Another state that should have gone with Alcidion....Electronic medical record costing Queensland hospitals millions
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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 Royal Brisbane and Women's Hospital is expected to roll out the second phase of the integrated electronic medical record this year.Credit:Fairfax Media
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.
The letter
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."
The ieMR
Although clinicians believe the use of an electronic medical record will improve patient care and safety, the use of Cerner software to implement the ieMR has caused serious concerns.
eHealth Queensland wants Hospital and Health Services to stump up an additional $130 million to help cover the shortfall of $256 million, and will go back to cabinet this year to request the remaining finances.
It also wants to see all hospitals paying a “service charge-back” to the department two years after the ieMR goes live, but doesn’t know how much that charge will be.
The Auditor-General’s report found that the ieMR had generally improved hospital performance, but the cost of implementing the ieMR for HHSs had “far exceeded” eHealth Queensland’s original estimates.
Part of that excess was because some HHSs had chosen to spend more to “minimise the clinical risk” of the rollout.
Four HHSs have already spent $136 million on the rollout at 12 hospitals.
The Auditor-General also warned that regional hospitals would be harder hit by the rising costs of the ieMR rollout than the larger city-based hospitals.
The Queensland Health spokesman said many of the HHSs had invested their increased surpluses into the rollout.
"As the ieMR is delivered across the state, net benefits are forecast to reach approximately $1.9 billion by 2025," the spokesman said.
The cost to hospitals
In 2014 Queensland Health changed course from an incremental approach to putting the ieMR into hospitals, and adopted a “big bang” approach fast-tracking the installation.
Queensland Health now wants to see 27 hospitals operating the ieMR by March 2021.
Hospitals also do not know how much the ieMR will cost to maintain after eHealth Queensland completes the project in 2025, according to the Auditor-General’s report.
PricewaterhouseCoopers, which worked closely with Queensland Health on the rollout, has modelled forecasting that the hospitals with the ieMR had realised $181.9 million in benefits.
Hospitals have already reported major financial deficits as they roll out the ieMR.
The Gold Coast HHS is preparing to implement the ieMR project from April 2019 at an immediate cost of $40 million across all its hospitals.
The Sunshine Coast HHS had planned to roll out the ieMR to Sunshine Coast University and Nambour General hospitals in October and November 2018, respectively.
But instead the Sunshine Coast rollout was delayed until 2019, going live in early February.
It reported an operating deficit of $14 million in the last year and warned this would be “even more fiscally challenging” as the electronic medical record went live.
Another state that should have gone with Alcidion....Electronic...
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