It has remained generally circumspect as controversy has raged about the roll out of SA Health’s electronic patient record, but now the global EHR powerhouse behind EPAS has pushed back at criticism after a review found the system couldn’t proceed in its current form.
SA Health's chief executive Dr Chris McGowan last week said an independent panel had “confirmed” concerns about the system and would determine if EPAS should be overhauled or abandoned.
“The independent expert panel will now look at options regarding the future of the EPAS roll out and will be consulting with stakeholders on the options,” McGowan said.
“The expert panel needs to determine if the issues raised with EPAS can be addressed adequately in order for it to meet the expectations of users in the future.”
Allscripts’ General Manager for ANZ Todd Haebich said the company welcomes the new review and plans to build on the positive outcomes achieved so far with the system and make it the best of its kind in Australia.
“We welcome the review. There is always room for improvement with complex clinical IT solutions and we will work with SA Health to action the recommendations of the review board,” Haebich told Healthcare IT News Australia.
“We are very receptive to areas that we can work on with SA Health to improve EPAS and we are fully committed to making it the best electronic health system of its kind in Australia. We believe we have already achieved positive outcomes and we can achieve much more.”
The scale of the labyrinthine implementation so far has been ambitious.
EPAS is a complex electronic health record system that includes various Allscripts modules, including Sunrise, Sunrise Enterprise Schedule and Sunrise Financial Manager, which constitute the core of the patient administration system, along with the Allscripts Sunrise Clinical EHR Suite that integrates into other hospital IT systems owned by SA Health.
According to Haebich, it has resulted in genuine improvements, with clinicians now able to access patient information across multiple sites for the first time in the state.
“In South Australia, thousands of staff use EPAS on a daily basis and the system operates 24 hours per day, seven days a week. The benefits of the implementation of EPAS are tangible,” he said.
“Use of the system has reduced medication prescription, dose and frequency errors from 5 per cent to 0.003 per cent. In real terms, this means that tens of thousands of medication errors – many of which could have had serious consequences – have been avoided.”
EPAS now hosts more than 24 million clinical documents and has processed more than 1.29 million patient visits, more than 2.2 million medication orders and almost two million pathology and medical imaging orders.
But the IT infrastructure project has been plagued by criticism since it was introduced by the former Weatherill Labor government in 2013.
Originally budgeted at $408 million in 2011, the cost of EPAS has increased to $471 million over the 10 years to 2021.
Concerns from clinicians have also been raised, and last year the state’s AMA claimed that if EPAS were a car it would be recalled. The doctor’s lobby group said a survey of medical staff suggested the system was “not fit for purpose” and had led to pathology mix-ups, prescribing mishaps and difficulty in finding records when they are urgently needed.
After being swept to victory, the Marshall Liberal Government paused the roll out in March and commissioned the independent review.
Allscripts’ Haebich said the vendor has a record of complex implementations globally, with 3400 hospitals using its software, including the UK’s Kings College and Salford Royal NHS trusts, and Phoenix Children’s Hospital, Washington Health System and University Hospitals in Cleveland in the US.
“Clinical staff in some of the most advanced healthcare settings in the world use Allscripts Sunrise,” Haebich said.
In the 2018 Black Book Global Healthcare Technology and EHR survey, the vendor was ranked with the highest client satisfaction scores in the Oceania region for inpatient and ambulatory EMR projects. Allscripts, which is the third largest public health IT company in terms of revenue behind Cerner and Epic, was also ranked as the overall leading vendor in the UK and South Asia markets.
Speaking with ABC Radio Adelaide on Thursday, SA Health’s McGowan conceded the department’s management of EPAS had contributed to problems with the system, pointing to successful roll outs in countries such as Singapore.
“I think the way we’ve executed [EPAS] has been poor,” he said.
“So it is able to be done well but it needs to be executed and implemented well.
McGowan also said the current version of EPAS was “quite superseded”.
"I can’t quite remember the numbers but we’re on version two and there’s a version seven around or something like that, so it needs to be updated.”
While the next stage of the review is underway, the underlying software in EPAS will be upgraded from v14.3. to v17.3, bringing the system up-to-date with Allscripts’ most recent software and providing improved clinical functionalities.
The expert panel, which is comprised of three health experts, is considering four options for EPAS, which remains accessible for 25 per cent of the state's hospital beds:
- continuing with a significantly modified EPAS, dubbed EPAS Mark II
- rolling out a modified EPAS at the Central Adelaide and Southern Adelaide Local Health Networks, before assessing requirements for further implementations into other health networks
- procuring a “fit-for-purpose” patient administration system to link into the clinical electronic medical record
- discontinuing the roll out and returning to market for a new solution.
It will deliver its recommendation by the end of November.