An independent review supports Island Health’s electronic record system remaining in place, but it will be “very different” than it is now, according to Dr. Doug Cochrane, provincial patient safety and quality officer.
Twenty-six recommendations were released Thursday in a report by Cochrane, who led a review into IHealth, a $178-million system that rolled out in March.
The B.C. Ministry of Health and Island Health agreed to a third-party review in July following a meeting with health care workers at Nanaimo Regional General Hospital. It also came after a call for an expedited and external review including from Dr. David Forrest, president of Nanaimo Medical Staff Association, who claimed the system is difficult to use, inefficient and that there’s concern about patient safety.
According to the report, the ability to deliver care has been adversely affected by the March rollout in “many areas of NRGH.”
It found that following implementation of IHealth, the rate of patients who left the emergency department without being seen increased to 2.3 per cent, higher than for any month last year. Medical and other professional staff members also saw fewer patients as a result of the time required for documentation. It also found follow-up to concerns of users who reported issues around performance, usability and safety was inconsistent.
Recommendations are around supports for staffing, education, and medication ordering and administration, for example that Island Health create an algorithm that alerts the pharmacy and the ward that medications haven't been given when a patient is transferred.
For Cochrane, at the crux of it all is medication order entry and clinical documentation, both introduced in March. He’s recommending a revalidation, which will look at what is working and what isn’t.
“That understanding of what works well and what doesn’t moves away from the assumption that the order entry capabilities of the system would work for everybody, under every circumstance because I think what we’ve heard over the past several months, and people have experienced, is that they don’t always work well and they don’t work in the way they would expect,” he said. “It’s too bad that it has to be done again, but you know, there’s such a wealth of knowledge from this experience in Nanaimo that we can’t let it go, we can only help make it better.”
Dr. Brendan Carr, CEO of Island Health, couldn’t say how much time and money it will take to implement recommendations, adding there hasn’t been time to go through them in detail. The review could also delay activation of the system at other sites.
Forrest said Cochrane has provided sage recommendations.
“We are obviously grateful and relieved that the concerns that the medical and non-medical staff have raised over the past eight months have been validated,” he said.
An oversight committee will be struck to oversee recommendations.