Decisions involving IT and communications technology across Victorian health organisations should be further devolved to local health boards, which will be responsible for owning the solutions and primarily accountable for their decisions, a ministerial review into IT throughout Victorian Health has recommended.
Released yesterday by Victorian Minister for Health David Davis, the review recommended that IT decisions be subject to normal business governance mechanisms and guided by state-wide health priorities; that the state-wide approach to IT be abandoned; and that a central governance council be created to oversee the role of IT.
For a decade, Victorian Health was embroiled in a series of setbacks and blowouts in an attempt to implement a state-wide IT strategy dubbed HealthSmart that looked to bring together the disparate IT systems used throughout the state. The HealthSmart project began as a four-year, AU$320 million project to update IT systems in hospitals and other medical facilities across the state that was due to be completed in 2007.
Davis said that the abolition of the HealthSmart participation policy, a document that ensured the use of HealthSmart procured solutions upon upgrading or purchasing a new system, would allow health services in Victoria to improve patient care and safety via the use of EMRs.
"The former Labor government's misguided HealthSmart 'participation policy' mandated an inflexible, wasteful, and ultimately unsuccessful one-size-fits-all suite of software to Victorian public health service providers, at enormous cost to the Victorian taxpayer," he said.
The review said that the participation policy proved to be "unnecessarily constraining" and forced smaller health services to purchase systems that provided more functionality than was needed. However, HealthSmart did not provide all the functionality needed by service providers, with the report saying that HealthSmart lacked "billing, clinical documentation, emergency department, and decision support for a range of specialist areas".
Due to the shared nature of HealthSmart, development tended to focus on the needs of larger organisations, which resulted in lower usability for clinicians in smaller providers.
"Over time, continuous compromise by smaller or specialist health services makes it less likely that the application will suit their needs," the report states. "The panel does not believe that the costs of maintaining the participation policy and the state-wide footprint approach are justified."
The report further recommends in the area of governance for future IT investment decisions that a state-wide health IT plan be developed, with the implementation of electronic medical records (EMR) across Victoria a priority, and that health service providers be required to develop an IT plan that includes the development of EMR as a prerequisite for central funding. Responding to the recommendations, the Victorian government broadly accepted them all, and said it would develop the state-wide IT health plan in the first quarter of next year.
The panel found that Health Shared Services (HSS) was unable to respond effectively to the recent changes in technology, such as cloud and mobility, and that HSS should be reviewed.
"HSS should be the subject of a review by external experts comparing the scope of services, structure of provision, costs, and value for money, with other possible future options. The review should also consider transitional arrangements, including the scenario in which some health service providers may wish to withdraw from HSS," the report says.
Looking at future procurement options, the panel recommended the process developed by the Victorian Information and Communications Technology Advisory Committee that espouses delivering projects in stages and realising business benefits earlier, as well as ensuring that IT systems are interoperable, modular, and reusable.
The report preferred the purchasing of services over a collection of systems, with the government in its response adding that projects should be based on the best "value-for-money proposals".
"The health sector should consider purchasing ICT as complete services rather than as systems or separate components of systems (for example, software, hardware, integration engines, operations) as part of a holistic value-for-money business case assessment," the report said.
The individual service providers will not be left to fend entirely for themselves, with the report suggesting that a central register of pre-approved vendors be created that providers can source from if they want to.
One recommendation rejected by the Victorian government was the suggestion that the personally controlled e-health records (PCEHR) developed by the federal health ministry move to an opt-out mechanism in Victoria rather than its current opt-in strategy. In response, the Victorian government said that it would "seek community, industry, and consumer advice as part of its contribution to current review processes underway on national e-health initiatives".
"Health ICT investments to date will be preserved, and interoperability between existing and future systems — supported by robust business cases with independent oversight — will be guiding principles," David Davis said.
The Victorian Health minister welcomed the findings of the report.
"The findings and recommendations are pragmatic, directional in nature, recognise the need to fully realise the current investment in health sector ICT, and position the health system for the future, particularly to meet the challenges of moving to e-health," he said.
Davis said that the state had learned the lessons from the HealthSmart journey, and would in future make ICT investments based on business cases.
"Labor's incompetent and failed HealthSmart ICT experiment is over."