Queenslanders’ health at risk from electronic medical record software, clinicians say
The built-in digital medical report (ieMR) is designed to permit each Queensland affected person’s full medical report to be shared throughout all public hospitals. The intention is to enhance affected person care and security however clinicians say the alternative is happening.
Projected to value $600 million in 2017, the ieMR mission was not too long ago revealed to be costing Queensland taxpayers not less than $1.25 billion for set up and upkeep alone till 2025.
eHealth Queensland is at the moment being investigated by the Crime and Corruption Fee.
The rollout of the ieMR mission might be comparable with the 2011 payroll debacle, in accordance with an unbiased advisor employed by Queensland Well being in 2014.
The 2011 debacle was triggered when a brand new payroll IT system deployed throughout the state’s public hospitals failed, leaving 1000’s of docs, nurses and hospital employees unpaid for months.
A fee of inquiry into the payroll situation was launched in 2013. Correspondence between senior eHealth Queensland employees in 2011 famous the payroll situation as a lesson to be learnt from within the rollout of ieMR.
Hospital employees wrestle to make use of software program
The built-in digital medical report mission has been pushed beneath a number of state governments regardless of repeated warnings and protests from clinicians, well being professionals and Queensland Well being employees.
eHealth Queensland bought “off-the-shelf” built-in digital medical report software program from US medical well being large Cerner in 2011. The software program is modified as technicians set up it in every hospital.
However hospital employees say they wrestle to make use of it, discovering it contradictory, erratic and poorly designed.
Each unbiased and inner analyses carried out for Queensland Well being have warned of vital points with Cerner’s software program, with not less than one report not escalated to the Well being Minister.
The set up of the medical report software program in pathology, anaesthetics, intensive care and different vital hospital sectors, overwriting specially-designed software program for every sector, has prompted specific angst.
In a single occasion in 2014, Queensland Well being demanded an unbiased advisor modify a closing report back to take away damning warnings about ieMR.
The advisor refused.
The spokesman for the appearing Well being Minister mentioned the 2014 report was produced beneath the Campbell Newman-led LNP authorities and questions over the report ought to be directed to that authorities.
In one other occasion, a shutdown of ieMR in Could 2017 on the Princess Alexandra Hospital that compelled clinicians to return to paper records-keeping was pinpointed by eHealth Queensland technicians as attributable to Cerner’s software program.
Cerner “disengaged” from the investigation and offered incorrect technical logs to the unbiased investigators employed by Queensland Well being, that report mentioned.
Cerner was contacted for remark.
Then-health minister Cameron Dick is known to haven’t seen the report.
9 hospitals up to now have ieMR put in, with Queensland Well being pushing for 27 hospitals to be on-line by 2021 after the division signed a five-year contract extension with Cerner in 2016.
A 2018 Auditor-Common report warned the mission was vulnerable to monetary collapse if the state authorities didn’t log off on a 3rd enterprise case this 12 months for an additional $256 million.
Crime watchdog ‘making inquiries’ referring to eHealth
The ieMR mission is managed by Queensland Well being director-general Michael Walsh and eHealth Queensland chief government Richard Ashby.
Dr Ashby has been in control of the mission since entering into the position in 2017, and led the rollout of ieMR software program on the Princess Alexandra Hospital in 2015.
In late 2018, after the Auditor-Common’s report was launched, chief medical data officer Keith McNeil was given higher oversight of this system.
Mr Walsh and Dr Ashby didn’t reply to questions in regards to the appropriateness of Dr Ashby remaining in his position as eHealth chief government and chief data officer whereas the CCC investigation was ongoing.
It’s understood the present CCC investigation into eHealth Queensland started halfway by means of final 12 months.
“The CCC can verify it’s making inquiries into allegations referring to eHealth Queensland,” a CCC spokesman mentioned.
“It’s not acceptable to remark additional. It is very important word all allegations ought to be handled as unsubstantiated till a closing final result is reached.”
The Well being Division created a medical excellence board populated by clinicians in an try and resolve issues detailed by employees and create stronger communication between the mission staff and clinicians.
Performing Well being Minister Mr Bailey’s spokesman mentioned there was “common session with clinicians and employees, audits, opinions and session with skilled consultant teams, together with the AMA and related unions, and stakeholders”.
“For the reason that introduction of the ieMR, there was a notable discount in medicine errors and eHealth and the [Hospital and Health Services] are repeatedly in search of methods to enhance the system and the standard of care they supply because of this,” he mentioned.
Senior hospital clinicians see must escalate issues
Clinicians say there’s widespread assist for an digital medical report in Queensland hospitals, believing it’ll enhance affected person well being and make the working day for clinicians simpler.
Nevertheless, many clinicians imagine the Cerner software program and eHealth Queensland rollout is so flawed they’re severely frightened for affected person security.
Involved that clinicians’ fears had been being ignored, the Australian Medical Affiliation Queensland in March 2018 arrange a separate committee to coach its members of the dangers to hospitals and the general public.
