With days to go before the South Australian election, the SA Health Minister has pledged an independent review into the controversial statewide electronic health record system that has plagued the government for years and become a campaign issue.
Former senator turned state party leader Nick Xenophon last month called for SA Health’s Enterprise Patient Administration System to be paused and investigated, while the AMA (SA) has advocated for fixes following a scathing survey of medical staff last year that found EPAS was not fit for purpose.
Announcing the review, Health Minister Peter Malinauskas conceded that the labyrinthine IT infrastructure project has encountered problems, according to In Daily.
“The rollout of EPAS is one of the most complex IT undertakings in the history of South Australia,” Malinauskas said.
“With this in mind, 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.”
But the minister said it’s not all bad news. SA Health figures claim over 1.29 million inpatient, outpatient and emergency department visits have been registered in EPAS, with more than 2.2 million medication orders and 1.8 million pathology and medical imaging orders placed via the system. The transition from paper to electronic records has also led to drastically fewer medication administration errors – from one in 20 to one in 3000 – in the state’s hospitals.
“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.
The review, which relies on the incumbent Labor Government being returned to power, would take advice from clinicians to ensure the system is best serving patients and staff.
“Labor would like to build on these improvements and will undertake a review to see how we can build on the current system.
“… If you get admitted to a hospital, whether you are in the North, central Adelaide or the South, clinicians should be able to access your health record so that they can provide you with the best care for your medical condition.”
Malinauskas also pledged that in 2018 EPAS would be fully functional at new Royal Adelaide Hospital, and installed at Mount Gambier Hospital and Flinders Medical Centre.
News of the review into EPAS has been welcomed by the AMA (SA), which has advocated for improvements to the beleagured EHR.
“Everyone agrees about the value of electronic medical records. But the implementation of EPAS had serious problems, with doctors’ concerns about the impact of EPAS on patient safety, usability, lost productivity and patient care being grossly underestimated," AMA state president Associate Professor William Tam said.
“We will be providing any EPAS review with important ‘warts and all’ feedback from our members who use the system. Reviewers will have from us an insight into its day-to-day use in hospitals from Noarlunga and Port Augusta through to Flinders, the QEH and the new RAH.”
The AMA (SA)'s recommendations for making the system more usable and safe include:
- Implementation of proximity login cards to reduce the current long waits to log into the system, which create inefficiency and delays, which was also a recommendation of the Coroner
- More terminals and improved placement and positioning of screens
- Improved, easier ways for a user to customise the display of information so that critical data is at doctors’ and nurses’ fingertips
- Better labelling of documents and improved search functions
- Collaboration between SA Health and AMA(SA)’s EPAS working group to make the system more usable and, in particular, the prescribing system workable for clinicians
- Integration with existing IT systems used in health, including primary care access for GPs and private specialists
- Dictation software to be investigated.
Tam also voiced concern about the further roll out while problems remain.
“The AMA(SA)’s role is to look beyond the political controversy, and to turn the focus back to what the review must be about: our hospitals having the best medical record and communication system to support the care of our patients,” he said.