Records review should be solid
The province has done the right thing in ordering a third-party review of the electronic health-records system launched in Nanaimo in March, but the terms of reference for the review should ensure the study is legitimate and thorough. This isn’t merely a matter of placating disgruntled doctors — lives are at stake.
The $174-million paperless IHealth record system was launched on March 19 at Nanaimo Regional General Hospital, Dufferin Place residential-care centre in Nanaimo and Oceanside Health Centre in Parksville.
Nine weeks after the debut of the new system, physicians in the Nanaimo hospital’s intensive-care and emergency departments reverted to pen-and-paper orders. More departments asked to follow suit.
Doctors said the system software was cancelling, overriding, changing or doubling up some drug orders and critical physician instructions. They said the system was slow, overly complicated and inefficient.
“The IHealth computer interface for ordering medications and tests is so poorly designed that not only does it take doctors more than twice as long to enter orders, [but] even with that extra effort, serious errors are occurring on multiple patients every single day,” wrote one doctor.
The government and Island Health painted a different picture.
After meeting with health authority officials, Health Minister Terry Lake said he was confident the health authority was “putting a plan in place to overcome any challenges and that patient safety is not at risk.”
A Health Ministry official said: “The system is working as it should, with no evidence that it is changing or deleting orders.”
But doctors and nurses continued to express their concerns. The newly formed Medical Staff Association, representing about 250 physicians with hospital privileges, called for an independent review of the system.
“Moving to an electronic system should enhance the care we provide, rather than jeopardize it,” said a report from the association. “We do not want a catastrophic event to occur in order to have our concerns heard. We do not feel that it is ethical to put patients at risk using a system that makes it difficult to ‘do the right thing’ and much easier to make a significant error.”
Adjusting to new computer systems as technology advances is a fact of modern life. But there’s a tendency to make the users work for the system, instead of the other way around. And that’s a tendency that should be resisted aggressively. The many doctors and nurses who expressed concerns about the new records system cannot be dismissed as Luddites resistant to change. And a new system, no matter its capabilities, is not an improvement if it adds to workloads and frustration.
Island Health intends to implement the IHealth system in Victoria hospitals next year. That rollout will go much better if concerns and issues are resolved in Nanaimo and Parksville.
The review should focus on how the system works. Perhaps it needs modifications, or better training is required, or both. The focus should not be on the doctors’ discontent, but on the reasons for that discontent.
The concept of the electronic health-records system is sound. This is the direction health care should be going. But the review should ensure the system’s primary purpose is to benefit health-care professionals and patients, not to satisfy bureaucratic requirements.