How Australian Health Agencies Can Master the Multi-Vendor Partner Ecosystem

When the NSW Audit Office recently reviewed the state's landmark Single Digital Patient Record (SDPR) program, it highlighted a challenge common to all large-scale digital transformations: the complexities of integrating new platforms with legacy systems [1]. This isn't a critique of one program, but a valuable lesson for the entire industry on the importance of robust partnership governance.

For leaders at state health departments, local health networks (LHNs), and other health agencies, this insight is crucial. When you procure a major clinical platform from vendors like Epic, Oracle Health, or InterSystems, you are orchestrating a complex delivery ecosystem. The success of these ambitious programs hinges on how well you design and govern the partnership model between your agency, your platform vendor, and your chosen system integrators (SIs).

Getting this right is essential to realising the benefits of an Australian EHR market projected to grow from $10.17 billion to over $31 billion by 2033 [2]. The question isn’t if you should use SIs, but how you can architect a collaborative ecosystem that thrives under pressure.

The Agency's Challenge: Leading a Complex Vendor Landscape

The Australian healthcare landscape requires agencies to manage a complex tapestry of state-based systems, national standards, and deeply entrenched legacy technology. The major platform vendors each present a different set of opportunities and challenges within this context:

• Epic is arriving through ambitious, high-profile transformations. The scale of the NSW SDPR, for instance — unifying over 220 hospitals and 600 community health centres — means success is defined by sophisticated, multi-party coordination between the agency, Epic, and a range of specialised partners

• Oracle Health (Cerner) is the strong incumbent in many states, including at leading institutions like Alfred Health, Western Health, and Royal Melbourne Hospital. Here, the agency's challenge is to guide the transition from legacy Millennium systems to newer platforms, a journey that requires careful management of technology debt and transition risks.

•  InterSystems often leads with its strength in interoperability. However, as one program director recently noted, "Interoperability is 10% technology and 90% navigating the people, processes, and data governance under local rules." That 90% is a shared responsibility, best led by the agency.

For agency leaders, the core task is clear: you must architect a partnership ecosystem that can de-risk the gaps between the vendor's promise and the reality on the ward.

What Agencies Should Expect from SI Partners

SIs offer their greatest value to the agency when they move beyond staff augmentation and act as a coordinating force that manages the complex seams in a multi-vendor environment. Think of your program’s delivery lifecycle as a value chain where your SI partners help connect every stage.

As an agency leader, you should expect your SI partners to deliver on four critical fronts:

Multi-Party Coordination: They must be able to run the complex orchestration between your agency, the platform vendor, and other third parties without creating unnecessary governance overhead. Research shows that organisations that bring together cross-functional teams achieve technology adoption rates 34% higher than those using isolated approaches

Embedded Clinical Governance: They must not just document clinical requirements — they must embed clinical safety and workflow reliability into every design decision, aligning with NSQHS standards from the outset

Workflow Reliability: In a high-acuity setting like an emergency department — which sees 8.8 million presentations annually across Australia — workflow disruption is a direct threat to patient safety .Your SI must demonstrate they understand and can protect these critical workflows.

Disciplined Conformance: Deep, practical expertise in navigating ADHA requirements, particularly My Health Record connectivity, is non-negotiable and must be verified.

Choosing the Right Partnership Model

The key is matching the partnership model to the complexity and clinical risk of your program. As the agency, you have the power to define this structure.

Co-Delivery establishes a tripartite governance structure between your agency, the platform vendor, and the SI. It’s best suited for large, complex statewide programs where shared accountability is essential. The level of governance, such as the 57 working groups established for the NSW SDPR, reflects the scale of such an undertaking and provides a strong foundation for managing risk.

Embedded Practitioner places experienced clinicians directly inside the SI's delivery team. This ensures clinical validation is a continuous process, not a last-minute check. As an agency, you can and should write this requirement into your procurement contracts for high-risk clinical areas.

Referral is the traditional model where a platform vendor recommends SIs. This may work for simpler deployments but can create communication gaps in complex programs, leaving the agency to mediate disputes.

Consortium / Prime sees an SI act as the prime contractor. This offers a single point of contact for the agency but carries fragmentation risk unless you ensure the prime enforces strong design authority and common delivery standards.

Australian Nuances That Shape Success

Two areas consistently create challenges for programs that lack deep local context:

National Standards with Local Teeth. The ADHA's My Health Record conformance requirements and the NSQHS Standards — particularly around Clinical Governance (Standard 1) and Communicating for Safety (Standard 6) — are not optional extras. Your agency must ensure these are baked into the program’s governance and delivery framework from day one.

State-by-State Variation. Procurement processes, architectural standards, and operational realities differ significantly between states. The Queensland Unify system failure — where coordination breakdowns led to child safety service disruptions — remains a cautionary example for the entire sector of what happens when local context is underestimated .

Three Success Factors to Champion

As an agency leader, your program's success and the safety of your patients are on the line. You should champion three core capabilities in your partners:

Actionable Clinical Credibility: Don't just ask if they have clinicians on staff. Ask: "Can a clinician on your team stop a build they believe is unsafe?" The answer reveals their true commitment to clinical governance. 

Local Expertise that Prevents Rework: A partner who understands the specific privacy expectations, state architectures, and conformance pathways in Australia will save your program from costly rework and delays.

Lean but Real Governance: Not every project requires the governance scale of a statewide rollout, but every project needs a clear framework that defines who makes decisions — especially when clinical workflows and technical constraints collide. Your agency must own and drive this framework.

Where to From Here

Governing a multi-vendor ecosystem in Australian healthcare is not a technology problem. It's a partnership design challenge with patient safety at its core. Agency leaders who succeed will be those who architect their partner ecosystem with the same discipline they apply to clinical care.

If you are an agency or LHN leader looking to pressure-test your partnership model before it gets tested by reality, our team at Medora can help. We specialise in designing the governance and assurance frameworks that turn multi-vendor complexity into a manageable, reliable delivery system.

Schedule a discovery call to explore how we can strengthen your partnership strategy.