When Island Health introduced its new electronic health record system at Nanaimo Regional Hospital in 2016, there was serious pushback from some physicians. It was felt the system was too cumbersome to work with, and several departments, including the emergency department and the intensive care unit, partially reverted to using paper records.
Fortunately, it appears those teething troubles have been largely overcome. In May, the emergency department began using the new system to order medications and associated therapies.
The intensive care unit remains on paper for now, because patients there tend to be complex and have rapidly fluctuating vital signs that may require more sophisticated monitoring and treatment orders. That’s still a challenge, though progress is being made.
Elements of the system have been installed at sites and services across Vancouver Island and the Gulf Islands, including Comox Valley Nursing Centre and The Summit long-term care facility in Victoria, and there are plans to begin using electronic records at Royal Jubilee Hospital and Victoria General Hospital in the fall. Progress has been slowed by the COVID-19 epidemic, and the full switchover will last several years.
Beyond hospital walls, physicians in the broader community will also be able to access medical records for their patients. There are two ways to do this.
If someone is receiving care from a number of physicians, as happens, for example, if the person has cancer, any of the doctors in that patient’s care circle can copy test results to the other attending physicians.
That matters, because it’s not unusual for such a patient to have a family physician, an oncologist, a urologist, a radiologist and perhaps a surgeon in his or her group. Results are maximized if every clinician in the circle sees what progress is being made, and adjusts the steps they take accordingly.
This has been a problem in the past, because many physicians work in private practice, and may use electronic systems that are not compatible with each other.
To get around that problem, a B.C.-based firm called Excelleris developed technology that links incompatible systems. That has greatly expanded the scope and reach of electronic records.
Alternatively, any of the physicians in a care circle can log into the Island Health Electronic Health Record system, declare themselves a care circle member, use a secure password that changes every six weeks, and see all of the patient’s lab work and imaging. This latter system is heavily audited to prevent abuse, along with safeguards in the form of various triggers that warn staff if something looks wrong.
The lessons learned at Nanaimo are that new electronic record systems should be phased in gradually, and that physician buy-in is critical.
Island Health was able to overcome initial resistance by hiring additional staff to help train and support doctors. Medical staff at all Island facilities have also been promised that they will be included in the decision-making before a new record system is introduced.
Despite these early difficulties, the benefits of electronic patient records are evident. The B.C. Cancer Agency gets some of the best results across North America in treating breast cancer.
The reason is that everyone involved in the program has access to the latest research and evolving knowledge of best practices. There is complete sharing of information among the several clinical specialties involved.
This is what electronic records promise. Too often, with paper records, the left hand doesn’t know what the right hand is doing.
Indeed, it has long been known that paper files and order sheets are a major cause of clinical error. They get mislaid, misread and, in emergency situations, are often simply not at hand.
It would be fair to say that the Nanaimo experience has been a learning process for everyone involved. But it also appears that genuine collaboration is now in place, Island-wide.
That’s a huge step forward, from a paper-based system that dates back to Florence Nightingale, to 21st-century information sharing.