The HI Service Operations Contract between NEHTA and the Commonwealth of Australia (as represented by the Chief Executive Medicare) was drafted at the commencement of the Service but has not been signed. The draft Contract was updated 6 months into the service operation to reflect that the legislation had been passed and to incorporate forward estimates and budget. This revision is also unsigned. The HI Service has been operating on a letter of understanding between the two organisations which requires them to operate in accordance with the intent of the contract.
At the time of the Review the contract is under review and remains unsigned. The major area of contention relates to the requirements of the Financial Management and Accountability Act 1997, which has introduced some constraints and differing views about the financial arrangements between the organisations.
Part of the challenge is that the level of demand that will be experienced when the system is in more active use is still relatively unknown and there is little information to identify potential spikes in utilisation that will impact resourcing and service levels. This will be an ongoing issue and requires a strong process between DHS and NEHTA to manage this effectively.
A number of issues were identified by stakeholders relating to the current SLAs for the HI Service. The major concern was the exclusion of scheduled downtime from calculation of SLAs, and the absence of limitations in contracts of the duration or frequency of maintenance outages. Outages have been a major problem to end users and have become more frequent over 2012, with the longest outage being 39 hours in October 2012. The circumstances of this particular outage do appear to have been exceptional, with failures in both production and failover environments and required parts being unavailable in Australia. It was reported that the increase in outages was partly triggered by activities that needed to be performed as a result of major changes to the DHS technical infrastructure environment. Given the integration between the HI Service and clinical systems with a 24x7 requirement, the expectation from CIOs is complete failover capability should be provided to guard against any system outages. A change request is being progressed to seek funding for dedicated failover capabilities for the HI Service.
A main concern for users was the lack of information being provided about the changes that are made during outages. Users were also concerned that there is often not an adequate period of notice being given before the system goes down for a scheduled outage for stakeholders to assess the impact and manage the outage.
Other aspects of the SLA that could be tightened to better support the users of the HI Service include:
- Alignment between the SLAs of the HI Service and the PCEHR system.
- SLAs for the vendor test environment as availability of this environment is critical for uptake. Given current and anticipated future levels of demand it would be appropriate to review the requirements for vendor test environments and develop an upgrade strategy and business case for enhancement of this infrastructure.
- Extended reporting on the analysis of root causes of incidents to enhance opportunities to learn from incidents and foster an environment of continuous quality improvement.
- Timeliness of reporting performance against SLAs needs to be addressed as this impacts NEHTA’s capacity to communicate effectively with stakeholders and manage the contract.
Recommendation 5 – Service Level Agreements (SLA)
It is recommended that consideration be given to:
- Revising the SLAs for the HI Service to:
- Ensure alignment between the Healthcare Identifiers and PCEHR SLAs
- Include scheduled downtime in measures of availability
- Include SLAs in relation to availability of the vendor test environment
- Enhance the management and resolution of any incidents that occur for the purposes of continuous improvement of the Service.
- Undertaking periodic independent review of performance against SLAs and other contractual requirements, such as reporting.
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