Tech & Science : Queensland Health’s History Of Software Mishaps Is Proof Of How Hard E-Health Can Be - - PressFrom - Australia
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Tech & Science Queensland Health’s History Of Software Mishaps Is Proof Of How Hard E-Health Can Be

13:30  08 november  2019
13:30  08 november  2019 Source:   gizmodo.com.au

Queensland Health’s history of software mishaps shows how hard e-health can be

  Queensland Health’s history of software mishaps shows how hard e-health can be A major difficulty with 'monolithic' e-health systems is that a single design team is attempting to solve an incredibly broad set of complex problems. Health systems involve interactions between dozens of different types of highly trained professionals. Building software to effectively support just one speciality to do its job efficiently is enormously challenging. Developers of unified electronic medical record systems must build systems that support dozens of them. As a result, it’s unlikely that such systems provide the best possible solutions for any particular speciality.

But Queensland Health ' s current adoption of massive centralised systems imposed from the top down is extremely hard to get right. A history of e - health system problems. The ieMR project isn't the first time Queensland Health has had difficulties with a health -related IT system. An attempt to replace

Queensland Health provides a range of services aimed at achieving good health and well- being for all Queenslanders. Dial triple zero (000). Emergency only. Police, fire and ambulance. 13 HEALTH (13 43 25 84). Non-urgent health advice.

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A directive ordering Queensland Health staff to avoid upgrades to the state’s hospital electronic medical record system during parliamentary sitting weeks was recently reversed. After the email containing the directive was leaked, the state’s health minister Steven Miles revoked the directive. He said the timing of upgrades should be based on “what’s best for clinical care”.

Queensland’s integrated electronic medical record system (ieMR) is designed to provide information about patients in the state’s health system. The ieMR was built by Cerner, a global provider of electronic medical record software. Like any IT project of this scale, it’s extensively customised for Queensland Health and individual hospitals.

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Queensland Health is a department of the Government of Queensland which operates and administers the state' s public health system. The Minister for Health and Ambulance Services Hon Dr Steven Miles is responsible for the department

List Queensland Health as your Employer. If you are a returning contracted employee and experience issues logging in contact 1800 198 175 for assistance (we may need to reactivate your account). If you are returning to Queensland Health , contact the Help Centre 1800 198 175 for support.

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The directive to refrain from ieMR upgrades during sitting weeks seems to be connected to 38 system outages earlier this year. Most of these happened following upgrades performed by Cerner. On at least one occasion, upgrades didn’t go smoothly, and led to system outages that required clinicians to revert to paper-based methods.

The rollout of the ieMR system to new hospitals, which began back in 2011, was put on hold earlier this year.

Monolithic systems may not be the future

A major difficulty with “monolithic” (that is, all-in-one systems developed by a single company) e-health systems is that a single design team is attempting to solve an incredibly broad set of complex problems.

Health systems involve interactions between dozens of different types of highly trained professionals. Building software to effectively support just one speciality to do its job efficiently is enormously challenging. Developers of unified electronic medical record systems must build systems that support dozens of them. As a result, it’s unlikely that such systems provide the best possible solutions for any particular speciality.

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Queensland has a long history of progressing health informatics in Australia. Queensland is also notable in being home to a number of prominent e - health enterprises such as the Australian eHealth Research Centre, Blue Care Smart Home, CharmHealth, Medical-Objects, iSOFT.

Health is a state of physical, mental and social well- being in which disease and infirmity are absent. The meaning of health has evolved over time. In keeping with the biomedical perspective, early definitions of health focused on the theme of the body' s ability to function

Because of this, research and development in e-health systems is moving away from monolithic, one-size-fits-all systems. Companies are instead working on allowing smaller, more specialised health IT systems to work together using parallel systems designed to work in concert.

In theory, this means clinicians and departments will be able to use the best software for their particular requirements, while each system can communicate with the others in a common language.

Of course, it won’t be quite that simple in practice. But Queensland Health’s current adoption of massive centralised systems imposed from the top down is extremely hard to get right.

A history of e-health system problems

The ieMR project isn’t the first time Queensland Health has had difficulties with a health-related IT system. An attempt to replace the payroll system, prompted in the late 2000s, was disastrous.

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That was the message that UCLA Chancellor Gene Block, UCLA psychologist Patricia Greenfield and health economist Anusuya Chatterjee delivered at Block concurred, noting that the brain finds it hard to process two things at once. He noted that he was recently reading a book that talked about how

The following is a list of software packages and applications licensed under an open-source license or in the public domain for use in the health care industry.

The Commission of Inquiry report into the payroll system is such a compelling description of an IT project failure that I use it to show my undergraduate students an example of what not to do.

The report describes a litany of problems including conflicted advisers, unrealistic timetables, woefully insufficient attention to software requirements, inadequate testing and, to top it all off, a lack of any contingency plan in case the system wasn’t ready in time. This led to the deployment of a system with known critical flaws.

The results were predictably catastrophic, costing the state hundreds of millions of dollars.

It’s important to point out, however, that the ieMR is a completely separate system. Nonetheless, a consultant’s report in 2014 reportedly said “no lessons have been learned” from the earlier payroll system disaster.

While later efforts attempted to fix issues identified at that time, decisions made previously - especially major architectural decisions such as the choice of a particular off-the-shelf software system - cannot easily be undone.

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Hard science and soft science are colloquial terms used to compare scientific fields on the basis of perceived methodological rigor, exactitude, and objectivity. Roughly speaking, the natural sciences ( e .g. biology, chemistry, physics) are considered " hard ", whereas the social sciences

met Queensland Health ' s pre-employment checks (these checks are conducted by your employing current Australian/New Zealand Birth certificate and Australian valid student photo ID card/ Proof of age card, or. A criminal history check is a mandatory Queensland Health employment requirement.

The problems are varied

Difficulty managing service upgrades is one of many challenges the ieMR project has faced. Other issues identified include:

  • extensive delays in the rollout across hospitals
  • cost increases and an inability to accurately predict deployment costs
  • concerns that software settings may have compromised the flow of information between clinicians treating a pregnant woman with serious health problems.
  • other patient safety concerns, including corrupted medication records. While no specific health events were reported as a result of this, incorrect medication poses an obvious safety concern.

Other states have struggled, too

While the concept of electronic medical records is attractive to clinicians and administrators alike, Queensland Health is not the only health operator to have struck trouble with electronic medical records projects.

Emergency departments in New South Wales hospitals implemented a new electronic medical records system (also supplied by Cerner) in 2009 as part of a planned statewide rollout. The system was unpopular with clinicians, and one peer-reviewed academic study indicated it was associated with longer emergency department wait times.

Since the commencement of the ieMR project in 2011, hundreds of millions of dollars have been invested. Sunk costs of this kind, and institutions that tend to follow the status quo, often discourage critical analysis and the exploration of alternative paths.

As the decision has been made to pause the rollout, now seems like an opportune time to properly consider whether current e-health system architecture is the best option for the future.

Robert MerkelMonash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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