DHBs in need of computer upgrade
Years of underinvestment is being blamed for the ‘‘ageing and fragmented’’ IT systems used by district health boards (DHBs) nationwide, with the Government eager to move with the times and upgrade crucial systems.
Health Minister David Clark has outlined the issue as a priority, with a draft digital health strategy in the works. ‘‘The Ministry [of Health] is exploring options for co-investment with DHBs, with the intention of accelerating work to address these issues.’’
His comments follow a damning Health and Disability Commission report into Wairarapa DHB’s ‘‘weak IT system’’, published this week. It highlights a series of IT problems which were, in part, to blame for a mistake that led to an elderly man’s cancer symptoms going unnoticed for several months.
In March 2016, the 72-year-old presented at a public hospital in the region having injured his hip and chest in a fall. An urgent CT scan was ordered and he was sent to be seen by a surgeon.
The radiologist who reviewed the CT images identified numerous enlarged rectal lymph nodes and recommended an endoscopic examination. The recommendation was issued on a ‘‘sticky note’’ in the DHB’s Picture Archiving and Communication System (PACS). Twenty minutes later another note was entered that did not mention the nodes.
The second note was the one emergency department staff acted on, with the first one not immediately visible. Several days later the man was discharged.
The report was not sighted again until eight months after his discharge. The man was later diagnosed with stage III cancer.
Commissioner Anthony Hill found the DHB in breach of the Code of Health and Disability Services Consumers’ Rights,. ‘‘[The] system did not allow for electronic sign-off and did not have a clear, effective and formalised system in place.’’
Wairarapa DHB chief medical officer Tom Gibson would not comment on the specific details of a patient’s case but said the DHB had taken immediate actions to improve its processes. ‘‘We deeply regret that this incident occurred and have apologised . . . Safety and quality of healthcare services remain our top priority, and every effort is being made to ensure that this incident is not repeated.’’
The IT system was being upgraded to a new regional system, with electronic sign-off ‘‘high on the agenda for this complex upgrade’’, Gibson said.
Current IT practices regarding test results vary significantly across DHB regions.
Capital and Coast DHB chief information officer Shayne Hunter said his organisation had used an electronic sign-off system for lab and radiology results since 2013, with unsigned results flagged. He confirmed the contentious ‘‘sticky note’’ function was in use within Wellington Regional Hospital’s emergency department and Kenepuru Accident & Medical clinic in Porirua.
At the other end of the country, Southern District Health Board chief medical officer Nigel Millar was confident in the DHB’s ‘‘clear and effective electronic system’’ used for the reporting and follow up of tests results. He said ‘‘sticky notes’’ were not used by southern staff.