As the Victorian Parliament picks over the bones of its now-scrapped HealthSMART program, key stakeholders have suggested that the project suffered from too many lines of accountability – but none with the power to compel change – and a standardised approach that failed to take into account the devolved reality of the State’s healthcare system.
Following the announcement in May this year that the Victorian Government would close down the $500 million eHealth roll-out, a parliamentary inquiry into the delivery of major infrastructure projects has directed its attention towards learning the lessons of the project’s failure.
Witnesses fronting the inquiry seemed to agree that imposing standardised patient administration and clinical systems across a diverse and devolved health system was always going to present challenges.
“The logic was you build it once and you implement it many times. The idea of the cost savings you get from building once and implementing many times is a fair point. I think the reality is that while we all like to think that hospitals and agencies do processes the same way, they do not,” said Gary White, health operations director for key HealthSMART contractor CSC.
The Baillieu Government has taken this conundrum to heart, replacing the state-wide HealthSMART roll-out with a hospital-by-hospital eHealth program that will see the multiplication of diverse platforms continue into the foreseeable future.
However, the opinion of both Government and non-Government participants to the inquiry was that some more muscular change management during HealthSMART’s lifetime would have gone a long way.
Newly appointed Secretary of Victoria’s Health Department, Dr Pradeep Philip said that while everyone agreed on the need for eHealth systems, not everyone was prepared to deal with the changes that this necessarily implied.
“A common system will never meet all of their requirements, because it would be impossible to account for the variation of every individual clinician...Any new system you implement which requires a change needs you to go and hold people’s hands and help them through that,” he said.
From White’s perspective, the number one issue preventing this sort of behavioural shift from taking place was the complex three-way contract relationship between CSC as the supplier, HealthSMART and each of the State’s health agencies with responsibility for day-to-day operation of hospitals, which blurred efforts to compel clinicians to alter their habits.
“I think that was the biggest issue,” he said.
“HealthSMART, as an agency, did not seem to have the power to force or implement that change upon the agencies. It was very much the agencies driving HealthSMART. That is where that contractual thing got slightly awkward because we were trying to implement in the agencies something which HealthSMART defined as a footprint, but the agencies were pushing back and were not willing to implement.”
These peculiarities of the Victorian public health system were put forward by CSC as just one of the reasons a nation like Brunei has been able to roll-out its comprehensive e-Health system in nine months at a cost of just over AUD$6 million, while the State of Victoria is now $500 million out of pocket for a hospital program that has been declared dead-on-arrival.
“I can tell you verbatim, [Brunei’s] Minister of Health there asked me why it takes so long in other jurisdictions. I mentioned committees,” said CSC Healthcare’s managing director James Rice.
“If it were not so serious, it would be funny,” lamented National Party MP and committee member David O'Brien.
Nearly all Australian Government jurisdictions have also embarked on an eHealth journey, and while some have come across implementation challenges, for example NSW Health’s widely rejected FirstNet system, none have been as comprehensively shut down as HealthSMART.
eHealth continues to attract significant funding across the States and Territories. Health ICT programs survived budget cuts in both South Australian and Queensland this year to emerge as the most valuable technology allocations in each State’s 2012-13 Budgets.
SA earmarked $193.6 million to roll-out a state-wide Enterprise Patient Administration System (EPAS) over ten years. Queensland Health will receive $66.3 million in 2012-13 to fund eHealth clinical systems and ICT infrastructure.