Canadian Cerner EHR investigation finds install was mismanaged, underfunded

The Ministry of Health's second investigation into Nanaimo's EHR project found that managers failed to leverage advice that could have helped prevent some of those issues.
By Jessica Davis
03:46 PM
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Cerner EHR Canada

Nanaimo Regional General Hospital in British Columbia, Canada. Photo via Google Maps

The Vancouver Island Health Authority's electronic health record implementation has been fraught with controversy since its launch in March 2016. And the latest investigation, by British Columbia's Ministry of Health, stands by provider complaints: The Cerner project was mismanaged – neither properly planned nor implemented.

In fact, the report found that had officials leaned on advice or experiences from other Canadian EHR installs, many of the problems could have been prevented.

The Cerner project went live in March 2016 at Nanaimo Regional General Hospital, Dufferin Place Residential Care Centre in Nanaimo and Oceanside Health Centre in Parksville. But the launch was quickly denounced by many providers -- some even refused to use the technology. This led to Island Health creating some stiff enforcement policies.

[Also: Canadian Cerner install under investigation again, but mishaps go deeper than the tech]

British Columbia Provincial Patient Safety and Quality Officer Doug Cochrane launched an investigation into the rollout soon after and found many critical functional deficiencies in the EHR.

For example, any user could inadvertently order unsafe medication doses. The EHR also had connectivity issues with the barcode reader – among a long list of other system flaws.

While IHealth addressed some of those issues, BC Health Minister Adrian Dix launched the second investigation into the project in Sept. 2017.

[Also: Epic notches a first with Canadian EHR install]

This second report found the crux of provider issues: Deep mismanagement. Those issues, combined with the "long-standing contentious relationship" at Nanaimo Regional General Hospital further exacerbated the situation.

"The report suggests the culture and governance at NRGH and Island Health has played a part in the IHealth challenges," according to BC officials. "There is a general climate of distrust in the hospital; stakeholders are deeply polarized, entrenched and dissatisfied with the current state of IHealth."

In fact, barely 50 percent of staff thought they could work collaboratively with leadership to make the project a success.

Another issue, brought to light by the President of the Nanaimo Medical Staff Association prior to the investigation, was the organization "was in a poor state of readiness when the system was activated."

In fact, the report found that the majority of nurses are less productive now than when they were on a paper-based system.

The EHR project, as a result, is seriously delayed and experiencing financial troubles. In fact, the initial $173.5 million budget won't be enough to complete the project. Island Health estimates another $51.1 million is needed to finish the rollout.

However, EY (which conducted the second investigation) suggested Island Health will need even more funding to wrap the rollout.

To overcome these issues, Dix said Island Health will appoint a mediator to support stakeholders to move the project forward. The mediator will work with stakeholders to help resolve issues plaguing the organization.

Further, the mediator will create a work plan with stakeholders on necessary actions to address the report's recommendations. Island Health was directed to adhere to the report findings and map out a realistic plan with adequate funds. The mediator will also monitor plan adherence.

"Over the past decade, hundreds of millions of dollars have been spent on IT projects that have failed to deliver the outcomes promised," Dix said. "By taking this action today, this government is making sure that we take a more thoughtful approach to these projects by slowing down, properly planning and engaging the right people in the right way."

While the Nanaimo Medical Staff Association told Healthcare IT News they're pleased their concerns have been validated by the report, the group is disappointed the system won't be suspended until the EHR is redesigned.

"Patient safety remains a priority for medical staff working in Nanaimo and this is why physicians raised these concerns," President of the Nanaimo Medical Staff Association David Forrest, MD told Healthcare IT News in an emailed statement.

"That being said, it's promising that government has made the decision… to address the fundamental issues in the relationship between healthcare workers and the Health Authority," he added. "If we're to engage with Island Health to find a solution, we clearly need a change to what's taken place in the past."

Twitter: @JessieFDavis
Email the writer: jessica.davis@himssmedia.com