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29 May 2016

Canada: Nanaimo Doctors Say Electronic Health Record System Unsafe, Should Be Shut Down

iHealth computer terminal cart.
Photo by Island Health
"Nine weeks after startup, physicians in the Nanaimo hospital’s intensive-care and emergency departments reverted to pen and paper on Wednesday 'out of concern for patient safety.'   "Doctors said the system is flawed — generating wrong dosages for the most dangerous of drugs, diminishing time for patient consultation and losing critical information and orders."

Nanaimo doctors say electronic health record system unsafe, should be shut down
by Cindy E. Harnett, Times Colonist , 
27 May 2016

Implementation of a $174-million Island-wide electronic health record system in Nanaimo Regional General Hospital — set to expand to Victoria by late 2017 — is a huge failure, say senior physicians.

After a year of testing, the new paperless iHealth system rolled out in Nanaimo on March 19. Island Health heralds the system as the first in the province to connect all acute-care and diagnostic services through one electronic patient medical record, the first fully integrated electronic chart in the province.

But nine weeks after startup, physicians in the Nanaimo hospital’s intensive-care and emergency departments reverted to pen and paper on Wednesday “out of concern for patient safety.”

Doctors said the system is flawed — generating wrong dosages for the most dangerous of drugs, diminishing time for patient consultation and losing critical information and orders.

“The whole thing is a mess,” said a senior physician. “What you type into the computer is not what comes out the other end.

“It’s unusable and it’s unsafe. I’m surprised they haven’t pulled it. I’ve never seen errors of the kind we are now seeing.”

Doctors are so concerned, they want Island Health to suspend the implementation.

“Take it away and fix it and test it before you bring it back — stop testing it on our people,” said one doctor. “Why wasn’t this introduced in Victoria first? If they went live in Victoria first, they would have a riot.”

The doctors, who fear reprisals, spoke to the Times Colonist on condition of anonymity.

The $174-million system started with a 10-year $50-million deal for software and professional services signed in 2013 with Cerner Corporation, a health information technology company headquartered in Kansas City, Missouri. Thus far, the company has been paid close to $12 million. The remaining $124 million is to be spent by Island Health for hardware, training and operating the system.

The system is being used in Nanaimo’s hospital, Dufferin Place residential care centre — also in Nanaimo — and Oceanside Health Centre in Parksville.

Since March 19, mobile touch-screen computer console carts have been rolling around hospital hallways. Voice-recognition dictation software immediately transcribes a doctor’s verbal notes into a patient’s electronic record, and scanners track each bar-coded patient bracelet around the hospital.

But doctors complain the new technology is 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, even with that extra effort, serious errors are occurring on multiple patients every single day,” wrote one physician at the Nanaimo hospital.

“Tests are being delayed. Medications are being missed or accidentally discontinued.”

Doctors can’t easily find information entered by nurses, the physician wrote.

There are also complaints about the pharmacy module of Cerner’s integrated system — the only joint build between Island Health and Cerner.

iHealth implementation staff brought in to input orders for physicians this week entered eight drug mistakes on one day and 10 on another, while there were no mistakes in the paper orders, doctors said. “If the experts can’t enter it correctly, what is the average Joe going to do?” one doctor said.

Another problem, they said, is patients’ drug orders disappearing from the system.

But Island Health spokeswoman Antoniette O’Keeffe said the system is safe and doing what it’s intended to do.

“We are not going back to paper,” she said.

“We can’t go back to paper. We don’t have the mechanics to go back to paper.”

Island Health acknowledges that documentation for staff doing emergency-department patient intake was a challenge, noting Nanaimo is the busiest emergency department on the Island.

Nanaimo has some of the top physicians in the country and “we respect the feedback they are giving us, and so we are listening to them and we are tweaking and modifying the system,” O’Keeffe said.

Challenges include getting medication orders into the system, getting clinical staff trained, work flow and documentation, O’Keeffe said.

More staff have been added to speed up admissions and others are working around the clock in the intensive-care and emergency departments to input handwritten physician orders into the system, O’Keeffe said.

Cerner is working with Island Health staff, “and they’ll be here until we get this fully implemented,” O’Keeffe said.

Island Health credits the system’s electronic warnings for catching about 400 human-caused medication errors and conflicts at three sites, saying it’s a sign that the system is working. It will produce a warning, for example, if the dosage is too high for a patient’s weight, if the drug is not appropriate for a particular disease or if there’s a drug conflict.

Across the country, thousands of medication mistakes are made daily due to human error, “and this system is designed to catch them,” O’Keeffe said.

Doctors respond that so many irrelevant flags pop up, it creates confusion, while the computer loses or duplicates drug orders.

The system was a decade in the making for Island Health. Twenty-three clinical teams were involved in developing various components and there was user-group testing, modifications and feedback, O’Keeffe said. Training has gone on for the last year, she said. “You can only bring a system so far and then you have to put it in a real environment to test it.”

By the end of the implementation, it’s expected family doctors will also be able to access patient files started in acute-care settings. Island Health is working on that component now, O’Keeffe said.

Once the system is working smoothly in Nanaimo, it will be installed in the north Island and then Victoria hospitals in 12 to 18 months, O’Keeffe said.

ceharnett@timescolonist.com

© Copyright Times Colonist

http://www.timescolonist.com/news/local/nanaimo-doctors-say-electronic-health-record-system-unsafe-should-be-shut-down-1.2264497

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