Painful birth for paperless health care

Island Health's new digital diagnosis, treatment and medical history recording system on a difficult learning curve in Nanaimo test rollout

Medical information specialist Shannon Cragg demonstrates the use of the new iHealth system at Nanaimo Regional General Hospital Tuesday.

Island Health remains firmly committed to iHealth.

But two months into its initial rollout in Nanaimo, the health of Vancouver Island’s groundbreaking $178-million paperless system is proving difficult to diagnose.

On one hand, you’ve got administrators saying more than 400 errors that would have slipped through under previous paper-based methods have already been caught by the new electronic record-keeping system.

On the other, you hear talk of frustrated doctors considering defying their bosses and reverting to the old system in the emergency room of Nanaimo Regional General Hospital in order to speed up diagnosis and treatment.

Ten years in the making, iHealth went live in the Nanaimo area March 19 as the first phase of a multi-step process to see it fully implemented in every facility in the Island Health region by 2018.

For the past eight weeks, each NRGH nurse has been trundling through hospital hallways with a wheeled touch-screen computer console, voice-recognition dictation software and a bar code scanner designed to track and record each patient’s diagnosis, treatment and history at the touch of a button.

Ultimately, the system is aimed at improving patient safety by bringing clarity, consistency and easy access to their records, with built-in safeguards designed to ensure they are getting the right doses of the right treatments at the right times.

But while iHealth appears to be largely delivering on those promises, its implementation has also slowed the work flow enough that some are questioning whether the gains are worth the losses.

While procedures for things like lab and diagnostic orders have reportedly been improved, that hasn’t necessarily been the case in some of the more intense areas of the hospital, like the ER and the intensive care unit.

“The overwhelming concern I am hearing is the effect on patient care,” Nanaimo Division of Family Practice Chairwoman Dr. Melissa Oberholster said. “Are there less procedures? Are waiting lists getting longer?”

Oberholster was very cautious not to be seen as passing judgment on the system, adding she has heard both positive and negative reports, but only on an ad hoc basis. She said Nanaimo area doctors are meeting next week to discuss the situation more fully.

“It’s difficult to speak about it because we have only heard anecdotes,” she said. “We have certainly heard the morale has been low. We will get the family doctors together to get a better idea of the impact.

“The other piece is that we haven’t had the doctors and the nurses together; how is it affecting working relationships and our collegiality?”

Rachel Kimler, the B.C. Nurses Union spokeswoman for Nanaimo said the nurses are in a similar place.

“There is not a lot I can say. The union supports and will continue to support electronic records,” Kimler said. “Some of it is growing pains, some of it may be system-related.”

Island Health’s chief information officer Catherine Claiter Larsen acknowledged the process has been painful, but said growing pains were expected as people switch to an entirely new way of doing things.

“It looks like a very normal distribution of the learning curve: some people already running down the other side; a few are not willing to start the climb; most are around the top of the hill,” she said. “It’s still going as expected with a change of this magnitude. It will take a good six months for everyone to return to their levels.”

Claiter Larsen said that while doctors are frustrated about the increased time it takes them to log information into the system, they are overlooking the time saved on the other end of the process. Nurses and pharmacists are no longer struggling to decipher hand-scrawled messages. The iHealth system has drastically reduced the number of follow-up calls and rewritten prescriptions.

“It was easy to scribble. They forget the amount of time it took for pharmacists to track them down.”

Oberholster said the experiences of other jurisdictions — Island Health is the second largest and seventh overall in North America to go completely digital — is reason to be skeptical.

“We will make some gains. If you read most of the information you get, you do not ever recover that productivity back to the baseline.”

Claiter Larsen said there is a payoff.

“We will never achieve perfect comfort, but people will begin to notice it less as time goes by. I’d like to acknowledge the perseverance of our Nanaimo partners,” she said. “The first activation is the hardest one. Patient care will be more safe and of a higher quality.”

