About 40 pages of the 105-page report were requested to be removed, including all "unfavourable statements" about the integrated electronic medical record project and references to a US children's hospital which recorded an "unexpected increase" in children's deaths after an electronic health record was rolled out.

The consultant refused in writing to alter the report, saying the company would “not engage in any activity that constitutes professional negligence or unconscionable conduct”.

The consultant's final unaltered report, leaked to Brisbane Times from within Queensland Health, found it appeared “no lessons have been learned” from the Queensland Health 2011 payroll debacle, and serious problems with the electronic medical record in other jurisdictions “[seem] to have been ignored”.

The consultants, Bushell & Cornish, further warned the integrated electronic medical record system could have similar consequences as the Queensland Health payroll catastrophe when released into Queensland’s hospitals.

In 2011, a failed attempt by Queensland Health to transition public hospitals to a new staff payroll system saw thousands of staff go without pay, triggering a commission of inquiry in 2013.

Queensland Health’s integrated electronic medical record (ieMR) is a multimillion-dollar project to install a statewide patient record that can be accessed by all doctors and staff at all hospitals, for all patients.

A spokesperson for acting Health Minister Mark Bailey said the consultant's report into the electronic medical record was commissioned by the Campbell Newman-led LNP government "and any questions about it should be referred to them".

“The recent Queensland Audit Office report into digital hospitals released just last month, confirmed the digital hospital program is improving healthcare and patient outcomes,” the acting Health Minister’s spokesperson said.

“Patient safety has markedly improved since the integrated electronic medical records was first rolled out.

“It has reduced the average length of stay, unplanned readmissions, and the number of serious falls and pressure injuries.”

Clinicians believe an electronic medical record is a valuable and powerful tool for doctors across the state, and one should be installed in Queensland hospitals.

However, since Queensland Health began the rollout of the Cerner software, clinicians and health bodies have repeatedly warned the state government the software is dangerously flawed.

In documents dating from 2014 to the present, obtained by the Brisbane Times, health staff have detailed their concerns about the suitability of the software.

Cerner was contacted for comment.

The ieMR is being rolled out to hospitals in several stages, known as releases. The first "basic" release prepares the hospital for the software by establishing the core electronic medical record to scan data into the system.

The second "digital release" installs electronic ordering and pathology testing, plus clinical notes, and has the software installed into emergency, maternity and other key sectors of each hospital.

The third, "advanced" release creates a fully digital hospital with electronic medication prescribing and management and anaesthetics operating on the ieMR.

To date, nine hospitals have the ieMR operating, with Ipswich Hospital the latest to roll out the software in December last year.

In 2014, Bushell & Cornish was contracted to assess impacts of the planned rollout of the software's second release on Queensland Health’s pathology and radiology units.

The final report, leaked to Brisbane Times, was deeply scathing in its assessment of the ieMR project and the risks associated with rolling out the software.

The scope of the 2014 Bushell & Cornish’s Impact Analysis of ieMR changes for Pathology Queensland and Radiology Services Operations report focused on the "digital release" of the software and included assessing patient safety outcomes.

Report author Christine Cornish was approached for comment.

The Bushell & Cornish report warned other jurisdictions that had rolled out similar software had experienced “catastrophic” results, including "hospital morbidity rates had doubled following the ieMR implementation" at the Children’s Hospital of Pittsburgh in the US.

An academic study, cited in the consultants' report and published in the respected American journal Pediatrics in 2005, detailed the "unexpected" increase in child deaths at that hospital.

"We observed an unexpected increase in mortality coincident with [electronic medical record] implementation," the 2005 study concluded.

In the Bushell & Cornish report, Ms Cornish wrote the Queensland Health project team did not provide key information “deemed mandatory for performing the ieMR impact assessment”.

The highly detailed report raised concerns the project team in charge of the rollout had refused to give Bushell & Cornish unredacted internal reports for their assessment.

“It was noted that many of the issues and potential impacts, which had been identified by clinical stakeholders … had been removed,” the Bushell & Cornish report found.

Bushell & Cornish also found lessons to be learnt from the 2013 Queensland Health payroll inquiry had not been addressed in the Queensland Health integrated electronic medical record project.

“Furthermore, it is not evident as to whether safety requirements have been adequately addressed,” Bushell & Cornish found.

“There is no evidence that mandatory activities have occurred to ensure the safety of the ieMR solution being deployed into operations across the continuum of healthcare providers for electronic ordering and results reporting.”

