EMRs: too big to fail?

One of our top stories this week was the retirement of Queensland Health director-general Michael Walsh after four years in the role, having had a few stints previously with NSW Health. Some in the Brisbane media thought they had a scalp following recent revelations that Mr Walsh had admitted that the roll-out of the state's Cerner integrated electronic medical record had been a big more challenging than acknowledged publicly.

Quelle surprise. Implementing an EMR in a large hospital system is enormously difficult and fraught, as numerous examples here and around the world attest to. And in Queensland, the ieMR roll out has never been smooth. Some clinicians still loathe it and would far prefer to stick to existing software or to try something different. That's highly unlikely at this stage, and we think Mr Walsh's comments were basic common sense.

The news comes as Royal Melbourne Hospital gets set to go live with its new EMR in its emergency department this weekend. The rest of the hospital, and the neighbouring Women's and Peter Mac, will see the full EMR implemented over the next year, with a go-live date of May. Royal Melbourne's ED needs to go live earlier as its existing system, Symphony, is out of support following EMIS' withdrawal from the Australian and New Zealand markets.

The Parkville project is going to be fascinating to watch. They have plumped for an Epic system, following the lead of the Royal Children’s, which did a big bang implementation of Epic in 2016 and switched everything on at once. RCH is now certified as Stage 6 in the HIMSS EMR adoption model for inpatients and Stage 7 for outpatients, and while no one has claimed the project has been easy, it seems to have been successful.

We hear that RCH is now ready to release some quality data on the improvements in safety and efficiency it has achieved with Epic at the annual HIC conference in August, so look out for that if you are heading to Melbourne.

However, there's always a reminder that it can go wrong. We thank one of our Pulse+IT Chat contributors for pointing us to this super article from Politico's Arthur Allen about Epic's adventures in Denmark. Epic was chosen for the Copenhagen region over another system that is in use in the west of the country, and it does not seem to have fared too well as yet.

From the article: “As for Epic, some politicians in the governing Christian Democratic coalition want to rip it out and install Systematic. That seems unlikely. After you spend half a billion dollars on an IT system, 'you come to live with it' … And 'Epic is too big to fail.'”

Meanwhile, yet another coroner has called for the implementation of a national real-time prescription monitoring system, another in a long line of coroners to do so. It was ACT chief coroner Lorraine Walker this time, lamenting the avoidable death of 43-year-old Jay Paterson from a polypharmacy overdose. Mr Paterson seemed to be able to secure opioids more easily in NSW than the ACT, which has a prescription monitoring system while NSW does not.

We have recounted in numerous articles over the years the foot-dragging and lack of action by several states on this issue, despite support and prompting by the federal health department. Victoria took the plunge and rolled out its own system while the ACT is using a version of the original system developed in Tasmania, and the federal government has since paid for a national data exchange so the other states and territories can get a move on. They've been encouraged to do so for the last decade and most are yet to make much progress.

However, while we think implementing RTPM technology is a good thing, it is not the panacea that people are looking for. As always, digital health technologies are tools. Without adequate support and interventions for patients with drug-seeking behaviours and resources for the clinicians who care for them, spending money on a tool like RTPM is a fool's paradise.

That brings us to our poll question for the week: Should the federal government or the states be in charge of RTPM?

Sign up to our weekend edition or Pulse+IT Chat to vote, or leave your thoughts below.

Last week, we asked: Do public health IT projects need better project governance? This one was overwhelming: 97 per cent said yes, and just three per cent said no.

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