SA Health's journey to e-health

SA Health's journey to e-health

Summary: Implementing e-health services for an entire state is a daunting task, but, as South Australian Health manager for e-health services, Bill Le Blanc, has revealed, even the preparation steps are complicated tasks.

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Implementing e-health services for an entire state is a daunting task, but, as South Australian Health manager for e-health services, Bill Le Blanc, has revealed, even the preparation steps are complicated tasks.

Bill Le Blanc
(Credit: Michael Lee/ZDNet Australia)

Speaking at the e-health track of CeBIT's 2012 conference, Le Blanc outlined the process through which SA Health went to transform its state-wide IT systems.

SA Health was forced to reconsider its IT systems and reporting lines because of legislative changes put in place to prepare for e-health records. Reforming the health department was a legislative requirement, relegating return on investment and other commercial considerations to be of lesser importance, according to Le Blanc. He said that the department consequently had to jump into reform headfirst.

Structural reform

Prior to the reform, South Australia's 70 state-owned hospitals all had their own IT departments, and were funded individually by health services. A significant problem was that each IT department had devised its own method of meeting the hospital's business requirements, but, invariably, departments from each hospital used different systems that were not necessarily compatible.

As part of legislative changes, SA Health moved the reporting lines from each of the individual IT departments to the SA Health chief information officer, who then had complete oversight of all 400 IT staff.

"For the very first time, our chief executive actually had direct control over every single employee in the health system," Le Blanc said.

The change of reporting lines also provided the SA Heath CIO with control over the budgets for each of the health services, which, until that point, had only seen SA Health as a source of funding, and not as a directing body.

"You've got all the different health systems spending their own budgets and making independent investment decisions. You need to be able to pull that in, and make sure that things that are being processed actually align with the strategic direction of the organisation."

He said that it also allowed SA Health to choose particular investments, and to back them with the necessary financial support. This would have been impossible, if an individual health service had tried to do it with an independent budget.

The SA Health board overseeing these investment decisions consists of health services executives, the CIO and senior finance staff from the Treasury, in order to keep it focused on the needs of the business.

Le Blanc said that at the end of the day, it was important to consider who was going to be the most affected by consolidating and reforming the state's IT services.

"If you haven't got your clinical workforce on-board, you may as well not spend any money. You can have the shiniest, most expensive, best technology in place, [but if] the clinician is not on-board, they either won't use it, or they won't use it for its full benefit."

Le Blanc said this meant that it was important for the board to not only see it as just an IT project, but to ensure that all clinicians also had a buy-in.

"The systems that we're putting in place are business led. It's chosen by the clinicians, for the clinicians. The underpinning technology wasn't even a factor in our decision-making process when we went out to market."

Workforce restructure

Between the state's healthcare facilities, there were 15 IT departments of varying sizes, which operated independently of each other and tried to do what they could for the facilities they were supporting.

"Each of them were trying to provide the full suite of services that you would expect from an ICT department, which means that almost by definition ... there was no opportunity for people to specialise," he said.

"The entire system was very fragmented and being serviced by hard-working people, but they were mostly jacks of all trades."

Le Blanc said that with the state preparing to roll out electronic heath records, that sort of workforce, as dedicated as it was, was not appropriate for the task.

"You can't run an enterprise-class electronic health records system on health-grade infrastructure with 400 generalists. By and large, the staff were dedicated and well skilled, but they were all doing things differently from each other, and there was no formal IT service-management disciplines in place."

The other half of the problem was that the existing IT workforce had bought into a self-defeating culture, where support staff would be seen as doing a good job when "putting out fires", even though the average response time for support was around the 30-minute mark.

"We had a culture that rewarded heroes and fire fighters. That kind of culture resists the implementation of structured processes that are designed to stop fires from breaking out.

"They thought that what we were doing was actually going to degrade service, because they liked putting the phone down and racing to the side of the clinician and fixing their problem, but they weren't taking a system-wide view."

Infrastructure

The problems that support staff had to solve were also exacerbated by the ageing infrastructure across many health services. Le Blanc said that the various health services had a total of 1608 PCs, which were only being replaced with the cheapest hardware available, due to limited budgets.

"We found that there were dozens of 10-year-old, Cold War-era PC-ATs around the place running DOS, because people couldn't afford to replace them," Le Blanc said.

Using the governance policy, SA Health forced these health services to rent PCs through the IT department for a maximum of four years.

"One of the benefits of that is that we now have a fleet of about 25,000 devices that are centrally managed ... and we know that [there's] no device out there that is over four years old."