The Bushell & Cornish report laid out a detailed impact assessment, including an "urgent" system issue with labels printed out by the Cerner Millennium ieMR software for blood test tubes.

These tube labels were too big, forcing Pathology Queensland staff to either remove the label and “breach protocol”, or perform blood tests manually.

The Bushell & Cornish report warned up to 40 per cent of blood tests would need this “manual intervention” to fix the labelling issue if the software as it stood in 2014 was released into hospitals.

In Queensland Parliament Estimates in July 2017, then-health minister Cameron Dick confirmed blood test labelling problems had occurred but denied it was a system issue, saying it was “a process issue”.

Between January 2017 and June 2017, there were 71 wrong blood samples in test tubes at Princess Alexandra Hospital, 80 in Cairns Hospital, 36 in Mackay Hospital, 117 in Townsville and 16 in the Children’s Hospital, Mr Dick said.

On the issue of user experience, the Bushell & Cornish report warned clinicians could find the system “counter-intuitive and multi-layered to the point where it slows down their work”.

“Tests may be ordered for the wrong patient … it may be possible to order tests without sufficient information,” the report found.

Patient records or data could be lost in the integrated electronic medical record, the report warned.

The cost of the digital hospital program was also raised in the Bushell & Cornish report, which warned "systemic problems" could cause headaches between Cerner and the department.

“Vendor management may become increasingly difficult and costly over time … this may lead to vendor performance problems and prolonged contractual disputes,” the report found.

“As such, revenue invested in the ieMR solution may become both an economic and political point of contention.”

The Auditor-General in late 2018 found the integrated electronic medical record project would cost $1.2 billion by 2025 for installation and maintenance.

In a series of emails dated 2014, obtained by the Brisbane Times, the general manager of Queensland Health Services Support Agency requested Ms Cornish amend her report to “limit its findings” as the report did not “align with the scope of work”.

“We now seek early rectification of the report to finalise the engagement,” the letter, dated July 7, 2014, and signed by general manager Helen Little, said.

Ms Cornish responded the demand would have seen more than 40 per cent of her report binned, including evidence from her research, and refused.

“The ieMR project has the potential to result in significant adverse outcomes for the patient, as well as having the potential to severely impact the quality and cost of services for Pathology Queensland and Radiology Queensland,” Ms Cornish wrote.

“The impacts of a failed ieMR Cerner implementation have already been evidenced in other jurisdictions including NSW emergency departments.

“In some jurisdictions throughout the world, outcomes have been catastrophic and morbidity rates have doubled.

“To this end, the duty of care which consultants must exercise when performing an assignment of this nature, which is funded by public monies, must be fully understood, particularly with respect to the law regarding professional liability and negligence.”

The final report included a compilation of research on electronic medical records around the world, many of which detailed critical failures.

Changes requested to the report by Queensland Health also included removing references to NSW Health’s emergency department use of Cerner software, the subject of a critical Deloitte review in 2011.

References to Denmark’s highly successful implementation of an ieMR were also requested to be removed.

The Bushell & Cornish report coincided with Queensland Health’s change of pace in the ieMR rollout from an incremental approach recommended by Deloitte in 2006. In 2014 the department switched to a "big bang" approach, fast-tracking the software's rollout into hospitals.

Ms Cornish also wrote twice to then-director-general of Queensland Health, Ian Maynard, making a formal complaint and raising her deep concerns about the risks involved in the rollout.

“I am writing to inform you that it is my firm professional opinion that the ieMR project has major systemic problems that will take considerable time and effort to address,” she wrote.

“... it seems highly likely that the ieMR R2 project, should it be released into live operations, will most surely result in adverse outcomes for patients.”

Ms Cornish also wrote that the report was based on “indisputable evidence elicited through extensive data analysis” and the key findings and recommendations were “a matter of public interest and must be urgently addressed if patient safety is not to be adversely impacted”.

“Failure to identify and appropriately address issues and risks identified in the … report has the potential to impact Queensland Health in a similar way to the payroll system,” she wrote.

Mr Maynard requested a copy of the report, and said he had arranged for Ms Cornish’s invoice to be paid immediately.

“I am considering the matters you have raised and I am in the process of having the material you have provided appropriately reviewed,” he wrote.

Mr Maynard declined to comment.

Queensland Health was asked what changes had been made to the integrated electronic medical record project in light of the report.

Do you know more? Contact Brisbane Times at brisbanetimesinvestigates@protonmail.com