In the wake of a controversial decision over an e-referrals tender for the Nelson-Marlborough District Health Board, one of the bidders, HealthLink, says the national health strategy needs overhauling and completely revising.
“We need to take a fresh look at the way in which healthcare IT is guided,” says HealthLink chief executive Tom Bowden in a letter to National Health Board chairman Murray Horn and Ministry of Health Information Group director Graeme Osborne.
It is an open letter to the health sector, which Bowden says is being widely circulated.
He has attached a reply from the Nelson-Marlborough board to an Official Information Act enquiry into a competitive bidding process for the supply of an electronic referrals system.
A table with the reply shows that the winning bidder’s solution was ranked 50 percent lower than either of the other two bidders but the winner’s price was five times that of the most competitive bidder, he says. BPAC, which was unsuccessful, had sought the information. The other two vendors are not named.
“While the best scoring/preferred vendor was told informally that they had won the bid, Nelson-Marlborough was then apparently directed to pause the bidding process,” Bowden says. “The contract has now been awarded to the worst scoring and most expensive supplier.
“My understanding is that the rationale behind these decisions to support the development of a regional South Island IT solution and that the directive to ‘make the right decision’ was given to Nelson-Marlborough by the National Health IT Board. Given the enormous disparity in costs and Nelson-Marlborough’s somewhat gloomy assessment of the value of the third-ranked system, I think it would make a lot of sense to undertake an independent assessment of what is going on.”
Bowden says he is at a complete loss to understand why interoperability standards are not being mandated and a competitive market for useful and innovative services opened up.
“I have for some time had mounting concerns at the direction that health IT is taking and I am somewhat skeptical at what is being achieved. My criticisms are aimed at the current round of efforts to connect community based healthcare providers with the rest of the sector. The National Health IT Board has expended considerable resources in this area, and, some four years on, we have yet to see much in the way of material progress.
“Among the projects being led by the board are GP2GP transfer, which has cost a lot of money and is still at a very fledgling stage; e-prescribing, which appears to be happening in hospitals but some four years on is still not available in the community; and share care, which seems to be struggling to make a mark within the sector.
“None of these projects appears to be delivering any tangible benefits to a hard-pressed sector that is desperate for automation and improved productivity.
“As a commercial provider of IT solutions for the sector, we are getting little if any help to get the job done and sometimes it feels as though a number of our key initiatives are even being undermined and perhaps even blocked.”
Bowden believes there are two key policy problems:
“We have delegated decision making and leadership to a group that appears to want to run and manage IT projects rather that to encourage innovation and investment,” he says, and “the design of the system (system architecture) is a rigid, hierarchical model and in my view most unsuited to the New Zealand healthcare environment, particularly given the fact that there is already an existing IT infrastructure in place that it would need to supplant.”
He says the health IT board seems to have taken a particularly hands-on approach, channelling investment through General Practice New Zealand and contracting it to build various systems, none of which appears to have gained widespread uptake… “it does seem a bit unfair that the limited amount of government funding is applied only to government-sponsored projects”.
Bowden notes that most countries are ceasing to build national systems because, he says, large, complex, centrally driven architectures are inflexible, costly and incapable of delivering the benefits that they promise.
“In my view, it would be an appropriate time to undertake an independent review of sector IT strategy in order to ensure that we are making the maximum progress possible,” he says.
“I view it as vitally important to the efficient functioning of the health sector that we achieve the best outcome from any public investment made in healthcare IT.”
Graeme Osborne says he has yet to receive the letter.