SA Health also consolidated server rooms into two centralised datacentres. This simplified matters, but also brought about an increase in risk. Le Blanc said that under the old system, if a hospital's computer room failed, a single hospital would be affected. But if SA Health's datacentre is impacted, the state would lose all health services.

To combat this, SA Health put into place dual fibre links between every hospital and the two datacentres, and triple redundancy links between the datacentre facilities themselves. Network connectivity was also designed so that in the event that the link between the two datacentres is severed, a route could still be made by using one or more of the hospitals' links.

Even the dual links between the hospitals and datacentres were created using separate paths and carriers to ensure minimal impact from outages.

"They're not in the same cable trenches, and they're through different carriers, so if Optus has an outage, we still have a Telstra carrier through a different cable in a different trench," he said, adding that this redundancy guards against outages from when "one of those pesky backhoe operators comes in to fix up a cable".

Topics: Health, Government, Government AU

Michael Lee

About Michael Lee

A Sydney, Australia-based journalist, Michael Lee covers a gamut of news in the technology space including information security, state Government initiatives, and local startups.

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7 comments
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  • It's amazing what sort of generalistic hokum these geniuses come up with to justify their empires and try to make themselves look good at these conferences.

    In actual fact, the centralised service desk in SA Health ICT is now a laughing stock among the users. Many good people have left, many more want to go. The whole centralisation process was a shemozzle, that went on for years and changed numerous times before being completed. The workforce is demoralized and the new projects are hampered by committee after committee.

    For the first time in my working life in IT I come to work purely for the pay. I loved being part of a hospital and contributing to the systems used, stretching my abilities and continually learning in the process. Working for SA Health is more about ticking boxes and covering your behind. At least we get to see the latest Dilbert strips before they are even published !
    incredulous-4d067
  • So true. Head in the sand. Centralisation has totally de-humanised SA Health ICT. The business hates it. Do they really think we are providing a better service? The calls to the help desk are dropping because users have given up. And it's also kind of insulting to say we were all jack-of-all-trades before centralisations knight in shining armour. We were providing a better service than we are now. How can we when were are all resources in silos that can't talk to each other!
    john.smith4
  • I'm afraid I have to agree with incredulous and jsmith22. In over 30 years of IT I have never seen this level of self delusion, incompetence, etc. except in other govt departments. The easy way to show that you are doing a fantastic job is to totally ignore rock bottom morale and complaints and just keep saying "we are doing a fantastic job"! You have to wonder why they can't reconcile their bank account with the new you beaut accounting system or why you would completely gut your legacy support to populate the new program and then ignore the problems and complaints this generates. BTW the fires are getting larger and more often since the restructure! Amazin'!
    gpmac
  • Change is painful. A lot of very bad practices that have been in place for years have been brought to light as SA Health has started cleaning up its IT act and anyone who thinks going back to that is a good idea is fooling themselves. We used to be in a hole with no way out. Now we are in a hole that has a route to the surface. It still ain't great, but it's a step in the right direction.

