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Coroner raises red flag on "ridiculous" e-health system

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The State Coroner has raised serious concerns about the impact of the state’s controversial electronic health records system on his ability to conduct inquests into hospital deaths.

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E-health under fire

Coroner Mark Johns told InDaily he had sought assurances from the Health Department, and Health Minister Jack Snelling, that the performance of his statutory powers would not be impacted when the $422 million Enterprise Patient Administration System (EPAS) is rolled out to South Australia’s major hospitals.

“I sought an assurance and they have not provided it,” said Johns.

He said the case notes produced by EPAS after a person dies in hospital are “a sort of higgledy-piggledy computer dump”, many times larger than case notes produced using other systems.

He believes his ability to conduct inquests into hospital deaths would be made “much more difficult” if he were examining the death of a patient whose health records were produced on EPAS.

“It’s all fine and dandy for Health to move to a paperless system … but they have to be able to reproduce that on paper so that the coronial system can operate,” he said.

Johns described one occasion in which the health records, produced on EPAS, for a patient who had died after a short hospital admission, were “scrambled”, much more lengthy than usual case notes and filled with unnecessary repetition.

“We have seen what we would have expected to be a 50 page set of notes become something in the order of eight times [larger].”

“This was a case where you would’ve expected a few dozen pages … that the pathologist could’ve mastered in 20 to 25 minutes.

“The pathologist [took] five hours to get through that mass of documents.

“And there were hundreds of pages for a three day [hospital] admission

“And a lot of the information was repeated, and repeated, and repeated.

“Once you scramble up the notes and make them eight times bigger with multiple repetitions … you make a task, which is already difficult, more difficult.

“What actually has to happen is they [SA Health] have to produce something in the English language with recognisable, hard data.”

He said the problems associated with EPAS case notes would multiply during a coronial inquest because 20 or more people would need to use and understand them.

“We get experts who look at the notes … sometimes you might have 15 to 20 lawyers [who require the notes],” he said.

“It’s a complex thing to do even with the clearest set of notes.

“All of these people aren’t going to learn EPAS – I’m not going to learn EPAS.

“It’s ridiculous, and not feasible.”

Johns said he was particularly concerned about the effect of EPAS on the coronial system once it is implemented at the state’s major hospitals.

“What I’m more concerned with is when the Flinders Medical Centre, Royal Adelaide Hospital and Lyell McEwin Hospital [start using EPAS],” he told InDaily.

“What I require is an assurance that on day one there will be no hiccups.

“If we can’t achieve that then it’s a matter of serious concern.”

He said he hoped SA Health would be able to rectify the problems before it implements EPAS at the larger hospitals.

Johns said he had also written to Snelling asking for assurance that his powers to seize case notes if necessary would not be impacted by the system, but no such assurance was given.

Johns was told SA Health was working to improve the collation of the notes.

A spokesperson for SA Health told InDaily the department was aware of Johns’ concerns.

“We are working with the Coroner’s Office to provide them with the detail required for their work as EPAS is implemented across the state,” the spokesperson said.

EPAS is currently in use at Noarlunga Hospital, the Repatriation General Hospital and Port Augusta Hospital, and other sectors of the health system, including SA Ambulance.

Clinicians have repeatedly complained that the system slows down care and risks patient safety.

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