By Julian Bajkowski
Australia’s troubled eHealth sector has been handed yet another negative appraisal after the Victorian Auditor General released a report cited “poor planning and an inadequate understanding of the complex requirements to design and implement clinical ICT systems” as the reasons for the state’s major online medical upgrade failing to deliver what it promised.
In its second examination of the HealthSMART project initially priced at $323 million, the Auditor General found that Victoria’s Department of Health had not just “exhausted its allocated funds” but only managed to deliver clinical ICT systems to four out of 19 health services.
The latest bleak review comes as the recently elected Prime Minister Tony Abbott – himself a former Health Minister – and new Health Minister Peter Dutton, try to figure out what next to do with Australia’s national e-health push being led by the National eHealth Transition Authority (NeHTA).
In August respected clinical leads including former Australian Medical Association (AMA) president Mukesh Haikerwal walked away from NeHTA in frustration triggering crisis talks between the AMA and Department of Health secretary Jane Halton.
The trials and troubles of eHealth are familiar territory for Mr Abbott who in 2005 demanded that patients needed to see a real difference from the technology, warning that he and the sector would have failed if this did not eventuate.
At the same time he questioned whether health federal bureaucrat’s pay should be contingent on outcomes. Yet almost a decade later, the prognosis on progress in Victoria is still poor according to the Auditor General.
“The Department of Health has delivered the HealthSMART clinical ICT system to only four Victorian health services and at a cost of $145.3 million. Some clinical ICT systems have issues that potentially affect patient safety and need to be closely monitored and resolved by the department and relevant health services,” the Auditor General said in his covering letter to the Victorian Parliament.
The report found that the project was beset with interoperability problems and that information often lived in isolated islands – essentially the opposite of what moving from paper records to electronic records was meant to accomplish.
The Auditor also found that the Victorian Department of Health:
• cannot demonstrate an auditable trail of authorisation by government of key changes in program scope and direction.
• did not have effective financial monitoring and oversight practices to monitor total expenditure and assess value for money compared to other systems.
• did not have effective governance and contract monitoring to ensure vendor performance.
The latest pasting is unlikely to come as a surprise.
The report noted that in November 2011 the Victorian Ombudsman reported that “the HealthSMART clinical ICT system, which had the potential to deliver the most benefits, had not been delivered as planned and was facing strong resistance among user groups.”
It also said that said the Ombudsman recommended that the four HealthSMART clinical applications had been started be finished (rather than progressing to the other 19) and that review the functionality of the system be put in place.
A year later in December 2012, the Auditor said, the state’s Public Accounts and Estimates Committee “noted that there had been a failure by (Department of Health) to recognise the extent to which HealthSMART would require health services to change their clinical ICT systems, ICT infrastructure and other specialist operations, in order to realise the expected benefits from the invested public funds.”
Then, in January 2013, Victoria’s Minister for Health set up an expert review panel to do a high level review and advice on the future of the project, including whther to pour more money into it.
“At the time of this audit, a confidential draft report by the expert review panel had been provided to the Minister for Health for his consideration,” the Audit Report said.Where it, or Australia’s wider eHealth agenda will go in the future, will come into sharper focus in coming months.
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