Provincial patient safety and quality officer Dr. Doug Cochrane has completed his review of the early functioning of IHealth, the electronic health record system implemented in three Nanaimo-area health facilities in March.
A report of his findings and recommendations was provided to staff and physicians today.
The report concludes that the IHealth system should remain in place and work be done to validate the order entry and clinical documentation functions of IHealth and refine these processes where appropriate to achieve the common goal of better and safer patient care. It also concludes that the experiences of staff at Nanaimo Regional General Hospital, Oceanside Health Centre and Dufferin Place be used to inform the design and planning of future implementations.
“As health care and technology have evolved, electronic health records are becoming a more and more important tool in a modern patient-centred health-care system,” said Health Minister Terry Lake. “I thank Dr. Cochrane and his team and the many staff and physicians across Island Health who participated in this review. It is through their feedback that we can improve care.”
The report makes 26 recommendations in the areas of improved safety, efficiency and future implementation. The recommendations stem from interviews with front-line care providers, IHealth staff, Island Health executives, and provider groups including the local medical advisory committee and medical staff association. The review team completed site visits, accepted written submissions, and invited experts from outside of British Columbia with experience in using electronic health records to observe the system.
“I thank all the staff who participated in this review for their dedication to caring for the patients across Vancouver Island,” said Cochrane. “The report provides an opportunity for Island Health to optimize how users and the IHealth system interact to improve care.”
Based on initial information provided to the review team, the scope of the review was narrowed from the terms of reference to focus on clinical documentation and medication order entry as well as system implementation. The review found that, much like a paper-based system, there is the potential for errors when using the system without diligent staff oversight, but that steps can be taken to minimize risks and increase the safety of care delivery.
The review also found that the system can be helpful for standard and routine care, however, for more complex care, aspects of the system needed to be reviewed and improved to address clinical needs. In addition, the system resulted in decreased productivity. The report also concluded that training focused on care delivery was required prior to implementation and that training in multidisciplinary teams would be beneficial to understanding workflows.
“We thank Dr. Cochrane for his work.” said Island Health CEO Dr. Brendan Carr. “I also want to acknowledge the support and hard work from our Island Health staff, especially our IHealth team in Nanaimo. In the pursuit of greater safety, higher quality services and a better experience for patients, the IHealth system establishes a single health record and plan of care across multiple settings; this is a significant advancement in the use of health technology in Canada. We expect there to be constant refinement in the tools and in our approach to implementation. We are committed to continuing to listen to and work with staff to ensure they have tools that support them in the delivery of the highest quality of care. IHealth will allow us to do this.”
An oversight committee co-chaired by the Ministry of Health and Island Health and including representatives from the local medical staff will be established to oversee the two recommendations involving the validation of the order entry and clinical documentation in order to promote a collaborative way forward for this work.
Island Health will now collaborate with the clinical and medical teams at Nanaimo Regional General Hospital to review and prioritize the recommendations, with the goal of implementing the recommendations as quickly as possible. Island Health will ensure the system is stabilized in Nanaimo before moving forward at other sites across the health authority.
In July 2016, Lake and Island Health asked Cochrane to review the functioning of IHealth at three sites, Nanaimo Regional General Hospital, Oceanside Health Centre and Dufferin Place. The review was conducted to assess and make recommendations to address any workflow and patient-care quality concerns identified, as well as to assess implementation at the three sites to improve introduction of electronic health records in other locations.
To read the full report and recommendations, please visit: http://ihealth.islandhealth.ca/2016/11/the-cochrane-report