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The big flip: NSW Health on an epic journey

25 November 2022
By Kate McDonald
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Pulse+IT can safely say that there’s not been a story in eHealth in Australia or New Zealand in the last 10 years that rivals the impact of this week’s announcement that NSW Health will go ahead with what have been lingering rumours over the last year and rip out its complex, hugely expensive but very much functional Cerner-based electronic medical record and replace it with Epic.

There are a few other systems being replaced too: Orion Health’s EMR instance in Hunter New England, the long-standing iPM patient administration system instances, and four or five equally long-standing laboratory information systems. A single system replacement was known to be on the cards for NSW Health Pathology, but the decision to go all in with Epic for the EMR and PAS still came as a bit of a surprise.

You can read about the decision and its ramifications here, here and here, and there are still some questions to be answered on what exactly those extra clinical systems that are in scope to be replaced involve. They could very well involve the two different electronic medication management systems – both incredibly complex and long-term projects to implement – and even the MetaVision ICU system is on the cards, we hear.

We’ve done a lot of ringing around this week and the consensus appears to be that the decision is bold, the project will be incredibly difficult over the next six or so years, and it will be incredibly expensive. eHealth NSW says funding has been secured, but the $141 million allocated last year is probably only enough to get Hunter New England off the ground. Where the rest of the money is coming from we don’t know. No offence to Newcastle but the Sydney metro hospitals are of a much greater magnitude and are going to require a hell of a lot more money.

The NSW Health announcement did take the wind out of ACT Health’s sails a little bit, which is unfortunate. The ACT seems to have managed what the Melbourne Epic implementations have and pulled off a big-bang go live with only the usual teething problems to complain about. One of our readers said there are still adjustments needed to the system, which they described as very complex. The reader was also a bit critical that there wasn’t really enough training for clinicians, and there may have been a bit too much emphasis on branding and signage on water bottles and laptop bags and not enough on support staff.

Otherwise, the feedback has all been good. The idea of opening the system up to GPs was also welcomed, and ACT Health and Parkville are now providing a model for not just Hunter New England but for a certain other state that we suspect wants to adopt the Australian model for Epic. But as to the extent and complexity of rolling out this enormous system to the whole of NSW Health, which has 220 hospitals, 120,000 full time staff and eight million patients to care for … there may not be enough popcorn on the planet.

That brings us to our poll question for the week:

Is NSW Health’s move to replace Cerner with Epic a good decision?

Vote here or comment below.

Last week we asked: Do you have confidence that ADHA’s infrastructure modernisation project is on the right track?

We have to say this poll received the fewest votes in the history of our opinion polls. Nonetheless, most respondents said yes: 61.5 per cent v 38.5 per cent against.

We also asked that if you voted no, could you provide practical advice as to why? Here’s what you said.

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3 comments on “The big flip: NSW Health on an epic journey”

  1. So, is NSW Health’s move to replace Cerner with Epic a good decision? Most said yes: 62 per cent to 38 per cent.

    We also asked: if yes, what benefits will it bring? If not, why not?

    Here’s what you had to say:

    – It just seems such a waste of money – one single solution does NOT fit all. How do Federally and private funded GP’s who refer to state health and private funded specialists who refer to state and private services (Path & Rad) who refer back and then refer again to state health and private hospitals funded by lots of people … all use the same system? It’s easy in The USA where its all under a HMO but here ?? Is this the end of our Australian health IT industry ?

