Govt spending on IT systems for healthcare

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nova

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#285698 10-May-2021 22:22

In the last week there has been a bit of news around IT spending in healthcare:

38 million for the system to manage covid vaccination bookings
55 million to upgrade IT systems for breast screening (BSA) to enable proactive enrollment of eligible people.

The first system is based on Salesforce technology, and Orion Health complained about it quite vocally, as they originally built the National Immunization Register, and thought they could have extended it for much less (they said 1 to 3 million for the bells and whistles, and much less again to just provide the support needed for the covid vaccination program). The new ystem didn't go through a proper tender process due to covid, and one of the justifications for choosing it was the successful implementation of the IT systems for breast screening which were based on the same technology.

Which is why the second announcement is interesting, if it is so successful why are they spending so much money upgrading it? It seems a lot of money in order to be able to contact the 300,000 eligible woman who are missing out. If you had access to the data it wouldn't take long at all to build something bespoke to do this.

I totally get how it is possible to spend so much money on IT systems, but I also think it could be done much cheaper in-house, and I think it is important to spend the money in NZ rather than have it go off-shore.

Anyone have any more knowledge on what is going on here? Is the procurement process above board?

Fred99

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#2705860 11-May-2021 09:32

Which is why the second announcement is interesting, if it is so successful why are they spending so much money upgrading it?

It's covered in the statement:

Low screening rates are probably the main reason why the 5 year survival rate NZ seems to have is shameful by international comparison (ie with Australia) - avoidable deaths mainly amongst Maori (as with cervical cancer). As well as avoidable deaths, late diagnosis implies far more traumatic treatment and higher costs to the health system.

nova

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#2705862 11-May-2021 09:38

I wasn't questioning the screening program itself, obviously screening is a good thing, but why does it require such a large IT spend?

Fred99

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#2705877 11-May-2021 10:11

nova: I wasn't questioning the screening program itself, obviously screening is a good thing, but why does it require such a large IT spend?

I don't know how the costs are calculated, but I expect there's more than a simple database as would be needed for a vaccine register. There are probably records like previous radiology images, lab results from biopsies and other clinical notes that should ideally be instantly accessible to specialists at the clinics.

Costs for IT systems baffle me. I think our local council spends about that much per year, all I can see from it working well is my rates bill, printed on paper and posted by mail, always arrives on time. Their website is an abject disaster if you're looking for information.

nova

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#2706436 12-May-2021 09:43

Fred99:

I don't know how the costs are calculated, but I expect there's more than a simple database as would be needed for a vaccine register. There are probably records like previous radiology images, lab results from biopsies and other clinical notes that should ideally be instantly accessible to specialists at the clinics.

Yes, for sure it is a complex project, but the cost is still ten times what it should be. An interesting article came out about this very topic today:

https://www.newsroom.co.nz/govts-opaque-42b-procurement

The discussion on the local multiplier effect of paying someone local to do the work vs getting it done overseas is interesting.

In this particular case, the thing that really interested me was the link between the two contracts. There was a herald article on covid IT solution last week, which cited the business case for it:

"And beyond its no-tender recommendation, the report goes on to point out that there is already what seems a tried-and-tested combo: Deloitte and Salesforce, who delivered the National Screening Solution (NSS) to track and manage breast cancer screening"

But in the announcement for the 55 million breast screening ugrade, Ayesha Verral referred to the current system as ageing:

The current ageing IT infrastructure puts the programme at risk. It lacks the flexibility to be easily upgraded to meet the needs of the community, and is no longer supported well by vendors

Presumably she is not talking about the NSS system when she says this, but if they have already successfully built and delivered NSS, then what is she talking about?

The combined spend here is over 90 million dollars, and the procurement process that is being used doesn't seem very robust or thorough given the amount of tax payer dollars involved.

Fred99

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#2706554 12-May-2021 13:36

I can't really comment, I don't know - every single major IT project spend seems ludicrous to me - but I'm biased and have never worked in the sector.

I agree with the comments about supporting NZ business but the conflict between "fair trade" and free trade agreements have been going on for 1/2 century. Maybe the first public outrage was when (IIRC - a long time ago) an Australian company won a tender to supply new carpet for some revamp of the beehive, defended by "they had the best offer and under CER etc". The bleating from local 'confident we're best in the world" carpet makers was headline news on TV. Of course they weren't - proof being they're all now gone.

I don't like the way the survey data was presented in the article. Of course about 2/3 (assuming the usual 3 qualified tenderers) are going to be somewhat dissatisfied with a process that awarded contracts to competitors, and of course small firms are going to be disadvantaged when there are detailed processes to qualify, probably set up that way - paved with good intent - to avoid corruption and ensure "fairness". Some 10 employee enterprise won't have an in-house compliance team nor feel inclined to want to pay "consultants" to set something up with no guarantee of getting a return.

When I fill out "customer satisfaction surveys" I tell lots of lies. It's the sensible thing to do if you want to try to manipulate the system in your favour. I bet I'm not the only one.