Tuesday, April 07, 2015

Now This Has To Be A Really Courageous Way To Go About Things. Good Luck With That Big Bang Plan!

This appeared a few days ago.

SA’s e-health rollout delayed further

Bension Siebert | 2 April 2015
Adelaide | The rollout of the State Government’s troubled $422 million electronic health records system has been delayed again.
The Government revealed today that the Enterprise Patient Administration System (EPAS) will not be implemented at the Royal Adelaide Hospital (RAH) before the transition to the new Royal Adelaide Hospital.
In June last year, Health Minister Jack Snelling announced that the statewide rollout of EPAS would be halted, following complaints from doctors that the system caused threats to patient safety, “rage attacks” and resignations, and the May announcement of federal funding cuts to health.
Snelling told InDaily at the time that the government would ensure the system is functioning properly at the RAH before the transition to the new hospital, so as to avoid clinicians having to adapt to a new physical environment and changes to work processes required by EPAS at the same time.
Now, clinicians will have to do just that.
SA Health said this morning that a stabilisation phase for the system – “which had involved reviewing and resolving a number of key issues” – was now complete.
The Chief Executive of SA Health, David Swan, said that in the time now available, it was most appropriate to concentrate on having the system up and running at the new hospital, rather than the existing RAH.
“The original plan to implement the EPAS solution into the current Royal Adelaide Hospital and then the new RAH was reliant on having a stable technical platform,” Swan said.
“This stabilisation work needed to be finalised before we reviewed the EPAS implementation schedule, and this has now been successfully completed.
“Upon review, and with the timeframe available to us, it has become apparent that the most appropriate approach is to concentrate our resources on implementing EPAS directly into the new Royal Adelaide Hospital in 2016.”
Swan said staff would have access to a thorough training program to ensure they are able to use the system effectively at the new hospital.
“A comprehensive training program is currently being developed and will be made available to all staff well in advance of the move to the new hospital,” Swan said.
“This training will include reviews of workflows, workshops and practical simulation training to ensure all staff are fully conversant with EPAS well before it is activated at the new RAH.”
Some medical officers have complained that training to use the system at other sites has been inadequate.
Last year, InDaily reported repeated claims by doctors and nurses that EPAS slowed down patient care and caused increased medication errors, among other problems.
EPAS is currently used at Noarlunga Hospital, Port Augusta Hospital and SA Ambulance Headquarters. Some clinicians have warned that attempting to implement the system at a major hospital would increase risks to patient safety.
EPAS was designed to be an integrated, state-wide electronic health records system – an ideal which has broad support among medical professionals.
However, its implementation has been plagued with problems.
In November, Noarlunga Hospital doctors said they were using paper towel to take down patient notes, rather than using EPAS, because the system was too slow to be used safely in emergencies.
More here:
The three paragraphs that amaze me are these:
“Upon review, and with the timeframe available to us, it has become apparent that the most appropriate approach is to concentrate our resources on implementing EPAS directly into the new Royal Adelaide Hospital in 2016.”
Swan said staff would have access to a thorough training program to ensure they are able to use the system effectively at the new hospital.
“A comprehensive training program is currently being developed and will be made available to all staff well in advance of the move to the new hospital,” Swan said.”
Struth!
Noarlunga and Port Augusta have 160 or so beds between them and are basic hospitals.
The Royal Adelaide Hospital is a 650+ bed tertiary referral and academic hospital with great complexity, a vast number of staff and many, many complex functions.
To attempt to open a brand new hospital of this size and complexity with new systems that have not been settled in to some degree and been configured gradually the new environment has to be a risk that is hard to see is worth taking. Opening a brand new tertiary hospital with brand new systems seems to me to be a prescription for disaster.
Time will tell! I will watch with interest…
David.

8 comments:

Anonymous said...

Struth! ..... it's the American way David. It's the American way.

So what have we Cerner (US), EPIC (US), All Scripts (US). Struth - exactly.

Jason O'Neil said...

Firstly David, EPAS is also being used at the Repatriation General Hospital which is a 300 bed acute care and teaching general hospital. So saying that EPAS has not been trial at a real site is incorrect. In saying this EPAS has not successfully been installed at any site and takes months for users to get used to the system, and this only works when the program and hardware are working at a reasonable pace. EPAS has been trialed and has not worked, it is time to abandon this program and find something that suits the needs of the health system and not just the bank balance.

