A four year program to establish an Electronic Health Record for 80,000 Australia's Defence Personnel has come in for some heavy criticism by the Australian National Audit Office.

A contract was issued in 2010 to CSC to implement an off‐the‐shelf product sourced from the UK’s Egton Medical Information Systems. The proposed system was originally called the Joint eHealth Data and Information System (JeHDI) and was later known as the Defence eHealth System (DeHS).

The system was intended to centralise, electronically capture and manage ADF health records and also inform health groups preparing for deployment in support of military operations.

Through incremental increases in scope the expected cost blew out over four years to $A133.3 million, some $A110.0 million higher than the original budget, although the costs have all times been borne internally using Defence’s departmental budget.

The report concludes that DeHS has actually increased administrative workloads in some areas. For example, pharmacists are required to record patient medication and prescriptions in both the FRED/PILS (primary dispensing and stock logistic systems for pharmacists) and DeHS; and external health care providers are required to submit clinical reports and referrals in paper‐based format for scanning, before electronic files are appended to patient eHealth records.

Initial plans to migrate health record data from existing repositories and paper records into the new DeHS system have not materialised, and the implementation of the pharmaceutical dispensing module has been deferred until late 2015.

While CSC prepared tools to migrate records from defence’s existing systems, this did not proceed owing to the discovery that they contained “poor quality data.”

Instead it was decided to prepare basic health summaries from patient Unit Medical Records and attach these to the personnel files in Defence’s Objective records management system.

“For recruits joining the ADF in 2016, DeHS may be the only system that will manage their entire patient record—from recruitment to discharge—while the medical history of current ADF members may need to be accessed from multiple sources, as required,” the ANAO report notes.

“Clinical practitioners have reported that clinical care of patients is generally not compromised by the absence of a complete patient medical history in DeHS, and that on occasions they will revert to Unit Medical Records to inform a patient’s treatment strategy. However, certain health groups have been inconvenienced by the absence of records, such as dentists recording details of patients’ dental history following the rollout of DeHS.”

DeHS is eventually expected to link with Australia’s national Personally Controlled Electronic Health Record (PCEHR) for the interchange of health information across private and public health systems.

The ANAO found that "the principal reasons for the increase in DeHS project costs were: a one year extension of the funded sustainment period; hosting the system externally rather than internally; and the inclusion of previously unbudgeted items such as training requirements."

"Overall, Defence’s planning, budgeting and risk management for the implementation of DeHS were deficient, resulting in substantial cost increases, schedule delay and criticism within government.

"During the initial phases of the project, Defence did not: scope and cost key components of the project; validate project cost estimates and assumptions; obtain government approval when required; follow a project management methodology; or adequately mitigate risk by adopting fit for purpose governance and co‐ordination arrangements.

"Defence’s planning and management of the initial phases of the DeHS project were well below the standards that might be reasonably expected by Defence’s senior leadership, and exposed the department to reputational damage."

“While the business case identified business requirements and key risks, it was also somewhat ambitious. Defence planned to: aggregate patient health records from multiple Defence systems; standardise business processes across all health groups at the same time Defence was redesigning its health services support model, including its contractual arrangements; and deploy DeHS in operational environments. However, the business case lacked detail on how these requirements would be achieved.”

The report concludes that between 2012 and 2014, Defence strengthened project governance and management arrangements to achieve the rollout of DeHS by December 2014, featuring most of the intended functionality,

"... notwithstanding the need for some corrective action, stakeholders have identified early benefits from the use of the system, including access to a single patient eHealth record," the ANAO report concludes.

Although some limitations remain, as Defence had “intended that the system would automatically capture civilian health care provider referrals and reporting; support dispensing of pharmaceuticals; and exchange information with Defence’s financial management and accounting system. However, this work was not progressed, which has delayed the implementation of agreed DeHS functionality and the realisation of intended benefits.”

The Department of Defence responded to the ANAO Report by noting, “Since the implementation of Defence eHealth System (DeHS), Defence has made significant improvements in the assurance of ICT projects. In particular, improvements in the governance of approval processes and the establishment of professionalization streams have reinforced the internal accountabilities.”

The full ANAO Report is available HERE