It was a bold vision but more than three years after starting its smart eReferral project, was WA Health sold a pup by big tech and big consulting?
Just over one year after awarding an $8.4 million contract to SalesForce and Deloitte to develop a comprehensive smart eReferral platform for the state, and three years after the original tender went out, WA Health has dropped SalesForce and Deloitte from the project and reverted to bare bones basics.
Instead, WA Health has retained HealthLink in an attempt to connect its hospitals to GPs, specialists and the community, via its more than 10-year-old Microsoft Sharepoint solution.
WA Health is remaining tightlipped about what happened, telling Health Services Daily that “the project has been reframed into two phases, with the first involving HealthLink SmartForms technology”.
HSD understands that HealthLink, which was part of the original “smart” platform solution pitched by Deloitte and SalesForce, will step up to try to at least create a link between the existing and antiquated Sharepoint solution and its secure messaging network.
Although this would represent some improvement to what WA has in place now – at least HealthLink’s network access to most GPs and specialists would be plumbed in to the centralised Sharepoint system – that system is now more than 10 years old and not fit for purpose to manage the modern real-time interoperability demands of a statewide hospital system.
It is understood that the part that Deloitte and SalesForce were originally contracted to do, a completely new statewide smart eReferral platform, using SalesForce technology to create a centralised dashboard for management and HealthLink to plumb smart forms and messaging to various system providers from there, has been dropped entirely.
The current WA system for referrals is run by a department called the Central Referral Service (CRS). It is manned by nurses and admin staff and involves a lot of manual processing.
In 2022, when the smart eReferral tender first went out, WA Health estimated that only about 26% of referrals across the state used secure messaging, while at least 50% of referrals submitted to CRS required manual intervention due to missing information or that the original referral was via fax.
At that time WA Health said it was looking for an “off the shelf solution” that talked to the major GP practice management systems, Best Practice and Medical Director, and Communicare, the patient management system used by most Aboriginal health services in WA.
Although the original tender was put out in 2022 it was not until February 2024 that the contract was awarded and when it was it was instantly controversial within the digital health community because neither SalesForce nor Deloitte had an “off the shelf solution”.
The tender had specified clauses about “WA first” and at least one tendering organisation was from WA, and at least one other tenderer had proposed a solution that would use far more modern and inexpensive web-based data-sharing technology at a cost of less than half what the tender eventually was awarded for ($4 million vs $8.4 million).
Adding to the controversy, at the time the contract was awarded, Deloitte was embroiled in the aftermath of the PwC tax scandal and was being lambasted for poor governance and potential conflicts of interest by a federal parliamentary inquiry.
Deloitte was also the consultant awarded a $10 million project for WA’s peak primary health network alliance WAPHA to build and maintain a centralised “data lake” for all the nation’s PHNs.
That project is now under a cloud because the Department of Health and Aged Care has made it clear that it does not believe PHNs should be concerned with extracting and storing patient data from the country’s GP practice networks (which many do now through PenCat and their own custom built data extractors via ePIP) but only with analysing that data for assessing the population health and provider needs of their local communities.
DoHAC intends in the next couple of years to take over the data extraction and storage process for de-identified data from GP practices through the Australian Institute of Health and Welfare, a process which it says will reduce waste by avoiding each PHN having to develop their own data management expertise, and create far more alignment across the country in population health data governance.
All of this puts a big question mark on the future of the Deloitte-led centralised WAPHA data lake project Primary Health Insights.
Some people who are close to the project claim that WAPHA got sold the whole idea by Deloitte as a part of earlier strategy work, and later Deloitte became the lead on the project.
The WA eReferral project feels like it has some elements of what some claim to have happened to WAPHA – big consultant, big technology group, shiny grand ideas, all backed in the end by government money.
SalesForce is doing work for the SA government on eReferrals but nothing went to tender in that state, possibly because the state had pre-existing SalesForce licenses for other projects
In Queensland, the big US technology firm has managed to secure some work with some big hospitals that want to trial digital front door and eReferral technology.
A big problem with the Queensland work is that if and when anything goes to tender in that state, all the pilot work will have been done by SalesForce so they would be a natural frontrunner to win the tender.
None of this is to say that SalesForce eReferral solutions aren’t appropriate or good solutions, albeit obviously the WA Health Department doesn’t seem to think too much of their solution now and SalesForce internationally aren’t big in healthcare solutions – in relative terms the Australian office is punching above its weight on winning healthcare work.
But it does pose a question around how effective state health departments are at assessing modern digital health interoperability technologies and how much they might be swayed by the “if it’s not IBM paradigm”, in making important decisions on major system infrastructure.
Big tech and big consulting have natural advantages in any procurement process in this country:
- You aren’t going to get criticised for picking them, no matter how hard and spectacularly they might fail and working in state health procurement is a tricky political balancing act most of the time;
- They have the slickest and best funded sales teams in the country;
- They have big capital bases, so they have no problem with difficult government requirements around liability, insurance and governance – a lot of smaller local vendors are not able to bid for some projects because they don’t have the capital to tolerate the risk and liability clauses of the state government contracts;
- There is an inherent belief that being so big their tech and integration capability will be superior (it should be right?).
This WA Health eReferral contract mess is just one case in point that on some occasions, at least, big can turn out to be bad in terms of both the technology on offer and capability.
A harder look at some of the smaller innovative tenderers might not go astray.
What if WA Health had chosen the tenderer which had a local vendor offering a modern web-based referral protocol as the key technology offering and a practice healthcare international integrator to do all the upstream work?
Just one year on that vendor has won major contracts with big hospitals in NSW and Victoria and major eReferral work with a large slice of the country’s PHNs, which are funding their local GPs to adopt the technology.
It has integrated all the major GP systems giving it potential access to most of the GPs in the country for any hospital wanting to connect better with the community and with Gentu, giving it access to about 2000 specialist practices and 10,000 specialists, many of whom will already be working in hospitals. It is also aligned tightly with the fast-evolving FHIR standards work being done in the country.
In other words, was this tender, involving a small and innovative local technology provider, worth a closer look in retrospect?
For now, WA Health is retreating and licking its wounds but it looks like it hasn’t given up on the original and sensible vision it had for better interoperability in the state hospital system. It is saying they now have a phase 2 in mind which suggests that when they have some basics in place with HealthLink and Sharepoint they are going to return to the grander vision with a new tender.
“The second stage will be informed by WA Health’s major outpatient reform agenda with a keen focus on benefits for patients not able to disclose details of contractual matters,” a spokesperson told HSD.
That Agenda is HERE.
It reads really well, but this document was published in 2019.
Also, as good and as comprehensive HealthLink’s secure messaging plumbing service is, secure messaging is yesterday’s technology in terms of modern healthcare system data sharing. It’s tied to old server-bound GP and specialist PMS systems, all of which are upgrading to web-based interoperability in the near term, driven by the federal government’s “sharing by default” programs.
Modern data sharing is going to be cloud-based, underpinned by FHIR and other key healthcare sharing standards and technologies. By tying their system to HealthLink now, WA Health might be doing the old “one step forward, two steps back” if they really want a modern interoperability platform for that state (although HealthLink itself has developed web-based smart referral technology). They should at least look at what some of the other states are doing in terms of cloud-based eReferrals and data sharing.
HSD asked both Deloitte and Salesforce to comment on this story but had not received a reply by the time we went to press.