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”.
“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.”
He said the rollout of Allscript’s Sunrise EMR at the two exemplar sites would be completed in 2020 and within the existing project budget of $421 million.
Just under 80 percent of this budget has already been spent deploying the system to only 28 per cent of all public hospitals.
Wider digital health concerns
The report also contains a number of recommendations beyond EPAS after the review panel found “the singular focus on EPAS implementation and investment has resulted in an underinvestment in digital health elsewhere in SA Health”.
“Limited investment outside of EPAS is underpinned by the absence of a comprehensive digital health strategy that addresses the needs of healthcare consumers/patients, regional health services, and community health settings including integration with primary care, mental health, aged care, palliative care and hospital in the home,” the report states.
As such, the government has agreed to create a digital strategy for SA Health that is overseen by a new digital health board and a separate ‘Digital Health SA body’,
The panel also said funding was needed to “sustain existing IT computing and network infrastructure which represents a significant risk to the State”, as well as invest in “secure messaging, contemporary desktops and mobility, unified communications and knowledge management”.