The Victorian government is hastening slowly to implement its "extraordinarily ambitious and hugely complex" Whole-of-Health ICT strategy, HealthSmart, as it labors to overcome the inertia that has long dogged the health sector.

Norma Fredrickson, manager of the program management office in the Department of Human Services, says her team has spent years setting specifications and arriving at solutions acceptable to the entire sector. Such a measured approach is essential to ensure confidence in the selected products and to smooth implementation, she says.

Now poised to pay major dividends, HealthSmart is one of many shared service initiatives underway across all levels of government in Australia, but it is arguably the most difficult. The program is one of the biggest IT projects ever undertaken in Australia, requiring massive logistical planning and development. The government set up the program to implement its Whole-of-Health information and communication technology (ICT) strategy, 2003-2007. The four-year program is aimed at modernizing and replacing ICT systems throughout the Victorian public health care sector.

Fredrickson says HealthSmart is the only integrated approach to health care delivery in the Australian health sector, set up in recognition of the integrated nature of health care. The government also accepts its spending on ICT for health was until recently significantly below that of other health jurisdictions across Australia, she says.

The program positions the sector to take advantage of other health initiatives like the Commonwealth's planned integrated health record. This will allow a common view of a patient across episodes of care and providers of health service.

"It's a way of rationalizing huge inefficiencies that have built up over many years that Health has been a provider of services to the community. It's also about leveraging off the buying power of health as a large sector within Victoria, and ensuring there can be some small 's' standardization in terms of common systems, common standards, a common approach," she says.

Business drivers for the project include improving the quality of care and reducing adverse effects and increasing the time clinicians can spend with patients. It's also about ensuring those involved in health delivery are available to do the work they trained for rather than being bogged down in processes that add little value. Finally, it seeks to address consumer demand for a more effective service delivery model.

HealthSmart recently signed a contract with TrakHealth for a client management system to be used by community health services across the state. Another milestone came with the granting of an implementation contract to clinical informatics vendor Cerner to implement IT applications across all public sector health providers.

Gartner Vice President Asia Pacific Richard Harris says while pressures over cost and paucity of resources have driven most Australian government shared service initiatives to date, it is the smallest jurisdictions which have been most successful so far.

"Local governments have probably the longest history in Australia with shared services," Harris says. "A decade or more ago they pioneered many shared initiatives, driven largely by their lack of resources and preparedness to do this jointly with other Councils, especially where they had trusted personal relationships. In more recent times, State and Territory governments have been the most enthusiastic adopters of shared services, again largely driven by pressures over cost and paucity of resources. Success has so far been strongest with the smallest jurisdictions. For example, the Northern Territory and ACT have the most developed - and accepted - shared services arrangements in place."

Harris says while there are aggressive moves in across government to achieve shared services, including the HeatlhSmart project, and aggregation of human services at the Federal level, these projects are very high risk and success is by no means certain.