EPAS system savaged by South Australian coroner investigating death of Stephen Herczeg
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South Australian coroner Mark Johns has launched a scathing critique of the troubled electronic patient record system, saying its faults may prevent him from establishing the truth.
Mr Johns is currently inquiring into the death of former Socceroo, Stephen Herczeg, at the Queen Elizabeth Hospital (QEH) last September.
Mr Herczeg, 72, suffered traumatic internal injuries after an oxygen tube was connected to his catheter.
Much of the coroner's criticism of the patient record system, known as the Enterprise Patient Administration System (EPAS), stems from its current ability, or rather lack of, to produce intelligible paper copies of patient records.
During testimony earlier this month from Bill Le Blanc, the man responsible for introducing EPAS into public hospitals, Mr Johns asked him to explain conflicting information and time stamps in Mr Herczeg's record.
Mr Le Blanc said he couldn't and it would take a specialist to do that.
The transcript shows that was the beginning of a remarkable courtroom exchange.
Mr Johns said: "You think it satisfactory if you can't interpret it, that it's been produced to me, in response to a direction from the court for Mr Herczeg's notes, and this is what I get? Is that satisfactory?
Mr Le Blanc conceded: "No, I don't think it's satisfactory."
The coroner was less than impressed.
"I'd suggest it's considerably worse than not satisfactory," Mr Johns said.
"I'd suggest that it is effectively preventing the coroner's court from being able to establish the truth of an incident involving a patient who died in very concerning circumstances ... that difficulty is entirely attributable to EPAS."
Print-out problems still need sorting out
Adelaide University Associate Professor of law, Bernadette Richards, says the coroner's point is a crucial one: medical records are not just a clinical resource, they have a legal standing.
"It matters quite significantly because the role of the coroner is to try to get to the bottom of things," she said.
"If the notes are opaque, if the information is unclear and they can't understand it, then how can they determine what's happened and how can they then explain it to the family, to others who need to know and to fulfil their role which is to work [out] why an unfortunate death occurred."
Mr Le Blanc has told the ABC that although EPAS print-outs had improved, there's still work to be done.
"As western health systems are moving away from paper-based medical records to electronic records, this is something facing all of us ... it's not just EPAS because these system were designed to have the information viewed electronically ... on screen it's clear," he said.
Given the legendary illegibility of doctors' handwriting, there's something of an irony in a computer system that produces indecipherable print-outs.
EPAS has higher accountability than paper system
Law society president Tony Rossi says greater clarity should be one of the advantages of EPAS, along with easier access to records across multiple sites.
But he argues all of that will be negated, if the Government doesn't fix the coroner's concerns.
"It's [the Herczeg inquiry] a wakeup call for the Government," Mr Rossi said.
He is also unsettled by another revelation during the Herczeg inquiry: hospital staff using other people's EPAS logins, despite departmental policy strictly forbidding it.
"It makes it very difficult to attach responsibility where there is a deficiency in the treatment of a patient, alternatively it also casts unnecessary doubt on others who have done nothing wrong," Mr Rossi said.
Mr Le Blanc says it will be impractical in a busy clinical environment to guarantee staff always use their own login, but he's very confident the login policy is being complied with.
"I believe the electronic medical record system has a higher level of accountability than the paper-based system," he said.
It's not the first time the coroner has raised concerns about EPAS's shortcomings.
Through an FOI request, the ABC has obtained correspondence between Health Minister Jack Snelling and the coroner.
In it, the Minister suggests the coroner's office meet with SA Health to discuss possible remedies to the paper print-outs.
The coroner declined, saying short of a fix ,which is SA Health's responsibility, there is nothing to discuss.
Mr Johns concluded his letter with the observation that "EPAS is a $422-million project. By my calculations you could run the state's coronial services for more than three quarters of a century on that amount of money".
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