Victorian Department of Health slammed in ICT system audit

The Victorian Department of Health has failed to implement clinical ICT systems across 19 of the state’s health services due to poor planning and inadequate understanding of system requirements, according to a damning audit report released Wednesday.

The audit examined the status of ICT systems in eight Victorian health service providers – including four HealthSMART system rollouts – to determine if they had been appropriately planned and implemented, and benefits were being realised.

Victorian Auditor-General John Doyle said in the report that the department “significantly underestimated project scope costs and time lines”. He said it also underestimated the required clinical and other workflow redesign and change management efforts.

As of this month, the cost of Victoria’s HealthSMART clinical ICT system rollout has blown out to $145.3 million or 150 per cent more than the original budget of $58.3 million, the Auditor-General’s report said.

“This translates to an average installation cost of $36.3 million for each of the four HealthSMART sites,” the report said.

“Clinical ICT systems in four non-HealthSMART sites have cost much less; the average cost of installation is $1.8 million per site, although in terms of functionality, each of the systems has major differences compared to the HealthSMART clinical ICT system,” the report said.

There was also evidence of several “potential clinical risks” at two HealthSMART sites related to the “discontinuity of patient treatment information during a hospital stay and confusion around the ordering and dispensing of complex prescriptions”, the report said.

Another HealthSMART site had an issue related to discharge summaries being completed prior to surgery or treatment, and system-printed prescriptions being amended by hand by clinicians with different medications.

“In the absence of appropriate controls and effective mitigations, these issues could pose serious safety risks to patients,” the report said.

Auditor-General Doyle said that although these hospitals have created manual workarounds to mitigate these risks, they “have themselves identified that these workarounds are not fail-safe and are prone to error”.

“The department and relevant health services have committed to take action to resolve these issues. This needs urgent attention and I will be monitoring the actions taken to implement my recommendations closely,” he said.

Furthermore, the department hadn’t created processes to oversee the management of risks or the “performance of installed clinical ICT systems at either HealthSMART or non-HealthSMART sites”.

In his opening letter to the Victorian parliament, Auditor-General Doyle said clinical systems outside of the HealthSMART program had been developed over time and were well accepted by clinicians.

“Although their functionality is not directly equivalent to the HealthSMART system, these other systems have involved significantly less capital and ongoing expenditure” he said.

Finally, Auditor-General Doyle made several recommendations to help fix issues with the deployment.

These included creating a strategic plan for the ongoing development of electronic medical record or clinical ICT systems across Vic Health, and review procurement, contract management and financial oversight practices for major ICT projects.

He also recommended that the department establish guidelines so that government approved projects, scope and schedules are followed.

The full report can be found here.

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