Rolling out a state-wide electronic health record system is no mean feat for the CIO of SA Health, David Johnston. The government organisation last month switched on its Enterprise Patient Administration System (EPAS) that is set to transform 12 hospitals across South Australia.
“This would be the largest IT-enabled project that the state has ever undertaken,” Johnston told CIO Australia. “It’s a significant initiative because it means that if it works here then it’s completely applicable to other states or countries, other jurisdictions.
“It’s basically leaping the industry forward by about 40 years; health is where manufacturing used to be back in the 1960s. It’s one of the last industries that has held out in terms of its usage of technology.”
The e-health system launched on August 25 at Noarlunga Health Service, with more than 2000 electronic medical orders placed in the first day. The system has been configured for about 30,000 users, and around 1200 people who have been trained to use the system at the Noarlunga hospital. The complete rollout across all hospitals is to take place over the next two years.
SA Health customised the Allscripts’ Sunrise Clinical Manager system to create the EPAS. It can be used for both clinical and administrative hospital functions, assisting in 80 per cent of healthcare workers’ activities.
A complex, lengthy project
Johnston is seven years into $422 million, 10-year project, having spent five years implementing the underlying infrastructure to support EPAS and two years developing the e-health system.
“It was very clinically-oriented so it wasn’t the IT department going out and choosing a system. Less than 20 per cent of the budget was on technology so it’s a massive business change project; it’s not a technology project.”
More than 50 projects were executed in the lead up to EPAS. These included creating a mirror copy of its Adelaide-based data centre for failover and backup/recovery, having redundant fibre optic cables between all the hospitals and data centres, and standardising the PC fleet by moving to a rental model rather than purchasing disparate PCs.
The system is configured to work with the federal government’s personally controlled electronic health records (PCEHR) scheme, with eight metropolitan hospitals and one regional hospital now sending discharge summaries to the PCEHR.
“The PCHER has gotten a bit of criticism but I think that’s a bit short sighted. If you look longer term it’s going to be extremely useful. We’ve had no issues in terms of connecting to it,” Johnston said.
“There’s a lot of work that goes on behind the scenes because it has to translate patient numbers into individual healthcare identifiers, which are allocated by the federal government. But for us it’s seamless, it’s just simply a checkbox.”
Integration of systems is one of the biggest challenges in getting an e-health project of this size and scale up and running, Johnston said. Using an electronic master patient index, Johnston was able to standardise patient numbering to send information electronically to GPs through a secure messaging system.
The PCHER has gotten a bit of criticism but I think that’s a bit short sighted. If you look longer term it’s going to be extremely useful.
“We encrypt it and we have a provider registry where it can be delivered to them in a secure fashion via the Internet and be unpacked into the GP's system.”
An integration engine was used to create one interface for more than 200 systems. Instead of taking a point-to-point integration approach, Johnston decided to use a ‘hub and spoke model’.
“As we bring new systems on, we only write that one interface because the integration engine [the central hub] pushes the messages around and delivers them to the proper system,” he said.
“Point-to-point integration ends up looking literally like a bowl of spaghetti because over the years one system gets connected to another which then gets connected to another. If one thing goes wrong you can have all kinds of unpredictable impacts.”