Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Wednesday, February 06, 2019

Just As The Shambles In Queensland Was Developing South Australia Felt It Did Not Want To Be Left Out Of The Fun.

Since the election of  Liberal Government in South Australia last year an inquiry into the politically controversial EPAS system has been underway. The inquiry report and the Government response was published last week.
Here is the Government Press Release:

EPAS goes as electronic medical records program overhauled

Stephen Wade MLC – Minister for Health And Wellbeing
The Marshall Liberal Government will roll out a new electronic medical records system for South Australian hospitals after the former Labor Government’s failed Enterprise Patient Administration System (EPAS) debacle.
An independent review into EPAS has recommended a fundamental reconstruction of the medical records program and that the EPAS brand be dropped.
Minister for Health and Wellbeing Stephen Wade said the review, conducted by an independent expert panel, found the EPAS program was centrally driven, poorly implemented, and rolled out IT elements that were not fit-for-purpose.
“One of the key findings is that the program was rolled out without a strong consensus from doctors and nurses and without properly engaging the software provider,” Minister Wade said.
“It just doesn’t make sense to lock out clinicians - the very people who have to use the system - and the software provider - the people with experience in making the system work.
“This is just another example of the former Labor Government not engaging clinicians and the taxpayers of South Australia paying the price.
“This isn’t just a minor error or oversight. It’s cost taxpayers hundreds of millions of dollars.
“More than $320 million has already been spent on the EPAS rollout. Less than a third of the way through the rollout, 80 per cent of the budget has already been spent.”
The new plan is a hard reset on the EPAS Program to a fundamentally new SA Health medical records program.
The way forward recommended by the Panel involves:
  • creating a SA Health Digital Strategy;
  • significant governance reforms that devolve responsibility for implementation and configuration to LHNs and clinicians; 
  • actions to improve the Sunrise EMR and Allscripts PAS software solutions and implementation;
  • focussing on two exemplar sites to implement the Sunrise solution that applies the Review's proposed changed approach, and any future decisions to implement the Sunrise EMR and Allscripts PAS are contingent on user acceptance at the exemplar sites; and
  • improving implementation approach and post go-live support, regardless of which solution is implemented
Minister Wade said the independent panel’s report includes 36 recommendations, all of which have been fully accepted or accepted in principle by the State Government.
“Whilst there are limitations with the Allscripts product, the bigger issues were with the configuration and the implementation,” he 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.
“We are committed to once again fixing Labor’s mess. We are reversing the damage done by Transforming Health, we are turning around the financial and operational performance of our central hospitals and we will bring our electronic medical records system in line with best practice.
“The EPAS Program roll out will not continue and SA Health will make immediate and significant changes to its electronic medical records program – to shift control from head office to the hospitals, to improve the software, and to improve the way SA Health manages IT projects.
“This includes working with our doctors and nurses to make the necessary improvements to deliver a fit-for-purpose system that is safe for patients and staff.”
Minister Wade said SA Health will implement the recommendations and the reset, rolling out the program at two ‘exemplar’ sites, the Royal Adelaide Hospital and Mount Gambier Hospital.
“These two exemplar sites will receive a new, significantly improved version of the Sunrise software, and new governance arrangements will put control back in the hands of the clinicians.”
The roll out of the Sunrise software at the RAH and Mount Gambier Hospital will be completed in 2020 and within the existing project budget of $421 million.
A new Program Board will oversee the delivery of the new project and will be led by the chair of the independent review panel, Mr Shane Solomon.
The independent panel’s report, and the State Government’s response, can be found at www.sahealth.sa.gov.au.
Here is the link:
As the Advertiser makes clear in its coverage it has taken a fair while to get to this point:
Here is the timeline they published:


2009: The former Labor government goes to market for an electronic medical records system for South Australia. It eventually opts for Allscripts and its Sunrise system.
2011: The Electronic Patient Administration System, overseen by health minister John Hill, has its budget approved by Cabinet. It was initially approved at $408 million but extended to $421 million in that year’s mid-year Budget review, with the slight blowout blamed on an accounting error.
2013: Under the leadership of new health minister Jack Snelling, the system, known as EPAS, used for the first time in the Noarlunga Hospital in August, 19 months after the program was approved. It started at the Port Augusta Hospital in December.
2014: EPAS rolls out to the Repatriation General Hospital. The independent review into EPAS says the first three rollouts were “extremely difficult experiences for staff and created considerable
bad publicity”.
2014: The rollout is paused in June, months before the statewide system was initially set to be completed. The pause allowed an eight-month “stabilisation phase”, which was devoted to fixing a range of problems, including billing and outpatient scheduling functions.
2016: EPAS starts at the Queen Elizabeth Hospital in June.
2016: EPAS crashes for 10 hours at the QEH in November, creating what the doctors’ union said was a “dangerous, chaotic crisis”.
2017: State Coroner Mark Johns, below, says EPAS is “effectively preventing the court from establishing the truth” in the death of former Socceroo Stephen Herczeg. The 72-year-old died at the QEH in September 2016 after a series of medical blunders when his catheter bag was mistakenly connected to “high-flowing” oxygen tubes pumping 15 litres of air a minute.
2017:A “phase-one” rollout starts at the Royal Adelaide Hospital in September, when EPAS has “limited clinical functionality” in the hospital’s emergency department.
2018: The Hampstead Rehabilitation Centre becomes the last hospital to go live with EPAS in March. New Health Minister Stephen Wade presses the pause button on EPAS when the Liberal Party wins the election and com-missions a review into it.
2019:The review recommends EPAS be renamed and reworked, with clinicians at the centre of the implementation process. The system — which clinicians will call Sunrise — will still use Allscripts and its Sunrise software. It’s planned to be up and running by 2020 in the RAH and the Mt Gambier Hospital.
Here is the link to the quite long article:
Here is a good run through of the plans going forward:

