Physicians at Nanaimo General Regional Hospital are still manually ordering medication through paper-based processes nearly three years after going live with a Cerner EHR implementation, according to the Time Colonist.
Physician David Forrest, MD, says problems with the system persist.
“I don’t think anything substantially has changed,” Forrest told the Colonist. “Overall, I don’t think the system is much different.”
Physicians, nurses, and other Nanaimo staff have resorted to using EHR workarounds in an effort to boost efficiency despite problems with EHR usability.
British Columbia Health Minister Adrian Dix launched a review of the $178 million Cerner system in September 2017 after providers raised concerns over its inefficiency and poor usability.
Executives at Island Health say user satisfaction with the Cerner system is improving among clinicians and other staff. Health system leaders are continuing to improve upon the system, called IHealth.
“IHealth was all anyone complained about two years ago and the culture at the hospital was toxic,” said Island Health Executive Medical Director Ben Williams.
Clinicians rarely complain about the system today, Williams said. However, physicians in the ICU and emergency department are continuing to use paper-based processes to order medications.
Williams maintains all departments across the hospital will eventually transition to electronic ordering processes in the near future.
Dix stated leadership has made some progress toward stabilizing and improving the system since the poor review two years ago.
“I think it will be very difficult and has been very difficult for a project that is over-budget and hasn’t met expectations to drive forward on it,” Dix told the Colonist. “A lot of people just wanted it abandoned but we have to proceed.”
Dix stated IHealth will expand to other communities outside the Nanaimo region in the future. Implementing the system across the island will likely cost another $54.1 million.
“The IHealth project continues — the question is, where is the next site and where do we bring it forward?” said Dix.
In 2018, Nanaimo physicians and staff devised 12 stabilization criteria to improve the system in areas including EHR performance, devices and workspaces, patient documentation, clinician and staff capacity, emergency department and intensive care unit, medical administration record, system issues, changes and improvements, and education training and knowledge translation.
According to Nanaimo radiologist David Coupland, MD, the IHealth system will never be fully functional across departments.
“Overall, it’s improving and more and more people are finding they can cope with it,” Coupland said.“Lessons have been learned, so I think it will be far better implemented with far less pain in the future.”
While Coupland has some reservations about the system’s ability to meet all expectations set forth by stabilization criteria, he maintains there have been improvements.
“It’s heading in the right direction,” said Coupland.
In January 2018, the British Columbia Ministry of Health concluded the EHR system had been implemented poorly and that staff training at the hospital had been insufficient to support the go-live.
In a report of the system review, investigators determined three of 28 critical patient safety events had been linked to problems with the IHealth EHR system.
Investigators also stated unreliable medical and organizational governance and poor system oversight contributed to problems with the implementation. The report stated Island Health prioritized completing the implementation in a timely manner over achieving a high level of quality or user readiness.
Despite its problems, investigators in the 2018 report stated the IHealth team has steadily made improvements to the system and that the organization has leveraged lessons learned to make further progress.