HealthLink boss calls for health IT overhaul
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In the wake of a controversial decision over an e-referrals tender for the Nelson-Marlborough District Health Board, one of the bidders, HealthLink, says the national health strategy needs overhauling and completely revising.
“We need to take a fresh look at the way in which healthcare IT is guided,” says HealthLink chief executive Tom Bowden in a letter to National Health Board chairman Murray Horn and Ministry of Health Information Group director Graeme Osborne.
It is an open letter to the health sector, which Bowden says is being widely circulated.
He has attached a reply from the Nelson-Marlborough board to an Official Information Act enquiry into a competitive bidding process for the supply of an electronic referrals system.
A table with the reply shows that the winning bidder’s solution was ranked 50 percent lower than either of the other two bidders but the winner’s price was five times that of the most competitive bidder, he says. BPAC, which was unsuccessful, had sought the information. The other two vendors are not named.
“While the best scoring/preferred vendor was told informally that they had won the bid, Nelson-Marlborough was then apparently directed to pause the bidding process,” Bowden says. “The contract has now been awarded to the worst scoring and most expensive supplier.
“My understanding is that the rationale behind these decisions to support the development of a regional South Island IT solution and that the directive to ‘make the right decision’ was given to Nelson-Marlborough by the National Health IT Board. Given the enormous disparity in costs and Nelson-Marlborough’s somewhat gloomy assessment of the value of the third-ranked system, I think it would make a lot of sense to undertake an independent assessment of what is going on.”
Bowden says he is at a complete loss to understand why interoperability standards are not being mandated and a competitive market for useful and innovative services opened up.
“I have for some time had mounting concerns at the direction that health IT is taking and I am somewhat skeptical at what is being achieved. My criticisms are aimed at the current round of efforts to connect community based healthcare providers with the rest of the sector. The National Health IT Board has expended considerable resources in this area, and, some four years on, we have yet to see much in the way of material progress.
“Among the projects being led by the board are GP2GP transfer, which has cost a lot of money and is still at a very fledgling stage; e-prescribing, which appears to be happening in hospitals but some four years on is still not available in the community; and share care, which seems to be struggling to make a mark within the sector.
“None of these projects appears to be delivering any tangible benefits to a hard-pressed sector that is desperate for automation and improved productivity.
“As a commercial provider of IT solutions for the sector, we are getting little if any help to get the job done and sometimes it feels as though a number of our key initiatives are even being undermined and perhaps even blocked.”
Bowden believes there are two key policy problems:
“We have delegated decision making and leadership to a group that appears to want to run and manage IT projects rather that to encourage innovation and investment,” he says, and “the design of the system (system architecture) is a rigid, hierarchical model and in my view most unsuited to the New Zealand healthcare environment, particularly given the fact that there is already an existing IT infrastructure in place that it would need to supplant.”
He says the health IT board seems to have taken a particularly hands-on approach, channelling investment through General Practice New Zealand and contracting it to build various systems, none of which appears to have gained widespread uptake… “it does seem a bit unfair that the limited amount of government funding is applied only to government-sponsored projects”.
Bowden notes that most countries are ceasing to build national systems because, he says, large, complex, centrally driven architectures are inflexible, costly and incapable of delivering the benefits that they promise.
“In my view, it would be an appropriate time to undertake an independent review of sector IT strategy in order to ensure that we are making the maximum progress possible,” he says.
“I view it as vitally important to the efficient functioning of the health sector that we achieve the best outcome from any public investment made in healthcare IT.”
Graeme Osborne says he has yet to receive the letter.
I have no problem fielding insults, barbed criticism and whatever else might be thrown but I do feel that those people wishing to just discredit others should not be shielded by a cloak of annonymity while they do so. If you want to go on the attack, please do say who you are and be upfront about it.
Any casual reader of this thread could be forgiven for thinking that health sector IT is run by a bunch of "well-poisoners". I don't think that conveying that impression is good for the sector do you?
