Victoria's HealthSmart system introduces 'safety risk' to patients

Victoria's statewide healthcare IT system has failed to achieve its goals, and has been criticised for putting patients at potential risk by administering wrong medications or incorrect doses.
Written by Michael Lee, Contributor

The Victorian Department of Health has an inadequate understanding of its clinical IT systems and failed to plan adequately for 19 of its services, according to a report from the state's auditor-general.

The report (PDF) found that the department "significantly underestimated project scope, costs, and timelines, as well as the required clinical and other workflow redesign and change management efforts".

At the centre of the state's issues is the statewide HealthSmart system. The clinical IT system has only been installed at four of the 19 state hospitals that it had been planned for, and only one installation is considered to be fully implemented.

At three of the sites, the systems introduced significant risks to patients, with prescriptions sometimes being manually amended to reflect the actual medication that should be prescribed, or instances where discharge statements would need to be completed even prior to surgery or treatment taking place.

Problems have resulted in over 100 incidents where medication has been missed or nearly missed, or medicines administered at higher doses than prescribed.

"While these three health services have put some manual workarounds in place to reduce the potential risks, they are not fail-safe, they increase inefficiency in the short term, and they do not provide a long-term solution to the identified problem."

A ministerial review of the HealthSmart system, released earlier this week, argued for the abolition of the "participation policy" that currently forces all 19 hospitals to use or otherwise adopt the system.

However, the auditor-general's report highlights that any decision to continue or discontinue the existing HealthSmart and disparate systems would be made blindly. The report states that the department has not created any processes to evaluate the performance of any clinical IT system, despite some of the non-HealthSmart sites being implemented at a fraction of the cost.

"Apart from some anecdotal statements and minor preliminary studies conducted by health services, [the Department of Health] and health services are currently unable to report on the delivery of intended benefits or outcomes from clinical IT systems. [The Department of Health] is unable to evaluate the benefits and value for money of one system versus others."

Although there is no data to highlight the benefits of each system in providing value, the report has calculated the cost of each system. At non-HealthSmart sites, the average cost of installation is AU$1.8 million. The systems at these sites have been developed with clinicians, and, according to the report, they enjoy "wide acceptance and support from end users" despite not being functionally equivalent to HealthSmart.

Across the four HealthSmart sites, the average installation cost is AU$36.3 million.

The report notes that at October 2013, the HealthSmart IT system cost AU$145.3 million, some AU$87 million (150 percent) over the original budget of AU$58.3 million.

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