Ongoing Update – Cochrane Report – March 3, 2017

The following was sent on behalf of Damian Lange, Director Clinical Operations, NRGH, and Dr. 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. Brendan Carr, has asked that we provide you with regular updates.

1. NRGH Quality and Operations Committee Meeting on CPOE Suspension
On Thursday March 2, the NRGH Quality and Operations Committee had its inaugural meeting. The meeting included NRGH clinical and medical leaders, representation from the Medical Staff Association (MSA), as well as multiple guests including regional and local representatives impacted by CPOE suspension. Formal minutes are pending. The following is a high level summary of the meeting:

• Executive Outline Task and Acknowledged Multiple Perspectives
Members of the Island Health Executive attended the first few minutes and opened the meeting by outlining the meeting’s task which was to develop a common understanding of what it means to suspend CPOE as requested by the MSA executive, determine what other processes are involved, and to begin work towards safely suspending CPOE. The Executive acknowledged that there would be many different thoughts and feelings regarding the decision to suspend CPOE. It was expressed that there was a common desire to have patient safety as the focus.

• Impact of CPOE Suspension on Other Advanced EHR Functionality
Dr. Fyfe presented a slide outlining interdependency between CPOE and advanced-EHR functionality such as the Electronic Medical Administration Record (EMAR), Bar-coded Medication, Nursing and Allied Health Documentation, Provider Documentation, Clinical Decision Support, Nursing and Allied Health Activities and Tasks. While it may be possible to preserve some advanced EHR functionality, CPOE acts as the “Hub” of the system and most other functions cannot be fully maintained without CPOE.

Uncertainty as to Mandate
As the meeting continued, there was some uncertainty regarding the exact task of the meeting. Dr. Carr’s letter to all staff and physicians indicated the commitment of the Island Health Board and Executive was to take steps to safely suspend CPOE as requested by the MSA executive. Members of the MSA Executive indicated they had received a commitment to return all function to those that existed prior to EHR activation 1b in March 2016. It was agreed to seek clarification from the Island Health Executive regarding the task at hand.

Some physicians asked if electronic ordering of laboratory and diagnostic imaging investigations would be affected by suspending CPOE. CPOE includes all electronically based orders and electronic ordering of lab and DI will cease with suspension of CPOE.

• Oceanside and Dufferin
It is anticipated that there will be no significant changes to the operation of the EHR at the Oceanside Health Centre.
There was considerable discussion about whether CPOE could continue at Dufferin Place. Dufferin Place ordering providers and clinicians represented at the meeting requested that CPOE remain in place. The Medical Staff Association and the Nanaimo Division of Family Practice expressed concern regarding ongoing use of CPOE at Dufferin place. No decision on this point was made.

• Training needs
It was reported that there have been over 190 new hires since activation 1b in March, not including new ordering providers. There is significant design, testing and training that needs to be done in preparation for suspension of CPOE.

• Staff Survey
At the meeting it was identified that while physicians had participated in MSA surveys, there has been less opportunity for members of the non-medical staff to express their views. Physician representatives at the meeting suggested that an anonymous survey of all staff and physicians be undertaken by Island Health. The Committee fully supported this and meetings are underway today to implement this decision.

2. Easy Identification of Patients returning to Emergency Department or Urgent Care
Patients making unscheduled returns to the emergency room within a short time frame are at high risk. It will now be easy for clinicians and physicians working in the emergency room or urgent care to see if a patient is returning to any emergency department or urgent care using FirstNet. There are new icons that will appear in the FirstNet “Info” Column if a patient has returned to the emergency department or urgent care centre in the last 24, 48 or 72 hours.

3. Revalidation Update
Thank you to all those who participated in revalidation activities. Initial survey results indicate a high level of satisfaction with these sessions. The MSA Executive has requested that maximum attention be given to suspending CPOE; therefore, further revalidations sessions have been put on hold so that clinical and technical teams can focus on CPOE suspension.

Yours sincerely,

Damian Lange
Director, Clinical Operations, NRGH

Dr. Ben Williams
Medical Director Oceanside