news The Western Australian Government has gone to market for a provider to establish a project management office (PMO) to coordinate overall development activities between its problematic Fiona Stanley Hospital build and its wider health department, just weeks after it admitted that the IT systems associated with the hospital had blown out in cost by an amount expected to be between $25 million and $50 million.
Fiona Stanley (FSH) is a new, 783 bed hospital being build south of the Perth central business district. It is billed as a flagship hospital for Western Australia, and was originally planned to be a paperless facility, featuring the latest in medical and information technology. However, the project has gone off the rails. In June last year Health Minister Kim Hames issued a statement noting that the $2 billion project had run late and would open in October 2014 instead of April, although it was more than 90 percent complete.
One specific issue which continues to dog the facility’s construction includes the “advanced ICT system” which contractor Serco is putting in place at the facility. The platform is billed as being able to deliver new levels of patient care and convenience by managing administration, patient information, medical records, communications and patient entertainment, all through one central facility. Serco is handling the rollout and part of the IT systems deployment, while British telco BT is conducting the telecommunications rollout. The Department of Health itself also has substantial responsibility for some IT systems.
In a tense session in mid-February, the State Parliament’s Education and Health Standing Committee grilled current under-treasurer Timothy Marney on the delays and cost blowouts. Marney confirmed that the $2 billion project as a whole had already suffered some $330 million in cost overruns, with about $151 million of that sum being allocated to ICT, including a portion going to another facility in Albany.
The issues with the setup of the IT systems may also have a potential impact on other facilities, given that it appears that Fiona Stanley was intended to act as a reference site for IT systems at other facilities.
In a request for tender document published this month, WA Health’s shared services division the Health Corporate Network noted that it was currently seeking a third-party provider to undertake integrated project management office services with relation to both the Fiona Stanley Hospital and wider South Metropolitan Health Service (SMHS) developments.
There are already two other PMO offices in existence with relation to the FSH development. One, termed the FSH Commissioning PMO, is responsible for managing the whole FSH commissioning program to get the hospital running.
The second, the SMHS Reconfiguration PMO, is responsible for managing the wider body of work that is taking place in that division of WA Health under the WA Health Clinical Services Framework 2010 to 2020 (CSF2010). CFS2010 is the high-level framework that sets out the planned structure of public health service provision in Western Australia over the next 10 years. It outlines the reconfiguration of health services across the WA Health system required to improve access to hospital care and to ease the burden and reduce dependency on tertiary hospitals.
Both existing PMOs include much wider responsibility than just ICT, being concerned with the total re-development of their respective areas within WA Health. However, both existing PMOs do explicitly include responsibility for ICT in their areas.
And the issue of ICT is a key one for the state at present. In the Fiona Stanley case, the issues with ICT have been some of the key problems holding the hospital back from being opened. In the February session, under-treasurer Marney said a previous task force which had been formed by the government several years ago with the purpose of looking at what was required to get Fiona Stanley operational had examined the ICT issue.
“One of our key concerns at the time was that Serco’s ability to deliver on its contractual requirements were critically dependent on Health delivering the ICT platform for the hospital, and my concern was that the track record for Health delivering on ICT projects was extremely poor,” he said. “Put the two together, that meant we were going to be up for some form of compensation to Serco because we could not give them the ICT platform that the contract promised them.”
This likely means that the new integrated PMO — which is being set up explicitly to manage the integrated program of work across both the existing FSH commissioning and SMHS reconfiguration PMOs — will concretely need to examine the ICT issue across much of WA Health as a whole.
The tender document notes that the new integrated PMO’s success will be judged on the alignment of both the SMHS and FSH programs, with ICT explicitly considered as one of those elements.
Marney said in February that WA Health is taking a markedly different approach with the deployment of ICT systems in the new Perth Children’s Hospital than it took in the FSH build. “… the approach will be to seek to source an off-the-shelf product that can be easily adapted to the new children’s hospital rather than constructing 48 systems from scratch,” he said at the time.
OK, I think we’re seeing two things here. Firstly, WA Health and the State Government in general has realised that it needs an integrated PMO to make sure that the Fiona Stanley Hospital deployment (including ICT), is linked with what the wider department is doing in terms of its wider re-development of its other assets, given that Fiona Stanley is supposed to serve as a model for other facilities, including with relation to ICT. All that makes sense, although one wonder why this wasn’t being done already.
However, the other thing that we’re seeing here is that WA Health, the Health Corporate Network and the Fiona Stanley team have never allocated the ICT systems involved here the kinds of project governance which they require. If you’re going to use the ICT systems being set up at Fiona Stanley as a model for other facilities across Western Australia, the ICT function here needs its own dedicated PMO, as that task itself is likely much larger than WA Health realises.
Think about it.
Other major eHealth programs around Australia have also suffered major problems in recent years. For example, University of Western Australia software academic David Glance has severely criticised the Federal Government’s personally controlled electronic health records scheme, stating the vast majority of those who have signed up have blank health records, despite the project’s half-billion-dollar cost. The project is currently under review.
Queensland Health’s eHealth project is significantly delayed, and in October last year the Victorian Government published a landmark review into the use of technology in the state’s health ecosystem, finding that its landmark HealthSMART program launched in 2004 had had its benefits, but that the state should devolve most decisions about IT back to individual health units such as hospitals and stop taking a strongly centralised approach to eHealth.
We’ve seen similar problems in every state — the development of new health IT systems is very much a non-trivial task, and the FSH IT systems are notably suffering problems. If this model is going to be deployed more widely, more project governance and management resources need to be ploughed into making sure other facilities don’t suffer the same obvious problems with ICT that Fiona Stanley still is.
As I wrote several weeks ago:
“I suspect anyone reading this article would have looked up from their computer screen in horror at Marney’s revelation that the Western Australian Government sought to construct “48 systems from scratch” when setting up the IT systems for the Fiona Stanley Hospital. Deploying off the shelf software should have been the assumed default position in this scenario, instead of seeking a customised solution. I would not personally be shocked if it takes another five years for Fiona Stanley’s IT systems to be bedded down, and I suspect most of the systems will not be deployed in other facilities.”
My opinion is that, even with the establishment of this integrated PMO, the Western Australian Government is still not taking the situation with respect its health IT systems seriously enough. This isn’t really a surprise — as we’re seeing the same thing around Australia — but it is disappointing.