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EPAS cost blows out again

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EXCLUSIVE | The cost of SA Health’s troubled electronic patient records system EPAS has blown out to almost half a billion dollars after the department was forced to ask Cabinet for another $49 million to pour into it, InDaily can reveal.

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The department approached Cabinet last month to request the extra funding for EPAS, raising the cost to taxpayers from $422 million to $471 million over the 10 years to 2021.

SA Health confirmed the increased cost to InDaily this morning. InDaily understands Cabinet has approved the request.

Doctors have repeatedly warned that EPAS slows down emergency carethreatens patient safety and blows out waiting lists.

In August, almost one in five medical staff using EPAS who responded to an Australian Medical Association survey blamed the system for “serious errors including charting medications for the wrong patient, critical delays in obtaining records on surgical patients and pathology errors such as mixing patients and specimens”.

However, SA Health figures show medication errors have reduced at sites where EPAS has been implemented.

SA Health Deputy Chief Executive Don Frater told InDaily in a statement this morning that the increased budget for the e-health records system would help improve its performance.

“Forecast EPAS expenditure includes the implementation of a major system upgrade to increase efficiencies, provide more advanced security and faster overall system performance,” he said.

“More than 340,000 South Australians have benefitted from having an electronic patient record within EPAS so far, and more than 20,000 staff and students have been trained in the system.

“Implementing the new system is an ongoing process and we continue to work closely with staff and clinicians to resolve concerns and make improvements to EPAS where necessary.”

SA Health expects to install EPAS at Flinders Medical Centre, Hampstead Rehabilitation Centre and Mt Gambier Hospital in 2018.

The system is partially installed at the new Royal Adelaide Hospital, providing administrative support but only some clinical functions.

“As we have previously said, we will implement the remaining clinical functions at the RAH progressively, with a view that all functions will be in use by early 2018,” said Frater.

SA Health figures show sites which use EPAS have enjoyed a significant fall in medication errors since having the system installed.

Errors fell from an average five per cent (one in 20) to 0.003 per cent (one in 3000) at those sites.

The proportion of patients leaving hospital with incorrect medication, without required medication or with medication they did not need fell from 12 per cent before the installation of EPAS to 3.5 per cent afterwards, according to the figures.

And more medical records – 94 per cent at the EPAS sites – now document patients’ medication allergies, up from 84 per cent at those same sites pre-EPAS.

However, an AMA survey, released earlier this year, revealed almost 20 per cent of respondents blamed the system for “serious errors including charting medications for the wrong patient, critical delays in obtaining records on surgical patients and pathology errors such as mixing patients and specimens”.

Forty per cent of respondents who had been using the system for more than two years said their opinion of EPAS was poor, while 18 per cent reported their opinion of the system was worse after they became familiar with it.

In the category of “near misses”, one respondent – who had been using EPAS for more than two years – reported this anecdote:

A patient had a cardiac arrest during a previous anaesthetic and presented one month later for a repeat try. After 90 minutes of searching by several staff members, the previous anaesthetic chart could not be found. The second anaesthetic had to be conducted without full knowledge of what had happened and why during the previous anaesthetic. (2+ years user)

A source within the department told InDaily this morning it was unlikely EPAS would ever be rolled out to all of the state’s hospitals, and that none of the SA sites with EPAS had been able to use it to to produce patient discharge summaries or clinical handover lists.

InDaily understands another, older electronic system, OACIS, is used to perform those functions instead.

Health insiders have previously claimed a relatively cheap software upgrade, featuring all the functions of EPAS and more was purchased by SA Health in 2009, but never implemented.

Coroner Mark Johns told InDaily early last year that the system hampers his inquests into patient deaths.

In June, then-Health Minister Jack Snelling reportedly conceded the budget for the system rollout may need to increase, after a document released to the Opposition under Freedom of Information laws forecast the system’s implementation at the new Royal Adelaide Hospital would push the cost up to $465 million.

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