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Royal Jubilee Hospital switch to electronic medical records expected to result in temporary delays

Startup scheduled for June 8; some patients could be diverted from ER as staff get used to using the new system
Royal Jubilee Hospital’s Patient Care Centre. DARREN STONE, TIMES COLONIST

When Royal Jubilee Hospital flips the switch for a full electronic medical records system next month, administrators say every potential crisis will have been planned for.

Some ER physicians, however, are warning of an “impending Code Orange.”

Months of planning and simulation have gone into the June 8 implementation of the last component of an electronic system at Royal Jubilee.

“Code Orange is a disaster response,” said Marko Peljhan, Island Health vice-president of clinical services for central and south Vancouver Island. “I wouldn’t see Code Orange as a possibility.”

Peljhan and Dr. Brian Mc Ardle, medical director and chief of staff at Royal Jubilee Hospital, acknowledge physicians and staff will face delays, but insist patients will still get quality care.

The Victoria and South Island divisions of family practice sent a letter to members on May 23 warning that Island Health expects “a temporary 30-50 per cent inefficiency” in the emergency department during the transition.

“Given the hospital capacity is already at 120 per cent, and staffing levels across the board hover at 80 per cent, the ED medical leads — including Dr. Mike Thomson, Dr. Jill Kelly, and Dr. Brian Farrell — have requested that [Computerized Provider Order Entry] be approached as an impending Code Orange,” the letter said.

Computerized Provider Order Entry or CPOE is the larger portion of the electronic medical records. Its implementation means a move away from doing tasks on paper, such as ordering medication, laboratory tests and radiology tests.

The letter said the situation will affect physicians in the emergency department, the rest of the hospital, Urgent and Primary Care Centres, and community walk-in and other clinics for an estimated six weeks, and an estimated 40 to 50 patients per day will need to be diverted from the ER to other areas of care.

Family doctors are encouraged to open up urgent-appointment bookings and to relay the information to patients.

The letter to doctors was posted online by the patient group B.C. Health Care Matters.

Mc Ardle said the change essentially involves “taking us away from writing things down on paper and sending it to fax machines and getting straight to the point, putting an order in a computer so that we can move forward with the patient’s care in a more timely and efficient manner.”

Nanaimo Regional General Hospital, which started with electronic records in about 2016, is the only other hospital in Island Health with a fully integrated electronic medical record system.

Mc Ardle said a lot of ­lessons were learned from ­Nanaimo.

He said he understands that a physician who might have written down an instruction in five seconds will find having to go to a computer and type in an item, tick all the right boxes, and make sure it’s correct, slower and frustrating at first.

Island Health has reduced procedure volumes during the implementation, brought in additional staff and focused on training. It has planned both a command centre and an urgent primary care centre from June 4 to June 21 at Royal Jubilee to divert some patients from the ER.

While the change will be hard for some physicians, for the most part, physicians, clinicians and staff want the hospital to “get it done,” said Mc Ardle. “I don’t think we’re underestimating the magnitude of the change. But I do feel comfortable that we put significant resiliency in place that we can manage that and so that we can support each other.

“We’re all trying to do the same thing. We’re all trying to make patients better.”

Peljhan said once it’s fully implemented, the system will bring significant safety benefits, less likelihood of medication errors and better team communication.

The same system will be implemented at Victoria General Hospital, Gorge Road Health Centre and South Island Surgical Centre in September.

There were plans for Victoria General to “go live” this week, but system testing suggested “we weren’t quite ready” and that was pushed back to the fall, said Peljhan.

“By separating it, we can maximize the amount of [resources] on the ground,” said Mc Ardle.

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