IT Governance lessons

As noted in some earlier posts, learning from others’ mistakes is the least painful way of avoiding trouble, provided we can apply those lessons meaningfully in our own circumstances. This latest case study arises from problems encountered in yet another large scale publicly funded IT project.  It offers numerous governance insights, which in my view, have relevance for organisations of all sizes in all sectors.

In 2011 South Australia commenced the implementation of an integrated Electronic Medical Record (EMR) and Patient Administration System (PAS), called EPAS. The approved Business Case of $421.5 million was, in the first instance, for a single system for all public hospitals in metropolitan Adelaide, a number of metropolitan public outpatient/GP clinics, and two country hospitals.

This project was to have been completed by 2014, however, on 30 March 2018, the future implementation of EPAS was paused pending an independent review  (96 pages) to determine the best options for delivering a fully integrated patient administration system and electronic medical record across the South Australian public health system.

This review was required to provide advice on the following areas:
● Whether the system is fit for purpose
● Whether the current system is safe
● Why the projected costs and schedule increased beyond the business case approved by Cabinet
● The impact on hospital productivity of the implementation of EPAS
● Adequacy of engagement and consultation to inform the design and implementation of EPAS
● Whether the user experience can be improved
● Implementation of EPAS
● Functionality of EPAS
● Proposed future direction for EPAS
● Future roll-out program.

The review found that “the implementation of EPAS contrasts with other successful EMR implementations in Australia, in particular:
• SA Health chose to implement the system without the assistance of expert organisations, including the Allscripts vendor, experienced in electronic workflow design and the change and adoption complexities associated with implementing EMRs.
The governance model is flawed, with accountability for outcomes poorly understood and managed.
• Clinical benefits from the implementation of the system are not well articulated and consequently not tracked, measured nor managed.
• Current governance arrangements do not empower clinicians to be the key decision-makers, therefore clinicians have not taken ownership of the system.
• Local Health Networks (LHNs) are not given accountability for implementing the system within their hospitals. The system is viewed by LHNs as a program of work delivered by the Department.” (emphasis added)

The review report provided 36 summary recommendations in charting “the way forward”, including:
• “creating an SA Health Digital Strategy;
significant governance reforms that devolve responsibility for implementation and configuration to LHNs and clinicians;
• actions to improve the Sunrise EMR and Allscripts PAS software solutions and implementation;
• focussing on two exemplar sites to implement the Allscripts solution that applies the Review’s proposed changed approach, and any future decisions to implement the Sunrise EMR and Allscripts PAS are contingent on user acceptance at the exemplar sites; and
• improving implementation approach and post go-live support, regardless of which solution is implemented.” (emphasis added)

Contact me on 0419 347 599 if your not-for-profit organisation would like a Board briefing on this IT governance case study.

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