The president of the Nova Scotia Nurses’ Union says trying to address challenges related to the launch of a new electronic medical record system is like “putting your finger in a dam,” and she’s nervous about a broader rollout planned for this spring.
Janet Hazelton is one of a group of voices that emerged this week after One Person One Record made its debut in December at the IWK Health Centre.
“Our nurses are extremely frustrated, ” Hazelton said in an interview Tuesday. She said the IWK is listening to feedback.
“I’m not trying to imply that they’re not listening, but there’s just so many problems that it’s like putting your finger in a dam. It seems that they solve one issue which sometimes creates another one.”
‘Started too soon’
One Person One Record, or OPOR, was launched at the Halifax children’s hospital with plans to expand more broadly this spring. The $365-million system, designed by health-care giant Oracle Cerner, is intended to replace paper medical records and lead to better co-ordination.
But Hazelton said so far her members find it cumbersome, and it’s causing delays admitting patients in part because basic tasks are taking much longer than they used to as staff try to navigate the new system.
“The employer is giving them lots of support, lots of IT support, but it’s not enough. They feel that it was started too soon, and that they ought to have gotten more education and they ought to have worked out some of the kinks before going live.”
Hazelton is not the only one raising concerns.
Internal memos acknowledge frustrations
On Monday, senior officials overseeing the rollout of OPOR pledged in an internal memo to do better, and the president of Doctors Nova Scotia acknowledged frustrations in a message to her membership.
“Over the past several weeks, we have heard clearly from IWK physicians, clinical teams, and administrative leaders about the ongoing challenges with the new clinical information system,” reads the email from the OPOR senior leadership team, obtained by CBC News.
“We understand the strain this is placing on care delivery, workflows, and confidence in the system itself.”
Doctors Nova Scotia president Dr. Shelly McNeil sent her membership an email that said they “recognize that this transition has been complex, demanding and at times deeply frustrating.”
McNeil goes on to say that Doctors Nova Scotia officials have “set clear expectations with the OPOR project team that physicians must receive more frequent, substantive and transparent updates on the work underway” to address challenges being experienced.
“Stronger communication and meaningful feedback loops with physicians are essential, particularly before further rollout across the province.”
3 key issues
The email from the OPOR leadership team identifies three issues it says are causing the greatest disruption with the system:
Routing, which leads to “delays, inaccuracies, or misidentified clinical information.”Ambulatory care workflows, which is “affecting scheduling, documentation and access to essential information.”Waitlist management within ambulatory care, which is “limiting visibility into patient needs and affecting prioritization.”
“Additionally, we recognize there has been concern with the overall stability of the clinical information system,” the email says. “We are meeting with senior leaders at Oracle Health to assess the root cause, seek immediate solutions, and implement these with urgency.”
The email goes on to say that as efforts are made to address the issues, officials are “actively evaluating all readiness considerations, including lessons learned from the IWK, to ensure the success of the upcoming go-live in May.”
“We are committed to resolving these issues and rebuilding your confidence in the system and in our OPOR team. The vision behind One Person One Record remains strong, and we believe in its ability to support better care, better coordination, and better outcomes.”
Officials welcome feedback
Senior health leadership for the province were not made available for interviews Tuesday.
In a statement, Health Minister Michelle Thompson said the launch of the new system is “complicated and complex work” and even with extensive planning and preparation, challenges were anticipated as the system goes through a major transition.
“We are fully in that transition period now, and I understand and appreciate it has been frustating and difficult at times. Change is not always easy, but I have every confidence that our clinicians have the skills, resilience and persistence to achieve success for their teams and their patients.”
IWK CEO Dr. Krista Jangaard said in a statement that the hospital has put additional clinical, operational and technical support in place to address issues as they arise and to support staff and physicians at the point of care.
“IWK Health remains committed to delivering safe, high-quality care to patients and families while continuing to improve the systems that support care delivery now and into the future.”
A statement from Nova Scotia Health said the OPOR program team is grateful to the IWK teams for continuing to share feedback and helping to address issues.
“It is important to emphasize that OPOR remains a cornerstone initiative for strengthening care across Nova Scotia; improving continuity, enhancing patient safety, and enabling clinicians to access the information they need, when they need it.”
Worries about further rollout
After years of delays, the Nova Scotia government announced the contract with Oracle three years ago. The most recent plan was for the system to first launch with the IWK, before a rollout across Nova Scotia Health facilities, beginning with sites in the central zone in May.
Hazelton said the concerns about system performance and education for users must be addressed before a broader rollout can go ahead.
“I’m as concerned as the nurses are at the IWK about that.”
The internal memos and Hazelton’s comments follow a recent staff meeting at the IWK where people could share their views.
Magazine article pulled
The email from McNeil, the Doctors Nova Scotia president, calls for doctors to “lead collectively, support one another and hold each other accountable to ensure we get through this transition in a way that supports physicians and protects patient care.”
It said Doctors Nova Scotia remains confident One Person One Record has the potential to strengthen health-care delivery in the province. “However, our belief in the long-term value of this work does not diminish the very real frustrations being experienced today.”
To that end, McNeil goes on to say that Doctors Nova Scotia intended to pull an article by the OPOR project team from the upcoming edition of the DNS magazine because it “did not reflect a balanced or accurate representation of physicians’ experiences transitioning to OPOR.”
“The go-live experience was far more complex and challenging than the article suggested, and its tone did not align with recent conversations we have had with physicians at IWK Health,” McNeil writes, adding that the organization was able to recall from Canada Post issues of the magazine that included the article.
“We will be reprinting the magazine without that article.”
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