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Thursday, April 05, 2018

It Looks Like South Australia’s EPAS Is To Be Paused For Review. What Comes Next?

As we learnt before the SA election the new Liberal Government has promised to pause EPAS for review.
Monday March 26, 2018

Looming EPAS expansion threatens Libs' election promise

The Marshall Government may struggle to meet its election promise to immediately pause the rollout of controversial electronic health records system EPAS, with its expansion at the Royal Adelaide Hospital looming within weeks.
Bension Siebert @Bension1
Stephen Marshall told an election forum late last year that the Liberal Party would “immediately” pause and review the rollout of the Enterprise Patient Administration System if it won government.
The Royal Adelaide Hospital opened in September last year, featuring a partial version of EPAS that provides administrative support but lacks key clinical functions, carried out instead using alternative systems, including paper records.
InDaily understands the installation of a fully-fledged version of EPAS at the state’s flagship hospital is due to begin on or around April 10.
New Health Minister Stephen Wade told InDaily this morning he is not sure whether it is possible – or desirable – to stop the looming upgrade in its tracks.
He said the newly formed Government was doing its “due diligence” to find out.
The feasibility of stopping the RAH expansion in just over a fortnight was “something we’re looking at at the moment”.
“We need to do our due diligence,” said Wade.
……
EPAS has, however, been credited with dramatic reductions in hospital medication errors at each of the sites where it has been installed.
Wade did not rule out entirely scrapping EPAS, depending on the results of the Government’s review: all options were on the table.
But he said the Liberal Party believed, in principle, that some form of electronic patient health record system was important for modern healthcare – especially given the increasing complexity of chronic conditions associated with an ageing population.
In November last year, InDaily revealed SA Health had asked Cabinet for another $49 million to pour into EPAS, raising its cost to taxpayers from $422 million to $471 million over the 10 years to 2021.
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”.
But SA Health figures released last year showed that sites that use EPAS have enjoyed a significant fall in medication errors.
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.
The full article is here:
Later last week we saw this:

‘Dud’ $471m patient record system put on hold

ROLLOUT of the controversial $471 million electronic patient record system EPAS — years overdue and more than double the planned budget — will be halted on Friday, as pledged by the new State Government.
The Advertiser
“The Royal Adelaide Hospital needs to address issues highlighted in recent accreditation reports and the unacceptable time many patients are having to wait in the Emergency Department for an inpatient bed. “Expanding the use of EPAS at the RAH at this time would have been an unacceptable risk to ...
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So the plug has been pulled but what is not clear is just what evidence is based on given some relevant clinical statistics seem to have been moving in a pretty positive direction.
Sounds like the system is working but the docs are still revolting. Is this a tech problem or a change management issue I wonder?
It will be tricky to pull out from here without some very compelling reasons I would have thought as there is a lot of money and effort tied up here to say nothing of some contracts I am sure.
I hope the final choices are evidence based and not politically based.
David.

3 comments:

Anonymous said...

No exit strategy, vendor lock-in, guess who has who by the throat.

Anonymous said...

Its clear EPAS has been surrounded by controversy from its inception - mainly because it had very little if any PAS functionality in its base product when it won the contract. It is probably too late to "pull the plug" now. However, an investigation should be launched into:
1. Why was this software chosen?
2. What were the key requirements and specifications against which the software was selected (are these still available, do they even exist)?
3. Who were the key stakeholders involved in the decision to choose the product?
4. Where are their evaluation and recommendation documents that state and clearly demonstrate that the features of this product stood head and shoulders above other PAS software applications to make it the number 1 choice.

This was a huge project to be implemented surely the above activities (at a bare minimum) had to be undertaken.

Andrew McIntyre said...

This is where the governments lack of attention to standards compliance bites back. Basing systems on rigorously tested standards compliance would make plug and play software much easier. The statement that "Yes we support HL7" is rarely tested and many systems use additional customized data segments (Z Segments) and non standard coding. This is also a danger with FHIR with a "useful" extension mechanism.

Getting the functionality you need, while staying within standards and developing a standard testable way to achieve it is hard work, but neglect that and vendor lock in is inevitable and painful. The breathtaking lack of understanding of how important getting the low level foundations as close to 100% correct and standardized as possible and actually testing those claims has plagued state and national level eHealth programs for two decades. The devil is in those details and to the generic managers that is all gobbledygook. They are reaping what they sowed.