eHealth NSW projects running behind schedule but benefits revised up
Several major eHealth NSW IT projects are running behind schedule, including the statewide roll-out of the MetaVision ICU system, Cerner’s Community Health and Outpatient Care (CHOC) EMR extension and the new incident management and rostering systems, but in many cases the estimated benefits have been revised upwards.
Acting auditor-general Tony Whitfield tabled a financial audit of NSW Health today that shows that of the nine major IT projects worth more than $20m that eHealth NSW is currently managing, six are running behind the original timeframes but all seem to be within budget.
The main laggard is the roll-out of the MetaVision system from iMDsoft to all adult, paediatric and neonatal ICUs in the state. The auditor-general reported that this $43.1 million project was supposed to have been completed in 2016 but will only get started in earnest next year, with a completion date of 2020 most likely.
However, the estimated quantitative benefits of the project, which eHealth NSW says is the world’s largest system-wide ICU clinical information system implementation, have been revised up to $481 million, more than double the original estimate of $211m.
As the auditor-general writes, over the next four years eHealth NSW plans to spend more than $240 million completing the nine projects with the expectation that the NSW health sector will achieve $2.7 billion in quantitative benefits from its overall investment of $671 million, or $3.98 for every dollar spent.
iMDsoft won the tender for what eHealth NSW is now calling the electronic Record for Intensive Care (eRIC) solution in 2013. It is also widely used in Queensland.
eHealth NSW said the first go-live of eRIC was planned to take place at Blacktown Hospital’s ICU in mid-2016. The design and build phase of the eRIC program began over a year ago with six build cycles completed and a remediation period to improve the user experience and user interface.
Of the other projects, the massive $170m electronic medications management (EMM) statewide roll-out appears to be on track for a completion date in 2018. As part of the project, Cerner’s EMM module will be implemented in 28 hospitals. It has already gone live at Concord Hospital and is about to at the Children’s Hospital at Westmead and Prince of Wales.
eHealth NSW has revised up its estimate of quantitative benefits of the overall EMM program from $369.6m to $479.2m. There is still no word as yet on when the Local Health Districts that use Orion Health’s EMR will choose an EMM system, but that is part of the overall budget.
Cerner is also building the Community Health and Outpatient Care (CHOC) system as an extension of its EMR. It has already been rolled out to a number of community health services over the last two years and was originally planned to be completed by next year, but that has been pushed out by a year to 2017. Its benefits have also been revised down from $401m to $265m.
Phase two of the roll-out of Cerner’s EMR is on track to be completed in 2017 and it seems to be on budget. It has the largest quantitative benefits associated with any project at an estimated $590.7m.
There will also be a two-year delay in the full roll-out of the $22m incident management system to 2018, and the timeline for the new statewide rostering system HealthRoster has blown out by five years.
The auditor-general has recommended that eHealth NSW perform a detailed review of the way it manages information technology projects. The review should analyse the reasons for project delays and identify strategies to mitigate the risk on future projects, he said.
Non-clinical and construction
HealthRoster was expected to be rolled out last year but now has a completion date of 2019, and it is in danger of breaking its budget. It was originally budgeted for $94.8m, which has since been revised down to $89.6m but $85m has already been spent.
The rostering system is seen as essential to bringing down the rate of NSW Health employees, particularly medical officers, who are not taking their holidays or are being paid lots of overtime because they keep getting called back to work.
Mr Whitfield reports that one medical officer earned more in overtime and call backs than in base salary in one year, and another earned more than $503,000 in overtime and call backs over the past three years.
NSW Health wants the new rostering system to provide better visibility of employees between rosters and to help minimise back-to-back shifts inside required rest periods, but admits there have been delays in the roll-out.
These delays have been caused by different maturity levels in rostering practices throughout the state, problems with software performance, and ongoing scalability issues which the auditor-general says are currently being resolved with vendors.
In terms of infrastructure projects, the auditor-general also reports that all four of the major hospital construction projects that had an estimated cost above $50 million or more were completed ahead of time and within the approved budget, including the Campbelltown Hospital redevelopment, the Hornsby Hospital redevelopment, the Missenden Mental Health Unit upgrade and the Royal North Shore Hospital clinical services building (pictured).
The Royal North Shore project was $62.1 million higher than the original budget due to scope changes and delivery of 60 additional beds.
In all, NSW Health is currently managing 20 major projects costing more than $50 million, at a total cost of $4.3 billion. The auditor reports that most projects are running on or ahead of time. At June 30, NSW Health’s infrastructure division had spent $1.6 billion on these projects, or 36.3 per cent of the original budgeted cost.
The auditor-general also found that four local health districts or specialty networks were not meeting performance expectations – three of which were rural LHDs that have special circumstances – and only South Eastern Sydney was assessed as a serious underperformance risk.
Mr Whitfield says the district has a formal recovery plan, but fell short of both expenditure and revenue strategies in 2014-15.
NSW ambulance response times remain above the national average and the time to transfer patients from ambulances to hospitals remains below target, but emergency department response times were, on average, met across all triage categories.
NSW has a longer average length of stay in hospital than the rest of the country at 3.1 days, and it also has more available public hospital beds per 1000 of population than the national average.
National elective surgery targets (NEST) were improving and near the state’s goals, although unplanned readmissions were at seven per cent compared to the Ministry of Health’s target of five per cent.
NSW Health reports that as elective surgery wait times do not include the time it takes for patients to see a specialist and get onto the waiting list because data on surgical access time is not recorded, the ministry is now working with the Australian Institute of Health and Welfare to devise a national measure on surgical access time, being the time taken from seeing the general practitioner to surgical care.