Friday, February 22, 2019
My Heavens The Queensland Saga Seems To Just Roll On And On!
Lucy Stone has continued the Queensland E-Health Saga this week.
First there was this:
February 11, 2019 — 10.20pm
Queensland’s public hospitals are dealing with multimillion-dollar blowouts to install an integrated electronic medical record that clinicians say is flawed and putting patients at risk.
Many Hospital and Health Services are floundering under the booming cost of the health department’s integrated electronic medical record (ieMR) project, while patients at some public hospitals have been affected by increased elective surgery wait times.
The state's Hospital and Health Services are statutory bodies running several hospitals and community health centres within each region, receiving state, federal and their own funding.
A Queensland Health spokesman said many hospitals had spent more than originally predicted as a result of "increased scope, the emergence of new technology, and features requested by clinicians".
The ieMR, the core of Queensland Health’s Digital Hospital project, uploads all patient data to a centralised medical record that is accessible by all doctors and clinicians, across any hospital in the state.
A Brisbane Times investigation, however, has found serious concerns about privacy and patient safety with the Cerner software being installed by eHealth Queensland, the department responsible for the project.
There are documented examples of patient data being entered into the wrong record, wrong blood labelling on test tubes, cervical cancer tests going missing and medications going missing, and alerts issued to clinicians warning of immediate risks to patient safety when using the software.
Queensland Health says the ieMR has reduced average length of stay, unplanned readmissions and the number of serious falls and pressure injuries. Hospitals that install the ieMR have experienced a reduction in medication errors.
Cerner has been repeatedly contacted for comment and while acknowledging emails, has not provided a response.
In July 2017 senior clinicians at a Queensland hospital wrote to former eHealth Queensland chief executive Richard Ashby to express their concerns about the rollout of the software at their hospital.
Dr Ashby resigned late last month after Queensland Health director-general Michael Walsh referred allegations of an undeclared personal relationship with an eHealth Queensland staff member to the Crime and Corruption Commission.
In December Dr Ashby was stripped of oversight of the ieMR project after an Auditor-General report found the program was at “critical risk” of collapse if another $256 million was not approved by cabinet.
In the letter, clinicians outlined in detail their concerns about having Cerner’s integrated electronic medical record software for operating theatre management, called SurgiNet, installed in the hospital.
SurgiNet allows clinicians and staff to manage patient information before and after surgery, including covering anaesthesia, medications and patient discharge.
“Our objections relate to the introduction of electronic systems, which are so inferior in functionality that they are not only a danger to patients, but also interfere with the workflow of clinicians trying to treat patients,” the letter began.
“As you are aware, large numbers of critical issues affecting SurgiNet were identified after the rollout. Fixes are currently being pursued but are proving to be difficult and costly.”
In a letter obtained by Brisbane Times, dated September 2017, then-health minister Cameron Dick wrote to the clinicians about their concerns.
Mr Dick wrote that Dr Ashby, Mr Walsh and other senior staff in Queensland Health had spoken with the clinicians and the hospital executive board “to discuss the way forward”.
He wrote that Hospital and Health Services would not roll out the integrated electronic medical record unless there was a “high level” of clinical support for the process.
“However it will be made clear that any HHS choosing to retain any legacy systems rather than replacing them with the respective Digital Hospital system may do so; however will need to make local arrangements for the maintenance of the legacy system and also risk-manage the duplication and safety issues that may arise from non-integration,” Mr Dick wrote.
Mr Dick concluded his letter saying said he “looked forward to the constructive partnership” of clinicians in “progressing the Digital Health agenda”.
A Queensland Health spokesman said hospitals with the ieMR installed often continued operating the "legacy systems", which are assessed by Queensland Health's clinical governance for patient safety risks.
"Where a decision is made to continue using such a system (or systems), they will continue to be fully supported," the spokesman said.
"Hospital and Health Services are independent statutory bodies, have their own budgets and have always paid, and continue to pay, support costs for their own legacy systems.
"This would have been the case whether ieMR was being implemented or not."
Lots more here including detailed costs:
Then came this just to ramp up the pressure:
February 13, 2019 — 9.48pm
Clinicians at Queensland's public hospitals say they “cannot remain silent” in the face of patient safety risks related to Queensland Health’s integrated electronic medical record project.
Their fears have been detailed in letters written by hospital staff, and by peak health bodies writing on their behalf, to Queensland Health’s director-general Michael Walsh, to the Health Minister, and to eHealth Queensland’s former chief executive Richard Ashby.
