Western Australia residents will have to wait until at least 2014 before the state’s health department will replace its ailing patient administration system (PAS).
According to the WA Auditor-General's latest report decade-long efforts to fix the system had been hampered by allocated funds not being spent. Further a replacement system would take up to eight years to deliver to regional and reural areas of the state.
The PAS is an electronic health record system which stores personal information about patients of public health facilities and helps manage care from admission to discard. All major medical facilities use such a system to coordinate patient care and guarantee clinical outcomes.
However, a report published by WA acting Auditor-General Glen Clarke into WA Health’s project to replace its problematic existing PAS — at an estimated cost of $115.4 million — found a myriad of problems.
“Health’s procurement of a new PAS has not been done well. It has been 10 years since a PAS replacement was first identified as a priority by Health, and six year since Parliament provided the necessary funds, subject to Health first satisfying certain conditions,” the auditor wrote.
“However, the funds are largely unspent, the State still does not have a PAS replacement and it is unlikely to have one in all metropolitan hospitals until at least 2014 and 2018 in regional areas.” The delay, Clarke said, meant Health’s operations remained “at risk” from inflexible technology and “out of date hardware”.
There were a range of issues underlying WA Health’s inability to replace the core system. For starters, the auditor found that governance arrangements were “unstable and poorly defined”. The Department had consistently been unable to produce a business case to replace the PAS that Government considered suitable.
Then too, WA Health’s procurement processes were problematic, involving the use of non-standard clauses in a support and maintenance contract, a failure to test the market before buying a new software licence in 2009, and the fact that Health did not monitor financial progress of the PAS procurement.
In fact, WA Health does not currently have a formal contract in place for PAS support and maintenance, or for the new licence for its current PAS which it bought in 2009. The audit report does not state who the current supplier of WA Health’s PAS is. Record-keeping about the procurement initiative was also poor, and there was no central register where conflicts of interest could be declared.
Clarke proposed a variety of measures to remediate the project, including the need for WA Health to work with the state’s Treasury to develop a business case for the implementation that would win Government approval and allow allocated funds to be released. Stable governance arrangements would also need to be put in place.
In a response, Health said it had moved to address its relationship with the licence owner of the current PAS, and was confident that it would have an initial rollout of the new PAS from mid-2011. It said it had also strengthened the associated ICT project management and governance framework.
In general, the WA State Government has suffered a number of high profile problems relating to IT projects over the past few years — especially in relation to its extensive shared services projects. The state spends about $800 million on ICT, according to Clarke’s report — representing one dollar in every five of its total annual spend on all goods and services.
However, Clarke noted there were numerous examples of ICT procurements that had resulted in missed deadlines, budget blowouts and a failure to realise promised benefits.
“The examples can be found in the private as well as the public sector and across federal and state jurisdictions,” the auditor wrote, noting a landmark 2007 report on WA Government ICT procurement had found that many were not being done well. “Budgets were often exceeded by more than 100 percent, and intended benefits were often delayed or not fully realised,” he wrote, noting that the WA Health example should serve as a warning to other state government agencies.