SA Health’s Bill Le Blanc hits back at EPAS critics

It’s been a trying few weeks for SA Health CIO Bill Le Blanc. Earlier this month he faced the wrath of medical unions and the scrutiny of the national media after a glitch caused an outage in the health authority’s enterprise patient administration system, EPAS.

Two more outages occurred over last weekend. On Tuesday morning page three of Adelaide’s The Advertiser newspaper read “EPAS fails ‘will be fatal’”. By the afternoon Le Blanc was being grilled live on radio.

“I never anticipated when I applied for this job I would have to go on radio, TV, the paper,” he said at the CIO50 awards in Sydney last night. “People screaming that IT…is basically going to kill a patient.”

Speaking as part of a panel, Le Blanc held aloft the damning newspaper report before defending the EPAS system, which is currently live across seven SA Health services.

“I went head to head with the head of the doctor’s union on talkback radio,” Le Blanc said, “and his claim was this system, an incorrect prescription, is going to kill someone. I said well let’s talk about incorrect prescriptions…”

Le Blanc, who was appointed to the role of CIO at the end of 2013, hit back at critics of electronic health records referring to hospital safety audits which he said reveal that “in a paper-based world where doctors are writing on script pads”, one in 20 of all prescriptions are incorrect.

“It’s either given to the wrong patient or the wrong dosage or given at the wrong frequency,” he said, adding that 12 per cent of people are discharged with incorrect medication.

“With the kind of systems we’re putting in place those hospitals where we have already deployed it… the prescription error rate dropped from five per cent to 0.03 per cent. One in three thousand,” Le Blanc said.

Of last weekend’s outage Le Blanc explained that his team patched a server that EPAS was running on at 1.30am and experienced a five minute outage.

Clipboard and pen

The EPAS’s first implementation was at Noarlunga Hospital in August 2013. It is now being used by more than 8,000 staff each day at Port Augusta Hospital, Repatriation General Hospital and The Queen Elizabeth Hospital, as well as a number of GP Plus centres and at SA Ambulance headquarters.

There will be a phased implementation of the system at the new Royal Adelaide Hospital when it opens, following a number of setbacks.

EPAS has been slammed by doctors and nurses unions, and the opposition Liberal government in South Australia who once called it “a case study in incompetence”. The overall cost of the project has blown out to $422 million.

Despite the criticism, it is part of a much needed digital transformation of the healthcare sector, Le Blanc explained. The data analytics made possible by the transformation will have huge advantages for patient outcomes.

“The way hospitals have delivered services until recently has been the way that they’ve done it since the 1940s. Other industries have leveraged digital technology to change the way they do business, and healthcare has been a little bit slow to do that,” he said.

Although healthcare had a rich history of administrative data, medical data was lacking, Le Blanc said.

After investing time and money into training doctors, “we then give them a clipboard and pen, and say here’s your information store. And by the way in terms of the tools you have to analyse that data we give them a big folder full of paper,” Le Blanc added.

“What big data and analytics is going to bring is an unquestionable evidence base. That gives you an enormous amount of data to actually base your decision making on and a lot of clinicians are crying out for it. They want that information.”

Evidence, not opinions

Le Blanc said that it was a small minority of “high profile medicos” that were complaining most loudly about the EPAS glitches and were opposed to the digital transformation of the health authority more generally.

“Doctors will tell you that at heart they are scientists. And as scientists they’re people of data and they deal with what we call evidence based medicine… That’s what they say,” Le Blanc said.

“Truth be told, for most of them, the evidence that they’re talking about is based on opinion. A lot of it is not based on evidence. So if you go to two different specialists in the same hospital with the same condition you’re going to get two different recommendations for what is the best treatment for you.

“[The digital transformation] is disrupting the business in a major way. Not everyone’s happy about it. Those that have already been practicing for 30 years have been expressing their unhappiness quite strongly.”

Questioned about the biggest challenge of his role, Le Blanc said it was bringing people along on the transformation journey.

“I have much fewer carrots and sticks that I can use. My sticks are not very big and I really don’t have any carrots to get people to move from an ‘as is’ to a ‘to be’ state… our businesses would be so much easier if it weren’t for the people,” he said.