Tuesday May 28, 2024 | VICTORIA, BC [Last updated June 2, 2024]
by Mary P Brooke, B.Sc. | Island Social Trends
The Island Health Authority here on Vancouver Island is upgrading their electronic health records system.
During the implementation this summer, there will be some changes to operational technology at two hospitals in Greater Victoria: the Royal Jubilee Hospital (1952 Bay Street in the Oak Bay / Richmond area) and the Victoria General Hospital (1 Hospital Way in View Royal).
This is part of a broader activation of their Computerized Provider Order Entry (CPOE) system at “some South Island sites”, starting with those two major hospitals.
The rollout will begin at Royal Jubilee Hospital on June 8.
Further activations at Victoria General Hospital, Gorge Road Health Centre and South Island Surgical Centre are expected to take place in September 2024, says Island Health.
Moving away from paper and fax:
By implementing CPOE that means Island Health will be moving from older systems involving paper, fax, or telephone to a modern computerized system allowing care teams to enter and send treatment instructions, including medication, laboratory and radiology orders – via a computer application.
Electronic Health Records (EHR) will be more readily up to date and more accessible to health professionals at any point in the care system.
Island Health calls these “significant investments we are making in the EHR” that they say “will benefit patients in a number of ways”:
- It will create a more efficient and safe health care experience.
- It allows care providers to enter orders for medication, diagnostic tests and other instructions directly into the EHR. This provides the whole care team with much more comprehensive patient information in real-time to better support patient care.
- It reduces the time between the physician ordering and the patient receiving medication/diagnostic tests and reduces potential errors from handwritten orders.
- Results in safer care for patients and less time repeating the same information at every visit to an Island Health site or service.
Elements of CPOE have been installed at several sites:
Elements of the CPOE system have been implemented at EHR at many sites, including 10 acute care sites, six Community Health Services sites, and five long-term care homes with each site experiencing a number of successes leading to enhanced patient care, said Island Health in a statement to Island Social Trends today.
Some examples include:
- Labour and Delivery: Central monitoring board, located in the main nursing station, offers a central location away from the bedside where nursing and medical staff can view life-saving information – mother’s and baby’s heartbeats and other vital signs in real time.
- Automated alerts for serious conditions like sepsis, delirium, or risk of falling equip care providers with the best possible patient information.
- A Post-COVID-19 Recovery Clinic connecting patient records to care providers through electronic clinical documentation.
- Violence screening documentation helps care teams prepare and care for patients where violent behaviour may be a possibility.
- Electronic medical orders for scope of treatment – eMOST – allows patients to reflect their individual wishes for important care decisions and supports Island Health care teams to honour those wishes.
Hospital ER as usual:
“Anyone in need of emergency medical care should continue to go to these hospitals as they normally would. As is always the case in our emergency departments, people will be triaged and the sickest patients will be seen first,” said Island Health in their May 28 statement.
“Island Health has worked closely with our clinical teams and physician partners to plan for the activation of CPOE.”
“While there has been training and support for care providers in the lead up to activation, some patient experiences may take more time than usual while our care teams transition to the new system.”
No significant impacts at ER’s:
“Given the advanced planning and preparation, the additional staffing and other supports that will be in place and the fact that electronic clinical documentation has been in place for several years, we are not anticipating the impacts to be as significant in the emergency department,” it is stated by Island Health.
“To support our staff and physician partners in providing the best care possible Island Health has undertaken significant planning to mitigate any potential impacts to patients.” This includes:
- Bringing in extra staff, including physicians and nurses with experience in this advanced EHR system, to support staff at RJH. This includes extra staff in the Emergency Department. Laboratory and Pharmacy to work side-by-side with staff while they adapt to the new system.
- Setting up a dedicated clinical area on-site at RJH to see patients who have presented to the emergency department but have non-urgent/primary care needs, to reduce pressure on the department and site capacity overall.
- In collaboration with Community Health Services, pre-booking casual staff and increasing Hospital at Home supports to increase system capacity.
- Communicating with community partners to enhance efficiency and processes for admission to long-term care, to mitigate patients requiring long-term care being admitted to hospital.
- We are communicating ahead of time to patients we think will be affected, for example directly through departments such as renal, ambulatory care and surgery.
- In the days ahead, we will have signage up at RJH letting people know that we are implementing CPOE and it may take a little longer to see a physician for minor injuries and less urgent issues.
- We have placed ads in South Island Black Press newspapers and we have launched a paid social media campaign to provide information about where to seek health care and advice for non-emergency conditions.
- Based on learning from experiences at sites elsewhere in B.C., Island Health is taking a measured approach by making this change in phases to lessen the burden on staff, who are doing incredible work every day to deliver excellent care to patients. For example, emergency department physicians have been working with electronic documentation for a couple of years now, which we introduced earlier, so that the scale of change from paper to electronic processes would be more manageable.
Efficiency level:
Island Health says the ER will be fine.
“With respect to the commentary specifically about reduced efficiency in the emergency department, our understanding of that statement is that it is based on previous experiences at other sites, for example when this was initially implemented at Nanaimo Regional General Hospital,” says Island Health.
“It’s important to note that this rollout at RJH and VGH is different than what most sites experience. Several years ago we implemented electronic clinical documentation at RJH and VGH, which is a significant component of the overall implementation. By doing that first, and CPOE now, we have lessened the burden for our care teams, which we believe will lead to less efficiency challenges,” says Island Health.
Temporary inefficiencies:
“Of course, we acknowledge there are temporary inefficiencies whenever a system like this is implemented. That is the standard experience at hospitals across BC, Canada and beyond,” an Island Health spokesperson said today.
“That’s why we needed to bring in additional supports and that’s exactly what we’ve done. We believe that the investments and processes we have put in place will support patients and staff in the ED.”
Island Health summarizes that they will:
- Bring in extra staff for multiple departments, including staff who have been through this implementation before that will be working in the ED
- Set up a dedicated urgent care area on-site at RJH to see patients who have presented to the emergency department but have non-urgent/or primary care level needs.
- In collaboration with Community Health Services, pre-book casual staff and increase Hospital at Home supports to increase system capacity.
Concerns from Health Care Matters:
BC Health Care Matters has released an info-graphic about health care access.
They also indicate that South Island Hospitals will soon face a 30% to 50% reduction in efficiency in emergency departments during the electronic records technology transition.
Health advocate and BC Green Party candidate Camille Currie says that this 6-week shift to a digitized medication system could trigger a Code Orange Disaster status due to interruptions.
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