1 July 2021

How ‘choosing IBM’ during COVID has failed us big time

Booking Engine Cloud

Choosing big global vendors over agile and experienced local players for state and federal vaccine administration contracts has proven an almost universal fail so far and has likely cost us a fortune

When one of our largest and most successful healthcare booking engines, Hotdoc, announced yesterday that it was moving into the hospital market, it confirmed the fourth major fail of a state government in building a suitable and robust vaccine administration system in time to serve at least the first stages of the vaccine rollout in their state. If the federal government had not bungled supply in the manner it has the failure would probably have been far more apparent.

Hotdoc expects their solution for the Austin hospital in Melbourne to be up and running within a week. It will include capacity to manage 1000 appointments per day, a complete scheduling solution, eligibility screening and stock management for AZ and Pfizer. A spokesperson for the group said that the solution would be fully transferrable for most hospital set ups, anywhere in the country and the group is already looking at delivering the solution to St Vincent’s hospital in NSW.

That Hotdoc can deliver its solution within a week which meets most of the criteria of the tender by the Victorian state government for vaccine administration in one of its major hospitals, and that the tendered solution, awarded to global provider Microsoft, is apparently still not ready, is a common story now across most of the big states.

The other states that have not managed to get their vaccine administration systems up and working in time include WA and NSW. It is understood that probably Qld has not been able to get its state wide system working and that SA has abandoned its initial tender, which resembled the Victorian tender in complexity and has adopted the free solution created by our other big local booking vendor HealthEngine, the Commonwealth Booking Platform (CBP), which was contracted late in the day by the commonwealth Department of Health (DoH), after it realised that it’s original plans to build its own national booking platform were impractical. If SA has chosen to adopt the free CBP platform then it has possibly saved itself considerable heartache and money as the Victorian system, which was based on a very similar tender, is being built by Microsoft at a cost of $5.8m, and is still not up and running.

Certainly it is apparent that none of the state based vaccination system builds or initial efforts to tender and build, all contracts with major global vendors, some in association with global consulting firms, have failed to meet the requirements of tender specifications put out by each state government.

Part of the problem was the requirements specified in some of the state contracts included a fanciful wish list of inventory tracking and management capability as well as the normal vaccine booking and administration functionality. The latter was mostly already off the shelf for most of the major local booking engine vendors all of which have been dealing in large numbers with multiple institutions and integrations for many years now.

The Victorian tender included some of the following requirements:

  • capability to support cold chain management including but not limited  to capturing data from temperature sensors throughout the supply chain and providing appropriate alerts.
  • integration with third party vendors / online ordering systems
  • ability to scan and track receipt and consumption of vaccine details down to the vial level including additional features to support safe and efficient use of multi-dose vials

The Victorian tender requirements are very similar to the SA tender requirements. Both mix the ability to do highly sophisticated stock and inventory management from source to distributor, with booking and related administration functionality. The two requirements are worlds apart, but it must have been more than obvious to most state government health departments that the “last mile” functionality that the major local booking engine vendors have developed over many years was more than suitable to meet all the tender requirements outside of the complex upstream inventory requirements.

What seems to have happened is that by combining the two disparate requirements the state governments have ruled out the local vendors for every state contract based on them not being able to fulfil the upstream inventory requirements. That and quite feasibly there has been a good helping of “no one gets fired for buying IBM”.

But we have almost universal failure of the states to have their global vendor built booking systems up on time with the inventory management component clearly a huge issue for the states and the federal government.

The states aren’t able to predict supply, so there is nothing talking to a federal system, and they can’t accurately target distribution because there are no third party integrations with the systems managing the GP sector, which are doing more than half the work so far, or their own systems simply aren’t up and running, so they can’t do their own vaccination hubs properly.

It’s a very expensive mess. Probably someone should be fired.

