Ongoing Update – Cochrane Report – April 7, 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

7 April 2017

SUBJECT: IHealth Update

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

Key elements of the go-forward support plan (details here) have been initiated, and include the new Quality Assurance (QA) Communication order, one-on-one coaching, and new device and technology upgrades to ensure reliability. I am pleased to provide you with an update.

1. EHR Quality Council
A new EHR quality council has been formed to oversee changes and improvement to the EHR. Recognizing the expertise held by our Nanaimo colleagues, NRGH end-users will comprise the majority representation on this new QC. Broad representation has been sought including an invitation to include representation from the Nanaimo Medical Staff Association (MSA). The EHR QC will be broadly empowered to make decisions regarding priorities and actions related to the safe and efficient use of the EHR.

2. Quality Assurance (QA) Communications Order
A new Quality Assurance (QA) Communication order has been developed to rapidly investigate and follow-up on issues as they arise. These can include:

  • Where did my order go?
  • The order I placed is not what I intended it to be?
  • Who changed my order and why?
  • I placed an order, but the Nurse if seeing something different.

In its first week, this order has been used by physicians, nurses and physiotherapists to identify important issues. In each case, a nurse informaticist has connected to the user to follow-up on the results of the investigation initiated by the QA order. Two of the QA orders have identified issues requiring a change to the electronic health record, and we will keep the user up-to-date on our progress.
We are grateful to users who identify issues using the QA and other support processes so that we can collaborate to improve patient care.

3. 1:1 Coaching
One-on-one coaching to optimize your EHR use is available from 0700-2300, 7 days a week. Email:

4. Prednisone Taper Order
A physician using the “CPOE Communication Order” has identified an issue regarding ordering a Prednisone Taper. We are investigating this issue and separate communication will provide further details. We thank the physician who brought this to our attention.

5. Brief Downtime April 5
Early in the morning of April 5, there was a one-hour system downtime (code grey). This unanticipated downtime resulted from a change made to improve storage. The root cause has been found and the vendor and technical teams have strengthen processes and checklists to avoid similar occurrences.

6. 1B Provider Update Attached
Please see the attached 1B provider update. Highlights include:

  • Details on device upgrades
  • To improve performance, remote desktop sessions will no longer “roam” from personal to Island Health devices
  • New note types

We appreciate your ongoing commitment to quality and patient care.

Yours sincerely,


Dr. Mary Lyn Fyfe
Chief Medical Information Officer