New South Wales special commissioner Peter Garling has prescribed an aggressive A$704 million (US$461 million) investment strategy to cure NSW Health's sick information technology systems, in a landmark review published late yesterday.
"What currently exists is a largely paper-based system with significant variation from clinician to clinician, ward to ward and hospital to hospital," Garling said in his comprehensive three-volume report on NSW's health system released yesterday.
"Whilst much of the work undertaken in NSW public hospitals is "high tech", its record-keeping system is a relic of the pre-computer age," he said. NSW Health's IT operations are in general led by departmental chief information officer Mike Rillstone, although each area's health service also has its own CIO.
The commissioner has recommended a "one-off injection" of A$704 million (US$461 million) to remedy a system that had been bogged down not just by paper, inconsistent documentation and illegible handwriting, but also substandard hardware, incompatible software and inadequate broadband connectivity.
"In my view, insufficient funds are allocated to information technology to get it up to the standard needed in an acceptable time frame," Garling said.
"Far more aggressive targets are necessary and must be set than those currently in place," he said.
The proposed four-year investment strategy, on top of the A$315.5 million (US$206 million) already planned, which he hopes will be rolled out by 2016, includes amongst other things an additional A$144 million (US$94 million) for a statewide rollout of an e-health record system; A$155 million (US$101 million) to boost network connectivity; A$85 million (US$55 million) on an automated rostering system; and A$112 million (US$73 million) on a medication management system.
Garling highlighted the cost of poor technology to patients' health. Following the analysis of one patient's brain injury, it was found that staff failed to monitor the patient's sodium levels. Garling said this was likely avoidable if the hospital had consistent documentation practices.
"The entry of the sodium results in the notes was not immediately obvious," Garling noted.
Dr McGlynn, who was interviewed by Garling for the inquiry, had said that the most commonly reported incidents at his hospital were prescription mistakes, because staff often failed to relate the patient's weight and age to the dosage.
NSW Health's configuration of the CERNER electronic medical record system, currently being implemented, also came under fire. NSW Health said it could not afford to include a "to do" list within the system and said that automated warnings to flag a patient's changed status during treatment wasn't necessary.
"In my view, medical alerts can play an important role in ensuring that optimal patient care is delivered," Garling said, however added that they should not be overused.
The National E-Health Transition Authority's (NEHTA) submission to the inquiry for clinicians highlighted that paper-based clinical reporting systems were not suited to current acute health care procedures, which often required a patient to move between several specialist facilities for treatment. NEHTA is the nation's peak e-health body.
Echoing a view by some clinicians, Garling brushed aside privacy concerns associated with implementing a state-wide electronic record system and has recommended one that can be "readily accessed by all health professionals". He noted that banks had overcome privacy obstacles similar to those faced in health care.
"Many privacy concerns are raised in the health sector which prove, on closer examination, to be based on unnecessary fears. Unwarranted privacy concerns may become an obstacle to much-needed reform," he said.