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E-health switch to secure new RAH


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The State Government has redirected funding for a vital, multi-million dollar electronic health records system to ensure the new Royal Adelaide Hospital can function when it opens in 2016.

The Enterprise Patient Administration System (EPAS) must work effectively in order for the new RAH to function.

The hospital had been designed without sufficient space to house all patient records in paper form, should EPAS fail.

The rollout of EPAS at new sites across South Australia will now be quarantined to the existing Royal Adelaide Hospital.

Health Minister Jack Snelling said this would prepare staff for the system’s use at the new RAH.

“We’re not going to roll out any more sites for the moment,” Snelling told InDaily.

“That will enable us firstly to concentrate on the new RAH, because [EPAS] is obviously absolutely critical for that project.”

Snelling said the decision to focus funding on the existing and new RAHs would avoid adding unnecessary complexity to the health system as it copes with a major redesign over the coming years.

He said it would also avoid a situation where RAH clinicians would have to both adapt to a new physical environment and, at the same time, deal with the changes to work processes required by EPAS.

Despite this, Snelling said he couldn’t guarantee the next site for EPAS would be the existing RAH, but only that that was the government’s position, for now.

“I’m not saying that we definitely won’t do any more rollouts before the RAH, but for the moment, we’re just having a rethink of it,” he said.

“When we’re in a position to say definitively what we’re doing, we’ll make that announcement, but for the moment, we’re having a rethink.”

Snelling attributes this rethink to health cuts in the federal budget.

“We’ve had $655 million ripped from us over 4 years by the federal government,” he said.

“That has forced us … to have a big rethink about how our entire health system is going to operate, and make some very, very difficult decisions.”

Snelling hinted that the statewide rollout of EPAS may not survive Treasurer Tom Koutsantonis’ knife, as he considers how to pass hundreds of millions of dollars in federal health cuts on to the state system.

“In the light of the federal cuts to health, we’re having to have a look at what we’re doing with everything,” said Snelling.

“I mean, that includes the capital projects that the Treasurer announced last Thursday, but we really need to throw EPAS into that mix.”

Those capital projects – upgrades to the Queen Elizabeth Hospital, the Flinders Medical Centre, and the Modbury Hospital, as well as the Noarlunga Health Service Redevelopment – have been deferred indefinitely.

Snelling said the government needed to “have a look at EPAS in the light of whatever decisions we might make as a result of these massive funding cuts”.

Last week’s Budget reduced funding for EPAS in the next financial year to $10.5 million – below half the average annual allocation it has enjoyed over the past three financial years.

The electronic system has suffered ongoing allegations it poses risks to patient safety, slows down emergency healthcare and causes medication errors, among other complaints.

According to spokeswoman for South Australian Salaried Medical Officers Association (SASMOA) Bernadette Mulholland, the union has held at least weekly meetings with the Health Department to forward complaints from medical practitioners about EPAS.

Chief Executive of the Nursing and Midwifery Federation (SA branch) Elizabeth Dabars said the union had received complaints about EPAS from its members within the last fortnight, and that it receives such complaints “consistently”.

Dabars said there were “patient safety, staffing and occupational health and safety concerns that have continued to occur, and that we’ve been raising over the last 11 months since EPAS had been introduced”.

Allegations continue to emerge about threats to patient safety resulting from the system.

College of Surgeons SA chairman, Dr Peter Subramaniam, released a statement last week describing an incident where access to urgent surgical treatment of a patient was delayed because of an EPAS-related issue.

The patient suffered no adverse consequences, but Subramaniam said surgeons were concerned that “EPAS in its current form is very likely putting patients at risk”.

“We are supportive of the government to suspend the rollout until the problem is fixed.”

Mullholland said that while SASMOA supports the implementation of an IT-based patient health records system, she also said unresolved problems with EPAS should be fixed at sites where the system is already in place, before it is implemented at any other facility.

But Snelling said launching EPAS at the RAH wouldn’t compromise patient safety.

The Royal Adelaide Hospital would be the first major hospital in South Australia to begin using EPAS.

“We’re approaching this in a very careful deliberate way,” he said.

“We’re making sure that we are taking no risks and that patient safety is paramount, but I’m very confident that we can deliver this project successfully.

“If you’re talking about electronic health records, where, potentially, people’s lives can be put at risk, that … requires even more careful management.

“There’s no getting around the fact that there are going to be issues [that] come up in the course of the rollout.

“Part of it is, until you’ve given these things a try, you know, a run in the system, you really don’t know what sort of difficulties you might encounter.”

He said his department’s advice was that issues with EPAS  at Port Augusta Hospital – where doctors refused to use the system in February, then reprised it in May – have been “substantially overcome”.

“Other clinicians that I have spoken to, both in the Noarlunga Hospital and the Repat Hospital … have been very satisfied.

“But of course it’s not to say there’s going to be 100 per cent happiness.”

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