Dufferin Place residential care centre in Nanaimo and Oceanside Health Centre in Parksville joined NRGH as the iHealth Guinea pigs. Next up is Campbell River and the Comox Valley, with the aim of getting staff acclimated to the new system before the new hospitals open in those communities in 2017.

At the end of the process iHealth will be in place across the entire Island Health system, not just hospitals.

“What our board has asked of us is to make sure we do it right,” Craiter Larsen said. “Other industries are so far ahead of us. This is the future of health care. This is what the next generation uses every day.”

Follow me on Twitter @JohnMcKinleyBP

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

Emily Harris (centre) started the in-person Monarch Moms meet-up groups in July, when it was much easier to physical distance in outdoor spaces. Harris started the group as a source of connection for women navigating the ups and downs of having a baby during a pandemic. (Nina Grossman/News Staff)
Victoria new mom group navigates challenges of motherhood in a pandemic

Monarch Moms meet once a week for physically-distanced connection

Saanich Police are investigating a broken window at the Greater Victoria School District office. (Devon Bidal/News Staff)
Saanich police investigating broken window at SD61 office

Police suspect the window was broken by a pellet, possibly from a slingshot

The Takaya inspired sculpture currently in Kent Laforme’s outdoor studio. The 25,000-pound piece of Vancouver Island marble could be installed on Cattle Point. (Kevin Murdoch Photo)
Stone Takaya sculpture could soon ‘howl’ at Cattle Point

Oak Bay inviting public suggestions for 25,000-pound marble sculpture

Joanne Smith has been visiting Goldstream Provincial Park since she moved to Langford two years ago. (Aaron Guillen/News Staff)
PHOTOS: Visitors flock to Goldstream Provincial Park for 2020 salmon run

‘I wanted to come here before I move back to Australia,’ says visitor

Provincial health officer Dr. Bonnie Henry presents modelling of COVID-19 spread in B.C., March 25, 2020. (B.C. government photo)
B.C. sets another COVID-19 record with 203 new cases

up to 1,766 active cases in B.C., two more deaths

Advance polls are open from Oct. 15 to 21 with election day on Oct. 24. (Black Press Media file photo)
FILE – A voting package for the 2018 electoral reform referendum. Vote-by-mail packages for the 2020 provincial election will look similar, according to information provided by Elections BC. (Katya Slepian - Black Press Media)
POLL: Have you voted yet?

As election day quickly approaches, hundreds of thousands of British Columbians have… Continue reading

Jordan Naterer, an electrical engineer from Vancouver, was last seen Saturday Oct. 10. (Facebook photo)
Search efforts to resume for missing Manning Park hiker; Trudeau speaks on case

PM says he’ll do what he can to ‘nudge’ efforts to find Jordan Naterer, yet has little leverage locally

Smartphone showing various applications to social media services and Google. (Pixabay photo)
National media calling for level playing field with Google, Facebook

In Canada, Google and Facebook control 80 per cent of all online advertising revenues

École de L’Anse-au-sable. (Google Maps)
B.C. records first COVID-19 outbreak at school, six weeks after students return to class

Three cases of the virus have been identified at École de L’Anse-au-sable

Green Party leader Sonia Furstenau is seen as she leaves media event during a campaign stop in West Vancouver, B.C., Tuesday, October 20, 2020. THE CANADIAN PRESS/Jonathan Hayward
B.C. Green leader hopes voters see value in minority government

The Greens received nearly 17 per cent of the popular vote in 2017 yet received just three seats

Local candidates Pam Alexis, Abbotsford-Mission, and Preet Rai, Abbotsford-West, look on as NDP Leader John Horgan main streets in Abbotsford, B.C., Wednesday, October 21, 2020. THE CANADIAN PRESS/Jonathan Hayward
B.C. NDP takes snap election risk during pandemic in quest for majority government

Green Leader Sonia Furstenau said the election was unnecessary and irresponsible during the pandemic

Most Read