The best way for Island Health to build trust in its new electronic health-records system is to make sure the system works. And the system should work for health-care personnel, not the other way around.
On March 19, Island Health implemented its $174-million paperless iHealth system at Nanaimo Regional General Hospital, Dufferin Place residential care centre in Nanaimo and Oceanside Health Centre in Parksville. It is the first in B.C. to connect most of a patient’s acute-care and diagnostic health-care services through one computerized medical record.
Nine weeks into the launch, senior physicians said it was a huge failure. They said the new technology was 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, [but] even with that extra effort, serious errors are occurring on multiple patients every single day,” wrote a doctor at the Nanaimo hospital.
Doctors in the hospital’s intensive-care and emergency departments gave up and reverted to pen and paper.
Health Minister Terry Lake met with Island Health officials and said he was confident the health authority “is putting a plan in place to overcome any challenges and that patient safety is not at risk.”
An official in Lake’s ministry said: “The system is working as it should, with no evidence that it is changing or deleting orders.”
That didn’t quell concerns. The newly formed Medical Staff Association, representing about 250 physicians with privileges at the Nanaimo hospital, is calling for an independent review of the system.
“Moving to an electronic system should enhance the care we provide, rather than jeopardize it,” says a report from the association. “We do not want a catastrophic event to occur in order to have our concerns heard. We do not feel that it is ethical to put patients at risk using a system that makes it difficult to ‘do the right thing’ and much easier to make a significant error.”
Despite those concerns, Island Health is pushing ahead with implementation of the system. Health authority officials say they have heard the concerns, and will implement recommendations from the Health Authority Medical Advisory Committee, which provides advice to the Island Health board and CEO.
Those recommendations include addressing fatigue in medical staffs, adjusting resources to alleviate workloads, improving trust in the system and working collaboratively to evaluate improvements.
But those are just words, when action is needed. A third-party review of the system is not an unreasonable request.
Island Health has a 10-year, $50-million deal with software developer Cerner Corp. of Kansas City, Missouri, considered to be the largest health-records entity in the world, and plans to spend another $124 million on hardware and training. It would not be unreasonable to require the software provider to have people on site to make sure the system works the way it’s supposed to, in real time, in real situations.
Advancing technology has changed the way most people do things, but there’s a limit. Software should be the servant of its users, not the master. It’s supposed to help people work smarter, not harder. A system that requires doctors to spend more time at a computer screen and less time with patients doesn’t make sense, especially in a province with a doctor shortage.
The health authority intends to roll out the electronic system across the Island. It should first make sure the system works the way it’s supposed to. The doctors and nurses who are concerned about the system’s flaws are not whining Luddites, but professionals whose first concern is patient welfare. Those concerns should not be dismissed.
