Doctors blast data system

By: Terry Deefholts

THE electronic medical records (EMR) system meant to streamline hospital data continues to frustrate North Coast doctors more than six months after its installation.

One US study has found software produced by the same company has increased paediatric mortality in one emergency department (ED).

The study, entitled Unexpected Increased Mortality After Implementation of a Commercially Sold Computerised Physician Order Entry (CPOE) System, was completed by eight doctors and related to the implementation of a CPOE system (produced by Cerner) in the Children’s Hospital of Pittsburgh in 2002.

It found the mortality rate at the hospital increased from 2.8 per cent (39 of 1394) before the CPOE implementation to 6.57 per cent (36 of 548) after CPOE implementation.

Local doctors warned of an increase in mortality rates before the current Surginet system, another Cerner product, was introduced in Grafton last year.

Chairman of Grafton Base Hospital’s Medical Staff Council Dr Allan Tyson yesterday blasted the system, saying standard computer skills were no help when using Surginet.

Dr Tyson referred to a time-and-motion study conducted by a fellow North Coast doctor which found it took four times longer to properly record patient records in the Cerner system than writing it down in the old paper method.

It is understood the same doctor video-recorded doctors struggling to use the system.

“No one is objecting to the concept of electronic records; we know it is the way we have to go,” Dr Tyson said. “But this system is very user un-friendly.”

A screenshot of some Cerner software which local doctors say is similar to the GBH system which is dangerous and inefficient.

He gave one example in which the enter key didn’t save data and move on, deleting and going back instead.

“Queensland and Victoria are using different software, both of which are better as far as I’m aware,” he said.

Another doctor, who has worked in the GBH ED, contacted The Daily Examiner but preferred to remain nameless, described the EMR system as a “total disaster”.

“It’s been bought by the State and rolled out across all NSW hospitals at a cost of between $70 million and 100 million,” the doctor said. “Some patients are still not having notes written. It is easy to document notes in the wrong patient’s chart and the rest of the hospital is still using paper, so the notes from the ED aren’t even in the notes for the rest of a patient’s admission. I have found that it hampers my ability to quickly assess what is going on with a patient when a medical emergency team is called to the ward.”

The doctor said he was about to start a letter-writing campaign on the issue because “to sit back and do nothing is to tacitly approve of the use of an inefficient and potentially dangerous system”.

Professor Peter Croll, head of Information Technology at Southern Cross University, said the Queensland Health payroll system that underpaid, overpaid and missed paying staff was an example of IT systems failing to meet expectations.

Professor Croll quoted Professor Jon Patrick’s critical essay on the failings with the Cerner system which concluded “any clinical information system has to be changeable promptly and at the will of each independent clinical community”.

“The ability to cope with change is often one of the biggest omissions in IT deployment,” Professor Croll said. .

Professor Peter Croll will deliver a free lecture on the risks and benefits of eHealth at the Coffs Harbour campus of Southern Cross University tonight from 5.30pm. RSVP to Donna McIntyre on 6620 3503.

NSW a silent success in e-health

NSW is leading the country in e-health with both doctors and patients benefiting from new technology, but why wont Health Minister John Della Bosca tell us about it, writes Bryn Evans.

When will some really good health news get some coverage? While the media has recently been fixated by the world financial crisis, political backstabbing, or the misdeeds of the latest rogue doctor, real progress has occurred in NSW e-health that will bring far-reaching benefits to everyone in the state.

On 1 October last year, St George Hospital implemented an electronic medical record system (eMR) for some 2300 clinicians across its emergency department, all wards including pathology and radiology, nine operating theatres and more than 300 outpatients clinics, and allows electronic discharge forms to be sent to general practitioners. The project has been hugely successful, and is the start of a state-wide program by NSW Health to introduce the eMR to every hospital in the state.

The eMR system was first deployed at the St George Hospital in the South Eastern Sydney & Illawarra Area Health Service (SESIAHS), followed by Calvary and Sutherland hospitals, and will be rolled-out to each hospital in the Area Health Service for some 1.3 million people.

All hospitals in the Illawarra region will go live in the next two months, followed by the Northern Coast Area Health Service which is in the middle of its eMR roll out.

In time eMR will spread state-wide.

Some Area Health Services with earlier, less comprehensive eMRs, are planning upgrades.

So why does NSW Health Minister John Della Bosca not tell us about it?

The eMR rollouts mean that patients treated in SESIAHS will have their patient details, medical history, test results and treatment notes updated and instantly available to any clinician attending to them.

No more tedious and inefficient questions such as “Which hospital and doctor did you last see?”, “What did your last test results state?”, “What medication are you on?”, or “Do you have your ultrasound scan with you?” that drive every patient to distraction.

There will be an immense improvement to patient safety as the eMR becomes available everywhere in NSW.

Adoption of an eMR on this scale is the most ground breaking IT project undertaken in Australian healthcare, and NSW Health is leading the way. It is the first step in a journey to provide electronic information that better supports clinicians and brings improved care to patients. Work procedures and practices will be fundamentally transformed as knowledge is shared to provide better patient care.

The eMR finally brings the benefits of ubiquitous online access, akin to electronic banking, within the reach of clinicians and health consumers. It also provides the foundation of information for the personal electronic health record, which health consumers could access over the Internet within the foreseeable future.

But why cannot NSW Health tell the public about this success?

Maybe they are scared of success, and the resulting demands by the Garling Inquiry for more funds to speed up deployment.

For once NSW Health have some really good news. It is following best practice, and has got it right, so they should tell us about it!