$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.

HealthSmart gets new head

By: Suzanne Tindal

The Victorian Department of Human Services has appointed a new CIO of health services who will also lead up the state's HealthSmart electronic health initiative.
Dr Andrew Howard, not the same Andrew Howard who holds the CIO position for the whole department and had previously been acting National E-Health Transition Authority CEO, will start next week.
A spokesperson for the Department of Human Services was sure there would be ample confusion caused by the two like-named CIOs.
The incoming CIO's role will include taking responsibility of HealthSmart, filling the shoes of Fiona Wilson who left last September.
HealthSmart began as a four-year, $320 million project to update IT systems in hospitals and other medical facilities right across Victoria, but has encountered deadline and budget problems.
Howard has had a medical career within the Victorian public health system, the spokesperson said, but has also held positions in the private sector at corporations such as NEC.

Vic rethinks e-health

By: Karen Dearne

VICTORIA is ruling a line under its patchy HealthSmart IT rollout, and has returned to the drawing board with plans for a new whole-of-health ICT strategy for the period 2009-2013.

When the now-$427 million program began in 2003, it was hoped that the ICT refresh and rebuild across the state's public hospitals, rural alliances and community health providers would be complete within four years.

But in April this year, Victoria's auditor-general Des Pearson said HealthSmart had been overly ambitious in its targets, and was at least two years behind schedule.

More than half of the original budget had been spent with only 24 per cent of the planned installations complete.

The audit office found that HealthSmart had failed to get the cornerstone Cerner clinical system working at any of its sites, and had replaced only one of 10 HOMER hospital systems which were obsolete when the program began.

Mr Pearson said the project judged most at risk, but with the greatest potential benefit, was Cerner's Millennium suite of e-health records, appointments scheduling, diagnostic services, results reporting and e-prescribing applications.

A $79 million deal with Cerner was signed in March 2006, but costs had risen by $17 million to $96 million in 2006 - the biggest price blowout so far, the audit office found.

"According to the original timelines, the acute hospitals in 10 health agencies should be using the clinical sysytems by now, but even if funding negotiations are concluded shortly, the first four agencies are unlikely to meet the June 2009 completion date," Mr Pearson said.

The department and the Office of Health Information Systems _ which has led the project _ have weathered repeated criticisms over technical and vendor aspects, including contract probity concerns raised in the state parliament.

It's also understood many of the state's health boards have raised concerns over the selection of systems and the likely cost to agencies of adopting the strategy.

Human Services secretary Fran Thorn defended the program at the recent Health-e-Nation conference in Melbourne(September 3), saying the first implementation of the Cerner suite would "formally commence" in October.

"Engagement with the next round of health services is underway in anticipation of rolling out to agencies over the next two years," she said.

HealthSmart was also rocked by early concerns over vendor iSoft's financial status and ability to deliver its next-generation software architecture, Lorenzo, as promised.

IBA Health Group bought out iSoft, and has taken over its contracts to supply the existing integrated patient and client management system, iPatient Manager.

To date, four agencies have implemented iPM, Ms Thorn said, and nine standalone health services are now using the client management system, TrakCare.

"Eight health services and 22 community health services will have these systems by this time next year," she said. "The integrated products support the management of patients across acute and community services, rather that just sharing data."

Last month, the Victorian Government allocated a further $104 million for HealthSmart in its 2008-09 budget.

Ms Thorn said HealthSmart would give the state ``one of the most up-to-date and capable health ICT infrastructures in Australia, ready for the future and able to adapt'' to a changing environment.

``Indeed, HealthConnect Victoria is leveraging off the investment in infrastructure and applications,'' she said.

``In partnership with our federal colleagues, a Shared Electronic Health Record project has been established to prototype a limited SEHR system across a number of public hospitals, primary and community care providers in the Bendigo Loddon/Mallee region.''

This project has received more than $1.5 million in federal funding, from October 2007 until June 2009.

HealthSmart two years behind schedule

By: Karen Dearne

VICTORIA's troubled $320 million HealthSmart project has failed to get the cornerstone Cerner clinical system working at any of its sites, and has replaced only one of 10 Homer hospital systems, which were obsolete when the program began four years ago.

Auditor General Des Pearson said HealthSmart was at least two years behind schedule and more than half of the budget had been spent with only 24 per cent of the planned installations complete.

In a long-awaited review, Mr Pearson said the original budget, which involved health agency co-funding, was not realistic, and the targets were too ambitious.

Victoria's Human Services Department and the Office of Health Information Systems have consistently deflected concerns raised in the state parliament by vendors, industry observers and even an anonymous group of healthcare workers.

The project judged most at risk, but with the greatest potential benefit, is Cerner's Millennium clinical suite, which includes health records, electronic scheduling, diagnostic services, results reporting, and e-prescribing capabilities.

