Rollout of electronic medical records getting changes after concerns grow

One of the officials overseeing the rollout of Nova Scotia’s $365-million electronic medical records system says lessons from the project’s launch at the IWK Health Center are already being applied ahead of the next launch in the central health region.

Tanya Nixon, Nova Scotia Health’s vice-president of the One Person One Record (OPOR) project, said officials are listening and paying attention to the experiences of people at the Halifax-based children’s hospital.

“The feedback we have received from the IWK team, including physicians, has been candid, it has been constructive and it has been exceptionally helpful,” he said in an interview.

The launch of OPOR, which was launched at IWK in December, aims to eventually eliminate paper records and give all providers treating a patient access to the same information.

Since then, representatives of doctors and nurses have started working on the site. Concern about flaws in the system He says this has affected patient care. The president of NSGEU, which represents administrative professionals and health care workers in addition to doctors and nurses in children’s hospitals, said it was “really a tough start.”

Sandra Mullen said people are showing up for scheduled appointments only to find out they don’t exist in the system. People who need blood tests are being asked to make appointments elsewhere, Due to problems with IWK’s online booking system related to OPOR.

Mullen said it’s been a stressful time for everyone.

“For example, when you need that medication and you put it in and it doesn’t show up in five minutes and it takes over an hour to get to you, that can cause serious problems,” he said in an interview.

Nixon said that with such a big change in technology, it is natural that challenges come and they are being worked on. Some of those challenges relate to people becoming more comfortable with the new system, while others are technology related.

For example, one of the things that causes problems in routing information in the IWK is that the physician dictionary, Key information about physicians and other providers within the clinical information system was not created in the way it was expected to be used, Nixon said.

challenges were to be expected

Despite the problems people are facing, Nixon said IWK, Nova Scotia Health and health department officials collectively decided things were ready to move forward in December after a “rigorous 90-60-30-day assessment process.”

“The technical challenges we face are not beyond the realms of expectation,” he said.

“And as issues are identified, they are being responded to in a timely manner.”

As the process gets underway at the IWK, Nixon said it is also providing information about preparations for OPOR to go live in the Central Health Region on May 9.

changes in the learning process

One of the visible changes being implemented based on the IWK experience is education and learning.

“We heard from our IWK colleagues that simulation and practice labs were really essential for preparation and we have implemented them and created a strategy for the central region,” he said.

The simulation labs will create an experience where trainees will be able to practice providing care with a clinical information system before going live, providing a degree of realism that was not part of the IWK training.

Nixon could not explain why such an approach was not used at the children’s hospital because those decisions were made before she became involved in the project. But he said the purpose of the phased-in implementation across the province is so that each region can benefit from lessons learned in areas that went live before them.

To this end, more integrated planning is now taking place with respect to clinical workflow and technology.

Nixon said, “Those conversations were not as in-depth as they probably should have been with the IWK.”

“We realize that an opportunity was missed, and we are working closely with our Central Region partners to ensure that this is not repeated and/or replicated.”

Assuming things go according to plan, OPOR will be rolled out in the Eastern, Northern and Western health regions during the autumn and winter of this year.

Nixon said people working in other jurisdictions that have gone through similar changes caution that it is difficult at first because it changes almost every aspect of clinical workflow. People need to be patient, he said, and it may take three to six months for things to stabilize at a site after the rollout.

Ultimately, however, he said the province will have a system that will be able to reduce patient safety incidents and duplications, as well as provide a “complete picture of the patient care experience” for every person who interacts with the patient.

“And the benefits associated with it are second to none.”

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