Wild Health understands the following about some of the state  and federal contracts:

  • WA – Saleforce + Deloitte: failed to deliver on time and had to contract 1st Group to provide interim capability for a few months. Now working to a degree where the 1st Group interim contract has been discontinued. 1st Group says its solution was working perfectly and could have been lifted and shifted across the country. !st Group got their solution up in just one week. $5m for global vendor to execute contract.
  • Victoria – Microsoft: not working despite tender document suggesting solution should be ready early 2021. Hotdoc has contract to help Austin hospital which does most of what the Austin hospital will need in terms of booking, support, administration and even inventory management at their end. Hotdoc says they too can lift and shift their solution anywhere in Australia. Hotdoc says they will stand their solution up in just one week. $5.8m contract mostly went to Microsoft.
  • NSW – working with existing Cerner infrastructure: still not up and running properly across the state as a single solution. Early in the year one large city based LHD requested they work with a local vendor for a an interim solution and that was up and running a few months back. That solution can be lifted and shifted across Australia as well according to that vendor.
  • SA – put a master tender out similar to Victoria but then appeared to have fallen back on asking each LHD to come up with their own solution. Some LHDs contracted global EMRs to do their hospital hubs but much of the state is now using the Commonwealth Booking Platform (CBP), developed by HealthEngine for the DoH. Apparently, the Health Engine solution is being used for all the SA vaccination centres now. CBP was contracted to be built by the DoH as a stop gap for any providers who did not have an existing booking solution and was put together within weeks by Health Engine at the last minute after the DoH realised that its intention to build its own national booking engine was fraught with complexity and most states had tendered their own solution in any case. Initially the CBP was expected only to be used by GP practices who did not have their own booking engine commercial relationship and odd other set ups. It’s uptake by vaccination hubs and hospitals in SA came as a surprise to some in the sector given the initially complex tender that SA had put out for its service, which resembled the tender put out Victoria requiring highly sophisticated inventory management and reporting. HealthEngine told Wild Health that the CPB solution is and has been available for use by any state that is interested in using it. In addition HealthEngine maintains it can set up a commercial solution in less than a week for states, hospitals or vaccination clinics, just as Hotdoc and 1stGroup, appear to have done for groups in Victoria, NSW and WA.
  • Qld – unknown but reportedly not up and running and in trouble
  • ACT – Epic based solution: up and running
  • Department of Health (federal government) master  supply chain and inventory management solution: Salesforce and Accenture: unknown whether this is technically up and running but given the parlous state of data coming out of Canberra, the complaints from every state on supply and the fact that the system is not connected to the GP network because it is run by third party local vendors who have not been required to integrate, it’s hard to see what value this contract is delivering to date if any to anyone.

We know the Victorian and WA contracts were both worth about $5m so if we amortise that across every state and territory, each of which went for a different solution to largely the same problem, it looks like between the states, various LHDs and the federal government we may have spent something north of $40m across the country on supply chain management and vaccine booking and administration systems, nearly all of it with large global vendors and consultancy firms, and most of it still not working.

If you consider that most of the state based contracts were for what Hotdoc, 1stGroup, HealthEngine, and a few other clever local vendors have been doing for years now and have been able to deliver on demand on an interim basis within a week or so via cloud solutions, then you might easily imagine that the vaccine booking and administration needs of every state and territory for their hospitals and mass vaccination hubs could probably have been delivered by one of these local vendors across the nation for something under $5m, and possibly less. For safety’s sake you might have even awarded two contracts to two local vendors so you had back up.

Instead, we have gone state by state, and in some states district by district, awarding very expensive contracts to big name multi-nationals, which undoubtably are capable operators in the right circumstances, but which in this instance have bitten off way more than even they can chew in the timeframe given them. All the while the over looked local vendors always understood intimately our very complex local health ecosystem because they have been developing their systems in it for many years now.

The final insult to the local vendor community?

Even though some groups such as Austin Health in Victoria and selected LHDs around the country have gone off piste with local vendors to sort out something their state government had failed to provide them and now have working systems, most of the state based contracts with the large multi-nationals still have to be honored. So if and when they do come online eventually, as occurred in WA with Salesforce and Deloitte, the local vendor will then be asked to stand aside.

There’s a lesson in here somewhere for our state and federal governments about the complexity of our health ecosystem and the ability of the local vendor community versus that of the big name global vendors to understand it and provide solutions faster and better in short and long term.