Digitising public hospitals

(Report 10: 2018–19)

Audit objective

The objective of our audit was to assess how well Queensland Health has planned, and is delivering, its digital hospitals program and whether it is realising the intended information-sharing and patient benefits.

Overview

The Queensland healthcare system is transforming to meet the pressures of an ageing population, the growing burden of chronic conditions, and changing consumer expectations.
 
In a digital hospital, processes are streamlined to create a ‘paper light’ approach, integrating electronic medical records (ieMR) with clinic devices, workflows, and processes. An electronic medical record is one of many applications that contribute to a digital hospital. The government has set a target for twenty-seven hospitals to fully implement the ieMR solution by June 2020.
 
Electronic medical records provide timely, accessible and legible information about patients at the point of care. It also provides the foundation for future transformations in health care delivery, like the ability to gain greater insights and decision support from the system’s data to improve the quality of patient care and operational efficiencies.

Recommendations

Department of Health and the hospital and health services

We recommend that the Department of Health and the hospital and health services that have implemented the ieMR solution (Note 1):

1. continue to work together to identify the actual cost to date of implementing and operating ieMR. (Chapter 2)

The Department of Health should:

  • use this information to update the Cabinet Budget Review Committee on the actual program cost to date. The information should form the basis for a more reliable estimate of what it will cost to complete the program and of the longer-term costs of maintaining the ieMR solution
  • in consultation with HHSs, consider whether the level of investment by HHSs to implement the ieMR solution is appropriate.

Note 1: The hospital and health services that have implemented the ieMR solution at varying ieMR stages include the Metro South Hospital and Health Service (ieMR advanced), the Mackay Hospital and Health Service (ieMR advanced), the Children’s Health Queensland Hospital and Health Service (ieMR advanced), Cairns and Hinterland Hospital and Health Service (ieMR intermediate), Metro North Hospital and Health Service (ieMR basic), and the Townsville Hospital and Health Service (ieMR intermediate).

Department of Health

We recommend that the Department of Health:

2. completes its refresh of the eHealth investment strategy based on the revised cost of the ieMR program and any impacts it has on the strategy for other programs (Chapter 2)

3. provides the Cabinet Budget Review Committee with:

  • updated timing for the realisation of benefits
  • a balanced assessment of benefits realised (and dis-benefits) across hospitals from all hospital and health services that have implemented the ieMR (Chapter 3)

4. provides greater assurance that it is obtaining ongoing value for money from its ieMR vendor by:

  • investigating options for demonstrating value-for-money pricing, including conducting comparative vendor price analysis where possible
  • assessing and documenting the ieMR vendor’s performance across its service contracts, with input from hospital and health services.

This should occur at appropriate intervals and, at a minimum, before each contract extension decision (Chapter 2).

5. re-visits the governance arrangements for the program as it moves from building, configuring, and implementing the ieMR solution to business-as-usual and optimising the solution 

This should include:

  • re-visiting the focus and roles of the eHealth Executive Committee, eHealth Queensland, and other areas of the department such as the Clinical Excellence Division
  • continuing to obtain an independent review of program benefits periodically. (Chapters 2 and 3).

6. develops and implements an engagement strategy for all current and planned eHealth programs to assess the effectiveness of its engagement with hospital staff and clinicians and the effectiveness of the system implementation (Chapter 2)

This should include:

  • specific actions, performance measures, and data sources to enable the department to assess how effectively the department engages hospital staff and clinicians
  • gathering information about concerns, risks, or dis-benefits that may inform the program about changes or modifications that need to be made to the program.

7. continues efforts to refine the business intelligence strategy and approach, and rollout solutions to hospital and health services to maximise the benefits from the ieMR implementation at each site (Chapter 3)

8. improves the preventative security controls of ieMR user accounts (Chapter 2).

This should include enforcing password complexity requirements and implementing a change management process to educate clinicians on appropriate password settings.

Hospital and health services

We recommend that all hospital and health services participating in the ieMR program:

9. report regularly on their total ieMR project costs and broader costs associated with their digital transformation (separated from ieMR costs) to eHealth Queensland as well as to their own hospital and health service boards (Chapter 2)

10. improve their employee termination processes to ensure they promptly remove an employee’s ieMR access when an employee or temporary staff member terminates their employment with their hospital and health service (Chapter 2)

11. implement a process to monitor whether reviews of inappropriate user access to ieMR patient data are completed (Chapter 2)

12. report dis-benefits to the program so the program can learn from these and if necessary, modify the solution or implementation approach (Chapter 3).

Other reports and resources

Delivering coronial services (Report 6: 2018–19)
Managing transfers in pharmacy ownership (Report 4: 2018–19)
Access to the National Disability Insurance Scheme for people with impaired decision-making capacity (Report 2: 2018–19)