Tuesday, September 20, 2011

Australia and Health IT: Will Government Officials Ever Learn?

Perhaps New Zealand professor Shaun Goldfinch's article "Pessimism, Computer Failure, and Information Systems Development in the Public Sector" should be required reading in their neighboring continent due northwest:

Pessimism, Computer Failure, and Information Systems Development in the Public Sector. (Public Administration Review 67;5:917-929, Sept/Oct. 2007, Shaun Goldfinch, University of Otago, New Zealand). Cautionary article on IT that should be read by every healthcare executive documenting the widespread nature of IT difficulties and failure, the lack of attention to the issues responsible, and recommending much more critical attitudes towards IT. link to pdf

Here's what's about to "go down" (no pun intended) Down Under, this time in the Australian state of Queensland:

Queensland Health eyes software system despite red flags
Koren Helbig
From: The Courier-Mail
September 21, 2011 12:00AM

QUEENSLAND Health is poised to sign a multimillion-dollar contract for computer software similar to that labelled "defective" by an IT expert who audited its use in southern hospitals.

University of Sydney's Professor Jon Patrick said electronic medical records systems built by Cerner Corporation for the NSW Government crashed frequently and risked patient safety.

A similar Cerner system installed by the Victorian health department also has been plagued by glitches and is five years behind schedule.

Dr. Jon Patrick's detailed forensic analysis of a Cerner ED system is at this link and has been a subject of numerous posts on this blog.

"I don't think there's any reason for optimism that they can be improved," Prof Patrick said.

Leaked internal documents have surfaced detailing problems already looming within Queensland, as bureaucrats negotiate with US-based Cerner to build a $243 million electronic medical records system in Queensland hospitals.

Technical information for the proposed Cerner system and existing IT platforms that it must work with was "often incomplete, not-comprehensive, inaccurate and out-of-date", a leaked position paper found.

Another email addressed to chief information officer Ray Brown, released to the State Opposition under Right to Information laws, warned of the increasing need to document potential risks "even if we can't find the resources to remove them" in case of disaster and patient death.

I guess dead patients can't complain about that, unless provided with underground megaphones.

"The no-surprises rule may be applicable and would help in a Coroner's Court," the clinical adviser wrote.

But, in a written statement, Mr Brown last night backed Cerner, which he said had successfully operated systems at the Royal Brisbane and Women's and Princess Alexandra hospitals for more than a decade.

A few anecdotes of success, let's ignore those pesky anecdotes of problems, and - WHAM! - let's spend billions and roll this out statewide/nationwide.

The problem with this (il)logic was well-explained by another physician Down Under who chooses to remain anonymous. See my August 2011 post "From a Senior Clinician Down Under: Anecdotes and Medicine, We are Actually Talking About Two Different Things" at this link. Read it carefully....

Mr Brown said Queensland had learnt from interstate problems and would implement an "end-to-end solution", rather than trying to marry different systems across hospitals.

Independent experts had verified the rollout and more than 4000 staff had been consulted, indicating their support for Cerner software, he said.

The debate came after The Courier-Mail yesterday detailed Opposition claims that Queensland Health bureaucrats deliberately changed an independent report to favour Cerner when hunting for software suppliers in 2009, which QH vehemently denied.

Prof Patrick, chair of Language Technology at the university's School of IT, said problems with Cerner's NSW and Victorian systems were well documented in 2009.

He said Queensland bureaucrats likely knew of the faults, which should have served as "red flags".

Cerner did not respond to a call for comment.

May I suggest that "red flags" often get ignored when the color green is present, at least in the U.S. (I don't know the colors of Australian currency.)


Who cares about "Red flags" when you can have wads of these?


-- SS

Addendum:

Dr. Patrick notes this at his aforementioned university page:

3.13 Statement on 22nd August 2011. I attended the HIC conference in Brisbane in the beginning of August and at a dinner hosted by IBM on the 2nd August I met Mr Greg Wells, the CIO of HSS, and the person responsible for the FirstNet roll out in NSW. He stated that Cerner had provided new software that would solve all of the User Interface problems and it was being rolled at the present time in the Northern Area Health Service region. He said all installations across the state would have this solution by Christmas this year. We shall watch with interest.

I guess solving problems like these simply takes a lot of pizzas and Coca-Cola.

-- SS

3 comments:

Steve Lucas said...

My personal belief is that we do not exist in a vacuum. Services and concepts migrate across academic and business lines to merge in products that are suppose to serve a purpose.

With that in mind I do not view the problems in health IT as unique. To the contrary, the problems in health IT are being exposed in other projects.

An example of this is this post from the BBC regarding consolidating 46 regional fire dispatching stations into 9:

Failed fire project wasted £469m, says committee of MPs

http://www.bbc.co.uk/news/mobile/uk-14974552

These quotes will be familiar to HCR readers:

“Hodge, who chairs the MPs' committee, said the project had been "flawed from the outset" and one of the worst wastes of public money for many years.

"The taxpayer has lost nearly half a billion pounds and eight of the completed regional control centres remain as empty and costly white elephants."

She said the project - launched in 2004 by the Labour government - had been terminated in 2010 "with none of the original objectives achieved and a minimum of £469m being wasted".

"The department excluded them from decisions about the design of the regional control centres and the proposed IT solution," it added.

The cross-party committee - which heard evidence in July - also said the project had been "rushed" and got Treasury funding without proper scrutiny of feasibility and costs.”

Matt Wrack, general secretary of the Fire Brigades Union, said he welcomed the report, but added that the fallout from the project was still being felt.

"[It] failed because ministers failed to listen to the voice of control staff and their professional representatives," he said.

He added that ministers believed the most effective approach was to build on the experience of local fire and rescue services, rather than imposing solutions from central government.”

So once again we have the battle cry that technology will save the day. Consultants are hired with no experience and a product that does not work is forced onto those who did not participate in its design and find it useless. Oh, and this is costing only GBP 4M per month to maintain.

Steve Lucas

Anonymous said...

Considering that the HIT devices causing these adverse events have not been approved by the FDA, the doctors who are using them should pause.

This is not user or human error, except for the errors of the doctors for using these dangerous devices in the first place and not calling out the leadership of UPMC for disruptive and self-serving conduct.

InformaticsMD said...

Steve Lucas writes:

With that in mind I do not view the problems in health IT as unique. To the contrary, the problems in health IT are being exposed in other projects ... So once again we have the battle cry that technology will save the day. Consultants are hired with no experience and a product that does not work is forced onto those who did not participate in its design and find it useless. Oh, and this is costing only GBP 4M per month to maintain.

"Only two things are infinite, the universe and human stupidity, and I'm not sure about the former."
- Albert Einstein (1879-1955)

-- SS