CPOE usage paused at Nanaimo Regional hospital

NANAIMO, B.C. – Island Health has pressed the pause button on the computerized ordering component of its new IHealth system at Nanaimo Regional General Hospital. Management says it has temporarily stopped usage of the Computerized Physician Order Entry system to give exhausted healthcare providers a break.

Dr. Brendan Carr (pictured), Island Health president and chief executive officer, told the Times Colonist newspaper that Island Health is suspending the computerized ordering of medications, lab tests and diagnostic images on the IHealth paperless system until improvements are made.

“Despite everybody trying really, really hard, there’s a level of exhaustion on the site,” said Carr. “When I go up there and talk to my colleagues, they’re tired and they’re really uncertain. I think we kind of just need to take a pause to give everybody a little space and then, from that, be able to go forward.”

On Feb. 7, members of the Nanaimo Medical Staff Association voted overwhelmingly to stop using the system. Later in the month, Health Minister Terry Lake and his deputy met with the Island Health board and senior management to discuss their concerns.

“We said: ‘Look, let’s work with the physicians and medical staff at Nanaimo, let’s walk through what [a suspension] would look like, because it may not be simple, it may actually have some unintended consequences,” Lake said.

The system, which connects all acute-care and diagnostic services through one electronic medical record, was rolled out in Nanaimo in March 2016. Nine weeks later, physicians in the intensive care and emergency departments voiced concerns about patient safety and reverted to pen and paper orders. They complained that the system was cumbersome and led to problems with medication orders.

In July, Lake ordered an external review by Dr. Doug Cochrane, the province’s patient safety and quality officer. Cochrane’s report found Island Health should have spent more time tailoring the software to the needs of front-line workers before introducing it. Cochrane also found potential for errors. He recommended that the more complex components of the system be reviewed and improved.

Neither Cochrane nor two other experts recommended turning off the order entry component of IHealth.

NDP critic Doug Routley, who represents Nanaimo-North Cowichan, slammed Lake for failing to suspend the system when problems surfaced months ago.

“Why would he allow patient safety to be put at risk for so long, because it’s clear that that’s what’s been happening,” he said.

Dr. David Forrest, president of the Medical Staff Association, which represents about 250 doctors, said he was pleased their concerns had been heard. The doctors are committed to the objectives of an electronic health-record system, to have one record per patient and to eliminate the safety concerns of the paper-based world, said Forrest.

“Our hope is that over the coming weeks and months, this can be redesigned to the satisfaction of healthcare providers and ensure it is safe and efficient,” said Forrest.

Improving the system means both fine-tuning software and training people to make better decisions on how to use the tools, said Carr.

“The compelling reason we’re doing this is because we know that these systems do contribute to a safer environment for patients. We know in Nanaimo that they were doing 3,000 orders a day and there were more than 2,000 alerts to staff when they were about to give the wrong medication to a patient, that we might not have seen working in the paper environment,” Carr said.

Lake said everyone is committed to making the system work. “You can’t do that if you don’t have people’s confidence.” Island Health is not changing its long-range plans to roll the system out to hospitals in Greater Victoria and the north Island, said Carr.