The simmering controversy over the new patient-record system at Nanaimo Regional General Hospital has boiled over. Some physicians have abandoned the system, and gone back to using paper records for ordering medications and lab work. They say the software is clumsy, slow and plagued by glitches.
As a result, one doctor has been suspended, and another is facing disciplinary action.
While the medical staff’s actions are troubling, nothing about the behaviour on either side of this dispute generates confidence.
On Island Health’s part, the authority has continually been the victim of its own inept management. In a review last November, Dr. Doug Cochrane, the province’s patient safety and quality officer, concluded that Island Health should have spent more time tailoring the software to the needs of frontline workers before introducing it.
Initially, the CEO apologized and put parts of the project on hold until improvements could be made. But last month, management announced a reversal of course. Staff had discovered the software was too embedded in other electronic records to be taken offline.
The new system was introduced in March 2016. Why did it take more than a year to uncover the impact of shutting it down?
The difficulties experienced in Nanaimo are common to almost every software startup. By some estimates, nearly half of all new electronic-information systems fail early on.
The causes are well-known. Staff find different technologies hard to assimilate. There is a new interface to learn and grow comfortable with.
And this is especially true when the software is complex, and when the users are under enormous time pressures, as hospital staff invariably are.
This was a textbook case of a startup that was always going to be challenging, even if every possible precaution was taken. But management failed to take those precautions.
On the physicians’ side, for all the software’s snags and setbacks, the decision to resume handwritten orders borders on confrontation.
Cochrane did not recommend shutting down the new software. Quite the contrary: He advised staying the course, albeit with needed improvements.
Some of the doctors at Nanaimo General have pointed to specific errors or omissions caused by the system. There have been cases of patients failing to receive prescribed medications or being given the wrong drug.
But this is also a common failing of traditional, paper-based systems. Physician error was a major cause of death in Canadian hospitals long before electronic records were introduced. It has been estimated that as many as 23,000 Canadians die each year because of preventable, adverse events in hospitals.
And the new software comes from a well-established product line. The company that designed it — Missouri-based Cerner Corp. — has installed health record systems at 25,000 facilities in 35 countries. Of course, every hospital is unique and some tweaking of a new system is always required.
Nanaimo General has already achieved some notable successes. To date, the software has generated 5,600 computer alerts about potential medication problems and 6,000 allergy alerts.
The process for ordering and taking an X-ray has been accelerated by nearly two hours, and lab-test results also arrive two hours sooner. These improvements in patient safety and timely care have to be weighed against the setbacks so far experienced.
This much is clear. Nanaimo Regional General Hospital plays a key role in delivering care to Central Island residents. It is intolerable that public confidence should be shaken by a conflict that has dragged on for months and shows no sign of abating.
If the breakdown in confidence between staff and management cannot be repaired, and quickly, it is time the board of directors stepped in. The current state of affairs is simply unacceptable.