Health IT Cluster questions DHB software push

The NZ Health IT Cluster is questioning the timing and approach of seven District Health Boards collaborating on a major patient management software tender and pointing to a major UK project failure as a warning.

In a letter to the principal consultant on the project, Simpl's Joanne Wakelin, and copied to the deputy director general of the information directorate of the Ministry of Health, Alan Hesketh, the cluster says the DHB collaboration "has the potential to profoundly alter the market both now and in the future".

The Cluster is an alliance of organisations interested in health IT, including vendors and is contracted to represent the views health IT vendors to the ministry. It wrote to members to seek their views on the software collaboration and a request for information (RFI) that was issued in December.

"Unsurprisingly, not all views solicited from members were complementary," the letter, signed by cluster CEO Andrea Pettet, says.

The health boards involved in the RFI are Canterbury, Nelson Marlborough, South Canterbury, MidCentral, Wairarapa, Whanganui and Northland. The December RFI says the effort has the support of the Ministry of Health.

The cluster says it supports the general thrust of the RFI and agrees there is a need for significant investment in health IT systems. However, the group is concerned about what it sees as a clear preference for proposals that meet all of the requirements.

"We see this, and the significant recent interactions by key players with large US based suppliers of monolithic solutions, as strong indicators of a preference for a strategy that will move away from the current best of breed standards based interoperable approach," the letter says.

"Our concern is that, whether or not this is in fact the best approach to the health sector's needs, there has been little or no public debate about what would be the most significant change in health IT strategy seen in New Zealand for at least a generation."

The cluster says the collaboration by the DHBs and the RFI seems to have been taken before a planned update of the national health IT strategy, "which should form the basis of the debate that we feel is required".

The cluster is concerned about the impact the RFI may have on the local health IT industry.

"The Health IT Cluster representing over 70 New Zealand organisations would greatly welcome an opportunity of discussing these issues of fundamental importance to our country with key stakeholders; not simply to pursue narrow sectional interest, but to ensure that all voices are heard before commitments are made that will alter for the next generation the way healthcare is delivered in New Zealand."

The cluster questions the use of the term electronic health record in the RFI, saying it implies a solution "which in our view is not yet established as the basis for the optimum approach".

"It also leaves open many questions about what is meant by an EHR, its architectural context, what it contains, who is its custodian, what are the implications in respect to security and confidentiality etc.

"We are concerned that given the preference for a single sourced option, there is an assumption that the current strategy based on interoperable standards with 'best of breed' solutions has not worked and therefore must be abandoned in favour of a monolithic single sourced solution.

"The underlying view seems to be that standards are too hard, we cannot progress them fast enough and that the number of interconnections, expanding exponentially as more applications are added to the ecosystem, create levels of complexity that are unmanageable.

"However, the reality of health IT in New Zealand for the last 15 years is that there has been no serious commitment at any level to make the decisions, develop the strategies or make the investments needed to attain the success of these strategies."

The cluster then points to recent failed efforts in the UK to "impose" a single sourced option on the NHS at a cost of about $60 billion.

"We would prefer to see priority be given to the development of the necessary architecture and infrastructure to enable data interchange across all care settings. This Services Orientated Architecture approach, along with a standards certification regime, would enable healthcare providers to select the best product for any given application area, confident in the knowledge that interoperability would be designed into the application."

The cluster also warns the RFI is at risk of pre-empting what may be "critical dependences".

Also of importance, the letter says, is the Ministry of Health's initiative to revise the Health Information Strategy.

"If this has the objective of providing a national vision of need, strategy, design and architecture, then this should provide the template for the DHBs in its strategic execution. The fact that the RFI precedes the published results of this exercise by as much as six months, is of concern in terms of addressing the need for a conformant strategy in New Zealand."

Some cluster members are concerned choice has already been narrowed to exclude their participation.

"The release of an RFP soon after the current RFI process, would support the view that a decision has potentially already been made," hte letter says. "Furthermore, this would preclude a full transformation programme of health services in New Zealand, which is considered by some as fundamental to the success of this vision."

In summary the cluster says it is very concerned about the risk to the local software economy if a single offshore vendor is selected.

"A move in this direction may force some vendors out of business and others to focus on international markets, putting New Zealand at the bottom of the 'food chain' in terms of product development and support. NZ is well known for innovative solutions and we believe a vibrant partner ecosystem will deliver better health outcomes for all New Zealanders.

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