Electronic health records are an important step, with the opportunity to improve outcomes and efficiency and reduce costs. But they can also be plagued with cost overruns, implementation problems and delays.
Island Health’s initiative is important for the region and province. But the concerns of doctors and nurses need to be addressed, and with a $50-million project, it’s worth going to a third party for a review of progress and issues, especially when patient safety is involved.
The rolling-out of a new computer system invariably involves growing pains and learning curves. Even without bugs and glitches, the process often means changing procedures and schedules.
More than 100 doctors have signed a petition asking Island Health to suspend the introduction of its $174-million electronic health record system at Nanaimo Regional General Hospital.
The petition asks that Island Health suspend the system’s implementation until the new software is fixed or replaced. They say it is cancelling, overriding, changing or doubling up some drug orders.
It has some doctors so alarmed about patient safety, they are contravening Island Health rules by speaking and writing against the new system. They are so fearful of repercussions, though, they have commented on the condition of anonymity.
While doctors are worried about these problems, we must remember that the paper system also produced errors, some of which have been caught by the new electronic one. By some estimates, medical error (mainly in hospitals) is the third leading cause of death in the U.S.
Island Health has a case to make, even if it’s not making it well. Indeed, most advanced countries are moving to electronic records.
One physician wrote that doctors at the Nanaimo hospital are not opposed to technology. In fact, they have been working with electronic health records since 2012.
“The system slows down the vast majority of doctors and nurses while providing no long-term substantive improvement in patient safety while in the short term, medical error and safety issues increase.”
Island Health will spend $50 million on the deal with software developer Cerner Corp. of Kansas City, Missouri. It will spend an additional $124 million for hardware and training. For that kind of money, it’s wise to ensure the system works in the real world.
That isn’t always the case.
“Outside of the world of carefully controlled trials, between 50 per cent and 80 per cent of electronic health record projects fail — and the larger the project, the more likely they are to fail,” wrote University of London professor Trisha Greenhalgh in The Guardian in 2011.
Island Health intends to expand the system to all facilities on the Island within 18 months. It is intended to be the first system in B.C. where all of a patient’s acute-care and diagnostic health-care services across the health authority are connected through one computerized medical record.
Island Health and Health Ministry officials say they are confident they can work out problems with the system, but the scope for error is huge. The U.K. set out to create a national health records system, and it was a disaster.
After spending the equivalent of $22 billion, the British government abandoned the effort.
It might be the challenges faced in Nanaimo are exactly what one would anticipate in this kind of change. It might also be that there are problems with the software, training or system design. But it’s certain that the launch won’t be successful if there isn’t buy-in and confidence, and both might be lacking.
The best solution is to bring in a consultant — agreed on by all sides — to do a quick independent review before problems and conflicts grow too large.
