Island Health offered Nanaimo Regional General Hospital physicians extra money to keep using an electronic health record system the doctors said was flawed and unsafe.
The offer was outlined in a July 12 memo from Dr. Jeremy Etherington, executive vice-president and chief medical officer, that has been obtained by the Times Colonist.
Medical staff were offered the money from July 1 to Sept. 5 in recognition, the memo said, of “the extra burden the new electronic health record has placed on many physicians during the roll-out phase of IHealth.”
Island Health said the offer would compensate for “the extra time required to use the computerized physician order entry [system] in conjunction with electronic clinical documentation.”
The memo offered $260 a day for on-call physicians. It offered up to $780 a day for emergency room physicians, but it’s unclear whether that amount was for one doctor or several. Island Health did not immediately return a call seeking clarification. The number of doctors who accepted the offer and what that cost Island Health was not available.
NDP health critic Judy Darcy said “it’s completely inappropriate” to use financial compensation as an incentive to get doctors to use a system they have repeatedly said is unsafe for patients and must be changed.
“The people who work there consider it a bribe, a way for Island Health to get them not to speak out and that’s simply wrong,” said Darcy. “It strikes me as a not very veiled attempt to silence public criticism of a government that wants only good news stories.”
A Nanaimo physician, who didn’t want to be named for fear of being disciplined, said trying to contract physicians to keep using a system they deem unsafe for patients is unconscionable.
“When you offer a professional person to accept something they see as wrong, that in my definition is a bribe,” he said.
The $174-million IHealth system was launched March 19 at the hospital, Dufferin Place residential care centre in Nanaimo and Oceanside Health Centre in Parksville. Nine weeks later, physicians in the hospital’s intensive care and emergency departments reverted to pen-and-paper orders, saying that computerized orders for drugs, diagnostic tests and patient care were randomly lost, buried or changed.
A confidential report by the newly formed Medical Staff Association, which represents about 250 physicians with privileges at Nanaimo’s hospital, said the doctors “do not want a catastrophic event to occur in order to have our concerns heard.”
Dr. David Forrest, of the Medical Staff Association, said the original intent of the hospital board was to compensate physicians for unpaid overtime.
“The rationale for the stipend was noble,” Forrest said.
“Ünfortunately it was linked to the use of IHealth, but that’s a past issue and we’re trying to move forward.”
On July 21, more than a week after the compensation was offered, Health Minister Terry Lake ordered a review of IHealth by Dr. Doug Cochrane, patient safety and quality officer for the province.
Forrest said it has become evident that the “adversarial” relationship between Island Health and the Nanaimo doctors is untenable and will make it impossible to move forward on whatever Cochrane recommends.
“No one thinks he will recommend pulling IHealth completely,” Forrest said. “We anticipate substantial changes will be made. We need to turn the page.”
Dermod Travis of Integrity B.C., a watchdog group, said it’s highly irregular to offer incentives to staff to use a system before a review of it is completed.
“I’m alarmed at the fact the hospital is in essence using public funds as leverage to get physicians and surgeons to use software that has not yet been signed off on by the review panel; it’s putting the cart before the horse,” Travis said.
Island Health has a 10-year, $50-million deal with software developer Cerner Corp. of Kansas City, Missouri, for the electronic health record software system. Island Health has budgeted an additional $124 million for hardware and training.
What the MEMO SAID
The memo about compensation reads in part: “a stipend equivalent to one-half a specialist session ($260) per day to each on-call physician whose department or division continues to use, or reimplements the use of, all active IHealth components in the admission and in-hospital management of their patients, both on wards and in the emergency department.
“Due to the volume of admissions, orders, and number of physicians working in the emergency department per day, a stipend of 1.5 sessional equivalents per day will be made available.”
