Doctor, CEO demands crippling health IT

Pressure to please both technology-minded clinicians and risk-adverse CEOs is stretching healthcare IT managers too thin, hindering progress in health departments, and leading to disasters like Queensland Health's botched SAP payroll project, IT procurement managers have warned.

Speaking to an audience of executives who manage the purchase and implementation of healthcare organisations' complex information systems, Elaine Lacey, assistant manager within Queensland Health's Information & Communication Technology Procurement Unit, conceded that conflicts between end-user expectations and managers' performance and governance requirements had caused major problems within her department and others around the country.

"We're caught between rocks and hard places because we have policies that must be the platform that we work from, but we try to do the best for our clients," she told the 50-strong crowd at a session of the Health Informatics Society of Australia's recent HIC 2010 conference.

"Our clients are often clinicians, nurses and doctors, and we're implementing systems to help them. But there is great difficulty in educating them in the right way to do things. It's only in the last couple of years that we've risen to the challenge of actually educating our clients."

Lacey is part of a 15-strong team that was formed four years ago to manage the IT procurement process, sourcing skills and capabilities from a 240-strong panel of providers. Since normal tenders can take up to six months, this approach was adopted to speed the sourcing of regularly-required skills such as business analysts: requests for information are sent to 20 to 30 panel providers, with responses quickly vetted and contracts awarded on an accelerated timeline. The program is currently managing over 170 contracts.

Yet an increasing sense of order at Queensland Health wasn't enough to avert the high-profile payroll disaster from which the department is still digging itself. After budget blowouts and incorrect pay runs, an auditor's report recently found, pressure from Queensland Health's board to complete the project had forced IT staff to skip a key stage of testing the SAP-based system, resulting in problems with payroll runs for the department's 78,000 employees.

This sort of difficulty is business as usual for Katerina Andronis, who in March left a position as director of information management with Melbourne's Peter MacCallum Cancer Institute and now serves as director of Deloitte Touche Tohmatsu's health practice.

"One of the challenges I had at my hospital was that I gave the doctors what they required because they were my customers," Andronis recounted. "But I didn't give the health department what they wanted, so I got into trouble. You have three groups of people you have to fight with: the financial, clinical and IT people."

Too often, Andronis said IT directors keen to help improve clinical systems end up compromising their ambitions and delivering "hybrid systems" that use extensive integration to link up patchwork assemblages of systems that often date back to the 1980s and 1990s.

In many cases, she added, department executives are so focused on procedure that they end up focusing on core administrative systems while specialist systems, needed by doctors, are purchased and left stranded without skilled staff to run them.

"Once the decision has been made to procure software, clinicians wipe their hands of it and walk away, saying it's an IT system now," Andronis recalled. "But clinical systems are very specialised; just because they happen to run on a computer doesn't mean IT specialists know how they work."

One attendee, who also works within Queensland Health, said he runs an IT team of 40 people and only three of them have any clinical knowledge. Yet when IT managers go back to CEOs for funding to pay skilled staff to operate the systems, it's often unavailable, leaving clinicians frustrated and many specialist applications never fully utilised, staffed or effectively linked with other hospital systems.

Clinicians "are human, and they want to do their own thing", Andronis said. "It's very difficult to manage, and it is costing the country billions of dollars. We want to put in systems that make clinicians' jobs easier, but we are still bogged down in the embryonic stage, putting in patient administration systems and the plumbing for the hospitals. Departments are mandating core systems, but there are many specialist systems within a big acute hospital that do not fit the one-size-fits-all paradigm."

Andronis' statements were echoed by one audience member, who got a broad round of applause after a rant in which he likened the IT purchasing process in health departments to "taking a 17-year-old and letting them buy any car they want, with any sized engine. We get clinicians to dream up what they want, then they go and buy it without even thinking about whether it will or won't work. We have people who don't know what should and shouldn't be used, who have the power to make the decisions on buying".