Tuesday, June 28, 2016

Health IT In The SA Public Sector Seems To Be Garnering More Than Its Fair Share Of Commentary. Something Must Be Not OK?

This appeared a little while ago:

Electronic Enterprise Patient Administration System: Asset or liability?

June 14, 2016 9:30pm
Medical Reporter Brad Crouch The Advertiser
THE controversial electronic Enterprise Patient Administration System replacing public hospital patients’ paper records goes “live” at The Queen Elizabeth Hospital on June 29. EPAS has encountered ongoing delays, a $200 million budget blowout and a conga line of clinical critics — but also is slowly gaining fans.
Instant health access ends the paper chase
DR Jim Holland likes his sport and his job. Now he can browse patients’ records in real time — checking anything from their latest blood pressure to their most recent medication on his smartphone — while watching the footy on his day off.
For the clinical director of the Noarlunga Hospital emergency department, it is a world away from fossicking around for paper records or talking over a patient’s condition with colleagues on the phone. Dr Holland is a fan of EPAS and predicts others eventually will be equally enthusiastic — once they master the system.
The introduction was not without hiccups. Clinical activity fell dramatically as staff struggled with a “clunky” new computer system.
Nearly three years down the track, and after numerous upgrades to the system, Dr Holland says going back to paper records would be unthinkable.
“It would be archaic,” he said. “If you took a random survey in the ED, I reckon at least 95 per cent of people would say it is an improvement.”
While there are claims the system puts patients at risk, Dr Holland and SA Health Chief Medical Officer Paddy Phillips point to some telling statistics from the three hospitals now using EPAS.
Before EPAS, audits found 5.8 per cent of all drug orders at Noarlunga, Repatriation General and Port Augusta hospitals had an incorrect dose, frequency or route (oral or intravenous). It has since fallen to 0.03 per cent — a change in medication error rates from one in 20 patients to one in 3000. In Noarlunga’s ED, monitors linked to EPAS are on mobile workstations as well as in the central area so staff can wheel a screen from patient to patient in cubicles. They can instantly check conditions of other patients without chasing up paper charts, and several users can view a patient’s condition at one time.
“Everything is visible to everyone. It is safer for us,” Dr Holland said.
He notes EPAS automatically alerts users if a patient has been prescribed a medicine that might cause an allergic reaction or if a dosage is unusual. In the past year alone, 15,000 automatic allergy alerts were triggered at the three EPAS hospitals — in the vast majority of cases, clinicians were aware of the ­allergy, but alerts serve as a safety net.
Some paper records must be scanned into the system, such as GP referrals, but Dr Holland says this is not a problem.
Prof Phillips said Noarlunga pioneered the system and it had evolved dramatically as clinicians gave feedback.
Read here for the rest of the pro and the against case:
The day before the ABC ran this story:

EPAS hospital system compromising patient care, SA doctors' union says

Posted 15 May 2016, 6:03pm
Patient care is being put at risk by SA Health's new electronic system EPAS, according to a doctor's union, which received a list of complaints from members following a recent rollout.

Key points:

  • Union receives 11 pages of complaints about EPAS
  • American system does not understand some Australian drugs
  • Union head says EPAS must be fixed or abandoned
  • Health Minister confident about EPA rollout at new Royal Adelaide Hospital
In the most serious complaint, a clinician at the Repatriation General Hospital (Repat) in Adelaide cited a rapidly deteriorating patient in an operating theatre urgently needing blood.
Staff rang the lab and were told to put the blood request through the new $422 million EPAS system.
The emergency blood took five minutes to order and the staff member said the delay compromised patient care.
South Australian Salaried Medical Officers Association spokesperson Dr David Pope said 11 pages of complaints from its members were handed to SA Health in March.
He said the State Government needed to treat the problems with EPAS more seriously.
"When you've got someone who's close to death, seconds count, so any delays that are caused by these systems affect patients and it can mean they can die when they otherwise wouldn't," Dr Pope said.
EPAS has only been rolled out at a few hospitals so far, which include the Repat and Noarlunga.
A constant complaint is the increased workload as staff described the system as clunky and incompatible.

'Workers doing more hours to manage EPAS'

One complaint said a public servant at Noarlunga Hospital had to start work an hour earlier each day to manage the extra documentation requirements of EPAS.
The staff member said the system could not read some ultrasound files so staff had to manually scan and upload the data as PDF files.
"There's been issues with this system right from its first implementation," Dr Pope said.
"It's had major problems and many of those haven't been addressed."
SA Health Minister Jack Snelling said he was unaware of the Repat Hospital case but said it warranted investigation.
"For every case you can cite, there would be many hundreds, if not thousands, of occasions where there's definitely been a better patient outcome because of EPAS," he said.
Lots more here:
Then we had this little snippet!

Earn $90k for good spin on ‘flawed’ health record system

SA HEALTH is offering more than $90,000 for six months for a spin doctor to convince the media and public its controversial electronic records program EPAS is a good plan.
South Australia Health hopes to hire a spin doctor for a six-month stint to convince the public that its highly criticized Enterprise Patient Administration System is worthwhile. The electronic records system is years behind schedule and over budget by over $200 million. Hospital physicians have formally complained that the system cut clinical activity by 50 percent, and have written a letter listing 37 major flaws and pleading for it to be shut down. SA Health named Allscripts as vendor of choice for the 80-hospital, $225 million project in November 2010 and signed the contract a year later.
All this was followed by this:

Health Minister Jack Snelling tips likely increase in cost of troubled EPAS computer system, which is critical to operation of new RAH

Daniel Wills, State Political Editor, The Advertiser
June 19, 2016 2:17pm
Subscriber exclusive
HEALTH Minister Jack Snelling has forecast a likely increase in the cost of a troubled computer system critical to the operation of the new Royal Adelaide Hospital.
The State Government is currently rolling out the Enterprise Patient Administration System to hospitals across the state, which allows clinicians to electronically access records.
The new RAH has been built without space for old-fashioned paper records.
The Opposition today released a document obtained under Freedom of Information which it said showed the cost of the bug-ridden system had blown out to $465 million.
The briefing note, from an SA Health official to Mr Snelling’s office, outlined changes which may be required to ensure smooth operation of the system and possible cost implications.
More here:
and then even this:

South Australian govt fights to keep using MS-DOS system

A local government department in South Australia is continuing to use software that runs only on an MS-DOS-based system, even though its licence for the product ran out in March.
The SA health department has been using the Chiron patients record system, which was developed in the 1980s, in several of its rural units.
At that time, the operating system predominantly used on personal computers was MS-DOS, renamed from PC-DOS, and sold by Microsoft.
The department has been the sole user of Chiron since 2008.

Lots more here:
To the outsider sounds rather like chaos reigns!

1 comment:

Oliver Frank said...

I note that my local colleague Dr. Jim Holland said or is quoted as saying that "Some paper records must be scanned into the system, such as GP referrals".

While this may be true, it is true only because despite more than ten years of pleading from GPs, SA Health has so far not implemented any system of secure two way electronic communication that is usable by GPs, such as Argus or any other Secure Message Delivery system. This means that the only way in which GPs, whose practices are heavily if not fully computerised, can send referral letters is on a physical piece of paper (with the patient or by post) or as an image (that is, faxed).

I wonder whether Dr. Holland as a hospital employee knows that most GP practices are heavily if not fully computerised and that many or most use SMD and want to communicate only electronically with other health professionals and organisations.