Dr David More MB PhD FACHI said...

I might have this wrong but I thought the Repat was being closed and has been being wound down for a while?

Odd place to be putting in new systems.

I am also rather confused when you say EPAS has been trialed and not worked but is being used?

David.

Benedict 16th said...

Article doesn't even mention that they had also planned to do TQEH at the same time as the old RAH, but then postponed that so they could concentrate on just getting the RAH working. Another EPAS project director has just resigned, so someone else has to step in and sip from that poisoned chalice....

Anyway here's to bracing for the next round of job cuts at the end of this month.

John Landers said...

David, although the Repatriation General Hospital has currently been slated for closure at some indeterminate future date, I can assure you that it is very much open for business and business as usual. The "wind-down" has been government imposed, by closing our emergency department and then our high dependency ward on the weekends. This however, has not deterred us from providing excellence in health care and we have simply found work-arounds in order to keep functioning at full capacity. We current perform 25% of all the public joint replacements, 25% of all the urological procedures and about 10% of ophthalmological procedures in Adelaide, including cataract, glaucoma surgery and corneal graft surgery. We are far from closing and are far from "wound down". We were the third hospital to have received EPAS and we were the hospital to have forced the brakes to be put on the roll-out because, for the first time, SA Health realised just how incapable this program was. To date, nothing has been done to address our concerns, except a lot of lip service. If EPAS does ever start at the NRAH, it will cause a meltdown because of the inefficient and unsafe way in which it performs.
For our troubles we have been told that we will be closing, but for the time being we are still getting up and going to work and performing our duties to serve the public who depend on us, so we would appreciate it if you would include us in the list of hospitals upon which EPAS has been inflicted.

Dr David More MB PhD FACHI said...

"so we would appreciate it if you would include us in the list of hospitals upon which EPAS has been inflicted."

I am not sure why it matters - given the disaster it apparently is - but there you go!

David

Benedict 16th said...

Dear Dr Landers - if everything is so peachy at RGH why did my patient get told
1) They need a new referral
2) mailed to an address they haven't lived at since 1984
3) Despite my referral sent to the RGH in February 2015
4) Despite there being approximately 10 letters in 10 years from the specialists involved in her care
5) That a referral is not technically required for a public patient in a public hospital?
6) Why have you removed the position of GP Liaison
7) Why does it take a case of RCC 3 months to be seen since you do so much of the southern urology
8) Why do the oaths require private referrals to places such as FPH or Blackwood for a patient to be put on a public waiting lost for joint replacement?

?

John Landers said...

Dear Benedict 16th, or ?, whoever you are,
I’m not sure how you got “peachy” out of anything I said, but allow me to respond. Gee, where do I begin with all of this?
1. New referrals are the only way that clinicians can receive updated health information about their patients, as patients may often not keep that information on the tips of their tongues.
2. Has the patient informed admin about the change of address?
3. Ever since the Repat was blessed with EPAS (the gift that keeps giving), referrals continually get lost in a never-ending sea of generic computer entries.
4. See point 1.
5. Referrals are required for public patients…..no specialist in the public or private system may consult on a patient without a referral from a primary care provider, expect in situations of emergency. You’ll need to take that rule up with medicare.
6. That was a strategic decision by all the area health networks who are utilizing a system for admin known are the “Hub”. This is a strategy that will be role-out to all public hospitals in due course. Therefore, instead of referrals going to the GP liaison, they go to the Hub and are triaged from there. No my decision and one of which I am not in favour.
7. Thanks to EPAS, our efficiency is down 50%. This is beyond our control and we have the state government to thank. I have no knowledge of this particular case however and suggest you contact Urology directly if you wish to actually advocate on your patient’s behalf, rather than just complaining on an IT forum. The Repat sees patients and undertakes necessary surgeries faster than any other public hospital in Australia.
8. Again, since the role-out of EPAS, activity in outpatients is down 50%. In order to maintain the same timely service that the public expects and deserves, the orthopaedic department have been seeing new patients through Blackwood. Without this, EPAS would have meant that patients could not have their surgeries as soon. I can assure you that when EPAS comes to the new RAH, there will not be the availability of innovative avenues to decompress waiting-lists as we have at the Repat.
Regards,
John