A tale of two tech sites
Health IT and horrible literary allusions got mixed together this week for Pulse+IT's brains trust as we pondered the tales of two different EMR implementations in two different cities. Royal Children's Hospital in Melbourne had the best of times, our story on its Epic implementation from last week racking up a huge amount of hits on our site. It's destined to be one of our most popular ever.
While it wasn't quite the worst of times for Sydney's Northern Beaches Hospital – there has been far, far worse publicity than this, we assure you – the ill-fated opening of the hospital last year has now caught Telstra Health's EMR in its spotlight.
We'll spare you our ruminations on the age of wisdom and foolishness, the epoch of belief and of incredulity, the spring of hope and the winter of despair, and ask you to assess these stories for yourself, but keep in mind that no state, no country and certainly no EMR vendor has ever experienced smooth sailing.
Sydney's Northern Beaches Hospital has come under a great deal of scrutiny since it opened last year. It has always been a bit controversial: long promised to the people of northern Sydney but resisted by many who invested years into Mona Vale and Manly hospitals, it is the enduring legacy of former NSW health minister and local MP Jillian Skinner, an extremely capable minister who was unceremoniously dumped by her party before her crowing glory was anointed.
The hospital's public-private partnership (PPP) status has always been a bone of contention and its cost long hidden. NSW has spent $600 million on the build and $400 million on road upgrades, added to the $1.14 billion it is paying Healthscope to run the hospital until 2038. It has 488 beds, 60 per cent for public patients and 40 per cent for private.
That it opened to horror stories in local and state media last year came as no surprise, and the NSW upper house is now holding an inquiry into it. To our great delight, public and private submissions to that inquiry are full of juicy detail, including about the state of the clinical and operational IT. Leading the charge in criticism has been the doctors' union ASMOF, which has shown itself to be seriously displeased.
There was an interesting comment in ASMOF's submission about the EMR seeming to have been developed not for a public hospital but for individual clinicians in rooms, and that is exactly what the original system was developed for. The NBH EMR is Emerging Systems' EHS, which was bought by Telstra Health in 2014 but which traces its roots back to the deLacy system developed by clinicians from St Vincent's Private Hospital in Sydney in 1992.
(Telstra Health points out that the NBH EMR is in fact a newly designed modular system, built specifically for hospitals, and is not the same as the St Vincent's system.)
It has been used successfully by St Vincent's public and private hospitals in Darlinghurst ever since, and is also installed at St John of God Midland in Perth, another public-private partnership.
The complaints from clinicians at the Northern Beaches are the usual – it appears to be slow and unresponsive – but their main gripe is that a promised health information exchange between the Telstra Health EMR and the Cerner system used in other NSW Health hospitals, including those in the same local health district such as Royal North Shore and Mona Vale, has not eventuated.
Doctors say they were promised they would not have to swap between two systems, but it appears that they will have to do so for the time being. Coming on top of staffing and resourcing problems, the IT issues seem to have compounded their frustration, and it's not hard to see why.
Northern Beaches Hospital has also seriously annoyed local GPs by not consulting with them on continuity of care and sharing of information. There's little more that gets up GPs' noses than being left in the dark about their sickest patients.
It's far preferable that people get these projects right rather than rush them so we are not going to quibble over delays. In Queensland, Sunshine Coast University Hospital delayed its ieMR implementation by a year but is now live, while Metro North and Darling Downs have been pushed back 18 months. Cairns Hospital looks like it is having a great deal of trouble getting its project on track.
There's also a state election due in Queensland by October next year and it's pretty obvious that Annastacia Palaszczuk and Steven Miles do not want questions about patient safety dominating the front page of the local rag. Allscripts' EPAS project dogged the former South Australian state government and the two implementations have a lot in common on a public relations front.
WA had its fair share of horror stories following the opening of Fiona Stanley Hospital – which still takes top prize for troubled new hospital openings, pipping Perth Children's Hospital, Queensland Children's Hospital and Northern Beaches for ugly headlines – and we understand that the roll-out of InterSystems' TrakCare at Bendigo Hospital is also behind schedule. There hasn't been an update on the Northern Territory's core clinical systems renewal project for a while either.
The only state where you don't hear bad news about the EMR is Tasmania, and that's because it doesn't have one.
The good news is these problems can be overcome, by focusing on fixing clinical and user experience issues or by pausing implementations until they are done right. We've written extensively in the past about NSW Health's problems with the Cerner eMR roll-out. It was paused in 2012-13, fixes were applied and it is now going well. Victoria had the same with HealthSmart – that project was cancelled, but the basic Cerner EMRs that were implemented in a number of very large health services are now being invested in and improved upon.
All eyes next year will be on Melbourne's Parkville precinct, which has seen Epic go live at Royal Melbourne's ED and the rest of that hospital and neighbouring Royal Women's and Peter Mac scheduled for a big bang next year. RCH has seemingly pulled off the impossible and smoothly implemented a complex system from Epic, which has had well-documented successes and failures internationally, with good figures on mortality and error reduction now flowing through.
One highly respected academic had a word of warning for us when we spoke to him at HIC about the RCH implementation. Paediatric hospitals are a special class and staff motivation to achieve the very best for their small patients is very high, he said. The test will come with a busier and messier hospital in Royal Melbourne.
That brings us to our poll question for the week: Should EMR vendors be penalised for poor hospital deployments?
Our poll last week asked: Will technology improve the quality of aged care? Three quarters (75 per cent) of respondents said yes, while one quarter said no.
On 7 June 2019, Pulse+IT published an article in the Blog section of our website entitled "Point of No Return for Dr Cerner" which contained statements concerning Dr Richard Ashby, the former CEO of eHealth Queensland. The article contained statements that may have been interpreted by readers that Dr Ashby was corrupt and forced to resign as a result. Pulse+IT accepts that, after a lengthy investigation of the allegations, the Crime and Corruption Commission of Queensland and Queensland Health have made no adverse finding against Dr Ashby, and no further action is being taken by either agency. Pulse+IT wishes to apologise to Dr Ashby for any negative inferences that some readers may have taken from our publication.