EPAS no more as SA govt moves to reset patient records system

By Justin Hendry on Jan 30, 2019 1:30PM

Six-month review finds "major changes" needed.

South Australia’s troubled electronic patient administration system (EPAS) will be overhauled after an independent review found “major changes” were necessary to improve the system.
The state government this week released the final report [pdf] from a six-month review of the system that has been a thorn in the side of SA Health since it was introduced by the former Weatherill Labor government in 2013.
While the report underscores problems across three key domains, it is particularly critical of SA Health’s implementation of the state-wide patient records system, which has suffered delays, usability issues and cost overruns over the past five years.
“SA Health chose to implement the system without the assistance of expert organisations, including the Allscripts vendor, experienced in electronic workflow design and the change and adaption complexities associated with implementing EMRs,” the report found.
“The governance model is flawed, with accountability for outcomes poorly understood and managed.”
It identified that the agency's “assessment that the Allscripts product met 60 percent of the state’s needs ‘out of the box’ was incorrect”, and as a result the business case was “unduly ambitious on the timing of implementation”.
Issues were also found with the Allscripts software but these were largely confined to the billing model in the Patient Administration System [PAS], which is “not fit-for-purpose and should be replaced by a system that is build and maintained for Australian billing conditions”.
Despite these problems, however, the review panel decided against discontinuing the system – one of the possible outcomes foreshadowed in an interim report last September – and will instead improve the existing Allscripts software, which was found suitable for continued use.
“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,” the report states.
This includes EPAS’ two underpinning IT components: the Allscripts Sunrise Electronic Medical Record software and the Allscripts PAS software, the names of which will replace the term EPAS.
“This will require major changes to how the current EPAS program operates,” the report states.
“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.”
The report has made a series of recommendations to improve the Sunrise EMR and Allscripts PAS software solutions, including an urgent upgrade of the current Allscripts solution software version – which is four years out of date – and a new billing module.
Royal Adelaide Hospital and Mount Gambier and Districts Health Services will be used as the test bed sites for the Allscripts solution with the proposed changes, with “any future decisions to implement the Sunrise EMR and Allscripts PAS are contingent on user acceptance at the exemplar sites”.
However, should “reasonable user expectations” not be met at the two exemplar sites by March 2020, the report proposes that “SA Health return to market to begin selection of a new enterprise system for the state”.
The report also outlines “significant governance reforms” to give clinicians and local health networks more responsibility for implementation, as well as better post-go live support.
In its response to the review [pdf], the Marshall Liberal government said it accepted or accepted in principle all 36 of the report’s recommendations.
“The Government will transition from the EPAS Project to a new electronic medical record project, which will utilise two Allscript software programs, a patient administration program and an electronic medical record program,” it said.
It also took the review as confirmation of its long held views about EPAS, arguing that the “EPAS program has been a failure and should be discontinued and replaced”.
“The review recommends that SA Health completely overhaul the program, reconfigure the underlying information technology and commence a rollout at two exemplar sites before a final decision is made on whether to continue to use the Allscripts suite of products.”
SA Health Minister Stephen Wade described the government’s new plan as “a hard reset on the EPAS program to a fundamentally new SA Health medical records program”.
More here:
Basically what is being done is to improve the implementation support offered to two new sites using the same software other than the billing system – which will be replaced and the whole effort is being rebranded Allscripts PAS and Sunrise EMR. No-one it seems wants to go back to square one!
Time will tell how remediation of current sites + two new exemplar sites will work out. I would suggest coming back in twelve months to see! In passing the reports are worth a browse for the detail of what has gone wrong over the decade.

1 comment:

Anonymous said...

I think this weeks poll points toward the underlying issue. There is also the state and federal inability to attract retain and listen to talented and highly skilled people. I find those running have no real grasp of how to act on a project board or assurance groups, pay lip service to business and system architecture. The end result is they enforce ridged constraints that become so brittle very quickly that when one breaks the result is catastrophic. Ill equipped to deal with divination the headless chickens revert to their true talent, bullshitting and stabbing one another.