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 in a report Thursday by Cochrane, who led a review into IHealth, a $178-million system that rolled out at Nanaimo Regional General Hospital and Dufferin Place in March.
Doctors have since formally expressed non-confidence in the system, and Dr. David Forrest, president of the Nanaimo Medical Staff Association, was among those who called for an external review last summer, claiming IHealth is difficult to use and inefficient and there’s concern about patient safety.
The B.C. Ministry of Health and Island Health agreed to a third-party review in July after meeting with health-care workers at NRGH.
The report found the ability to deliver care has been adversely affected by the March rollout in “many areas of NRGH.” It says there has been a drop in the efficiency of care delivery for most services, and in the two months following implementation, the rate of patients who left the emergency department without being seen increased to 2.3 per cent, higher than any month last year. The report also found while users of the system were actively engaged in reporting issues, follow-up was inconsistent and many users reported a lack of feedback.
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. He recommends revalidation, a look at what works and what doesn’t.
“You want to have the right tools to do the right job and the computerized systems that compose IHealth do some aspects of this work really well and some aspects, we learned, not so well,” 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. It may mean more time until the next site is activated.
According to Carr, staff will be engaged from Nanaimo and future sites and restoring trust will be fundamental moving forward. He said its important to acknowledge people’s experience of not feeling listened to or that “they could trust us.” The focus was on the tool and making it better, he said, and there was a disconnect with what staff were saying about the tool not working for them and “we need to own that.”
Whether it's possible for Island Health to regain the trust of medical staff is the big question and it’s the health authority's responsibility to change the approach to ensure that happens, according to Forrest, who believes there needs to be a partnership.
He said Cochrane has provided a good number of sage recommendations.
“One of the major concerns for all of us has been that we really felt we have not been listened to, no one has heard our concerns and very clearly they have been validated,” he said.
B.C. Health Minister Terry Lake said the lesson is to work closely with the local team to make sure people are familiar with the system being put in place and their input and feedback is being put in place.
“You can’t just say this is the system and it’s going to work, you really have to get people on board for these big types of change management projects,” he said. “And you know, we’re humans, right, no one really likes change in the way they do things. It was always going to be difficult.”
He did say the report validates concerns of physicians and other medical staff, and that these things are never perfect. Lake said it’s easy to be critical, but Island Health is a pioneer.
“No one is doing this to the level that they were hoping to get with this, so this will get us all to a better place,” he said.
An oversight committee will be struck to oversee recommendations.
-with files from John McKinley, Black Press