NSW Health to act on FirstNet issues

NSW Health has identified issues with configuration, training and support of its FirstNet clinical information system (CIS) following a government-commissioned independent review.

Linked gallery: Photos: Health Informatics Conference 2011

Implementation of the Cerner FirstNet CIS began in 2008, and was expected to improve information management in more than 200 emergency departments across the state.

But clinicians resisted the change, leading NSW Health Minister Jillian Skinner to engage Deloitte consultants earlier this year for an independent review.

A NSW Health spokesman this week said that the Director-General was currently considering a draft report from the review.

“As with all major IT projects, there have been implementation issues,” the spokesman said.

“It is expected that the review recommendations will lead to a comprehensive program to address issues raised in the review process.”

The review included consultation with University of Sydney academic Jon Patrick, and Sally McCarthy, president of the Australian College of Emergency Medicine.

In March, Patrick published a 190-page analysis of the FirstNet roll-out, including feedback from emergency department directors and software performance experts.

McCarthy told the Health Informatics Conference in Brisbane on Tuesday that 98 percent of clinicians’ feedback in the Deloitte review was negative.

The CIS displayed information in non-intuitive ways, called for irrelevant inputs (like asking if a male patient was pregnant), and was unstable, she said.

She added that FirstNet had decreased the productivity of some senior staff by up to 40 percent, and redirected doctors’ attention from patients to a computer program.

Clinicians also complained of a lack of support that caused change requests to take “months or sometimes years to resolve”, McCarthy said.

Patrick explained that Cerner had designed the software so that any surface-level changes also required changes to be made at a structural level.

“It’s unmanageable,” he said. “Staff don’t know where to make a change, administrators afraid to make a change because documentation is unreliable or out of date.

“It’s [NSW Health service provider] Health Support Services and Cerner that come together and create the problem. Everyone loses despite what the technocrats say.”

‘If you don’t vote, you don’t get to complain’

Cerner executive Judy Van Norman said she was not involved in the NSW deployment, but speculated that too few clinical staff participated in the design process.

She told the conference that successful e-health “clinical transformations” required changes to be made to an organisation’s technology, culture, practices and workflow design.

Change should be led be an executive leader, dedicated clinical leaders, stakeholder champions and informal leaders, and supported by strong governance processes, she said.

“Sometimes the people who are most vocal are the people who didn’t invest their time and then show up later and want to shoot holes in the decisions that were made,” she said.

“I call that a ‘if you don’t vote, you don’t get to complain’ kind of syndrome.”

NSW Health’s spokesman said FirstNet was selected “using a process led by clinicians and actively involving clinicians who would be users of the system”.

FirstNet has been deployed in nearly 60 NSW hospitals to date, and managed information about admissions, vacant beds, patient waiting times and the availability of medical test results.

It was part of stage one of the state’s electronic medical record (eMR) program, which aimed to replace paper records with online records about a patient’s care in hospital.

“Unlike the earlier emergency department standalone IT systems, the FirstNet software requires more clinical information to be entered,” the spokesman said.

“This data now forms a foundation element of the broader electronic medical record for the patient throughout their care across the hospital and across care settings.

“It will also provide an essential contribution to the ability of the NSW eMR to interact with the planned national electronic health record through the provision of electronic discharge summaries and other care summaries.”

Stage two of the eMR program was expected to commence next year and extend the electronic system to outpatient and ambulatory care settings.

Implementation of a new critical care clinical information system would also commence in 2012, together with the first phase of electronic medication management.

Antony Sara, CIS director of the South Eastern Sydney and Illawarra Area Health Service, noted that issues with the FirstNet module did not extend to other eMR program aspects, including Cerner’s SurgiNet and PowerChart products.

However, he noted that “times of change is when errors happen”, and called for electronic and paper forms that “look the same in content and flow”.