Capital Coast Health, the Wellington district health board, will be moving towards a web-based Citrix thin-client IT system over the next two years as it abandons its long-controversial SMS system.
Combining IT resources with Hutt, Hawkes Bay and Taranaki has also been mooted. Certainly in recasting its computing systems and infrastructure, a lot of example will be drawn from the way these and other DHBs have done IT, says CCH director of information management and planning Andre Snoxall, and there will be less duplication of effort. He praises Taranaki’s web-based system.
The current CCH system -- SMS (Shared Medical Systems), the Allegra clinical records application and the infrastructure that surrounds it -- are simply not suited to the needs of a modern health service, Snoxall says. The purpose of a system like SMS is basically to keep track of patients moving through the hospital, he says. Nowadays, the focus is much more on a person’s health status throughout their life, on meeting their needs outside the hospital and ensuring they end up there as infrequently as possible.
This means many people other than doctors -- pharmacists and community nurses, for example -- need access to patient information, and a centralised system virtually inaccessible from outside the hospital is no longer appropriate.
SMS was installed in the late 90s, among accusations of conflict of interest involving then CCH chief executive Leo Mercer, who had previously acted as a part-time consultant to US-based SMS. An Audit Office report in 1999 found there was no case to answer. However, CCH staff continued to express dissatisfaction with the system and the laboratory and pharmacy modules were abandoned in 2000.
In-house support costs are high, Snoxall says, with four full-time staff maintaining SMS and another two the clinical records system. Outside support is no longer available, he says. CCH is the last user of SMS in New Zealand, Health Waikato having abandoned it almost two years ago.
CCH will now embark on 12 months’ analysis of its options and 12 months’ implementation planning, while SMS runs its course. Replacement of the current "fat" client-server infrastructure by a web-based model will be the first stage, to be followed by new applications choices. This process will involve extensive consultation with other district health boards.
SMS is not even a client-server system, says Snoxall; it is completely centralised. The Allegra clinical records system is “closed”, he says. “It is not ODBC-compliant. You can’t even put an SQL query system over it.”
But despite the inevitable renewed criticism the SMS decision will attract, Snoxall declines to label the exercise a waste. “I don’t think I’m qualified to say [choosing SMS] was a wrong decision. I wasn’t around at the time, and it seemed to be what the doctors of the time thought they wanted.” The change in the fundamental structure and perspective of the health system has happened more quickly than he, for one, would have expected, he says.
Once DHBs begin to adopt similar systems with a thin-client design, and increasingly use the same applications, several geographically adjacent boards like CCH, Hutt, Taranaki and Hawkes Bay have to consider whether it is worthwhile having separate IT teams, he says. The possibility of some co-operation along those lines has already been discussed among those boards.
But Snoxall can’t ever see a uniform set of software over all DHBs in the country. There must be competitive suppliers, he says, and what suits a large district will probably not suit a smaller one.
The $26 million cost figure applied to the SMS system at CCH by the daily press is something of an exaggeration, Snoxall says, since it included all the networking and PCs.
A new setup is likely to come in at a significantly lower cost, he says, but there has to be a new system. Continuing to upgrade on the basis of the no longer appropriate SMS design is not an option. Putting in the new infrastructure is budgeted at $4 million in the first year and about $2 million in the second. “The [cost of the] administration and clinical records applications, I really can’t say. It could be $1 million to $2 million, it could be as much as $10 million.”