The Vancouver Island Health Authority has reversed a decision to suspend part of its $174-million IHealth electronic records system, despite concerns among some medical staff that problems – including potentially dangerous dosing errors – have not been fully addressed.
“We still feel strongly that the system needs to be suspended in order to be redesigned because of these safety issues,” Dr. David Forrest, president of the Nanaimo Medical Staff Association, said Friday.
“And it is quite clear to us that [VIHA] has not been able to fix the system, to date, with it up and running.”
In February, VIHA said it planned to temporarily suspend the part of the system used to order medications and tests such as X-rays or lab work.
Last month, however, VIHA reconsidered, saying the feature – computerized provider order entry, or CPOE – had become “fundamentally intertwined” with other electronic health records already in place and that to put it on hold would jeopardize improvements CPOE has provided, including quicker turnarounds on lab tests and X-rays.
“The order entry [element] is really the driver of so many other activities,” VIHA president Dr. Brendan Carr said in an interview, adding that, “the idea of suspending the order part [of IHealth] takes down a lot of the other functions.”
The disagreement over whether to hit pause on the order feature is part of a bigger controversy over IHealth, which is designed to get rid of paper records and create a “one patient, one record” system.
VIHA has been rolling out the IHealth system in stages since 2007 and in March of 2016, launched CPOE and other advanced functions at two sites: Nanaimo Regional General Hospital and Dufferin Place.
Within months, health-care workers raised concerns, including orders being missed or incorrect doses not being flagged when they should have been.
In July, 2016, the province ordered an external review by Dr. Doug Cochrane, B.C.’s provincial patient safety and quality officer.
Dr. Cochrane’s review, released last November, included 26 recommendations, including that Nanaimo Regional General Hospital medical staff and VIHA work to “revalidate” the order-entry process.
The Cochrane report did not recommend suspending IHealth. But the report described several events that “directly impact the safety of patient care,” including excessive doses of medication that were not detected by the system and the possibility of unintended overdosing from multiple orders of high-risk medications on the system.
Since that report was released, the stakeholders have been trying to work out how to move forward.
Despite problems, IHealth is providing benefits, including safety alerts to physicians about side-effects or other medication concerns, Dr. Carr said.
VIHA has taken steps to address worker fatigue related to the new system, including additional support staff, he said.
“There’s no doubt there is a tremendous amount of fatigue … the magnitude of change for people with these kinds of changes is just massive and we know that people are tired,” he said.
“We also heard ‘we are tired of the uncertainty’ – so part of our intention here is to say we need people’s best efforts moving forward. Because that’s the right thing to do for our patients and that’s the shortest path through this,” Dr. Carr said.
A recent survey by the B.C. Nurses’ Union, obtained by The Globe and Mail, said 396 members responded to a survey about IHealth.
The survey found some positive feedback: 73 per cent of respondents said their proficiency with the system had increased over time, compared with 12 per cent of respondents who disagreed with that statement.
However, 54 per cent of respondents said the system put patient safety at risk, compared with 28 per cent of respondents who disagreed with that statement. Nearly 70 per cent said the system took time away from patient care, and a majority of respondents – 62 per cent – did not agree that the quality of documentation provided by the system is a significant improvement over transcription and paper charts. Just 26 per cent of respondents who said it was an improvement.
And 32 per cent of respondents answered “yes” when asked whether they had seriously considered leaving their workplace or retiring because of IHealth.
Medical staff who have concerns about IHealth support the idea of moving to electronic records but want to ensure it is done effectively, Dr. Forrest said.
“It’s become quite clear to medical staff that the system either can’t be fixed or [VIHA] is unable to fix it in its present form,” Dr. Forrest said, adding that medical staff believe the system needs significant redesign.
Major technology projects are notoriously complex and expensive. In a 2016 report, B.C.’s Auditor-General recommended central oversight of government information technology projects, noting the province spent an estimated $668-million on developing new systems and upgrading existing ones in the 2014-15 fiscal year.
Editor's Note: A previous version of this story said a survey by the B.C. Nurses Union found 62 per cent of respondents agreed that the IHealth system was an improvement over transcription and paper charts. In fact, 62 per cent of respondents said they disagreed with that statement.Report Typo/Error