A senior staff member at Hunter New England LHD says inadequate clinical testing, centralised decision-making, and workforce readiness failures have left clinicians dealing with problems that should have been addressed long before the SDPR went live.
A senior source inside Hunter New England Local Health District has told Health Services Daily that clinicians were required to use clinical workflows they had not been given sufficient opportunity to test before NSW Health’s $2 billion single digital patient record went live.
Consequently, critical validation work was required to be undertaken while the system was already being used to deliver patient care.
A senior staff member closely involved in the implementation has told HSD exclusively how centralised decision-making, limited access to integrated clinical simulations, and changing technology assumptions undermined the district’s preparations for the Epic-based system.
The source, who spoke to HSD on condition of anonymity, said the implementation had concentrated too heavily on deploying technology rather than ensuring the system supported the way multidisciplinary clinical teams actually delivered care.
HSD’s source said the problems should not be interpreted as evidence that Epic itself was unsuitable for NSW Health.
“This platform can fly, but we broke it,” they said.
The four most damaging implementation decisions were insufficient local ownership of clinical workflows, excessive centralisation of clinical decisions, inadequate multidisciplinary simulation, and readiness planning based on assumptions that subsequently changed.
“Having seen Epic operating in other health services, I remain confident in what the technology can deliver,” HSD’s source said.
“My concern is that we approached implementation too much as a technology deployment and not enough as a fundamental change to how clinicians deliver care.”
If given the opportunity to begin again, the source said the LHD should start with clinical workflow mapping and validation, followed by workforce preparation, training, and technical readiness.
Only after those processes were completed should a go-live decision be made.
Given how many LHDs are yet to start implementation of the SDPR, it’s advice that NSW Health and the SDPR Implementation Authority might want to listen to.
“The biggest thing I would change is the sequence,” said HSD’s source.
“We needed to understand and validate how care would be delivered, then prepare our workforce and technology to support it, and only then determine whether we were ready to go live.”
HSD’s source acknowledged that a transformation of this scale would inevitably encounter problems and praised the Hunter New England workforce for continuing to deliver care through the implementation.
“I don’t believe every issue could have been prevented,” they said.
“A transformation of this scale will always have challenges. But I do believe we could have reduced the clinical disruption, workforce frustration, and amount of remediation required after go-live.
“Ultimately, I would not change the ambition of SDPR. I would change how we brought clinicians into the design, validation, and ownership of the change.”
Hunter New England became the first NSW local health district to implement the SDPR on 27 May 2026, following a two-week delay to its original go-live date.
The implementation was the first stage of NSW Health’s statewide program to replace fragmented clinical information systems with a single digital patient record.
But HSD’s source said the rollout exposed fundamental weaknesses in how the system’s clinical workflows were developed, tested, and approved.
“We were often preparing clinicians to use workflows before we had sufficient opportunity to validate those workflows ourselves,” the source said.
“Earlier access to the content, with protected time for local clinical review, would have allowed us to better understand the changes, influence implementation decisions, and prepare our workforce.”
Testing individual functions, not patient journeys
Much of the SDPR’s build, testing, and simulation was managed centrally by the Single Digital Patient Record Implementation Authority (SDPRIA), Epic, and statewide working groups.
Although Hunter New England clinicians participated in those processes, the district did not have sufficient opportunity to bring different clinical disciplines together to test complete patient journeys.
“What we needed was greater visibility of the end-to-end clinical workflows within the SDPR build, rather than access to individual components or specialty-specific demonstrations,” HSD’s source said.
“… this meant we could see how individual functions worked, but not always how they interacted across departments, specialties, and systems.”
The district needed earlier access to a mature, integrated environment where clinicians could simulate medication administration, pathology, blood transfusions, patient transfers, and documentation using local workflows.
The source said this could have exposed gaps in clinical handovers, duplicated documentation, unclear professional responsibilities, dependencies on medical devices, and processes outside the SDPR.
“The key learning for us was that technical build validation is not the same as clinical workflow readiness,” they said.
