Dire prognosis for Britain's health software revamp

Lorenzo, the long-promised patient record system at the heart of Britain's 10 billion pound ($25 billion) National Health Service IT upgrade, has been exposed as foilware, with iSoft having "no believable plan" for completing development. The Lorenzo system was initially scheduled for release in March 2004, but there has been a series of delays and no British hospital trust is yet using the new software. ISoft Australia is supplying the same products for state health projects, including Victoria's $323 million HealthSmart.

The latest delivery date is 2008, but a review in February by CSC and Accenture - iSoft's partners in three NHS regional rollouts - found the date to be far too optimistic. Further, a scathing report, seen by The Australian, warns that Lorenzo may not achieve the performance necessary to support a system used by about 600,000 NHS healthcare staff and 30 million patients. "No evidence was seen for the development or testing of technical procedures that would be required for operation and maintenance of the live system," the report says. "This is the main risk to the successful delivery of a fit-for-purpose system based on the Lorenzo framework and products to the local service providers. "Technical requirements and development processes have only been considered from the bottom up," the report says. "There has been no holistic view of the behaviour of a complete system built upon Lorenzo."

The report says it's likely that large amounts of development already completed will need to be reworked during testing, "and it's anticipated other significant performance and operating issues will be encountered".

ISoft's share price has been in freefall since the start of the year, when the NHS began applying pressure over delays, and reports of accounting irregularities emerged. The meltdown wiped 90 per cent off the company's value, and was only arrested when its bankers agreed to a brief reprieve. ISoft announced a shock loss of almost 400 million, and now faces investigation by financial regulators. Last week, Accenture was reportedly trying to negotiate an exit from the NHS's Connecting for Health program, while CSC has agreed to take over management of Lorenzo, with an option to take direct control "in the event iSoft is unable to meet its obligations".

While iSoft has been spruiking Lorenzo's capabilities for years, its latest annual report reveals that product rollout is currently limited to early adopter sites in Germany and Singapore. "We expect to see the start of Lorenzo user functionality in Britain from late 2007 onwards," iSoft says. "Our activities in Britain remain dominated by the provision of services around a strong installed base of existing clients. "Work under the NHS is building up, with the initial delivery of existing products such as iPatient Manager (iPM) and iClinical Manager (iCM) into many NHS health trusts. Isoft says existing systems are being packaged with core elements of Lorenzo technology, enabling those systems to communicate with the new national network. "Existing applications will be upgraded to Lorenzo functionality from late 2007. This will provide customers with a phased, low-risk migration of their systems," iSoft says.

British Conservative MP Richard Bacon says iSoft's system is way behind schedule, has major flaws and there are serious doubts that it can be made to work before the program is due to be completed in 2010. Bacon describes iPM and iCM as antiquated, and says recent installations by hospital trusts "in the expectation that a working Lorenzo system will be delivered" may be a massive waste of money and effort. "Why are iPM and iCM being installed instead of the Lorenzo system promised and demonstrated three years ago," Bacon says. "They seem very unstable, and there is a new horror story every week. "We could end up with very poor systems installed and no upgrade path."

Similar questions are also being asked here. Victorian Health Minister Bronwyn Pike recently told the public accounts and estimates committee that Victoria was contracted for the iPM product only, although the contract "requires iSoft to make new developments and product releases available for no additional cost". "This will include the new Lorenzo product it is currently developing, within the bounds of the patient and client management functionality," she says. Department secretary Patricia Faulkner told the committee: "we have obviously been aware that iSoft is struggling with its partners in Britain to deliver its products". "They are beyond the range of what we have contracted for".

Shadow health minister Helen Shardey says the problems with iSoft's capacity to deliver were known when the contract was awarded. David More, an independent consultant and e-health blogger (aushealthit.blogspot.com), says iSoft's failure appears inevitable. "In November last year I had the opportunity to review, in detail, the hospital information system being offered to an international client for a 300-bed tertiary hospital," More says on his blog. "It was clear at the time that the Lorenzo suite was little more than foilware. The system was a concocted blend of old and new components, was obviously unintegrated and lacked any common utility in its user interface. "Needless to say, I recommended no further engagement be had with iSoft and that alternative providers should be considered."

More says NSW Health should not rely on its escrow arrangements with iSoft to protect the rollout of patient administration systems in three area health services this year. "There is no point holding obsolete software code in escrow," he says. "All that does is provide a false sense of security that something can be done when iSoft fails. "Well, maybe it can be used to fix the occasional critical bug while buying time to identify new software to replace the doomed system."

More says organisations in NSW and Victoria that purchased iSoft on the basis of future promises "have clearly let their respective health systems down very badly". ISoft Australia shrugs off the problems engulfing its parent company. Local communications chief Laurie Giles says the local position is "fundamentally unchanged". A three-day iSoft Healthcare Forum will take place as planned at Sanctuary Cove, Queensland, later this month.

Meanwhile, an industry insider says the real risk for Australia lies in the efforts and focus iSoft will have to invest in the NHS project. "So they will be less focused on projects in Australia, which represent only 10 per cent of their total revenues," he says. "They are also under a lot of pressure to cut costs, and it's hard to develop new products when you're cutting costs."

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Deadly public hospital delays

Queensland cancer sufferers are being forced to wait more than four times longer than recommended for life-saving treatment. A damning Queensland Health document has exposed the potentially deadly delays that many public hospital patients and their families must endure. The fresh health scandal is a significant blow to Premier Peter Beattie only four days from Saturday's election.

The internal memorandum, obtained by The Courier-Mail, reveals priority two patients with aggressive tumours, bleeding or pain are waiting up to 34 days for radiation treatment. The recommended maximum wait time for such patients is 14 days. Priority three patients with breast or prostate cancers are waiting up to 89 days while 21 days is the recommended maximum.

A Medical Radiation Professionals Group spokesman said yesterday that a shortage of radiation therapists was mostly to blame and wait times would blow out further as more therapists quit Queensland Health. "It seems the Health Minister has mistakenly chosen to focus only on doctors and nurses and unfortunately the Queensland public is paying the price," he said. Health Minister Stephen Robertson played down the waiting time figures, saying that the Government was addressing the problem. "Timeframes will fluctuate from week to week," he said.

The August 29 memorandum, with the subject heading "Delay in Treatment", gives a breakdown of the waiting times for the four public hospitals which conduct radiation treatment. Townsville Hospital priority two and three cancer patients wait up to 34 and 89 days respectively. Princess Alexandra Hospital cancer patients are waiting 50 days for treatment on priority three cancers and 36 days for priority two. Cancer patients of the Mater Hospital and Royal Brisbane and Women's Hospital also face significant waits beyond what is recommended.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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