Hitting reset on IHealth
Nanaimo’s hospital has been boiling since its new electronic health records were introduced, and now the provincial government has stepped in to get the project back on track. Electronic health records are the way of the future because they are a powerful way to ensure better patient care, but installing such a complex system has to be managed carefully. Island Health didn’t do that.
Last week, a report written by Ernst and Young and commissioned by Health Minister Adrian Dix said the project is far over budget and was badly mismanaged. The firm also advised that Island Health should not roll it out over the rest of the Island until the problems are fixed.
Doctors at Nanaimo Regional General Hospital have been protesting against the system since it was implemented in March 2016, saying it lowered productivity of health-care workers and put patient safety at risk. Staff were spending far too much time feeding the system, which took them away from patients, and the computers were making dosage errors in medications, the doctors said, although the report found only three of 28 “critical” patient-safety events were related to the computer system.
The controversy was only the most visible part of the problems.
The budget was $173.5 million, but it will cost at least $54.1 million more to finish it, the report says.
“Worse than that, of the initial budget, $20 million was completely unfunded,” Dix said.
That was indicative of wider issues that suggest Island Health did not plan thoroughly enough for something that was bound to be difficult, and didn’t learn from the experiences of other jurisdictions in Canada. In fact, some of the recommendations call into question Island Health’s ability to carry out some fundamental tasks.
Those recommendations included: reviewing the governance structure for IHealth and all of Island Health, ensuring readiness and training before it is rolled out elsewhere, and developing a realistic financial forecast and funding model.
Comprehensive computer systems can be of great value in ensuring better patient care and safety, but they are planned from the top down. Their capabilities are so attractive that the decision-makers put too little emphasis on the effects on the people who have to work with them every day.
The systems analysts and programmers build the system, but doctors and nurses have to make it work. If it makes their jobs harder or takes them away from their primary job — helping patients to get better — that’s a problem.
Ernst and Young found that the hospital was not prepared for the huge changes. Staff weren’t sufficiently engaged, consulted or trained. How can the government fix that? Dix has decided to appoint a mediator, who will treat everyone, including Island Health, as stakeholders with equal interests in making the project work. If there are disputes that can’t be settled, deputy health minister Stephen Brown will be the “tie breaker.”
The poisonous atmosphere at the hospital means the mediator will have a difficult job. The report said fewer than half of staff and physicians surveyed agreed it would be possible to work collaboratively to make IHealth a success.
Island Health, which has accepted the report’s findings, must heed the recommendations in the report and repair IHealth. Although staff believe their concerns have been ignored for the past two years, they must find a way to put that bitterness aside.
Electronic health records are coming, and everyone in health care must make them work.