In a press release, the AMAQ mentioned when such giant initiatives had been rolled on the market had been “sure to be issues” and it had established the committee to report clinician issues on to the AMAQ council.
“AMA Queensland president Dr Dilip Dhupelia met with Well being Minister Steven Miles late final 12 months and highlighted the necessity for hospitals, the place ieMR is being rolled out, to interact extra successfully with clinicians to make sure effectivity within the office,” the AMAQ assertion mentioned.
“This allows clinicians to be assured that affected person security stays the highest precedence.
“AMA Queensland will proceed to work intently and collaboratively with Queensland Well being because it digitises the state’s public hospitals and well being services.
“AMA Queensland will proceed to advocate for clinicians to make sure every day office duties not intervene with delivering world-class affected person companies.”
The AMAQ additionally wrote to Queensland Well being director-general Michael Walsh detailing key issues about “a number of main issues within the system” in the course of the mission’s rollout at Mackay Base Hospital in September 2018.
Senior clinicians at hospitals throughout the state have additionally detailed their issues on to Mr Walsh and Dr Ashby.
The Auditor-Common in late 2018 famous that clinicians had seen a must “escalate their issues in regards to the eHealth program”.
“We’re conscious that some clinicians have raised issues in regards to the ieMR answer with the director-general of the Division of Well being and the Australian Medical Affiliation of Queensland,” the Auditor-Common discovered.
Rollout value can’t be said precisely: Auditor-Common
Queensland’s Hospital and Well being Providers areas, every managed by a person board, have been pressured by Queensland Well being to simply accept Cerner’s software program or be left with all prices of sustaining their authentic software program.
A number of HHS areas which were implementing the ieMR mission have reported main price range deficits, citing higher than anticipated prices to put in and preserve the ieMR.
The hospitals don’t know how a lot they must shoulder for upkeep prices when the rollout is full, and neither does eHealth Queensland, in accordance with the Auditor-Common report.
Additional, the Auditor-Common discovered eHealth Queensland couldn’t precisely state how a lot the rollout has value so far, because it didn’t have the software program to take care of correct accounting logs, and hospitals couldn’t precisely report the cash they’ve spent.
A September 2006 Deloitte report commissioned to information Queensland Well being in methods to implement the ieMR mission really useful an “incremental” method, putting in the software program by integrating data from different methods.
That advice was initially endorsed by Queensland Well being when the contract with Cerner was signed in 2011.
However in 2014 the rollout was modified from an incremental rollout to a “massive bang” method, rolling your complete software program out in a reside surroundings at hospitals.
The rollout was expanded once more in 2017, months after Queensland Well being signed a five-year contract extension with Cerner, elevating the variety of hospitals receiving ieMR from 25 to 27 by 2021.
In December 2018, the Auditor-Common’s scathing report into the digital hospital program mentioned eHealth Queensland had severely underestimated the price of the ieMR rollout.
“This system is now at a vital junction as a result of it can’t full implementation … with out extra funding,” the report mentioned.
The Auditor-Common additionally discovered eHealth Queensland had failed to make sure Cerner was offering worth for cash and had not bothered to return to market in 2016 to verify for aggressive distributors earlier than signing the contract extension.
A Queensland Well being spokeswoman mentioned an earlier Auditor-Common’s report in 2013 discovered the unique contract with Cerner was acceptable.
“The choice to barter with Cerner beneath a ‘closed request for proposal’ for the ieMR answer was because of Cerner being the one ieMR product supplier in Australia which met Queensland Well being’s performance and scale necessities, confirmed by an exterior unbiased advisory firm,” she mentioned.
“Because the product was already in broad use on the time in New South Wales and given the transfer in direction of a nationally appropriate affected person report system and beneficial pricing, it was adopted by Queensland.
“The appropriateness of the method was confirmed by unbiased opinions and a broad session with senior medical and managerial employees, the medical senate, medical networks and well being unions and was audited by the Queensland Audit Officer in 2012/13.”
An try and roll out Cerner’s software program in NSW hospitals, which led to clinicians elevating issues about affected person information being entered into the improper medical data, triggered an investigation by the NSW state authorities in 2011.
In Victoria, a multimillion-dollar mission to implement Cerner’s digital medical report software program at eight public hospitals in 2003 was deserted after a scathing Auditor-Common’s report in 2013 discovered that “poor planning and insufficient understanding” had led to solely 4 hospitals implementing this system at a value of $145 million.
The Victorian Auditor-Common’s report additionally discovered points that “probably have an effect on affected person security” within the software program.
Queensland Well being’s rollout of the built-in digital medical report is now vulnerable to monetary collapse if additional funds aren’t accepted by cupboard in 2019, whereas clinicians are left with software program they are saying isn’t match for objective and inflicting critical affected person hurt.
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Lucy is the city affairs reporter for the Brisbane Occasions, with a particular curiosity in Brisbane Metropolis Council.