Health Minister Adrian Dix is ordering a second independent review of a controversial electronic health records system that created a stalemate between Island Health and the doctors refusing to use it.
The $174-million paperless IHealth system was launched in March 2016 at Nanaimo Regional General Hospital, Dufferin Place residential care centre in Nanaimo and Oceanside Health Centre in Parksville.
The system was scheduled to roll out to other Island health facilities this year, including in Greater Victoria, but was delayed after some doctors said it caused dangerous dosage errors and took time away from patient care.
Some refused to use it, reverting to handwritten orders for medications and lab tests.
“There’s been significant concerns about this system since 2016,” Dix said. “We need to determine where we stand, what changes need to be made and have a clear understanding of what the costs are to completion of IHealth on Vancouver Island.”
The province has asked professional-services firm Ernst & Young to complete the new review this fall and make recommendations.
It will assess what action has been taken since the first review and confirm the challenges in using the system, as well as plans for improvement.
It will also review whether the system is likely to achieve the intended benefits, plus assess the financial status.
By July, $72 million of the $100 million budgeted had been spent, according to the provincial budget update released Monday. The project completion date has been extended to 2020 from 2017.
“We’ve spent a significant amount of money and we’re just in Nanaimo,” Dix said. “That’s one question I want to see answered: Where do we stand and how much will it cost to achieve what we need to achieve here?”
Dix said a budget for the new review will be determined in “coming days.”
IHealth will remain in use during the review.
Last year, the B.C. Liberal government asked Dr. Doug Cochrane, the province’s patient safety and quality officer, to conduct the first independent review of IHealth. Cochrane found potential for errors and said the system shouldn’t be introduced elsewhere until it is fully functional.
Island Health initially agreed to suspend it, but then said the system was too entrenched to pause safely. Instead, it committed to improving IHealth, while keeping it in use.
Dr. David Forrest, president of the Nanaimo Medical Staff Association, said an external, comprehensive review of IHealth is all the physicians ever wanted.
“We are delighted that the minister has undertaken this as a priority, especially when he has so many competing concerns as a new minister and new government,” Forrest said.
While Island Health has said the system has caught thousands of order errors that would have hurt patient health, doctors using the system maintain the quality of care for patients has deteriorated. “We have expressed strongly for the past 18 months that the IHealth system compromises patient safety and quality of care and must be fixed or suspended,” Forrest said.
Drug orders are still being altered in the system, medications dropped without explanation, duplicate orders still occur, and laboratory investigations and imaging orders still get cancelled, Forrest said.
The Cochrane report was excellent, said Forrest, but this review is broader.
Recommendations arising from Cochrane’s findings have not been fully addressed and in some cases fixes have caused other problems, Forrest said.
The hospital’s emergency and intensive care departments continue to use a paper-based ordering system because of doctors’ concerns about IHealth.
Forrest maintains that, for doctors, there’s an ethical issue involved with Nanaimo being the only hospital in Island Health forced to use IHealth. If the system is improving patient care it should be expanded. But if there’s a concern and it can’t be expanded at this time, “then it’s not ethically right to expose the citizens of Nanaimo to a safety risk,” he said.
Amy Smart,Cindy E. Harnett