A growing number of health professionals are asking for a sober second look at the new iHealth electronic record-keeping system being test-driven in Nanaimo for future implementation across Vancouver Island.
On the record, doctors and nurses are saying very little about the $178 million system that has now been in place for nearly three months and marks a fundamental change in the way diagnoses and treatments are recorded.
But off the record, the angst continues. More than 100 health care providers — mainly doctors — have signed a petition requesting use of the system be suspended until its issues are addressed. Department heads are scheduled to plead their case to Island Health’s medical advisory committee — which includes physicians from other Island hospitals — June 21. And some observers are suggesting an independent third party be brought in to do a review because management has too much invested in the system to properly judge its efficacy.
Critics have primarily focused on how iHealth has reduced the pace of treatment in Nanaimo Regional General Hospital’s emergency and intensive care units and turned caregivers into highly-paid data entry clerks. Island Health said it was unable to respond to reports the number of patients doctors are seeing per hour in the Island’s busiest emergency room has dropped by one-third to one-half.
Some critics also suggest the system is resulting in missing or misplaced orders putting patient health at risk. And another concern has recently emerged; some doctors don’t trust the system to properly record their orders and provide a proper paper trail to protect them in the wake of something going wrong.
In previous interviews, officials said the health authority remains committed to the system, adding it is working as planned and catching errors that would have previously slipped through. Any errors that may have occurred under the new system are being blamed on improper use of the program.
In response to an interview request for this article, followed by a series of specific emailed questions about the concerns detailed above, they declined to respond directly.
Instead they issued the following statement.
"We are continuing to work collaboratively with our physician colleagues and clinical staff on refining the new iHealth tools and processes. When fully implemented, the aim of iHealth will be to improve the quality and safety of care offered to our patients.
"We are continuing to meet with provider groups as we continue to implement IHealth. This is a huge and complex project. There will continue to be learning as we implement this new system. As the system and our processes continue to be modified daily based on input from staff and physicians partners, we are unable to provide data at this time."
Nanaimo doctors met earlier this month to discuss the issue. Nanaimo Division of Family Practice board chairwoman Dr. Melissa Oberholster was cautious in describing what they concluded. She said the group will be issuing a position statement in the near future, but acknowledged concern is widespread among its membership, which includes a majority of family and hospital physicians in the Nanaimo area.
“There’s definitely far more of an unanimous feeling than I initially thought,” she said. “It’s not just a single group, or specific individuals. Nothing has affected all of our members like this. There are people that we care about in the hospital that deserve us to be advocates for them.”
Meanwhile, B.C. Nurses Union Pacific Rim chairwoman Rachel Kimler was similarly restrained in her comments, but acknowledged Island Health’s public statements do not match what the union is hearing from its members.
“Nurses still continue to raise concerns about patient safety and workload,” Kimler said. “Island Health does seem to be motivated, but the solutions are not coming as fast as doctors and nurses would like. People don’t trust the system and we are going on 10 or 12 weeks now.”
As the public faces of their professions locally, Oberholster and Kimler are among the few health care professionals speaking publicly on this issue. When asked, each acknowledged they have peers who say they are reluctant to speak out.
Privately, some caregivers have suggested to Black Press that nurses are employees of Island Health and are afraid of job-related repercussions. Doctors, meanwhile, are concerned they will lose hospital privileges.
Neither Dr. Anthony Booth, acting president of the Nanaimo Medical Association, nor Dr. Drew Digney, emergency and trauma site chief for Nanaimo, responded to requests for interviews.
Oberholster said Nanaimo doctors are very conscious of their role as a template for Vancouver Island and perhaps for health regions across the province. They want to make sure Island Health gets it right.
She is also concerned about the role iHealth can — and is — playing in the attraction and retention of physicians.
“In some cases, it’s minor, sometimes it is in the major folder,” she said. “IHealth puts a magnifying glass on the situation.”
Kimler said the nurses remain in support of the concept of electronic records, they just haven’t been convinced that this system is ready.
“We’re struggling with the implementation. We want to work with VIHA to address the issues. All parties have patient care first in mind. We’ll get there. Hopefully it will be a linear progression, not having to take a step back.”
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