Ongoing Update – Cochrane Report – February 10, 2017

The following was sent on behalf of Ben Williams, Medical Director, Oceanside
to all Nanaimo Regional General Hospital, Oceanside Health Centre and Dufferin Place physicians and staff

Dear Colleagues,

As outlined previously, Island Health President and CEO, Dr. Brendon Carr, has asked that we provide you with regular updates on activities and actions related to IHealth. The following are highlights from this week:

1. Input from Nanaimo Medical Staff Association
You may have heard that the Nanaimo Medical Staff Association (MSA) surveyed their members this week regarding IHealth. On Wednesday, the MSA executive shared their recommendations with Island Health President and CEO Dr. Brendan Carr and other Island Health medical leaders and requested a response from Island Health within 24 hours.

Island Health is committed to making the changes required to ensure the safe and efficient use of the EHR – including the suspension of aspects that are not working if timely solutions are not available. In keeping with Dr. Cochrane’s advice to all of us, we are committed to the Functional Revalidation process as the vehicle to determine which aspects of the EHR are working, not working, and how to proceed. Revalidation sessions are scheduled to begin February 20, 2017 and are constituted primarily of front-line physicians, pharmacists, nurses, and other allied health staff.

The advice provided by Medical Staff to suspend CPOE and revisit Clinical Documentation would require that we proceed with major changes in advance of, and outside of the Revalidation process.

Dr. Carr has written the MSA executive to acknowledge this call to action, and clarify with the MSA executive and all stakeholders involved on how we would proceed with this advice and Revalidation in parallel, given the significant efforts involved in both activities. Dr. Carr also noted the need to consider that there are still different perspectives held amongst the medical staff and across other disciplines.

Island Health looks forward to working with physicians as well as all staff at NRGH, Oceanside and Dufferin Place to determine the best path forward.

2. President and CEO Engagement with Clinical Leaders
When Dr. Carr was at NRGH on Wednesday, he had the opportunity to meet with a large group of NRGH clinical leaders. At the meeting, Dr. Carr thanked clinical leaders and staff for their ongoing work and noted that the dedication of staff was reflected in the statistics released earlier this week which showed, amongst other findings, a significant decrease in ALC rates: Great job!

Dr. Carr appreciated the candid dialogue and multiple perspectives and noted the need for ongoing work to improve relationships amongst all care providers.

3. Revalidation Oversight Committee Update

The Revalidation Oversight Committee met for the third time earlier this week. Minutes of the first two meetings are available at http://ihealth.islandhealth.ca/2016/11/the-cochrane-report/

I understand that all parties recommitted to revalidation and that details regarding the upcoming revalidation sessions were confirmed.

As described previously, the Revalidation process was recommended by Dr. Doug Cochrane and agreed to by Island Health, the Nanaimo Medical Staff Association, and the Ministry of Health. Through upcoming revalidation sessions focused on medication orders management, front-line physicians, nurses, pharmacists and other allied health staff will work together to confirm “what is working and what is not working:” If aspects of the EHR are found not to work, solutions both inside and outside the EHR will be considered.

4. IHealth-Related Data
I had a chance to look over the data distributed with this update earlier in the week. Some interesting tidbits:

  • Physicians and other providers place over 3000 electronic orders daily at NRGH.
  • Since IHealth implementation, there have been:
    • Over 2000 computer alerts warning staff that a medication was going to be given to the wrong patient.
    • Over 3000 computer alerts warning ordering providers (physicians, midwives and nurse practitioners) of drug interactions. Over 600 of these resulted in a change in clinical decision (for instance, the physician ordered an alternate medication).
    • Over 5500 computer alerts warning ordering providers of possible patient allergy to the intended medication. Over 1400 of these resulted in a change in clinical decision.

5. Code Grey Today
Those of you currently on-site may be aware of a code grey earlier today. This Island-wide system downtime occurred as a result of firewall issues at the provincial data centre in Kamloops.

6. Frequency of The Updates
Some of my physician colleagues have provided generous feedback that these updates, while useful, need not be daily. My intention is to provide updates at least weekly, and more often if required.

Yours sincerely,

Dr. Ben Williams
Medical Director Oceanside
Email: ben.williams@viha.ca