SA Health's EPAS system auto-deleting follow-up appointments

Follow-up appointments for discharged Adelaide patients are being automatically deleted on a daily basis due to configuration issues with South Australia's EPAS system, the state's auditor general has revealed.

The maligned $422 million EPAS platform has long been a challenge for the state due to cost overruns, usability issues, and delays. Earlier this month it suffered a nine-hour outage across three major Adelaide hospitals.

In its annual report into the state health department's IT systems tabled yesterday, the SA audit office revealed user error with the system had resulted in follow-up appointments for 258 discharged patients being cancelled between June and August this year.

EPAS handles appointments for things like medical imaging, pathology, medications, general care and diet.

The office found around five medical imaging treatment orders for patients were being cancelled on a daily basis at the Repatriation General Hospital and Queen Elizabeth Hospital specifically.

The EPAS system is configured to automatically cancel future treatment orders when a patient is discharged. System users are required to manually tick a box in order to change from the 'standard' setting and retain appointments.

These interface issues "have the potential to be even greater at larger sites," the audit office said.

SA Health told the auditors it was working on a system configuration change to address the issue, involving the notification of pending treatment orders on patient discharge.

The audit office also took SA Health to task over the ability for doctors to request a patient's treatment on behalf of another doctor, given all doctor provider and prescriber numbers are viewable in the system. The clinician whose details are used would not receive a notification.

Similarly, administrative and clerical staff can issue patient treatment orders in EPAS outside of their allowed permissions, the audit office said.

SA Health said it had designed EPAS to allow a doctor the ability to enter orders on behalf of another, but pledged to change the functionality by next October to only allow a final order for medical imaging to be processed with the signature of an accredited requestor.

It also promised to review EPAS acccess levels for admin staff by next June.

Crashing devices

EPAS system users are continuing to suffer from slow and crashing workstations, as well as delayed printing and inefficient document scanning, the audit office found.

"A sample of users consulted indicated that EPAS does not respond to user input approximately twice a day," the auditors wrote.

"Users must wait for the system to respond, unaware of the period of time to wait for the system to become responsive, or if a restart is required. User reporting of these issues to the EPAS program ranges between daily and weekly."

Quick mouse clicks between EPAS screens causes the system to become unresponsive for at least five seconds, and switching between modules can take the system up to 20 seconds to respond, the report found.

SA Health told the audit office the complaints stemmed from a "small percentage" of overall users.

But it said it had implemented a significant number of fixes to address the crashing issue, the most recent in August, which it claimed had provided "significant relief", and is working with EPAS vendor Allscripts to monitor the problem.

The EPAS system is now either fully or partially live across eight sites, but it will face its biggest challenge next year when it goes live in the new Royal Adelaide Hospital.

The auditor-general in May said the system was unlikely to be properly stable in time for the opening.