Saturday, February 21, 2009

District Health Board software push

I read with interest an article in New Zealand's Computerworld about the NZ Health IT Cluster’s questioning of a Request For Information (RFI) issued by seven District Health Boards (DHBs) for a single patient management system and citing the challenged NHS NPfIT project as a reason to be cautious of this approach.

A point overlooked in this debate is the role of effective governance in the health sector. The article points out that there has been a failure to achieve interoperability through architectural standards, that the RFI is pre-empting the update of the national health IT strategy, and that a single IT system is already deemed to be the only solution– these are significant governance issues. What is going to be done differently to ensure that health sector, or even the DHB collective’s, IT-enabled initiatives will be successful in creating (and not eroding) ongoing value?

Reading the background on the RFI, it is very clear that the health boards place an emphasis on an IT solution, rather than how IT will be used, to deliver benefits. In the absence of sound governance, will anyone even be held accountable for realizing the claimed benefits? Experience and research has proved time and time again that technology is only part of the equation and that desired outcomes can only be achieved with full consideration of the required changes to the business model, business processes, organisational structures and culture, the way people work, and the involvement and commitment of all stakeholders. These are the areas where DHB collaboration must occur and it must be addressed as part of a whole programme of change within a structured and integrated governance framework.

Typically IT drives these initiatives when the clinicians won’t and that should be seen as a red flag — just as it was for the ill-conceived NHS NPfIT project. IT has the potential to improve health care but IT alone will not solve the problem of adoption. A survey found that only 62% of doctors think NPfIT will improve patient care and only 20% of consultants had a card to use electronic records. A US survey of physicians' adoption of outpatient electronic health records found only 13% adoption rates. How can the claimed benefits be achieved given these adoption rates?

Research by the IT Governance Institute is very clear on how organisations successfully create value from investments in IT-enabled change – there is:

  • Strategic, leadership-sponsored commitment to IT governance—to align IT decisions with business objectives and to monitor performance with clear accountability for achieving benefits
  • Recognition that IT is not just about implementing technology—it is about unlocking IT-enabled business change
  • A structured approach to the governance of IT-enabled investments, based on proven practices for doing the right things, the right way, getting them done well and getting the benefits.


Anonymous said...

This blog has a whole list of reasons why central IT for helath won't work along with some ideas for improving it.
It's well worth reading....

Baz Wood said...

Update: Health report pushes for national shared service agency and criticises IT decision making at the DHB and ministry level. Computerworld The annex to the report does a good job of identifying the governance issues