A failure by the Western Australian (WA) Health department to procure a new Patient Administration System (PAS) in the last 10 years has put patients' lives at risk, according to a report by WA acting auditor-general Glen Clarke.
(Hospital image by Adrian Boliston, CC2.0)
The PAS is a vital hospital patient record system that can contain all information about a patient including medical history, pharmacy and pathology information. The report notes that the PAS is one of a public hospital's most critical systems because without it, care for a patient can suffer.
The WA Health department currently uses two PAS systems: one for metro hospitals that was commissioned in 1995 and a separate system for country hospitals that was built internally. According to the report (PDF), the department realised in 2000 that the metro system was outdated, and that the supplier would no longer support the system from 2002. Clarke highlighted, however, that Health still has the same system in place 10 years later.
"Health's procurement of a new PAS has not been done well. It has been 10 years since a PAS replacement was first identified as a priority by Health, and six years since parliament provided the necessary funds, subject to Health first satisfying certain conditions," the report noted. "However, the funds are largely unspent, the state still does not have a PAS replacement and it is unlikely to have one in all metropolitan hospitals until at least 2014 and 2018 in regional areas."
The report revealed that the WA Government had allocated $52 million to be spent on the implementation of a new system but the Health Information Network, the group in charge of the procurement process, had failed four times to provide a suitable business case to the government in order to access the funds to upgrade the systems.
The available funding also fell well below the estimated $115.4 million cost for a new statewide PAS system.
The acting auditor-general said failure to update the system could have dire health consequences for patients in Western Australian hospitals.
"An example of this occurred during the vancomycin-resistant enterococci outbreak at royal Perth Hospital in 2001. Six months before the outbreak, clinicians requested the development of a micro-alert code to assist in tracing infected patients. However, this was not done because the PAS lacked the system flexibility and the cost of creating the flexibility was considered too high," Clarke said.
"Subsequently, Health designed the code to enable it to respond to future outbreaks though it took three weeks to develop."
The report also cited unstable governance for the system upgrade, as part of the reason behind its delay. There had been a high level of turnover in the Health Information Network since 2007, including the resignation of four chief information officers.
"Good governance and planning are critical to successful ICT procurements, but they have been poor in the PAS procurement. Health's governance arrangements were unstable and poorly defined," Clarke said. "It was still identifying its business needs and requirements when it agreed to procure a replacement PAS from the supplier of its existing PAS."
The Western Australian Health Department said it had begun to address the issues outlined in the report.
"[WA Health] is confident that it will have an initial roll-out of the PAS from mid 2011," the department said in the report. "WA Health has also strengthened the ICT project management and governance framework ensuring suitable protocols for reporting, record-keeping, controls and accountability."