Health system requires a technical heart transplant

It Seems The Computerised Heart Of The Australian Health System Is Dangerously Close To A Heart Attack, writes Dr David More.
During the last week of April - and just prior to some fairly significant budget cuts to the Health System, there was some quite concerning news emerge regarding some computer systems which are crucial for the overall health system.
The systems I am talking about are those huge and complex systems that are operated by the Department of Human Services and which help support the doctor payments of Medicare billing, the systems supporting the PBS, Centrelink and possibly the PCEHR as well as a range of registries covering such things is paediatric vaccination and so on.
The systems which are part of providing payments to doctors and pharmacists have become utterly critical to the cash flows and operations of these services. Loss of these systems for even quite brief periods of time may very well result in considerable disruption of these services.
As background, parts of these core computer systems were initially installed in the mid-1980s and use IBM System 360 compatible mainframes. The software used to support these systems has been developed in a data-base tool called Model 204 (http://en.wikipedia.org/wiki/Model_204) which is written in IBM System 360 Assembler - the most basic of computer language for IBM mainframe computers. This software is even older having begun its useful life in 1972. It is fairly inflexible software but in part makes up for this by being very efficient in the processing of transactions - which is something that Centrelink / Medicare do vast numbers of daily processing payments and so on to millions of people. Why the age of both the hardware and software is important is that there are now vanishingly few people with the skills to maintain and update the software and hardware and fundamentally both are now well past their ‘use-by’ dates!
Inevitably what happens with software systems of this age is that either they must be updated as requirements change - think MBS payment rates, legislative change and rules and Centrelink payment rules etc. - and inevitably the lack of flexibility and skills means all sorts of tricks and workarounds are developed to keep the system working. These ultimately become so difficult and costly to maintain that, even if the old hardware can keep being maintained, a replacement needs to be planned and undertaken.
The scale is the issue was made clear by The Treasurer in late April, 2014.
Centrelink computer broken: Hockey (Phillip Hudson, The Australia, April 25, 2014)
“Joe Hockey has warned of a shock multi-billion-dollar hit to the budget to fix the 31-year-old Centrelink computer system, which is in “bad shape” and a drag on productivity that is holding back crucial policy change.
“Human Services Minister Marise Payne said the system, based on 1980s technology, was also hampering the government’s efforts to cut red tape and shift Centrelink into the digital world.
“The Treasurer said the biggest surprise he had received since coming into power was the -deterioration in government infra¬structure, particularly the Centrelink computer system in Canberra, which would cost “billions” to improve.
“Mr Hockey, who is preparing a structural overhaul of welfare and payments in the budget next month, said changes were being stymied by the system.
“My overwhelming concern is that it is inhibiting the capacity of the government, to some degree, to roll out policy that properly addresses the problems in the economy and the budget,” he told radio station 3AW.
“Centrelink’s Income Security Integrated System is vital to the delivery of $400 million in social security payments every day.”
The link to the full article is:
www.theaustralian.com.au/nationalaffairs/welfare-computer-brokenhockey/story-fn59niix-1226895359866
The size of the task is made clear by reports that it is estimated that it will cost $12 million to develop the business case for the system update. The replacement of the systems themselves is believed to be likely to cost a billion dollars plus.
This update will clearly be one of the largest and most mission critical projects ever undertaken in Australia with any significant disruption to payment flows resulting in issues for the national economy.
As Mr Hockey points out above Government policy is already being stymied by system inflexibility.
All we can hope for is that a replacement core transaction system can be planned, specified, procured and successfully implemented before the unreliability and inflexibility of the present system reaches levels that are unacceptable or worse. In recent time system outages have been by no means rare.
See here for a recent example:
http://www.smh.com.au/it-pro/ government-it/centrelink-childsupport- suffer-systems-outage- 20140428-zr0rd.html
What is required is what amounts to a technical heart transplant for the very core of the Health System and the Community Support System.
The track record of Government in delivery of major IT projects has frequently been one of cost overruns and delays (from Governments of both major political persuasions) and the risks (technical, financial and cultural) are really enormous. Clearly we have reached the time when the replacement has to be undertaken but you really have to hope the string and chewing gum holding the current system together can survive long enough for the transition to be delivered successfully and without additional risk caused by excess haste.

---

“What is required is what amounts to a technical heart transplant for the very core of the Health System and the Community Support System.”
DR DAVID MORE

---

I have to say that while I am sure planning for this upgrade has been going on for a while it does seem a little worrying that government has only now started to develop the Business Case for a transition to a new system.
I note in passing that there are also concerns with the security of the access portal to these systems with the site at www.my.gov.au having been recently been cited as being insecure.
While all this is a long way from what is traditionally talked about as e-Health it is an absolutely vital part of Australia’s eHealth Infrastructure providing the part of the base for both the Personally Controlled Electronic Health Record (PCEHR) and the Individual Health Identifier (IHI) service among others.

Dr David More
Health IT Consultant
Dr David More is a Health IT consultant with more than 20 years’ experience in the e-Health area. His blog can be found at www.aushealthit.blogspot.com and covers all matters e-Health. He may be contacted via the links provided on the blog.