Vancouver Island health-record battle persists, one doctor suspended

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Ongoing tension over a $174-million electronic records system used by the Vancouver Island Health Authority has resulted in at least one doctor being suspended and additional physicians being recruited to cover for those who refuse to use the system.

VIHA put out a call for doctors to provide "shadow" coverage earlier this month.

"As you might be aware, a cadre of General Internal Medicine physicians in Nanaimo has declared an intention not to use the [computerized provider order entry] component of the electronic health record, in contravention of Island Health policy," VIHA's executive medical director, Dr. Jennifer Grace, said in a May 4 letter addressed to "internal medicine colleague" and provided to The Globe and Mail.

"This is a letter of appeal to you for urgent coverage of [General Internal Medicine] at the Nanaimo Regional General Hospital in order to provide 'shadow' coverage to medical patients," the letter says, adding that the "shadow" role would be paid at the rate of $1,850 a day, plus "travel, accommodation and meal allowance."

Internists are specialists who look after adults with a range of complex medical conditions, including diabetes and heart disease. There are between 15 and 20 internal medicine physicians working at the Nanaimo hospital and about half of them have said they want to return to paper records, says Dr. David Forrest, an internist and president of the Medical Staff Association at Nanaimo hospital.

VIHA wants the internists to use computerized provider order entry – a system that allows physicians to enter orders directly into the computer and is part of IHealth, an electronic health records system launched at three VIHA sites in 2016.

One doctor was suspended for 24 hours earlier this month after he refused to use the system, citing patient-safety concerns.

About half a dozen physicians have been hired in temporary roles recently and that coverage is part of ongoing efforts to provide support for users in adapting to the system, Vancouver Island Health Authority president Brendan Carr said on Friday.

That involves a "quality-assurance process" in which doctors follow orders through the system to determine how or why any changes were made, Dr. Carr said.

The backstop positions also help ensure coverage by physicians who are prepared to use computer orders, he said.

"If there are 12 physicians in internal medicine who are covering the call schedule, and four or five who are struggling with this [computerized system], that puts a lot of burden on the others – so we have said we will bring some colleagues in who can support the call schedule," Dr. Carr said.

The costs of hiring those additional physicians are not part of the original budget allotted to IHealth, which included resources for support and training, Dr. Carr said.

The additional hires are part of a problematic rollout for IHealth. Following complaints from doctors, provincial health minister Terry Lake ordered a review of IHealth in July, 2016, by Dr. Doug Cochrane, B.C.'s patient safety and qualify officer.

The Cochrane Report, released in November, noted 34 Canadian health-care sites with more than 3,800 "physician partners" are using systems from the same supplier for computerized provider order entry.

The experience of these Canadian organizations is that the "implementation process is highly disruptive, particularly in the first number of months following activation," the report said.

The Cochrane Report made 26 recommendations, including that medical staff and VIHA "revalidate" the order entry capabilities of the IHealth system.

That process hasn't cleared glitches flagged more than a year ago, Dr. Forrest maintains.

Health-care organizations are adopting or looking into electronic record systems to make it easier to share information among health-care providers and to reduce medical mistakes, including drug-related errors.

A 2016 Canadian Institute for Health Information report found patients experienced preventable harm in one of every 18 hospital stays in 2014-2015. The most common of four categories – at 37 per cent – related to health care and medications, like bed sores or getting the wrong medicine.

(The other three categories are infections, procedure-related such as bleeding after surgery and patient accidents, such as falls.)

VIHA remains committed to IHealth, Dr. Carr said.

"We know we are not the first people to do this – what we are doing in Nanaimo has been done in hundreds of other institutions in North America and hundreds of thousands of doctors have dealt with the very issues that our doctors are dealing with," Dr. Carr said.

"We also know from the experience of other places that have done this, it takes several years to work through this. Particularly for doctors who are looking after very complicated patients, like the internal medicine physicians are – the impact on their practice is huge," he said.