Island Health will suspend a key piece of its electronic record system at Nanaimo Regional General Hospital as doctors remain concerned about safety of the system.
The health authority has agreed to put a system that allows doctors to place electronic orders for things like tests and medication on hold after the Nanaimo Medical Staff Association requested it be suspended while improvements are made.
It’s not the first time the medical staff association has taken issue with $178-million IHealth system that rolled out last March. Last June, doctors delivered a non-confidence vote in the new system to the health authority and requested the ordering system be removed while it’s worked on. Concerns expressed then were IHealth slowing the pace of treatment in critical areas such as the hospitals’ emergency room and missing or misplaced orders.
An external review of IHealth was called for last July, including by Dr. David Forrest, president of the Nanaimo Medical Staff Association.
Until now, Island Health has continued to use IHealth, but has taken steps to address staff fatigue and boost staff trust at the recommendation of the Health Authority Medical Advisory Committee, a team of medical professionals. The health authority later agreed with the B.C. Ministry of Health to a third-party review, which ultimately supported keeping the system in place but offered 26 recommendations for improvement.
According to Forrest, despite a lot of work by Island Health, there has not been any substantial change and safety concerns and efficiency issues identified early after the system was launched still exist today. Physicians have increasingly felt more action needs to be taken, and in a vote on Feb. 7, 75 per cent felt the action required is suspension of the order management process so it can be redesigned to meet the needs of users. Forrest said the reason is safety.
“We are obliged under the [Canadian Medical Association] code of ethics to take steps to prevent patient harm and we felt this had come to a point where we had to invoke that ethical imperative,” he said, adding issues with medications that go missing in the system and orders that are translated differently than what they were put into the system as are problems that have persisted.
He said the hope is suspension will facilitate a close look at the system so that it can be redesigned to prevent or address safety concerns they’ve had and reduce inefficiencies.
Dr. Ben Williams, Island Health medical director for Oceanside Health Centre and physician lead for IHealth, told the News Bulletin 20 recommendations from the review are in varying degrees of progress, while the rest are future-oriented or for the Ministry of Health.
He said the Island Health executive board received a request from the medical staff association to suspend the computerized physician order entry system and it also met with Health Minister Terry Lake. It was decided it was appropriate to take a small step back to take a greater step forward to use the technology to improve patient care, Williams said.
While physicians at NRGH, Island Health and members of the care team are committed to making improvements needed, Williams said in the last several weeks it became clear physicians don’t have the confidence to continue using the system during that process.
“We decided together that we’ve got to have the confidence of the health professionals on site,” said Lake. “Even though Dr. Cochrane and two other experts that we brought in that are familiar with electronic health records didn’t recommend doing that, you can’t move forward unless you’ve got that collaborative spirit that everyone feels confident in the system.”
Nanaimo MLA Leonard Krog, who previously called for an independent review of the system, said IHealth has been problematic from the start and doctors and hospital staff who have used it have pointed out for months it wasn’t working and was endangering public health. Finally Island Health is essentially admitting that, he said.
Island Health will meet with physicians, technical experts and staff in the next two weeks about what it means to suspend the computerized physician order entry system, the impact and a plan. Williams said steps will be taken so patients continue to receive outstanding care at NRGH and other IH facilities during the transition. When the suspension begins and what needs to happen to bring the entry system back also has to be discussed.
“It’s an integrated system and so we’re actually going to have to spend some time with the people who use it every day…along with our technical team figuring out what it means to withdraw [computerized physician order entry], what the other implications are and then developing timelines and education around it,” Williams said.
Oceanside Health Centre, which has had IHealth since 2013, will keep the entry system.
– with files from John McKinley, Black Press