government, which will allow it the right to access individual patients' records.
This is 'Big Brother' at its worst.
The draft, which the AMA said had been released last Thursday night before the Easter long weekend, would mean the government had the power to "require a document, extract or copy containing health information (within the definition of the Privacy ACT 1988) about an individual".
The legislation had its grounds in making it possible for the government to conduct administrative checks"This is an act of bureaucratic voyeurism that strips patients of all rights to privacy. It presses the face of government at the keyhole of every surgery in the country. Doctors will be compelled to hand over highly sensitive medical information to justify Medicare claims potentially including a patient's intimate concerns and examination findings, their test results, weight, sexual health, infections ... nothing is protected.
"Worse still, under this legislation patients don't even have the right to know that their records are being accessed. There is no compulsion to even advise patients, let alone seek their permission," Capolingua said.
"Government has no business accessing these records. This information is between the doctor and the patient, and must remain so," she concluded.
There has been a lot of attention on health record privacy in recent times with the attempts to introduce national electronic health records, as they would make private information more readily available. The government is facing the need to pass new legislation to make the introduction of an individual health identifier possible, which the National e-health Transition Authority believed would take until next year.
The office of Federal Minister for Health and Aging Nicola Roxon was unable to provide comment in time for this article.

Qld Health buries TrakHealth suit

By: Renai LeMay

in brief Queensland Health has settled its long-running lawsuit with e-health vendor TrakHealth and its parent InterSystems.
TrakHealth dragged Queensland Health into the state's Supreme Court in December 2005 after the department terminated a contract with the vendor for the implementation of the department's Clinical Information System project and related software. The e-health vendor claimed it was owed damages.
However, Queensland filed a counter-claim against the e-health vendor as well as InterSystems and its CEO Terry Ragon.
"The parties have now agreed [to] a settlement which resolves all matters in issue between them, including all claims and counter-claims in the proceedings, to their mutual satisfaction," a statement issued by TrakHealth this morning said without providing further details.

Roxon lost on e-health, opposition claims

By: Suzanne Tindal

The Federal Government's lack of a true electronic health agenda had left an opposition offer of bipartisanship on the issue dangling useless by the wayside, Shadow Health Minister Peter Dutton said yesterday.
"[Health and Aging Minister] Nicola Roxon and I don't always have a perfect made in heaven relationship, but nonetheless, when I first sat down with Nicola coming into this portfolio only six months ago I gave her an undertaking that we would — on the issue of e-health — provide bipartisan support," Dutton said speaking yesterday at the Annual Health Congress in Sydney.
We've seen no evidence of an agenda which we can support as we go forward.
The upfront expense and long lead times of e-health solutions meant that the benefits wouldn't be delivered for what was politically, a long time, according to Dutton.
Yet the offer was not being used, the shadow minister said: "I offered that bipartisanship from day one. The offer stands today, and we've seen no evidence of an agenda which we can support as we go forward."
His comments echoed those made by Booz and Company principal Klaus Boehncke at the conference. "It's fair to say that political leadership has not been exhibited here as it has elsewhere," he said, pointing to US President Barack Obama, who put e-health onto the agenda in his first address at the White House, the German Federal Health Minister Ulla Schmidt's spruiking of her country's e-health card and the tremendous drive in Singapore to get electronic health records up and running by 2010.
"What you see then in Australia because of this lack of leadership is that many of the states are pursuing their own separate visions of e-health programs," Boehncke said.
The lack of drive and vision has seen talent go overseas to where the fruits of its labour might be implemented, he said. "[There are] disillusioned Australians from the National E-health Transition Authority and from Queensland Health and from a lot of healthcare areas, working hard to make sure that Singaporeans get an electronic health record next year."
What you see then in Australia because of this lack of leadership is that many of the states are pursuing their own separate visions.
In order to move from this point, Boehncke highlighted three areas he thought needed urgent attention, the first being a national e-health investment strategy which was "much more than a business case" since it defined what would be built, for whom and why. NEHTA currently has a business case for a national e-health strategy, which needs to go before the Council of Australian Governments before funding can be allocated to it.
The second was a national infrastructure and definitions around how data would be shared, where it would reside and who owned the data. Where the data resided would go into consultation after the business plan was approved, according to NEHTA CEO Peter Fleming, speaking at an IIR conference last week.
"At this stage the current thinking is that we will not have one central electronic health record that everyone's part of. The expectation is that there will be multiple electronic health records around the country and that those health records will be provided by various players. In some cases it may be health insurers, in some cases it may be Google or Microsoft, it may be professional bodies," he said.
"Where I think we will end up is that we will have a large indexing service not dissimilar to the type of web technologies we know today that knows where an individual's records are stored and can pull that data back as required. Given the current physical restraints, I think that index will also contain some summary data, things that might be required in an emergency.
The last issue Boehncke outlined was the national health identifier, which he spoke on in expanded fashion since it touched upon prior work of his with the past government's controversial Access Card. "[NEHTA is] developing a number for every Australian. But having a number isn't the same as developing an identifier," he said. Boehncke said it was necessary to have that number linked to the physical person, for example, by using a card, but when he asked people in Australia how they thought the person would be linked to their number, he received a lot of different answers.
This type of stuff really makes the things that were stored on the Access Card seem insignificant.
"I get high-ranking state health ministry officials that tell me people in Australia don't need to be identified securely because they trust their GP... The GP will identify the patient," he said. "Other people tell you oh no, no, no, there'll be a new Medicare card. It'll be a smart Medicare card."
Those people thought it would be easy to upgrade the Medicare card to take on new duties, but it wouldn't be, according to Boehncke.
"Let me tell you, from my Access Card experience I know that's not going to be easy because you're moving from a payment card to what becomes an identity card. And you'll have all these questions like we had with the Access Card. Like can you put a photo on it."
When someone asked if the government was dithering because it was frightened of opening up an Access Card type can of worms, Boehncke said that an e-health card would be much more frightening than the previous government's controversial card because of the type of data it would have stored on it.
"This type of stuff really makes the things that were stored on the Access Card seem insignificant because your health data holds a lot more information about you," he said. "To be afraid of an Australia Card when you are trying to identify people in the health setting might be natural when you look at the Australian history in a lot of these debates," he said.
Yet he believed people would voluntarily take up an e-health card because unlike the Australia Card of the Access Card, an e-health card has a true value proposition — the opportunity to save lives.