Health agencies balance IT mandate with local innovation

Many Australians would still be unaware of the recent debut of the government’s long-brewing personally controlled electronic healthcare record (PCEHR) initiative. Yet even as healthcare organisations across the country race to implement it, some are questioning whether the technology is really all it’s cracked up to be.

With PCEHR standards being driven downwards from the federal level, many state-run healthcare organisations have been scrambling to get the necessary infrastructure to support the new environments.

“I don’t think there are too many healthcare providers that are ready for that at this point in time,” Bruce Windsor, CIO with Victorian regional healthcare authority Loddon-Mallee Rural Health, said some weeks before the PCEHR deadline.

“Each of them might have agreed at a high level, but the question is how long it takes to get those standards into place – and then how they might affect and filter down into the local providers.”

With over 150 local providers, 5000 staff and a $500m total ICT spend, it’s a big ship to turn quickly. Some authorities have worked to smooth the process by introducing top- down mandates, but Windsor worried that these could obscure the issue – and distract from bottom-up initiatives, such as telehealth, that offer great promise to improving service delivery but run the risk of being sidelined in the rush towards PCEHR.

“At a state level we have mandated product sets that cause me at least some philosophical debate around whether we should have mandates or be looking for outcomes,” Windsor said, noting as an example the push towards electronic recordkeeping even though many risk- management issues around paper records still haven’t been resolved.

“The mandate might be that we’ve got to use a certain package to deliver this,” he said, “but at the end of the day it really should be about the outcomes, and about the areas that really to make a difference to regional and rural healthcare. Coming from the top, it’s difficult and slow, and there’s a lot of work and time and expense being spent; when it’s done from the bottom up, there’s a lot more flexibility for us, and it’s much more satisfying.”

Deciding just how to balance the push for standards with the need for innovation and flexibility isn’t easy – as New Zealand’s Health Benefits Limited (HBL) knows all too well. Founded in 2010, the organisation has been given a mandate to trim over NZ$700m from the country’s healthcare ICT by 2015 – and a push towards shared services is only part of the solution.

In addition to driving top-down mandates, HBL is working hard to source innovative ideas from the proverbial shop floor – and has found a wealth of innovative ideas whose implementation has depended on getting two ministries and CEOs from 20 different health authorities singing from the same hymnal.