IHealth includes the implementation of an Electronic Health Record (EHR) with advanced functionality, with the goal of having one record and plan of care for residents in our communities.
IHealth benefits will include improved safety, enhanced continuity of care and collaboration among care providers, faster testing and medication turn-around-time, better decision-making and greater patient involvement in care decisions.
For more on IHealth and the EHR, please visit the IHealth website.
After more than a decade of planning, full activation of the EHR began on March 19, 2016. This process took place at three sites: Nanaimo Regional General Hospital (NRGH), Dufferin Place and the Oceanside Health Centre, located in Parksville.
An External review into IHealth, led by Dr. Doug Cochrane – the provincial patient safety and quality officer – was completed in November 2016. Dr. Cochrane recommended that the EHR remain in place, and made 26 recommendations for improvement. Island Health has actioned and initiated work on 20 recommendations (one of the recommendations is for the Ministry of Health, and the remaining five recommendations are future-oriented). For more information, please visit The Cochrane Report.
On February 17, 2017, Island Health indicated that it was going to take steps to suspend the EHR’s Computerized Provider Order Entry (CPOE) toolset, given concerns raised by the Medical Staff Association in Nanaimo (CPOE is a system that enables physicians to enter their orders directly into the computer). Local technical and clinical teams, other stakeholders and the NRGH Local Quality and Operations Committee (LQOC) immediately began work on a plan for the safe suspension of CPOE.
Through these discussions, the complexity and impact of suspending CPOE has been reviewed and better understood. As a result, NRGH leaders have requested that new ways of supporting, and not suspending, CPOE be defined. CPOE is fundamentally interwoven with other key parts of the IHealth system, and suspending it would significantly impact these functions and jeopardize the benefits realized by our patients, including enhanced medication safety; reduced antibiotic, medical imaging, laboratory and blood product turn-around times; and a new ability to clearly and legibly share our patients’ information across time and space.
The Island Health Executive and Board of Directors endorse the direction to support, rather than suspend, CPOE. A locally developed plan is being implemented to provide immediate and improved supports to ensure that physicians and clinical staff feel confident in providing care with the EHR. This plan will be reviewed with staff and refined as required.
We are grateful for the work of the NRGH LQOC and NRGH staff and physicians who have helped identify supports that will have the greatest value and impact. These include supports for specialty areas as well as all provider groups, technology improvements, and new mechanisms for quality assurance, reporting and decision-making.
Safe, quality care is the top priority for Island Health as it implements IHealth. Island Health greatly values the commitment of NRGH staff and physicians to patient safety, and to the quality and experience of care. We acknowledge that views on the CPOE and IHealth vary, and we are committed to demonstrating new ways of listening, supporting and responding to concerns.
The implementation of IHealth has been a monumental change for all frontline healthcare workers. We are grateful for the input and guidance that we have received from clinical and technical teams, and remain committed to putting supports in place to ensure the provision of the best and safest care possible.
BY THE NUMBERS
IHealth is resulting in safer care:
- Physicians place over 3,000 electronic orders daily at NRGH
Since IHealth implementation at NRGH (March 19, 2016 – June 30, 2017), there have been:
- More than 8,200 drug allergy alerts (27% of those, or 2,214, resulted in the order not being placed)
- More than 5,100 alerts warning of potential drug interactions (17% of those, or 890, resulted in the order not being placed)
- More than 2,400 alerts about patient mismatches (ie, the patient being scanned was not the same patient in the active PowerChart window)
CPOE and related processes are resulting in faster care:
- Through CPOE, the turnaround from time of physician order to result or medication delivery is significantly reduced by the elimination of all manual steps in the previous paper-based ordering process
- Antibiotics given 55 minutes faster (median measurement)
- X-rays taken 102 minutes faster (one hour and 42 minutes)
- Laboratory (ie blood) tests results obtained 112 minutes faster (one hour and 52 minutes)