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‘Hard reset’ on EPAS after review details litany of failures

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SA Health will make “immediate and significant changes” to its controversial electronic patient records system EPAS, after an independent review prompted the State Government to order a “hard reset” on the troubled rollout.

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The contentious Enterprise Patient Administration System – which has come under sustained criticism from clinicians and the state’s coroner Mark Johns – will undergo an upgrade and re-branding, although the “functional” underlying software application will continue to be used.

The newly-released report of a review chaired by former Telstra Health managing director Shane Solomon detailed problems created by the software solution supplied by US company Allscripts, the centrally- implemented approach by SA Health and the overall governance of the program.

“SA Health chose to implement the system without the assistance of expert organisations, including the Allscripts vendor,” the report found.

“The governance model is flawed, with accountability for outcomes poorly understood and managed [while] clinical benefits from the implementation of the system are not well articulated and consequently not tracked, measured nor managed.”

“Current governance arrangements do not empower clinicians to be the key decision-makers, therefore clinicians have not taken ownership of the system.”

However, the report found that “considering the substantial people and financial investment in the existing EPAS solution… every effort should be made to optimise the underlying elements of the EPAS Program”.

Those are the Sunrise EMR (Electronic Medical Record) and Allscripts PAS (Patient Administration System) – terms that will now be used instead of ‘EPAS’ as the Marshall Government seeks to draw a political and practical line under the debacle.

“This will require major changes to how the current EPAS Program operates,” the review found.

“Unless the governance, clinician engagement, configuration and implementation issues are addressed, there is unlikely to be a significantly better outcome from choosing a different software solution.”

In its response to the review, also released today, the Government argues that “the review finds that the EPAS program has been a failure and should be discontinued and replaced”.

“The EPAS Program should not continue as planned… the review recommends that SA Health completely overhaul the program, reconfigure the underlying information technology and commence a roll-out at two ‘exemplar sites’ before a final decision is made on whether to continue to use the Allscripts suite of products,” the Government’s response to the report says.

The software used in the existing program’s “billing module” is “not fit-for-purpose”, the Government says, and will be replaced “by a system that is built for Australian conditions”.

The review found more than three-quarters of the EPAS rollout’s initial $421.5 million budget under the former Labor government had been spent by last year – with only around a quarter of the project actually rolled out.

“This isn’t just a minor error or oversight – it’s cost taxpayers hundreds of millions of dollars,” Health Minister Stephen Wade said in a statement today.

“More than $320 million has already been spent on the EPAS rollout.”

He called the new approach “a hard reset” on the EPAS system to “a fundamentally new SA Health medical records program”.

The review recommends establishing a new SA Health Digital Strategy, with major governance reforms that will see responsibility for implementation and configuration devolved to local health networks and clinicians.

In the short-term, the revised system will be implemented at two ‘exemplar sites’ – the new Royal Adelaide Hospital and Mount Gambier and Districts Health Service – with any future decisions to implement the Sunrise EMR and Allscripts PAS “contingent on user acceptance at the exemplar sites”.

The Government have accepted either fully or in principle all 36 of the report’s recommendations.

“Whilst there are limitations with the Allscripts product, the bigger issues were with the configuration and the implementation,” Wade said.

“The lack of consultation led to the implementation of a system that’s clunky and cumbersome, doesn’t meet the needs of our medical staff and is in need of a major overhaul.

“We want an electronic records system that improves patient outcomes rather than undermines them… we want to empower our clinicians and staff with the right tools so they can make the best decisions for their patients.”

He said the rollout of the Sunrise software at the RAH and Mount Gambier Hospital will be completed in 2020 – within the existing project budget of $421 million.

Asked why he was retaining the Sunrise software, Wade said: “I’ve never said that medical records don’t work.”

Solomon told media today that “it’s not about the software – it’s all about the clinician engagement”.

That’s despite Wade insisting that “Labor’s EPAS debacle will be scrapped and replaced with a new program” based on “a fundamentally different IT system”.

However, Labor’s Health spokesman Chris Picton said: “The Liberals are saying they are scrapping EPAS, but they’re basically changing the name.”

“This is an exercise in spin could be an episode of Utopia,” he said.

“The same software provider and system is being used, with the review recognising the merit in doing so.

“Now we just have Stephen Wade spinning as hard as he can to make his language align with the expectations he set that EPAS would be scrapped.”

Before the March 2018 election, Labor had also committed to a review of EPAS, with then-Health Minister Peter Malinauskas saying he would “seek input from medical staff in SA Health on how to improve” the system.

“The rollout of EPAS is one of the most complex IT undertakings in the history of South Australia [and] unsurprisingly there have been complications along the way in shifting our paper-based patient records system to an electronic system that functions across local health networks,” he said at the time.

But Malinauskas insisted the program had significantly reduced the number of medication errors made in SA hospitals, from one in 20 to one in 3000.

According to SA Health, the proportion of patients leaving hospital without the correct medication has dropped from 12 per cent to 3.5 and the proportion of records that include a patient’s medication allergy has increased from 84 per cent to 94.

“Since EPAS was introduced, there have been significant improvements in patient safety, with a reduction in medication errors, better continuity of care, improved patient privacy and more efficient patient care documentation,” Malinauskas said last year.

Allscripts Australia & New Zealand general manager Todd Haebich said the company expected to increase its Adelaide workforce in coming years, and “looks forward to working more closely with SA Health to fulfil what it has set to out achieve – the establishment of a statewide electronic medical record”.

“Allscripts is a global leader in healthcare information technology solutions that advance clinical, financial and operational results… it is consistently ranked as a ‘best-in-class’ system world-wide,” he said.

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