Patient safety risk examples given by some clinicians in their correspondence included difficulties administering medications and medications going missing in the software.
Health Minister Steven Miles said Queensland Health consulted "in depth" with all hospital clinicians before, during and after the rollout of the integrated electronic medical record at hospitals.
"There have been no reports of patient harm linked to the implementation of the ieMR, indeed the [Queensland Auditor-General] has found the system is improving patient outcomes," Mr Miles said.
"However, all systems, including paper-based systems, have risks and Queensland Health works with clinicians to identify and address these risks."
In one incident, eight clinicians spent half an hour trying to decipher a medication dose prescribed through the integrated electronic medical record (ieMR) system to determine whether a patient had received the correct dosage.
Clinicians also highlighted the “inordinate amount of time to complete simple prescribing tasks” and ward rounds taking many hours longer each day because of the software.
Dr Ashby resigned late last month for “personal reasons” after Mr Walsh referred allegations of an undeclared personal relationship with a Queensland Health staffer to the Crime and Corruption Commission.
The CCC has been investigating eHealth Queensland, the department responsible for the ieMR, for months.
The ieMR is designed to connect all the state’s public hospitals, allowing all clinicians to access any patient’s medical record from any hospital.
Clinicians have expressed strong support for installing an electronic medical record at hospitals, believing it will improve patient care and lower the burden on the health system, but have raised concerns the ieMR is not being rolled out safely.
One letter from clinicians said while they were supportive of electronic health systems, they protested the rollout of “inferior” systems that risked patient health.
Mr Miles said issues or suggestions on the ieMR rollout were dealt with as they occurred.
"No hospital or health service would even attempt a transformative project of the scale and importance of digital hospital without the backing of the majority of clinicians and other stakeholders," he said.
A Brisbane Times investigation has revealed serious safety concerns with the ieMR, including an independent 2014 report that warned of potentially “catastrophic” consequences on a par with the 2011 payroll debacle if the software was rolled out.
Queensland Health requested that report be modified to remove the warnings. The independent consultant who wrote the report refused.
Mr Miles had earlier questioned why the LNP did not heed the report commissioned during the Campbell Newman LNP government and said Labor had made changes to address some of the report's concerns.
In one letter, a clinician wrote that the ieMR’s prescribing system “was prone to mistakes especially in a rapidly evolving situation of a critically sick patient”.
The ieMR software was purchased “off-the-shelf” from US medical technology giant Cerner in 2011 and is modified to suit each hospital as it is rolled out.
"The Director-General himself personally meets with clinicians twice ahead of any digital hospital rollout to understand they are happy with the training they have received, and asks them whether they believe the system can go live safely and effectively," Mr Miles said.
"If the clinicians don't believe this is the case, the rollout does not proceed."
Cerner has been contacted for comment by Brisbane Times and has not provided a response to questions.
and lastly this:
February 14, 2019 — 5.28pm
The Queensland premier has been questioned in State Parliament on whether she will halt the rollout of Queensland Health’s integrated electronic medical record.
It follows relevations about the state’s public health clinicians detailing serious concerns with the project’s fast-tracked rollout and the consequences for hospitals including patient safety risks.
Dr Richard Ashby, the chief executive officer of eHealth Queensland and responsible for the rollout until late December, resigned two weeks ago for “personal reasons” after Queensland Health director-general Michael Walsh referred allegations of an undeclared personal relationship to the Crime and Corruption Commission.
Health Minister Steven Miles immediately ordered the halt of a second major eHealth Queensland digital project, the $200 million patient administration system replacement.
In Question Time on Thursday, opposition health spokeswoman Ros Bates asked the premier Annastasia Palaszczuk about the status of the integrated electronic medical record (ieMR).
“The Auditor-General has exposed that Queensland Health's ieMR project is $256 million over budget,” Ms Bates said.
“The CEO of eHealth Queensland has resigned under corruption allegations and medical staff say that the project puts patient safety at risk.
“Will the Premier finally order a halt to the rollout of this project until all of these issues are resolved?”
A Brisbane Times investigation has shown a series of errors caused by the ieMR, including blood tests labelled with the wrong patient data, personal information going into the wrong patient record, data going missing and clinicians struggling to use the unintuitive and poorly-designed software.
I suspect, strongly, this is becoming a political beat up by a few powerful doctors who are determined to get their way and will stop at nothing to get it.
I would love some feedback from the ground as to why systems that seem to work fine in NSW are so risky and dangerous in Qld?
Posted by Dr David G More MB PhD at Friday, February 22, 2019