In the early hours of November 12, 2022, several hundred staff from ACT Health gathered in the directorate's office as the territory's digital health record kicked into gear.
The office was decked out with a balloon arch and confetti canons were set off as the system went live. There was also a big mock red launch button, which represented the "DHR go live".
Some officials appeared to be crying when it was confirmed the system would be ready to go live after an earlier technical difficulty delayed the launch by an hour-and-a-half.
All of this was captured on video and formed part of a 17-minute documentary produced by ACT Health created as "a reflective piece for the ACT government employees involved in the project".
But while the launch of the program was marked by balloons and confetti, behind the scenes issues were emerging including millions in cost blowouts and a poor culture in the team delivering the project.
The ACT Integrity Commission has now launched an investigation into the conduct of ACT Health executives involved in the delivery of the multi-million dollar system.
Cost blowouts
The digital health record collated about 40 separate paper and digital records used by the ACT's public health system into the one system.
In action, the record can be seen in the territory's public hospitals in the big portable monitors used by clinicians as they traverse from ward to ward.
Health Minister Rachel Stephen-Smith said the system has transformed healthcare in the territory and the financial issues did not affect the operation of the digital health record.
"There are many benefits of the system that make it a success," she said.
"The DHR has transformed the way clinical care is provided in ACT public health services, tracking the engagement with a community member and giving clinicians the information they need to help provide better care for patients."
But while audits found the digital health record had created positive changes, the financial management of the program was ineffective.
The cost to deliver and maintain the system until 2027 will be close to $400 million. There was a more than $160 million cost blowout associated with the project.
The system was implemented in one day and was dubbed as a "big bang approach" by authorities. This essentially meant they ripped all the existing systems at once and this was replaced by the digital health record.
The project was initially expected to cost $213 million to deliver and maintain, but this ended up growing to $378 million. An extra $80 million in extra funding will also be needed to support the record over the next three years.
Health bureaucrats may have also wrongly paid a series of invoices for IT services associated with the project.
One audit found ACT Health had been billed for services inconsistent with the terms of an estimated $110 million contract. The audit found staff did not have the ability to accurately confirm what was being paid.
This was uncovered after the directorate received a blizzard of nearly 120 invoices in June 2023 alone totalling $7.9 million. There was $3.6 million paid during the month and the remaining $4.3 million was accrued.
Further reviews have found invoices may have been wrongly paid as recently as June this year, including invoices paid for travel and work hours without sufficient support documentation, poor financial compliance and over-payment of invoices due to the mistreatment of GST in a program used by the record.
While the ACT Health documentary highlights challenges faced by the program, the financial difficulties are not mentioned.
'A clinical transformation activity'
The documentary, produced in-house, tracks the project during and in the months before and after the digital health record was launched. It was set to be a reflective piece for staff but also used as a potential interest piece for other jurisdictions.
It was released under freedom of information, with a note accompanying the release saying no costs were incurred to do the video as it was produced in-house.
Inspirational music plays in the background throughout the documentary. It's the kind of music one could expect to hear in a documentary about an athlete overcoming their struggles to miraculously qualify for the Olympics.
There are snippets from a lecture, with an official speaking on a stage where the letters "DHR" are spelled out, similar to how TEDx Talks had "TED" on their stages.
The then-chief information officer of ACT Health, Peter O'Halloran, tells the crowd the program is so much more than a typical IT project.
"Whilst I work in IT, this is not an IT project; this is purely a clinical transformation activity," he said.
"Fundamentally the idea is it's one single system that gives clinicians at their fingertips the information they need to help provide better care for the patients they have in front of them."
In an interview for the documentary, Mr O'Halloran highlighted the pressures of the project. He likened it to doing 40 or 50 projects all at once.
"Those who aren't involved in healthcare IT don't understand the enormity of what we're doing and the complexity of it," he said.
He said decisions had to be made quickly to ensure health authorities met tight deadlines for the project.
"You make a decision, you make the best decision at the time you've got and you move forward," Mr O'Halloran said.
"If you need to come back and revisit it you do but if you agonise for days over things, you're sunk, you simply won't make the timeline and at a burn rate of over $200,000 per day for the team, it's too costly to sit there for a week and contemplate - you just need to make a decision and move on."
A common theme among the audits was the ACT Health Directorate was focused on delivering the program to meet the timeline without any regard to cost.
The decision to take the so-called "big bang approach" was made without clear documentation, audits found.
'Many instances of tears'
Dozens of staff were employed as part of the digital health record. The documentary revealed about 600 people were interviewed for roles.
But it wasn't all confetti and balloon arches.
Cultural issues were plaguing the team with "many instances of tears".
A staff survey, conducted in late-2022, showed reports of burnout, an unsustainable workload and poor treatment.
Staff were worried about a lack of transparency around training and recruitment processes.
There had also been "unsustainable pressure from the DHR increasing risk of mental health problems and burn out".
It showed there was a lack of people management skills, "major difficulties" with workplace communication and a blame culture.
"A sense of being blamed when something goes wrong and that influence is projected in an unpleasant way by some managers," the survey said.
Lots of flex leave had also been amassed over the time due to the pressures, the survey also showed.
These results were initially redacted, despite being released through freedom of information, with ACT Health citing fears it could negatively affect the wider directorate as the reason for blocking the released of the negative feedback. This decision was overturned by the Ombudsman.
This was a far cry from the images presented in ACT Health's documentary, suggesting the "reflective piece" may have missed some things.