"The first release of the clinical system has been tested by various user groups and is ready for use, but none of the four lead agencies have committed to using the new system," the report says. "According to the original timelines, the acute hospitals in 10 health agencies should be using clinical systems by now, but even if funding negotiations are concluded shortly, the first four agencies are unlikely to meet the June 2009 completion date."

The $79 million deal with Cerner was signed in March 2006, but costs rose by $17 million to $96 million in 2006 -- the biggest price blowout in the program.

A Cerner spokesman yesterday declined to comment, citing contractual obligations.

Reation suite.

ISoft ran into difficulties supplying systems to the British National Health Service Connecting for Health program, and was subsequently acquired by another Australian firm, IBA Health Group.

Communications director Greg King said IBA Health was "comfortable tracking to the time frames set by HealthSmart" for completion in 2009.

"The procurement process took longer than expected and the project started nine months later than anticipated, so the department, lead agencies and we as vendor are doing quite well catching up," he said.

"We've got nine lead agencies in our portfolio. We already have three live, we have one in implementation and two others are in the planning stage, so we've only got three sites pending."

Mr King said it was "always good to have a third pair of eyes looking at large projects" such as HealthSmart.

"We don't see anything in his report that we have any major disagreement with," he said.

Oracle achieved the best result among technology suppliers, with its E-Business financial management system implemented in eight of 11 participating agencies. The remaining three were due for completion this month.

Mr Pearson found the Oracle project came in $500,000 over the original budget, at $26.8 million.

TrakHealth has set up its standalone Client Management System in two community health centres, and a further 10 sites wish to install the product.

Mr Pearson found there was "room for improvement" in the shared services arena, where underperformance had a knock-on effect on systems availability.

Meanwhile, a lack of interest by agencies in taking up the payroll system might "trigger" payment of a revenue guarantee to the vendor.

Victorian shadow minister for health Helen Shardey said the auditor's findings were not unexpected, but the extent of the project's failure was a surprise.

"We have supported this kind of technology to bring our health system into the 21st century, so the massive failure is a tragedy," she said. "The project has been completely botched, and it points to a government that is just not capable of delivering on these important projects."

Melbourne leads AU$10m Victorian e-health rollout

By: Suzanne Tindal

Two community health agencies servicing the western suburbs of Melbourne and Bendigo have implemented Intersystem's Web-based TrakCare healthcare information system, the first deployments in a AU$10 million rollout across a number of Victorian health agencies.

In a first for Victorian community health, TrakCare will allow patient information to be captured within a single electronic medical record, allowing patients to only register once for most services including general practice, mental health, physiotherapy and occupational therapy.

Previously, the health centre had a "large number of systems," according to Clare Amies, CEO of Western Region Health Centre -- which has 13 different sites around inner and outer Melbourne -- making it necessary to repeatedly enter patient information into the various systems and databases for each site.

In addition to the reduction of duplicate entry of data, the system also allows the centre to better coordinate patient's appointments, according to Amies.

This has lead to significant cost savings, for example, by having appointment information in a single location. This has allowed the health centre to book interpreters over many appointments, instead of booking them individually for each one -- which often occurred while using the previous manual system. The change allows the health centre to avoid paying the minimum tariff of one and a half hours work for only one sitting.

The TrakCare system also allows the healthcare centres to create reports about referrals within and outside the organisation. The reports can aid in identifying when a patient can't be referred to a specialist service within the centre, such as when waiting lists are too long, for example, and where else they can be referred to externally.

TrakCare also helps identify in the meantime what other services are available that could be of use to patients on waiting lists, Amies said. For example, a diabetic wanting to see a booked-out dietician could have access to a diet educator, who might be giving a seminar in a clinic or who could point the patient to other relevant resources.

The allocation of resources will now receive a leg up from TrakCare's information, according to Amies. "We now have tangible data to take to the Department of Human Services -- we've been live for a year and we're just starting to collect some really good information," she said, allowing the health centre to "respond to the needs of the community and plan better".

The system has been built to adhere to privacy legislation, a spokesperson for the Department of Human Services said, adding: "There are processes in place to make sure privacy is upheld."

Patients are able elect whether or not to make their data available across the different sites and services, Amies said. "Sometimes people don't consent to everybody and sundry reading their notes," she said, but added: "Not many elect out. Most people are happy that it's secure in that people can't access it unless they're authorised."

Ten other health agencies are currently implementing TrakCare and intend to go live between now and the end of 2008. Another 12 agencies have entered into an expression of interest stage which should see them implement TrakCare by the end of 2009.

Implementing TrakCare is part of the Victorian government's AU$360 million HealthSMART program.

Vic HealthSmart IT chief quits

By: Karen Dearne

THE director of Victoria's $427 million HealthSmart IT rollout, Fiona Wilson, has resigned from the Office of Health Information Systems for personal reasons.

"Ms Wilson will be relocating to be closer to her partner in Auckland, and I can confirm she will be leaving the Department of Human Services towards the end of October," a DHS spokesman said.

