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E-health system caused "rage attacks", patient risks

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Doctors at a South Australian regional hospital refused to use a new electronic health records system after it caused medication errors, “rage attacks”, resignation threats and risks to patient safety, senior doctors have revealed.

Problems with the Enterprise Patient Administration System (EPAS) caused doctors at Port Augusta hospital to totally withdraw from its use in February, until an agreement was negotiated with the State Government to use a combined system of paper and electronic patient records.

Last Monday, the hospital returned to full use of the system after SA Health introduced “enhancements”.

InDaily has obtained an extraordinary letter, dated February 14, 2014, in which the Flinders and Far North Doctors Association warns SA Health CE David Swan that the e-health system could cause a patient’s death.

“We are concerned that it is only a matter of time before there is a significant EPAS related mishap or fatality,” the letter said.

“The system is more prone (than the former, paper-based system) to medication errors and there have been several such errors.

“Our Resolution (sic), is that EPAS be immediately and totally withdrawn from Port Augusta hospital and a return to the previous paper based system in the interim.”

The letter outlines significant safety concerns.

“At peak hours, doctors sometimes have to queue to use available computers (to use EPAS),” it says.

“The system is rigid in areas such as orders, medications and diagnoses does not allow free texting. There is a defined list of diagnoses which is by no means exhaustive and often too specific to be appropriate.

“EPAS does not allow for shades of grey in clinical medicine.

“The result is that clinical decisions are not always guided by all the relevant facts.”

The letter also warned that EPAS risks the confidentiality of patient records.

It says this risk could increase as the system rolls out around the state over 10 years at a cost of $422 million to taxpayers.

“Sensitive patient information is immediately accessible at the click of a button to clinicians not directly involved in patient management.

“A clinician in Noarlunga for example with no professional interest in a patient could at will scour a patient’s file at Port Augusta.”

According to the letter, the system resulted in emotional breakdowns among medical staff and the suspension of clinical privileges.

“There have been rage attacks, tearful outbursts and avoidable conflicts. Some experienced staff members have threatened to leave the hospital and others have had clinical privileges suspended all because of EPAS.

“As country-based practitioners we worry about the long-term impact of this on staff attraction and retention in rural and remote areas.”

Representatives of the Australian Medical Association attended negotiations with SA Health to revive EPAS in combination with a paper-based system.

According to AMA president Patricia Montanaro the concerns of doctors at Port Augusta hospital have not been completely assuaged, but they trust the assurances of SA Health that problems with EPAS will be fixed.

“We have taken the assurances of SA Health on face value and we’ll be monitoring the system to make sure this is efficient and effective for the doctors,” she said.

“Doctors are really very clear that they will not compromise patient safety. Doctors will always stand up, no matter what the cost, if they are concerned.”

She said a state-wide electronic health records system continued to be an important and laudable aim, but that such a system was always going to be difficult to implement in practice.

“An electronic health record for the whole of the public sector health system is an absolutely audacious aim,” she said.

“If someone come in to you unconscious in an emergency department, having their health record anywhere in the state is a really important – a good aim.

“It is not at all a surprise that there are going to be things that need to be sorted.”

A spokesperson for SA Heath told InDaily: “SA Health is continuing to work with clinicians at Port Augusta Hospital on the rollout of the Enterprise Patient Administration System (EPAS).”

“For a period of less than six weeks, clinicians were temporarily using a combination of the electronic and paper-based systems at the site.

“Enhancements have been made to the medication and fluid ordering functions of the system and additional training has been provided to Port Augusta Hospital staff.

“A majority of the clinicians at Port Augusta Hospital have adapted extremely well to the new EPAS.

“Some doctors and other health staff at the hospital have been provided additional support and training, and system enhancements have been made, as the new electronic health record’s roll out continues.”

“We are committed to working with our doctors, nurses and allied health staff across all sites to ensure EPAS meets the needs of our patients and our staff.”

The revelations raise concerns for the new Royal Adelaide Hospital, which will rely on EPAS.

According to former president of the SA Salaried Medical Officers’ Association Dr David Pope, the new RAH is being built without enough space to house paper records for all patients should the system fail.

In December last year, Port Augusta hospital became the first rural site in South Australia to begin using EPAS.

EPAS is also being used at Noarlunga Hospital, Noarlunga GP Plus Super Clinic, Aldinga/Seaford GP Plus Super Clinic, Aldinga/Seaford GP Plus Health Care Centre, Morphett Vale GP Plus Health Care Centre, SA Ambulance Headquarters and Repatriation General Hospital.

The authors of the letter declined to comment.

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