Victoria abandons health IT centralisation
Victorian health organisations will have a greater say in choosing and developing health IT systems after the state's ministerial review panel recommended greater devolution of decision making to health boards.
The Victorian government ordered the review in late 2012 following the collapse of the HealthSmart program. It was one of 10 large IT projects heavily criticised by the Victorian Ombudsman in a November 2011 report.
Victoria's move goes against the prevailing winds in the Australian public health sector, with most other states maintaining centralised decision-making and purchasing within state health departments.
Former South Australia Health CIO David Johnston told the Australian Centre for Health Innovation (CHI) conference in Melbourne last week that a single strategy for planning, purchasing and roll-out made sense for SA, but that it would not work in Victoria.
Victoria has a number of long-standing health IT alliances, including five in rural areas, that have made collective investment decisions predating the HealthSmart program.
Victorian Health Minister David Davis said the Ministerial Review of Victorian Health Sector ICT, undertaken by an independent review panel, sets out how Victoria should plan, fund, govern and implement ICT investment in health in the years to come.
“The findings and recommendations are pragmatic, directional in nature, recognise the need to fully realise the current investment in health sector ICT and position the health system for the future, particularly to meet the challenges of moving to eHealth,” Mr Davis said.
The review panel recommended greater devolution of decision-making to health boards but also recommended that a central governance role be retained to scrutinise major capital projects.
It recommended that “each health service provider is accountable for its own ICT procurement based on sound business cases” and that “the role of the [health] department is to stipulate priorities and objectives, not mandate specific systems”.
It recommended that future ICT investment be based on sound business cases and on critical priorities such as building electronic medical record capability across the state.
The Victoria government has only allocated $100 million over four years to investing in health IT, a small amount compared to other states. The review panel was asked to come up with recommendations for how these funds would be best spent.
One of its recommendations was to use some funds to encourage the widespread use of Individual Healthcare Identifiers (IHI) across state in order to allow new clinical decision support technologies to be developed.
“Given the architecture for IHIs has already been developed and there are trial sites active in Victoria, the panel agreed that building upon this base was the most appropriate way to build interoperability across the Victorian health sector,” the review states.
The panel has proposed the development of a statewide health ICT plan under the guidance of a governance council, and that this council should consider mandating the adoption of basic standards such as HL7, AMT and CDA for health service providers making new ICT investments.
It recommended that once the health ICT plan is comprehensively formulated, it should then co-ordinate with national eHealth initiatives, including but not limited to the PCEHR.
It recommended the governing council should ensure that any investment in PCEHR capability also supports the refinement of health service provider ICT systems that will improve health services regardless of the success or uptake of the PCEHR over time.
“The panel viewed the development of PCEHR as dependent on the implementation of healthcare identifiers,” the review states. “The IHI has a utility beyond PCEHR and therefore is a priority for the development of EHRs regardless of the final form of these records.
“While current and potentially future work will be required to verify initial estimates, the costs are expected to run into the tens of millions of dollars. The statewide health ICT plan might well be formulated to achieve greater connectivity and transferability of health information regardless of the final state of development of the national eHealth initiatives.
“The Victorian Department of Health should independently assess the progress of the planned rollout of the PCEHR against milestones. Based upon objectively reported uptake and utilisation of the PCEHR, it should plan progressive implementation of agreed ICT systems across the state to contribute to the PCEHR.”
The department should also carefully consider resolutions arising from the national eHealth strategy review that is currently being undertaken by Deloitte, the panel said.
Mr Davis said the government supported the majority of the panel’s recommendations.
He said health sector CEOs and chairs of rural alliances will be advised of the documents and the next steps to implement the recommendations.
Posted in Australian eHealth