    – It is currently functional and users are familiar with it. There will be significant transitional and teething issues to move to EPIC as it is a more complicated system (despite more capable/ powerful)

    – Streamlined training, staff mobility, patient history and records available in context and within workflows wherever needed

    – A fully integrated patient record, not only across NSW, but across the rest of the Epic Australia users

    – We should be moving away from these monolithics apps, and put in smaller integrated systems; otherwise these big vendors will continue to lock their clients into their solutions

    – No increased benefits huge additional cost

    – What a waste of public funds. How can we justify wait lists and closing services and then waste the tax payers money without reasonable justification

    – Money would be better spent integrating with external health care providers, GPS, Specialists, Private sector et

    – Starting from scratch for our thousands of clinicians will be incredibly expensive and labour/training intensive. Benefits of single record for patients won’t be realised for a decade or more based on how long it took NSW to get everyone onto eMeds…. Have also heard Epic is not very customisable – how will innovation and improved practice be handled if this is true

    – Cerner is not fit for purpose, causes large delays in patient treatment and turns clinicians into data entry clerks. Not to say epic will be any better but it sincerely can’t be worse than cerner – moving to paper would be an improvement

    – Complex training issues. Replace a poor emr with another poor emr so not worth the cost and risk

    – Massive cost for marginal benefit. A waterfall program that will build a legacy system with little adaptability to support models of care that would actually make a difference to cost pressures, rising demand and staff burnout.

    – Better vendor

    – Consistent workflows across the state

    – Statewide eMR

    – Transition to statewide approach and EPIC will lead a quality implementation approach

    – Shared record great patient portal and go portal.

    – Interoperability & self managed changes

    – Interoperability of the next level with big data future

    – It will hugely stifle innovation in the long term

    – The money to replace everything in a functional system could be used for better patient care or investment interoperability projects.

    – Consolidation of resources

    -Improved user interface = greater adoption = improvement for patients

    – Unnecessary big spend on a system that works.

    – Cost to the state

    -Consolidated information

    – It’s the same old story of drinking the Kool Aid of a big US brand and equating price with quality. This has been repeated multiple times in several Australian states over the last decade and more. So there will be the same old stumbling blocks and nary an improvement in clinical or financial returns

    – Statewide consistent eMR

    – If it’s working then why spend A$1 billion plus to replace one lot of functional but ageing technology with another. Doesn’t make any sense!

    – ridiculous waste of money. Will step back 10 years. $1B of better value…not a chance. Ludicrous decision. Low end LIS, unproven PAS at scale – madness. As a NSW taxpayer – not happy! Put the $B into nurses.

    – Rethinking digital processes

    – Take a look at the problem SA Health had trying to implement a combined PAS and EMR – it failed so how does NSW Health think they can accomplish it!

    – Epic is much more user friendly
    The ability to share information across LHNs will be amazing!

    – Very costly and brings every clinician and administrative staff back to drawing board to design, learn and use new system which would be buggy at the start.

    – You cannot simply transpose an American (privatised, segmented healthcare) system into an Australian context.

    – Unified interface – reduce transcription errors, better UX. Current interface is disjointed and offers a poor experience to clinicians. When done well Epic is… Epic. Expect teething pains as I’ve seen in Singapore this visit though!

    – Move away from Oracle

    – Fully integrated single platform

    – something different, bold, new and unification of systems. it will slow down localisation, customisation, development and past addons will be interesting. access to gps will benefit as well, integration needed

    – A purpose built community health module that has proper group functionality, not something cobbled together to represent one. Also, a client app – what a treat in 2022!

    – The outcomes they tout were possible with their current ownership of multiple HIE technologies they never chose to employ.

    – It will replace Cerner eMR which is cumbersome.

    – Integrate the whole medical records within one platform.

    – Useability.

    – Haemorrhaging of more and more money with the same result. Interoperability platforns exist for a reason.

    – pulling out a working system for another overseas system that will require huge amounts of additional changes to suit the Australian market sounds like a money pit, and a concern for continuity of care

    – A state wide EMR that is well supported with more health services being connected, Parkville, ACT now NSW.

    – Interchangability and knowledge sharing across the system.

    – Diversify the market, open opportunity to look with fresh eyes.

    – far superior system

    – Since Hunter New England Health does not use Cerner. It is better that NSW Health moves to one system rather than the current situation.

