Waikato DHB virtual health mistakes cannot happen again, say doctors

Former Waikato DHB chief executive Nigel Murray and former board chair Bob Simcock were in charge of a business case for SmartHealth that was rushed through. Photo / Christine Cornege

Doctors at Waikato District Health Board have slated its roll-out of the controversial SmartHealth app as an expensive waste of time and money that must not be repeated.

In a scathing submission to a DHB review of the virtual health technology, from the Waikato Senior Medical Staff Association, doctors from 20 specialities criticised the business case for SmartHealth, its implementation, functionality and the American company HealthTap that powers the virtual platform.

The Auditor-General launched an investigation into the procurement of the $15 million contract with HealthTap in December following a damning Audit NZ report which found it should have been done through an open tendering process, the business case was not written specifically for SmartHealth, and there was no investigation into other options.

In October last year the Herald revealed the business case, which has never been released to the public, was rushed through board approval by former chief executive Dr Nigel Murray and former board chairman Bob Simcock.

In the submission, dated February and March 2018 and signed by association chair Dr Margot Rumball, doctors criticised the lack of detail, transparency and timeline of the procurement in mid-2015.

"Only two clinicians reviewed this document, two days after it was written, and three days before it was approved. The time from first version [July 15, 2015] to the final approved third version [July 20, 2015] was five days, encompassing a weekend," Rumball wrote.

"This appears to be an extraordinarily short time commitment for such a significant financial commitment."

One doctor called the business case "woefully short of important detail" and did not explain what the Early Innovator License Fee of $7.39m was based on, or purchased.

Waikato DHB interim chief executive Derek Wright says it is too early to comment on an Ernst and Young review of HealthTap and SmartHealth. Photo / Alan Gibson

There was a lack of quality outcome measurements, including no calculation for the risk of reduced quality of patient care brought about by diverting $15m from the budget to pay for the project, Rumball said.

They also worried over an absence of any disclosure of potential conflicts of interest.

"It was unclear whether any of the contributors or authors of this business case may have a financial benefit or otherwise in this proposal.

"It is noted that one of the reviewers was subsequently employed by the project, with a projected annual salary of $250,000."

Implementation of SmartHealth was inadequate, with target patients and clinicians not properly identified, the submission said.

In one case a surgical clinician spent six months vetting his clinic for potential consultations but at each clinic of 20 patients, found only one or no appropriate candidates for SmartHealth, compared to the 17 a plan for that service suggested.

And doctors complained about "persistent pressure from management" to use virtual health in daily practice without consulting clinical staff on the relevance to their practice.

Virtual wards rounds advocated by managers involved Thames Hospital doctors consulting Tokoroa emergency department patients, which doctors deemed "clinically inappropriate".

Clinicians raised issues about a lack of an after-hours pharmacy for virtual patients which meant they would still require an emergency department consultation, but the concerns were not heard.

"The experience has led to a lack of trust and a perception of a deep lack of understanding about the delivery of healthcare."

The rollout was overwhelming, with some clinicians signing up to "stop the persistent emails".

"Other clinicians persisted, but had to deal with inappropriate consults from patients elsewhere in the world, including one clinician who cited an unacceptably high number of irrelevant inquiries about how to make a penis bigger."

There was also opposition to a doctor rating system and concern was expressed about the significant extra workload on senior doctors, availability requirements and the risk of clinicians feeling "invaded and demoralised" by the constant exposure to patient demand.

They labelled the app inflexible with a US-centric platform and raised concerns over security, slow response from HealthTap to issues, and complexity for patients.

The most vulnerable and in-need patients were the least engaged, doctors said.

Rumball agreed virtual health was viable but there was a "lack of conviction that HealthTap will be capable of providing this".

"There is a general perception from senior medical officers' feedback that HealthTap is not fit for the purpose of virtual healthcare delivery at Waikato DHB."

She said doctors were anxious that without a fundamental overhaul of the implementation process, that any new virtual health system will also struggle to attract targeted users.

"The simple reality of health economics is that Waikato DHB cannot afford to take this risk."

Interim chief executive Derek Wright said the DHB was in the middle of the review being conducted by Ernst and Young, who had sought feedback from a range of stakeholders including senior doctors.

Wright said it was too early to comment on that feedback because the review was not complete and it was unclear when the board would make a decision about whether to continue with HealthTap.