Forum: Large-scale Health IT is a risky business

Almost everywhere, the dream of integrated electronic healthcare has fallen well short of reality

After last week’s exposé of ICT initiatives within the Ministry of Health (see letter in response), it is hard not to come to the conclusion that large health projects are terribly fraught.

That story retailed a number of suggestions that the Ministry’s National Systems Development Programme (NSDP) is showing signs of, well, project stress, in what has been a month of bad news for New Zealand’s hard-working health sector.

Almost everywhere that health executives or authorities have pursued the goal of integrated electronic healthcare the dream has fallen well short of reality — and usually cost a bucket of money along the way.

Most prominently right now, there is the UK National Health Service’s NPfIT (National Programme for IT) project, which has redefined the term “project failure”. So many things have gone wrong with this project that it is hard to enumerate them quickly, but, like our 1990s Police INCIS project, it was based on the wrong technology, and that’s never a good place to start.

NPfIT was based on a technology that hadn’t been fully developed, iSoft’s elusive Lorenzo, while INCIS was based on one — IBM’s OS2 – that was shortly to be discontinued, despite IBM’s insistence to the contrary.

Despite all this, every year Computerworld New Zealand gets to see some brilliant health IT projects, usually local rather than national ones, and sometimes put together on the smell of an oily rag or in what could only be described as “skunkworks” mode — projects developed to get around corporate IT.

Last year’s Computerworld Excellence Awards saw several strong initiatives of this kind. The most formal of these was West Coast DHB’s PRISM project, which had a budget of just $2 million. That project, assisted by government PROBE funding, made health records available electronically to health providers both in different fields of practice and in different areas of the Coast.

That task was made easier because West Coast DHB directly employs many of the GPs on the Coast — and harder because telecommunications services were a bit rough and there was a lot of ground to cover.

“Our system gives us a whole new order of speed, efficiency and accuracy in making sure the right patient records are in the right place at the right time,” the DHB’s Wayne Champion told Computerworld last year.

Numerous digital X-ray projects around the country are similarly delivering both reduced costs and improved information access for medical practitioners.

Another project, LEAP IT, from the National Paediatric Oncology Steering Committee, delivered simple technology to answer a national need — the ability to track child cancer sufferers in later life.

That project is instructive. It involved building a new database to allow national, and even international, access to patient treatment information. It’s the kind of project that some IT managers might try and close down — you can’t have these databases proliferating outside of IT’s control, can you?

But it works, and it’s cheap and it’s quick — and all of this together makes it low-risk. It was also run by practitioners, people who other IT professionals would refer to as “the business”.

It is understandable that organisations want to avoid having umpteen separate data respositories, log-in systems and so forth. But, equally, there are times when point solutions really can be the answer.

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