"For quite a while now, Fiona has been travelling across the Tasman to do her work here, and also continue her relationship with her partner in New Zealand."

The spokesman said there had been no decision made on an interim or permanent replacement for Ms Wilson but her departure was a big loss to the organisation.

"She has been a big driver in health ICT reform, and she has been critical to all the achievements to date," he said.

Ms Wilson was appointed to lead the OHIS when it was established in mid-2003 to manage the department's HealthSmart program - a four-year $323 million ICT refresh and rebuild across the state's public health hospitals, rural alliances and community-based health providers.

The project was originally due for completion in 2007. It remains unclear when the project would be completely rolled out.

Meanwhile the first implementation of the long-awaited Cerner clinical system "will formally commence" next month, Victorian Human Services secretary Fran Thorn recently told the Health-e-Nation conference in Melbourne.

Cerner's Millennium suite provides e-health records, appointments scheduling, diagnostic services, results reporting and e-prescribing applications.

"Engagement with the next round of health services is underway in anticipation of rolling out to agencies over the next two years," Ms Thorn said.

Last month, the Victorian Government allocated a further $104 million for the HealthSmart program in its budget for 2008-2009.

At the same time, the Human Services Department began consultations over a new whole-of-health ICT strategy for 2009-2013.

Meanwhile, Andrew Howard, who has been acting chief executive of the National E-Health Transition Authority, is set to return to the DHS following the appointment of Peter Fleming as NEHTA's CEO.

Mr Howard is the department's chief information officer.

HealthSmart two years behind schedule

By: Karen Dearne

VICTORIA's troubled $320 million HealthSmart project has failed to get the cornerstone Cerner clinical system working at any of its sites, and has replaced only one of 10 Homer hospital systems, which were obsolete when the program began four years ago.

Auditor General Des Pearson said HealthSmart was at least two years behind schedule and more than half of the budget had been spent with only 24 per cent of the planned installations complete.

In a long-awaited review, Mr Pearson said the original budget, which involved health agency co-funding, was not realistic, and the targets were too ambitious.

Victoria's Human Services Department and the Office of Health Information Systems have consistently deflected concerns raised in the state parliament by vendors, industry observers and even an anonymous group of healthcare workers.

The project judged most at risk, but with the greatest potential benefit, is Cerner's Millennium clinical suite, which includes health records, electronic scheduling, diagnostic services, results reporting, and e-prescribing capabilities.

"The first release of the clinical system has been tested by various user groups and is ready for use, but none of the four lead agencies have committed to using the new system," the report says. "According to the original timelines, the acute hospitals in 10 health agencies should be using clinical systems by now, but even if funding negotiations are concluded shortly, the first four agencies are unlikely to meet the June 2009 completion date."

The $79 million deal with Cerner was signed in March 2006, but costs rose by $17 million to $96 million in 2006 -- the biggest price blowout in the program.

A Cerner spokesman yesterday declined to comment, citing contractual obligations.

Replacement of the antiquated Homer hospital system with a modern Patient and Client Management System has also been fraught. HealthSmart initially signed a $50 million contract with local firm iSoft in 2003 to replace the legacy system with iPatient Manager, an "interim" product that would in turn be replaced with Lorenzo, a highly capable next-generation suite.

ISoft ran into difficulties supplying systems to the British National Health Service Connecting for Health program, and was subsequently acquired by another Australian firm, IBA Health Group.

Communications director Greg King said IBA Health was "comfortable tracking to the time frames set by HealthSmart" for completion in 2009.

"The procurement process took longer than expected and the project started nine months later than anticipated, so the department, lead agencies and we as vendor are doing quite well catching up," he said.

"We've got nine lead agencies in our portfolio. We already have three live, we have one in implementation and two others are in the planning stage, so we've only got three sites pending."

Mr King said it was "always good to have a third pair of eyes looking at large projects" such as HealthSmart.

"We don't see anything in his report that we have any major disagreement with," he said.

Oracle achieved the best result among technology suppliers, with its E-Business financial management system implemented in eight of 11 participating agencies. The remaining three were due for completion this month.

Mr Pearson found the Oracle project came in $500,000 over the original budget, at $26.8 million.

TrakHealth has set up its standalone Client Management System in two community health centres, and a further 10 sites wish to install the product.

Mr Pearson found there was "room for improvement" in the shared services arena, where underperformance had a knock-on effect on systems availability.

Meanwhile, a lack of interest by agencies in taking up the payroll system might "trigger" payment of a revenue guarantee to the vendor.

Victorian shadow minister for health Helen Shardey said the auditor's findings were not unexpected, but the extent of the project's failure was a surprise.

"We have supported this kind of technology to bring our health system into the 21st century, so the massive failure is a tragedy," she said. "The project has been completely botched, and it points to a government that is just not capable of delivering on these important projects."