“We needed the opportunity to validate how the system supported care across the entire patient journey, with the people who would actually be using it.”
Instead, problems that might have been identified through earlier simulation emerged after implementation.
“Much of that validation has subsequently occurred during stabilisation, when it should have informed readiness,” the source said.
Related
Central control, local responsibility
HSD’s source said the governance structure had concentrated too much clinical decision-making within the central implementation program, while local health districts remained responsible for delivering safe patient care.
Clinical workflows were largely developed and managed through the SDPRIA, Epic, and statewide working groups, with input from local clinical representatives.
But the source said Hunter New England LHD did not always receive detailed workflow information early enough to understand how those processes would operate across its hospitals and services.
“One of the challenges with the model was that clinical workflow design, technical delivery, and implementation decisions became too closely intertwined centrally, while the LHDs retained responsibility for delivering safe care without always having sufficient visibility or influence over those decisions,” the source said.
They stressed that statewide coordination and standardisation were essential, but argued that clinical implementation should have remained firmly under the control of the health districts delivering care.
“Ultimately, my position is that the central program should have owned the technology, the Ministry should have owned statewide clinical governance, and the LHDs should have owned the clinical implementation and validation of workflows.”
The source said this would have required earlier access to agreed workflows, protected time for multidisciplinary clinical review, realistic simulations, and clear processes for escalating unresolved safety concerns.
“The lesson for future implementations is that we cannot separate the people accountable for delivering clinical care from the decisions about how that care is delivered.”
Eight-week waits for system access
Workforce readiness problems extended to the process of granting clinicians access to the SDPR.
HSD’s source said the end-to-end process of obtaining appropriate access could take up to eight weeks, involving identification of the correct role, prerequisite training, approvals, and allocation of system permissions.
Completing training did not necessarily mean a staff member was able to perform their duties within the system.
“Staff could have completed their education but still be waiting for the permissions required to undertake their clinical responsibilities,” the source said.
“We also saw situations where staff had access to the SDPR but not the specific functionality required for their role, creating further requests and delays.”
In some cases, staff were rostered to work but could not complete certain activities within the SDPR without assistance from colleagues, further escalation, or temporary workarounds.
The source said these arrangements placed additional pressure on clinical teams and introduced potential risks to documentation, ordering, and continuity of care.
Urgent access pathways, including just-in-time provisioning, were available, but the distinction between standard access requests, additional permissions, and urgent escalation was not always clearly understood.
“The key learning is that access provisioning is a clinical readiness and patient safety issue, not simply an IT administration process,” the source said.
“Staff need to have the correct access, for the correct role, before they are expected to deliver care using the system.”
Mobile functionality missing at go-live
The source also described how assumptions about the availability of Epic’s mobile application influenced early device planning, only for the functionality not to be available when Hunter New England went live.
Mobility had been anticipated as part of the system’s capabilities, informing expectations about how clinicians would access patient information and complete tasks at the point of care.
However, the source cautioned against assuming mobility had been formally committed for go-live or attributing procurement decisions to particular individuals without reviewing the planning records.
“Mobility was not available to HNE at go-live, which meant that some of our device planning assumptions did not align with the functionality ultimately delivered,” they said.
Consequently, clinicians relied more heavily on shared workstations on wheels, medication carts, and desktop computers.
In some high-acuity settings, particularly emergency departments, device availability, placement, and accessibility created difficulties.
“The broader lesson is that device procurement and clinical workflow design cannot be undertaken independently of confirmed system functionality,” the source said.
Silence is not evidence of success
They also warned that a reduction in complaints or incident escalations after go-live should not automatically be interpreted as evidence that clinical workflows were functioning properly.
The source was concerned that staff might have become fatigued by repeated escalations, adapted to difficult processes or developed alternative ways of completing their work.
“The key learning for us was that silence is not evidence of successful adoption.”
The district’s stabilisation work now included greater clinical engagement to understand whether intended workflows are being followed and whether the system is supporting safe and effective care.