    Anyone who is going to work 'purely for the pay' really shouldn't. Get a job you enjoy somewhere else. That will be good for you and good for the IT guys trying to build an SA Health that can work effectively.
    DrDan-bd40a
  • Apart from self delusion, Health now has an ethos that caauses people to hide the actual facts of how badly things are going. Bill suggests that response times were 30 minutes and that was bad. Now, you are lucky to get things fixed within 3 weeks! That doesn't mean the helpdesk job stays open 3 weeks, no that is closed asap. The problem just isn't fixed, just the problem record closed. Why you ask - well, because though we had "hospital IT silos" before, now we have technology silos. People aren't able or allowed to follow a problem through to resolution, so you check your little bit and if problem not there, close helpdesk job. eg printer problem, printer won't print a PAS record. Desktop person turns printer off and on closes job. Problem still there. New HD job, Unix person checks printer Q, no problem closes job. Printer still not working. New job - main frame person checks finds problem and fixes. User has to raise 3 jobs that get bounced around or closed before problem sorted. Very typical scenario.
    Oh goody we now have no PC's older than 4 years. Sorry wrong. By the way has Health checked the age of their servers - scary! Some of them are approaching 6-8 years old.
    By removing all those nasty "jack of all trades", Health has brought in nice people from all over, who lack the knowledge of the business, ie Health. A huge amount of in depth business knowledge has been thrown away. I was stunned the day that a high up, recently brought in central IT manager, had to have it explained to him that yes, a major trauma centre does work 24 x 7!!!
    I totally agree that the new systems need clinician buy in or it won't work. But you CANNOT totally ignore the underlying technology, as is happening, as then you get a bright shiny toy that won't actually do the work required. When the clinicians later find that software won't give them the reports or the flexibility required they will not use the system. This is not to denigrate the clinician input but it should be part of the input required, not the only input.
    SAR-98425
  • I would like to say that two of the successes of the centralisation process have been the PC Fleet rollout and datacentre creation. However as there is no fleet replacement for Network Infrastructure, which is effectively left up to individual hospitals to fund, and since the Health Budget is requiring Health Services to save money a perfect storm of significant risk has been created that is now seeing PC’s connected to over 10-year-old, Cold War-era switches, routers and cabling. Not only does this now pose a risk to PC connectivity but also to current and future projects that include the enterprise e-health record system. I personally don’t want to see these projects slowed down or fail due to these infrastructure risks. So please Bill, as with the PC Fleet, stop the health services making their independent investment decisions in relation to this critical enabler of current and future health projects. The health services will then indeed be able to more closely align with the strategic direction of the organisation.
    Rooscal
  • Ode to smoke and Mirrors
    Once again the lovelley froth rise's to the public domain to express the wonders of the alleged expert management of a health system desperate to keep a voters attention at election time.
    all the nice apparent tiime and cost effecient implementations from the heads that have yet to see the true inner workings of a massivley diverse and critical function of a government (delivery of health services) we the general public pay for it directly.
    personally the only true results seen from this vaccum is major monetory waste and a service that now takes three times longer to achieve a below standard delivery
    It has de humanised any IT Staff to the point of hand ballers and paper shufflers, removed any form of want for staff to use incentive and dare they speak out about it, this will just lead them to a land of complete isolation and be labelled as outspoken and are just simply ignored by apparent expert management.
    Many simply left to work for the third party providers that are simply milking the cash in based on appualing contracts that health have signed . The proof of this is in the continual rotation of new staff coming through health and at best lasting 3-4 months, the so called training that has been offered is beyond poor, words fail to truly spell that one out.
    The latest project being signed up for a state wide project costing in the millions with a offshore company that is all but finacially failed and close to recievership, yet still health are driving it as the end to be all in solving all the clinicians wishes and attempting to running it on a completly outdated and bandaided infrstucture aging beyond 8-10 years old , oh but the desktops are all shiny shiny, yet still running dear old Xp thats what 10 years old now along with office 2003 really modern that one hey. as yet beinfit for or even a true mention of the actual patient has yet to be seen but all the SA health and Hospital exec's have all the latest toys all implented under the ever so internally loved exemption process and then states that these are now part of what is IT and add these new toys to ever growing list of what IT staff are to support regardless of training or not nor any extra staff added to meet the needs of the business requirement. and of course its all built on the ITIL standard (It Totally Insults Logic)
    Health has also re-defined its own view on just what IT actually supports and how. recently Telstra have gained on site support for tesltra owned devices using SA Health IT staff to trouble shoot Tesltra owned devices Tesltra and are also recieving easy money from the local hospitals direct budgets for just having Tesltra owned devices in thier building another fantastic project result which of course will benifit the patient by adding the cost of the carpark and now the 20 bucks a day to watch TV whilst attempting to recieve health services thier taxes paid for, awesome work health all dependant if that service is finacially viable for the doctor / clinician to be bothered with or can use as leverage for better income whilst holding the public to ransom, but again in this wonderful speech not a mention of it, fascinating to say the least. all these apparent improvements are hard to spot in the capital of the state with the major hospitals but there will be a nice new shiny one heaven forbid did anyone metion the country services yes this can be found beyond Port Wakefield / mount Barker for those unfarmiliar with what is country, this area (country) hasnt even got endorsement from cabinet to fund it so expect little to nothing there. how ever im certain SA health will have a form you can fill in to complain about it this will do nothing but make you feel a little brighter on the day.
    at best it achieves the sound of one hand clapping , then addresses the media with
    a pretty suite and some soothing "its all good" words on how they had to force things to achieve what they have now.
    A certain English Prime minister tried this trick back in the late 30's addressing the waiting media with a piece of white paper in hand and claiming "it's all good" "peace in our time he called it" history proves where that went
    now that SA hospitals are now money vending machines for Telstra and the clinical fraternity gets it's latest Merc, Bmw, and new house to stay with it, all concerned are "all good with it"
    oh the ones still waiting in line they are called pateints by the way
    Satchel
    Satchel-68050