'It’s challenging': Issues persist as B.C. modernizes hospital technology

British Columbia’s two biggest health authorities are pushing ahead with the massive task of modernizing the information technology systems in their hospitals, with issues already plaguing the effort.

CTV News has heard from a number of frontline workers in different facilities who describe poorly executed roll-out plans, inefficient and clunky interfaces, and a slow-down in efficiency as they grapple with the transition from predominantly pen-and-paper operations to full digital. One called the switch, undertaken amid the pressures of the pandemic, “traumatizing”. 

Vancouver General Hospital began the transition in November and sources describe ongoing problems, with a serious issue last Wednesday where no one could access the CST Cerner system, meaning all patient information, booking systems, records and other material was inaccessible. One senior staffer described it as “paralyzing the biggest hospital in the province,” and said they were not given an explanation as to why. https://bc.ctvnews.ca/resignations-and-retaliation-b-c-health-care-workers-see-increasingly-toxic-workplaces-1.6265688

When asked by CTV News, Vancouver Coastal Health confirmed there was an issue but downplayed it as a Citrix server problem, not Cerner, and insisted that “The system was back up and running shortly after with no disruption to hospital services or patient care."

They acknowledged, however, that the access issue impacted all VCH sites with CST Cerner, as well as Providence Health sites like St. Paul’s Hospital and Provincial Health Services Authorities campuses, including the BC Cancer Agency and BC Women’s and Children’s Hospital, which are also on the same system.

CTV News raised the issue with the health minister and asked him if patients were safe during the transition.

“This was a process being put in by the previous Liberal government that was delayed for six years with very little action,” said Adrian Dix. “We're making progress, hospital by hospital, and I think overall, the transition in most of the hospitals has gone well. It is challenging.”

TWO HEALTH AUTHORITIES, TWO SYSTEMS

Technology has been part of B.C.’s hospital system for decades, but most of the documentation – from booking surgeries to ordering pain medication – has been done on a paper form and multiple software systems have been used across health authorities. Around 2010 the decision was made to consolidate systems when modernizing.

Vancouver Coastal Health chose to continue with the newer software from Cerner, while Fraser Health decided to continue with a different provider, Meditech, and its updated product: Expanse. Eagle Ridge Hospital will be the first acute care facility in that health authority to make the switch next month. 

“That's going to be a comprehensive, longitudinal care record for the patient that will allow the care team to have surgical history, medical history, allergies, immunizations -- all that information will fit in that electronic record,” said Dr. Amyeen Hassanali, the chief medical information officer for Fraser Health. 

When CTV News asked why the two biggest health authorities will be using different systems and what that would do for patient care, he said the health authorities required “read-only” access for healthcare professionals outside their jurisdiction, which is a continuation of the current Unifying Clinical Information (UCI) and CareConnect systems in place now.

“Provincially there is a lot of work being done to help with health information exchange,” said Hassanali. “We really need to move forward with this change to allow our providers and our medical staff and our clinical staff to be able to practice healthcare a lot more consistency and higher quality.”

INSIGHT INTO THE ISSUES

Most of the frontline workers CTV News spoke with did so anonymously for fear of retaliation since they were frustrated and critical of the chosen software and its implementation, but a recently retired surgeon provided unique insight. 

Dr. Sanjiv Gandhi stepped down as head of cardiothoracic surgery at BC Children’s Hospital in January, and revealed he’d raised many concerns dating back to the days when the upgrade was being discussed and he confirmed they occasionally lost access to CST Cerner patient records since the switch over in March of last year. 

“Yes, there were times when the system shut down, which meant patient care shut down,” he said, which didn’t halt surgeries but could lead to delays to transfers to other departments and access to medication.

Gandhi confirmed what other doctors have described: they are spending more time with clunky software systems than with patients and nurses are spending valuable time inputting information rather than providing hands-on care to patients. 

“Things fall through the cracks, things take longer and it is less safe,” he said. “Maybe some of those bugs will get ironed out as the system plays out over years, but it’s not a quick fix, it's not a month of growing pains.”