So come on guys, either argue a little more politely and objectively or... if you really have to go on the attack, do so openly.
Posted by Tom Bowden at 6:22:28 on July 5, 2012
We have a total population of 4 Million, most DHB's in the WORLD have more than that EACH.. NZ is in no way LARGE in the scheme of things so lets get real. Reality is we only need 3 DHB's at best and one IT System to run the whole country.. Plus save the poor tax payer a fortune / reduce waiting lists..
Posted by SNMP at 15:49:40 on July 4, 2012
Posted by A Geek at 17:04:34 on July 4, 2012
As you will read I am proposing that instead of funding and running specific projects, the MOH uses the same funding applied as incentives to stimulate innovation amongst competing providers- This is working around the world.
I also advocate interoperability standards rather than proprietary solutions. How much use will it be if the Nelson and Wellington eReferral systems cannot communicate? Currently they won't.
This is not sour grapes about losing a tender, the deal was won (and then lost) nine months ago and besides which was only worth $35,000 a year to us.
Fact: HealthLink is not delivering GP2GP. Because we believe in the concept we are providing our messaging network for it at no charge and we are being paid $36,000 per annum to provide first level support for it. The software was developed by GPNZ. We are helping as and where we can to make it work.It is hard going.
Overall Comment: We are agents of change and currently change is not happening fast enough for us. Making Health IT work is a long game and to get results you need to make the right moves at every step. We simply do not believe that the current approach is delivering the goods.
Readers of this thread may also enjoy this article.
If for some reason any of these links do not work, please contact me at the email address below and I will send them to you directly.
Tom Bowden firstname.lastname@example.org
Posted by Tom Bowden at 13:51:59 on July 4, 2012
GP2GP, despite a lengthy requirements phase, was delivered in a fraction of the time and cost of its UK counterpart and didn't even get further than the requirements stage in Australia where it was blocked by the leading GP vendor. Naturally, there are practical challenges in transferring entire patient records - not least because the relevant messages are larger than anything that the transport service provider has previously dealt with.
On the other hand, the first NZ E-Referral specification dates back to 1997 and in 2012 we are still arguing about which implementation to use and waiting for a standard data model. Whether this should be resolved by businessmen, clinicians, bureaucrats or software development professionals is a moot point. Perhaps a combination, with everyone sticking to their particular area of expertise.:)
Posted by Private Opinion at 15:20:30 on July 4, 2012
However I am calling into question the current economic model and the decision to manage and implement these systems centrally, rather than to define standards and create a contestable, competitive and ultimately collaborative marketplace.
It is too important to the NZ economy just to leave the current policy which has now been running for four years unquestioned when it has yet to deliver nand shows no imminent signs of doing so.
NZ has the best joined up Primary Care in the OECD, bar possibly Denmark (view Commonwealth Fund comparisons 2005-2012). As a sector we are used to getting things done and if that means making radical change to the way we do things, then thats what we will do.
I have been called by a number of people supporting my stance and intend to continue to press for change on this front. We need to improve health system productivity and we can do it- If we are allowed to get on with the job.
Posted by Tom Bowden at 20:43:27 on July 4, 2012
What happened in the decade leading up to the Horn Report and National Health IT Plan? - I think that Ian McCrae described it as a "10 year cup of tea"..not to mention the odd trip to the Commerce Commission.
Private vendors are crucial to the solution, but I don't think that they are the only component. Healthcare is predominantly a public service and some regulation by those directly accountable to the tax payers is required; furthermore, funding organisations to produce interoperability solutions that save every single vendor from solving the same, common, problems (ultimately, at the public expense) might just be a smart way of joining those dots.
Posted by Private Opinion at 22:07:00 on July 4, 2012
Posted by Anonymous at 21:39:48 on July 4, 2012
Posted by Anonymous at 11:49:15 on July 4, 2012
Posted by Anonymous at 11:20:46 on July 4, 2012