Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health ServiceCHAPTER 10INFORMATION SYSTEMSIn this Chapter, we look at the information technology (IT) implications of our recommendations for the healthservice. The various recommendations made by us throughout the report require the integration of financial,human resources/personnel and clinical activity information down to patient level.10.1 OVERVIEWThere has been under development of information systems throughout all aspects of the Irishhealth service from policy-making through to implementation. There needs to be anaccelerated programme of investment in information systems to extend SAP and PPARS to allmajor spending agencies.SAP is a fully integrated software package with available modules including financials, materialsmanagement, human resources, payroll, asset management and asset maintenance. PPARS(Personnel, Pay, Attendance and Recruitment System) is the human resource module of SAP.SAP financials are in use in the Eastern Regional Health Authority, Midland Health Board andNorth Eastern Health Board. PPARS is a national project and the first phase is inoperation in five health boards and St. James’ Hospital. Current developments will see theremaining boards and larger hospitals developing specifications to implement SAP financials andPPARS.10.2 THE CASE FOR IT INVESTMENTClinicians need to have access to cost, performance and clinical outcome information in orderto provide quality health care in an efficient and effective manner. The international literatureindicates that throughout the world countries/jurisdictions are striving to improve the qualityof health care information. This requires significant State investment in information systems andhuman resources.The case for increased investment is twofold. Firstly, at a health board/agency level, ITinvestment will deliver more process efficiency. IT facilitates the re-engineering of businessprocesses from inefficient manual processes to the most efficient automated processes. Acommon system for the differing processes also allows the development of shared services tooptimise efficiencies and concentrate expertise.Secondly, the real gain will be in the quality of information that becomes available to managersat all levels to enable more timely and effective decision making as well as benchmarking acrosssimilar hospitals, departments and services to deliver a more effective, optimum service.We note that the Independent Estimates Review Committee said "the strengthening ofinformation systems should command a higher priority and implementation of improved personnelsystems should be accelerated so that value for money can be better assessed" 1The main benefits of increased IT investment can be characterised as strategic and operational.1Paragraph 9.4 Estimates for Public Services 2003 - Report of the Independent Estimates Review to the Minister for Finance,December 2002.116
Chapter 10 Information SystemsStrategic benefits include:●●●●Enhanced performance evaluation, planning and monitoring;Devolved budgetary control and management;Benchmarking and comparative analysis based on best practice; andImproved financial transparency.Operational benefits include:●●●●●●Systems and processes which allow users to focus on service delivery;Regular, timely and accurate financial information and reporting;Financial and related activity analysis;Reduction in resources involved in financial transaction processing;Increased focus on value for money and greater transparency in resource use; andImproved budgetary control and financial management of resources.10.3 CONDITIONSWe have no doubt that there is an IT deficit in the health sector and that significant investmentis overdue. However, it has to be understood that investment (of many millions of euro) in ITwill not, of itself, solve the problems of the health service. Spending additional resources on ITsystems without fundamental changes to the health system will not deliver the value for moneybenefits that are regularly cited to support such expenditure.The amount of money involved issubstantial and for this reason the greatest of care must be taken to ensure that theexpenditure takes place under conditions that will deliver on the value for money expectations.Resources and skills in change management will be needed to gain full value from the proposedinvestment in information systems. We have seen what has been achieved in the Midland HealthBoard in terms of management information generated by new IT systems (see Appendix 9).On the other hand, it was suggested to us that where there had been expenditure on IT in thehealth services, the expected benefits were not always achieved because personnel had notchanged their pre-existing practices and had not adapted to the new IT environment.Commensurate with the expenditure on IT, a change management programme is needed toensure that the transition from old to new ways of running services takes place.It is normal practice when seeking sanction for investment in IT systems that management drawup a comprehensive business case indicating the value added by the proposed systems – to dootherwise risks wasting public funds. The standard business case in this instance covers:●●●●The business context: why it is being done and its fit with strategic priorities;The expected benefits: strategic, process effectiveness and efficiency;The costs: including staff, consulting, licensing, support, maintenance, managed service,hardware, software; andRisks/challenges: culture change required, commercial risk, project management andgovernance, change management.We believe that it is imperative that the business case made should be expanded to providegreater assurance that the proposed IT expenditure will deliver the outcomes specified. In117
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Commission onFinancial Managementan
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TABLE OF CONTENTSEXECUTIVE SUMMARY
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6.4 COMMUNITY DRUG SCHEMES 80Medica
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Executive SummaryEXECUTIVE SUMMARYT
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Executive SummaryWe do not underest
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Terms of ReferenceTERMS OF REFERENC
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GlossaryEstimates for Public Servic
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Chapter 1 Introduction and Backgrou
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Chapter 1 Introduction and Backgrou
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Chapter 2 Overview and Issues2.2 OR
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Chapter 2 Overview and IssuesTable
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Chapter 2 Overview and IssuesProble
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Chapter 3 Managing the Health Servi
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Chapter 4 Service Planning, Budgeti
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Chapter 5 Accountability - Hospital
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Page 101 and 102: Chapter 8 Audit ReformCHAPTER 8AUDI
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Page 107 and 108: Chapter 8 Audit Reformaudit reports
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Page 123 and 124: Chapter 11 ImplementationRecommenda
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Page 127 and 128: Appendix 1Appendix 1COMMISSION MEMB
Page 129 and 130: Appendix 1He has held this position
Page 131 and 132: Appendix 2SIPTU*South Eastern Healt
Page 133 and 134: Appendix 3Name of AgencyBord na Rad
Page 135 and 136: Appendix 3Name of AgencyIrish Blood
Page 137 and 138: Appendix 3Name of AgencyWomen’s H
Page 139 and 140: Appendix 4Department of Health and
Page 141 and 142: Appendix 4collated and assessed by
Page 143 and 144: Appendix 4The most detailed element
Page 145 and 146: Appendix 4Ratifying and Submitting
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Page 153 and 154: Appendix 5Appendix 5DIAGNOSIS RELAT
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Page 157 and 158: Appendix 6Appendix 6AUDIT OF STRUCT
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Page 161 and 162: Appendix 8Appendix 8 - Integrated M
Page 163 and 164: ADDENDUMNumber Recommendation IT Ti
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Brennan Report - Department of Health and Children

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