History and Ongoing Challenges of Australian e-Health Record Systems

Article Title: National electronic health record systems as ‘wicked projects’: The Australian experience

Aims & Method: This review of public policy initiatives aimed to identify and discuss why attempts to implement electronic health record systems at a national scale frequently run into trouble. It also examined why lessons from the past seemingly do not inform efforts to rescue existing projects or subsequent initiatives. Thirteen individuals who were close to or personally involved in national e-health record systems design, development and implementation in Australia were also interviewed.

Results: Attempts to design and implement a national e-health record system in Australia exhibit many features of ‘wicked problems’. A wicked problem is one that is difficult to define and solve. The authors suggest that there are three aspects that help explain the disappointing results of investments in two large-scale national electronic health record initiatives:

• Politicians and policymakers failed to recognize that these projects were complex and risky. They were tempted by enthusiasm around electronic solutions to healthcare.
• Conventional project management approaches were used. These approaches are effective for ‘tame’ situations, but not in multi-stakeholder environments and projects with ‘porous’ boundaries, and
• An unwillingness to learn from failed approaches. Conflicting priorities and values were not viewed as important aspects of the projects. This presented opportunities for productive negotiation and development.

Implications: Australia now has 15 years of experience attempting to build a workable national e-health record system. The ongoing complexities of designing and implementing a national e-health record system relate closely to the definition of a ‘wicked problem’. Learning from past errors and involving the right people in the future interactions could help to avoid national e-health system ‘wicked projects.’

Our onward queries: Will the proposed shift to an opt-out model and financial incentives for use by GPs see the Australian My Health Record become a useful tool that is valued by those delivering and receiving healthcare?

Full reference of article
Garrety, K. McLoughlin, I. Dalley, A. Wilson, R. Yu, P. (2016) National electronic health record systems as ‘wicked projects’: The Australian experience. Information Polity, 21, 367-382.

Link to article on publisher page: http://content.iospress.com/articles/information-polity/ip389