Paper health records just can’t cut it
T he electronic health record system that Island Health is trying to implement, along with most other B.C. health regions, has been a frequent topic in the Times Colonist, the most recent article being the editorial “Health system needed a pause,” on Feb. 28.
As one who has been involved with this project for years, it is disturbing that the reporting has a bias that leaves the reader with the unfair impression that the Nanaimo fiasco is all the fault of IHealth, the agency managing this complex process, and that it is yet another grandiose government-scheme failure.
Granted, IHealth and the software vendor, Cerner, deserve criticism for not engaging users effectively — especially doctors. Poor engagement is a well-known cause of EHR implementation failure, but, in this instance, this is not just due to lack of effort or resources applied to the problem.
Two adages apply: “You can lead a horse to water but you can’t make it drink;” and “It takes two to tango.” Nanaimo doctors, in large part, remain unengaged to the point of active resistance in some cases, for a variety of reasons not always related to the EHR system itself.
That said, as the Cochrane report confirmed, there are real problems that have been or will be addressed, but these are not new or unique to Nanaimo, and there are none that cannot be resolved if there is a will to do so. Hundreds, if not thousands, of health-care entities around the world use this EHR system, and still manage to do their clinical work safely.
When a new treatment or surgical technique presents, doctors avidly commit their energy, intellect and money to its mastery because they believe it will allow them to do their jobs better and/or quicker. Not so for EHR, where many doctors do not perceive sufficient value to invest the effort required to make it work for them, and herein lies the crux of the issue of poor engagement.
With doctors, what is being asked of them is to radically change the way they work, learning a whole new way of interacting with patients, coworkers and the medical record that will cost them time and money they do not believe they can afford and provides no tangible benefit to them personally. It’s a tough sell.
The point of investing hundreds of millions of tax dollars in electronic-records technology is massively improved access to much-needed medical information that will improve communication, quality of care, access to care and safety. But it’s got to work effectively for front-line clinicians, and getting there is a daunting task. It will cost time and money and irrevocably change workflow, but it’s got to happen or quality of health care in B.C. will fall even further behind.
Epic Systems CEO Judith Faulkner once said: “We are Epic — we suck less.” This gibe was directed at Cerner, Epic’s only serious competitor in this market. Compared to today’s consumer technology from Apple, Google, Microsoft and others, software from Cerner and Epic does suck, especially from a usability perspective.
Tragically, this is “state-of-the-art” in this market niche, with no sign of the disruptive technology so desperately needed to displace these behemoths in the foreseeable future. The fact is, for B.C., it’s Cerner or paper for a decade — a prediction I fervently hope is wrong.
Doctors can torpedo health informatics in B.C. Most of us are independent contractors, not employees, so our jobs do not depend on conformity. However, the question becomes: Is it a viable or even ethical strategy for doctors to obstruct the implementation of health-information technology? The answer should be a resounding no.
The furor in Nanaimo might be a blessing in disguise. Perhaps because of it, IHealth and Cerner understand that they must do better. IHealth must acquire (pay for) the most up-to-date technology that Cerner can provide, and Cerner must fast-track usability improvements that will mitigate frustration for users, if they are to be successful in the Canadian market.
Efforts to educate and engage clinical users must receive a much higher priority, but in the end, doctors must engage and figure out how to make the EHR system work for them. Paper represents too great a loss for all concerned.
Health-informatics professionals take this fact for granted, but clinical users still need to be convinced. When that happens, engagement will follow.
It can be done. Anesthesiologists did it, and my colleagues in Nanaimo have been using the Cerner Surginet Anesthesia Information Management System ever since the first day of implementation in March 2016. None of them are interested in returning to paper records.
The difference is engagement. We put the effort into tailoring the software Cerner provided into something that works for anesthesiologists, albeit begrudgingly. It is hard, frustrating, tedious and sometimes infuriating work, but we recognize the value of data and know that paper records just can’t cut it anymore.