    – Epic is a more modern platform and better suited for Australias healthcare
    one system statewide

    – Its replacing one American behemoth with another. EPIC is even less willing to open its doors to any solutions but its own. American EMR vendors are all about upselling as a lock in to their solutions. One of these days this country will wake up to the fact that their are better alternatives. I doubt if the ROI will ever be achieved.

    – Bold to put it mildly. A single health record and fewer points of transition / re-entry is beneficial to safety, along with fewer logins for end users, I’d hope.

    – Having the public sector all on one medical record will be a huge win for both the clinical and administrative staff in NSW. The opportunities for interoperability, assistance between teams across the state, IT capabilities – eg shared procedures etc, joint requests for enhancements, and for staff to move between health services with ease are huge.

    – Absolutely brilliant decision.

    – Ditching Cerner seems a great step forward. Should be more reliable??

    – Operating a single instance should lower implementation and on going operations and maintenance costs

    – More cohesive record. It would be great if it could traverse states – particularly border towns such as Tweed Heads/Coolangatta and Albury Wodonga

    – Cerner seems to be replaced in multiple large installations including the >1B US$ Veterans contract they had won. There must be a undisclosed reason protected by a NDA.

    – An enterprise system would provide for a much more seamless user experience but also importantly a more comprehensive and accessible health care record.

    – One record for the whole state, fantastic approach

    – Waste of tax payers money – cerner already works, everyone knows how to use it. typical nsw health making lives more difficult than they should be. think about the training, the time it will take to acclimatise to yet another product. another decision that appears to be made on a whim, by people who don’t actually have to use the product. consult the frontline more, we’ll saving billions and keep everyone happy

    – Standardisation, rich data source

    – It will link with ACT health nicely

    – Ability to ensure the state has a product that will be upgraded in all areas of care, inpatient , outpatient , mental health, community and so on as so many versions of current EMR redundant & not functional. Be able to provide the consumer/patient a better user experience and patient journey!

    – EPIC looks more user friendly and ability to find documents, consent forms etc is a bonus from what Cerner provides.

    – Too costly and complex with too much risk. What were the real incentives for change I wonder…

    – Coherent and consistent, advanced interface for clinicians once they have mastered it.

    – Its lot of money and resource being spent to change a system that could have been done via another offering

    – Clear benefits around patient care, interoperability of health information and ROI

    – swapping one major US vendor for another, displays poor understanding of data and interoperability.

    – Waste of taxpayers money on retraining 80+% of state.

    – More user friendly system. Will be great that all facilities within NSW health will be using the same electronic environment

    – System designed by nurses has to be an improvement

    – A greatly improved user experience with modern interface and tools such as mobile apps that feel nice/fairly intuitive to use. Not perfect but probably the best available.

    – POTENTIAL for improved outcome in areas such as clinical outcomes, patient safety, patient & family engagement, throughput, efficiency, financial performance, and research effectiveness. Potential in caps because you don’t just get these from installing a system – it is all about the rest: clinician engagement, careful configuration, training, support etc.

    – A statewide, truly single, patient data record is a great aspiration and in time will be the core for huge improvements in healthcare. Ability to more easily share patient data between systems in NSW, ACT and Victoria will also support patient care.

    – Cerner is ok for inpatient settings but terrible in small outpatient clinics. Epic seems to be able to do both.

    – Great benefits for patients with integrated system and my health app. Great benefits for users with user friendly view. Great benefits for executives with dashboard KPI which drive operational decisions. Great benefits for researcher and analytics for easy data warehouse management. Epic is a great EMR but the question is if the organisation is willing to change the culture in using Epic.

  2. Piggy backing of an existing system like Cerner at Westmead would have been far easier and more cost effective. Cerner eMR has progressed dramtaically over the last 5 years and this is going to be difficult to duplicate.

    • Instead of using the existing vendor Cerner, we are going for EPIC. How much training would it require for individuals and medical staff who are already using cerner. Most of the state is on cerner and instead of expanding that, buying something new. Complete wastage of public money.

      • Name - NANCY

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