Ongoing Update – Cochrane Report – March 29, 2017

The following message has been sent to staff and physicians at Nanaimo Regional General Hospital (NRGH), Dufferin Place, and the Oceanside Health Centre on behalf of Dr. Mary Lyn Fyfe, Chief Medical Information Officer

29 March 2017

SUBJECT: IHealth Update

Dear Colleagues,

Earlier today you received a memo from Island Health President and CEO, Dr. Brendan Carr, indicating the Executive and Board’s endorsement of the local direction from NRGH leaders to support, rather than suspend, Computerized Provider Order Entry (CPOE).

We are grateful for the work of the NRGH Local Quality and Operations Committee (LQOC) as well as NRGH staff and physicians who have helped identify the supports that will have the greatest value and impact. These include supports for specific specialty areas as well as all provider groups, technology improvements, and new mechanisms for quality assurance, reporting and decision-making.

Key elements of the go-forward plan are summarized in the following table and then described in more detail below. Several aspects of the plan have been initiated; additional details and information about how to access the supports are included in the attached IHealth 1B Update. The go-forward plan and other changes will be reviewed at the next meeting of the LQOC on April 7, 2017, and refinements will be made as necessary.

I. Enhanced Support

1. New interim and enduring roles to support new EHR processes and workload
2. 1:1 coaching, with physician compensation and locums where requested
3. Develop local expertise with advanced education, site visits, and specialty roles
4. New devices and technology upgrades to ensure reliability and usability

II. Quality Assurance and Safety Culture

5. Real-time, in-the-moment, paper-to-electronic quality assurance for orders
6. Rapid cycle revalidation and improvements, rotating by specialty
7. Blame-free, closed-loop environment for error reporting

III. Governance/ Accountability

8. End-user driven EHR Quality Council to prioritize changes and improvements
9. Island Health liability for IHealth system errors
10. No changes to paper-based ordering in the ICU or ED

We look forward to receiving your feedback and suggestions on the plan through your manager and/or medical lead; and making changes as required to support all NRGH staff, physicians, and patients.

Yours sincerely,

Mary-Lyn

Dr. Mary Lyn Fyfe
Chief Medical Information Officer

1. New interim and enduring roles to support new EHR processes and workload
Discussions have been initiated to define how new roles and resources can be incorporated into the NRGH clinical team to provide both temporary relief and enduring support for the new EHR enabled workflows. Funding has been made available to support new models, and the following has been discussed to-date: 1) extending the role of Nursing Unit Assistants to support physicians, 2) addition of Nurse Practitioners as part of the Internal Medicine and/or Nephrology teams, and 3) funding locums and supernumerary physicians.

2. 1:1 coaching, with physician compensation and locums where requested
A sign-up process is detailed in the attached document. If additional physician workload relief is requested for medical staff to participate in 1:1 coaching, funding for locums and/or supernumerary physicians will be supported. New online learning assets embedded within the EHR are being fast-tracked with a target May 2017 availability.

3. Enhanced local expertise with advanced education, site visits, and specialty roles
Some NRGH medical staff have requested support to become EHR experts. Advanced education opportunities will be provided, including in-depth training, site visits, and Canadian peer collaboration.

4. New devices and technology upgrades to ensure reliability and usability
A team of technical experts was on-site in February 2017 to diagnose root cause issues that are contributing to reliability concerns. Physical hardware is being upgraded and/or replaced and other technical changes are also being made. Details can be found in the attached document.

5. Real-time, in-the-moment, paper-to-electronic Quality Assurance (QA) for orders
In response to NRGH medical staff concerns regarding CPOE, and specifically the view and management of orders across the interdisciplinary team, an in-the-moment quality assurance process will be made available to demonstrate the translation of paper-based orders into the CPOE enabled environment. The quality assurance process will be initiated with General Internal Medicine (GIM), and proceed based on the needs as defined by the GIM service.

6. Rapid cycle revalidation and improvements, rotating by specialty
NRGH physicians and staff provided highly positive feedback on the first round of revalidation, and have asked that these efforts be reinitiated as soon as possible. A modified revalidation process will be initiated the week of April 10, 2017 to support rapid, visible changes and improvements. Revalidation will be completed in parallel with the orders management quality assurance processes, and rotate by specialty based on priority as determined by the site.

7. Blame-free, closed-loop environment for error reporting
Island Health is committed to a culture of safety and blame-free reporting of errors. A new on-site quality assurance command centre has been established today, Wednesday, March 29, 2017, to provide rapid response to concerns as raised, and to close the loop with reporters within the clinical shift where possible. To support this, a new QA Communication order has been developed to rapidly investigate and follow-up on issues as they arise. Details can be found in the attached document.

8. End-user driven EHR Quality Council to oversee changes and improvements
The first meeting of the new EHR Quality Council (QC) will be held on April 10, 2017. NRGH end-users will comprise the majority representation on this new QC, including representation from the Nanaimo Medical Staff Association. The EHR QC will be broadly empowered to make decisions regarding priorities and actions related to the safe and efficient use of the EHR.

9. Island Health liability for IHealth system errors
If there is an error in the EHR that causes or contributes to a clinical error, Island Health bears the responsibility for that error. Each clinical user is expected to attend training, remain current regarding EHR updates, and to use the system with the associated supports responsibly.

10. No changes to paper based ordering in the ICU or ED
The current use of paper-based ordering in the ICU and ED will remain in place.