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E-health failure on the cards for new hospital


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SA Health is drawing up contingency plans to make the new Royal Adelaide Hospital viable without the state’s beleaguered electronic health records system.

The $1.8 billion hospital was designed without storage space for paper-based patient records. It was expected to function, instead, using the Enterprise Patient Administration System (EPAS).

The $422 million electronic system has been dogged by complaints it puts patient safety at risk and slows down emergency care.

Its rollout was paused in October to ensure it would be safe to use at the new Royal Adelaide Hospital by the time it opens in 2016.

However, a report by the Auditor-General, tabled in parliament last week, reveals SA Health is working on contingency plans, in case the system is not up and running in time.

“SA Health is planning contingency options for the nRAH in the event that EPAS is not ready to deliver its requirements,” the report reads.

“SA Health recognises that, from an operational perspective, if EPAS was not rolled out to the nRAH, the current impact on the proposed model of care … is unknown.

“Any alternative solution is expected to require modified processes and manual workarounds…

“… central paper record storage at clinics and wards and daily transport for paper records will be required.”

Despite the admission, Health Minister Jack Snelling told InDaily this morning he was confident the system would be safe and ready at the new RAH by 2016.

“We paused the rollout of EPAS at other hospitals to ensure we had it ready for the opening of the new Royal Adelaide Hospital, and we are confident that it will be ready in time for the opening of the hospital,” Snelling said.

A joint decision of the EPAS program and the Central Adelaide Local Health Network on whether the system will be ready for implementation at the new hospital is planned for early next year.

The rollout of EPAS is now not expected to be complete until “well into 2017 and will require greater levels of staffing than originally expected”.

The report reveals that advice to state Cabinet in June of this year warned of an $87 million deterioration in the program’s finances over 10 years, on top of $49 million of budgeted contingency funding.

This included a forecast $71 million shortfall in program benefits; as of September this year, the expected loss of benefits was revised to $83 million.

More than 4,800  separate defects with the system have been raised since the program began.

EPAS was meant to have been rolled out across the state by July this year, but has so-far only been implemented at six sites, including the Noarlunga and Repatriation General hospitals.

“The EPAS program is confronting and addressing significant problems, involving critical system functional deficiencies, implementation delays, financial cost escalation and loss of benefits,” the report says.

It says no formal procurement strategy had been developed for the EPAS program and that more market testing – and less direct negotiation – should have occurred.

It cites a submission to state Cabinet from October this year, which admits there had been an underestimation of how much work practices would have to change for doctors and nurses with the implementation of EPAS.

It says that while SA Health had expected EPAS to be “mature, stable and meet the functional requirements specified” a significant rework of the system had been necessary for it to adapt to the Australian healthcare context.

The report also reveals a “suitably qualified” EPAS Program Director was not appointed until February of this year.

The status of a legal claim, launched by SA Health against EPAS vendor AllScripts and disclosed in 2013-14 SA Health (then Department of Health and Ageing) financial statements, is unknown.

InDaily contacted the South Australian Salaried Medical Officers’ Association and the Australian Nursing and Midwifery Federation for comment.

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