Pros and cons of a single vendor exposed
It seems like just last month that we were taking a close look at the roll-out of the Cerner integrated electronic medical record (ieMR) in Queensland (and what do you know, it was) but we were still keen when a large report on the system by the state's auditor-general thumped down on our table this week, figuratively speaking.
The main headlines following the report's release were about a probable blowout in the budget for the system, estimated at $1.2 billion in total since it began in 2011 until its expected conclusion in 2025, mainly due to extra resources being required by individual HHSs. We've reported on this in the past.
Reading the report closely, however, you can see that it makes a lot of the fact that Queensland has gone down the single vendor track and questions whether the state is getting value for money on its investment, not having tested the market for some years. While it repeats its 2013 finding that cleared the state government for its initial procurement of the system, this is still an issue that rankles with other EMR vendors as well as specialist software providers.
(It brings into question as well the issue of Queensland Health only inviting Cerner and DXC to tender for the huge PAS replacement project, rather than going to an open tender.)
From the report, we see that Queensland Health is now dividing the ieMR into three categories: basic, intermediate and advanced, with the intermediate level consisting of what was once called the digital hospital stack, and the advanced level including the medications, anaesthesia and research (MARS) modules. Some anaesthetists are still not happy about that, including those in Cairns who want to stick with their existing Winchart system or go to market for an alternative.
The Cairns anaesthetists have been told that they can have what they like, but Queensland Health won't pay for it or support it. It seems it's the same story with Townsville, where doctors have arced up over the maternity module, saying the Cerner system has not met their needs as the workflows do not align with the hospital’s processes. We hear that the Townsville clinicians wanted to stick with their existing maternity system – Matrix, from Meridian Health, which is also being rolled out in NSW – but were told to use Cerner instead, and it seems they are none too happy with that. Unfortunately, the auditor-general makes clear in his report that specific clinical concerns with the ieMR solution were out of scope for this week's audit.
While there are grumbles, some organisations are happy with Cerner's system, including St Stephen's at Hervey Bay, which recently became the first in Australia to achieve HIMSS Level 7 for its inpatient EMR. Royal Children's Hospital in Melbourne, which uses Epic, was recently certified as HIMSS Level 7 as well, but that is on the outpatients EMR adoption scale.
We had a chat recently with UnitingCare Queensland's lead clinical information officer Patricia Liebke about the steps needed to get from 6 to 7, and we'll bring you that story next week. In the meantime, Pulse+IT hosted a webinar this week explaining what the different levels are and the difference between the inpatient and outpatient models. You can take a look at that here. We hope to have a chat with RCH soon as well about their steps from 6 to 7 in what is a much bigger, far more complex hospital.
During the webinar, HIMSS Analytics' client relationship manager Tina Hashim said HIMSS had done assessments across all of the NSW LHDs, along with quite a few in Queensland, Victoria, the ACT, Tasmania and the NT, although where each hospital sits is still under wraps. Medications management, barcode scanning, nurse documentation and CPOE are big parts of the HIMSS criteria, so while a few hospitals would be HIMSS Level 5, we reckon most of the country would still be 2 or 3.
When New Zealand conducted this exercise a couple of years ago, it found exactly the same – a few ahead of the pack, but many still mainly on paper outside of the basic pathology, radiology and pharmacy systems.
Back in Queensland, the digital hospitals audit report found that while there was a belief that the ieMR was providing better, safer care, the purported benefits have been slow to be realised and the cost of the overall program has been underestimated. When you are talking $1.2 billion, that's a lot of underestimation, and it seems clear that if the program is to be extended to 27 hospitals by 2025, it will need more money. We'll see how much the government has in the kitty.
While $1.2b seems like a lot to Australia, spare a thought for the sums being spent on the Cerner system that is going to replace the Department of Veterans' Affairs VistA system in the US. The total cost is expected to come in at $16 billion, $10b of which is for Cerner itself.
Cerner was rated by Black Book as being the best vendor for the job and it is all above board, but it was interesting this week to read a follow up to an explosive investigation earlier this year by Politico into the very shady crowd surrounding one Donald J Trump, three of whom have decided to get involved in the VA EMR program. Have a read of this follow-up story from Pro Publica and see how things are done in the Southern White House, while its current inhabitant is still in situ.
That brings us to our poll question for the week: is a single EMR vendor policy the best one for state health departments?
Last week, we asked: Do you think the My Health Record will rate as an election issue? No, most people said. 22 per cent said yes, but 78 per cent said no.