EPAS labelled a dud by South Australian doctors forced to use it

THE electronic patient record system earmarked for the new Royal Adelaide Hospital has been savagely criticised — by doctors who’ve been using it for the past two years. READ THEIR LEAKED LETTER

• Read the full letter from the Flinders and Far North Doctors Association here
• Auditor General: RAH faces delay over $422m computer system

DOCTORS who have used the controversial $422 million electronic patient record system intended for the new Royal Adelaide Hospital say it puts patients at risk and must be scrapped. In a letter to SA Health chief executive David Swan and Health Minister Jack Snelling, obtained by The Advertiser, doctors have pointed out 37 separate failures within the Enterprise Patient Administration System.

They say it is so bad that staff have given up on reporting its problems. Some doctors had even resigned out of frustration with a system that was making their work too difficult.

The controversial system has been in use at Port Augusta Hospital for two years and doctors there are pleading with the State Government to scrap it rather than install it at the new Royal Adelaide Hospital.

“Please take EPAS away ... please replace EPAS with something much better,” the letter from the Flinders and Far North Doctors Association implores.

Doctors struggling with the system have found it caused errors in medication, drug dosages being missed and patient safety to be compromised.

Among cases cited where treatment was delayed because staff were bogged down by EPAS was a recent situation in which a woman who had just given birth and was haemorrhaging “had delayed detection as staff were preoccupied with data entry”.

Doctors who have used the controversial $422 million electronic patient record system intended for the new Royal Adelaide Hospital say it puts patients at risk and must be scrapped.

SA Health on Wednesday insisted the EPAS roll out would continue and that it would be used at the new RAH, which has no storage room for paper records.

The doctors’ list of 37 problems includes:

FAULTY diagnoses not being rectified in records;

INCORRECT medication being given;

NO tracking of who had altered patients’ records;

MEDICATION required being missed due to screen design and “numerous’’ occasions where drugs had been signed for by nurses but showed up on EPAS as not being given;

EXPERIENCED doctors quitting work at Port Augusta due to exasperation with the system, to the point the hospital has half the number of on-call doctors compared to two years ago;

PATIENTS not being attended to immediately because clinicians were focused on computer screens;

LOGGING on taking up to seven minutes, screens regularly freezing, data being lost;

PATIENTS listed as being in the waiting room hours after being treated and discharged.

“It is very easy to select the wrong medication and sign for it without realising — these ‘incorrect medication’ errors will be more difficult for nursing staff to detect than (hand written) illegibility,” the letter states.

“(Medication) doses are missed if nursing staff don’t scroll down.

“Changes in drug dose often mean missed doses.

“Some early provisional diagnoses that are added as diagnoses and later found to be incorrect are not fixed as no one is responsible.”

The letter notes the system is forcing doctors to choose from a fixed database of diagnoses when entering information.

“Often a clinician is forced to choose the ‘next best fit’ which often isn’t accurate,” it says.

“It is much more common to see clinical staff at workstations than providing hands on care at the bedside.”

This was the case with a patient recently found to have had inadequate bowel and bladder care.

The situation has reached a point clinicians fed up with the system are no longer reporting problems.

“Nowadays many people have ‘reporting fatigue’ and will just leave issues unreported as there is such a long delay to resolution that it seems pointless and we just need to get on with our core business of caring for sick patients,” the letter states.

An SA Health spokesman said that “we continue to work closely with our clinicians at the Port Augusta Hospital regarding the EPAS program and we have made a number of improvements to address the issues they have raised”.

“The implementation of EPAS across seven sites has already led to substantially reduced rates of medication prescription and administration errors, faster location of patient information and improved continuity of patient care.”

SA Health appointed a full time EPAS account manager at Port Augusta Hospital to deal with issues.

Opposition health spokesman Stephen Wade said the log of problems ``confirms the patient record system is a massive and dangerous waste of taxpayers’ money’’.

“It is damning that South Australian doctors who have been using the $422 million EPAS for two years have called on the Weatherill Government to dump the program,” he said.

“I’m particularly concerned that doctors believe patient health will be compromised as a result of the many failures identified.

“From the very beginning, the Weatherill Government said EPAS was a vital tool for the operation of the new RAH, yet months before the opening fundamental flaws and problems continue to infest the program.”

EPAS HOW AND WHY

WHAT IS IT

THE Enterprise Patient Administration System (EPAS) is an electronic patient record system, intended to provide a statewide electronic health record.

IT will replace existing electronic as well as paper patient records.

STAFF and clinicians using the system are able to access patient information electronically and order tests, medications and review results from computers at the patient’s bedside and other points of care.

THE BENEFITS

SA HEALTH says medication prescription and administration error rates are substantially reduced compared to paper records due to improved legibility and built-in alerts for appropriate drug dosing, drug-drug interactions and drug allergies.

THERE is improved continuity of patient care and it is quicker and easier to locate a patient’s record.

MULTIPLE users can access a patient record simultaneously, saving time in searching and retrieving paper-based records.

THE PROBLEMS

ITS cost has blown out to $422 million and Auditor-General Andrew Richardson has warned of further blowouts.

IMPLEMENTATION was put on hold in 2014 and only Port Augusta, Noarlunga and the Repatriation General Hospital now use it as well as three GP Plus clinics and the SA Ambulance Service. Last year Repat doctors complained the system had cut clinical activity by 50 per cent.

THE Royal Australasian College of Surgeons last year labelled EPAS ``disastrous’’ and warned it could not guarantee patient safety under the system.

CLINICIANS using the system say some of the supposed benefits have not materialised.

THE FUTURE

OFFICIALS insist it will be ready for the new Royal Adelaide Hospital — which has been designed without storage room for paper records. The new RAH is expected to take patients in November.

The EPAS system is expected to be introduced to the Queen Elizabeth Hospital in June.