Mediator may be needed to resolve CPOE spat
June 7, 2017
VICTORIA – The president of the B.C. doctors’ professional association says it’s time to repair the troubled relationship between Nanaimo medical staff and the health authority over electronic health records.
Doctors of B.C. president Dr. Alan Ruddiman (pictured), who toured Nanaimo Regional General Hospital earlier this month, said the quarrel is creating an unhealthy work environment and affecting patient care.
The hospital is one of the pilot sites hosting Island Health’s new IHealth system.
“There has to be a solution to this and I think the road to healing and fixing this is definitely bringing the two parties to the middle. Either they do this together on their own, or perhaps they need a mediator to get through this,” Dr. Ruddiman said.
Island Health CEO Brendan Carr said the health authority is not only fully on board with the idea of mediation – it has already made moves toward it. “We have been suggesting that for quite some time,” Carr told the Times Colonist newspaper.
“I think it’s absolutely true that there’s been harm done through the whole process that has nothing to do with the system, that is about relationships and trust,” he said.
Island Health has solicited a third-party consultant and “workplace culture committee” to offer on-site support to staff. Relations between physicians and Island Health leadership would be included.
Ruddiman said he found morale low among the hospital’s doctors and was disappointed to see that the health authority is refusing to pull a computerized entry system for ordering medication and lab tests that some doctors have said continues to create dosage problems and other errors.
“I met with a whole group of physicians across all of the different specialties who have, I think, shared and very frankly shared their concerns and their ongoing discomfort with the IHealth electronic health record as it relates to computerized order entry,” Ruddiman said.
“They’re fully supportive of a move to electronic health records. But the system in place at the Nanaimo hospital remains fraught with serious problems, even 14 months after implementing them. That just simply cannot continue.”
Island Health said this winter it would suspend the order-entry component to make improvements, but later reversed its decision, saying the component was too entrenched in the overall system. It also found the system had benefits such as automatic alerts about patient allergies and drug-interaction problems.
Carr said the rift isn’t just between the health authority and medical staff, but between colleagues on site. While some physicians are focused on fighting the order-entry system, Carr said other medical staff want to move forward with IHealth.
But while Ruddiman called on Island Health to respect some doctors’ calls to revert to paper-based entry of medication and lab-test orders, Carr said that won’t happen. “There’s a tremendous amount of evidence that the system is doing what it’s meant to do and creating benefits for patients,” he said.
The health authority has identified the root causes of some of the changing and disappearing orders – which Carr has said happens when another staff member changes a dosage or order without having a conversation with the original physician.
The same changes occur in a paper-based system, he said, but are more evident now.