Nanaimo IHealth setup under review
B.C. orders probe; MDs say electronic records system is ‘flawed and unsafe’
B.C. Health Minister Terry Lake has ordered an immediate third-party review of a controversial electronic health records system that doctors say is “fundamentally flawed and unsafe.”
The $174-million paperless IHealth record system launched March 19 at Nanaimo Regional General Hospital, Dufferin Place residential care centre in Nanaimo and Oceanside Health Centre in Parksville.
The system is scheduled to roll out to Victoria hospitals next year.
“This review is to acknowledge and address the concerns that have been raised, with the goal of ensuring safe, quality care for patients,” Lake said.
“It’s an important step to make sure we’re on track.
“We want to implement a system that will be safe and essentially do what we want it to do.”
Dr. Doug Cochrane, patient safety and quality officer for the province, will lead the review. Cochrane, a practising physician and a neurosurgery professor at the University of British Columbia, can bring in additional expertise where required.
Island Health has a 10-year, $50-million deal with software developer Cerner Corp. of Kansas City, Missouri, for the electronic health record software system. Island Health will spend an additional $124 million for hardware and training.
Nine weeks after the debut of the electronic health record system in Nanaimo, physicians in the hospital’s intensive-care and emergency departments reverted to pen-and-paper orders. More departments have asked to follow suit.
Physicians say the system software is cancelling, overriding, changing or doubling up some drug orders and critical physician instructions.
Lake said the review will provide an assessment of the system, including workflow and patient quality concerns, and look at how to improve implementation at future sites.
Cochrane has not been given a deadline or financial cap, but Lake said he hopes the substantial work of the review will be completed by the end of September. Cochrane is expected to meet with all concerned health-care providers, including doctors and nurses.
“It’s very important to get this done properly,” Lake said.
The minister said he does not believe patient safety is at “immediate risk” and that the system will continue to be used unless Cochrane recommends otherwise. The review might include recommendations for immediate, short-term and long-term actions and strategies, he said.
Island Health CEO Dr. Brendan Carr said the health authority undertook the changes “understanding it would take significant ongoing efforts to improve and stabilize the system.”
“We remain committed to ensuring electronic health records support the highestquality and safest patient care possible.”
Dr. David Forrest, president of the Nanaimo Regional General Hospital Medical Staff Association, which represents about 250 physicians, last week called the system “fundamentally flawed.”
The association called for an expert, expedited, external and independent review.
Lake and deputy minister Stephen Brown met with Carr, Forrest, nurses and other health professionals on Wednesday for an update on the program’s implementation.
The minister has also consulted with Doctors of B.C.
Forrest said doctors, the province and Island Health remain committed to an electronic health record that is safe and improves patient care.
“This has been a difficult process, but we are very grateful for the minister’s attention to this and intervention to facilitate this happening,” he said. “I think this is huge because of the implications to the rest of the province.”
An $842-million electronic health records system, called the Clinical Systems Transformation Project, is being built in the Lower Mainland. The system, to be completed around 2024, uses similar Cerner software. The Vancouver project was touted as building on the Island’s success.
Evaluating the rollout of Nanaimo’s electronic system isn’t easy, Lake said, because no other health authority in B.C. has attempted to introduce a systemwide electronic health record.
“It’s sort of at the leading edge, so there’s no template,” he said. “We really haven’t gone down this path, at this scale, before.
Judy Darcy, the B.C. NDP’s health critic, had also called for an independent review.
“I think it’s a good thing the minister has finally listened, but I think it’s unfortunate it’s taken him months to pay attention,” she said. “It shouldn’t take political pressure to listen to doctors and nurses’ concerns of patient safety.”
Lake acknowledged staff concerns in May but said he was confident that there was no risk to patient safety. He noted, however, that he would be concerned if those same concerns were still being voiced in four weeks.
On Thursday, the Health Ministry said it was a joint decision with the health authority to order the review.
“All of us would have hoped we would have been at a better place by now,” Lake said. “This is a wise step to make sure we’re headed in the right direction.”