Directors of seven Sydney hospital emergency departments have damned NSW's $100m clinical information system FirstNet, blaming it for declines in the quality of patient care.
NSW Health's deputy-director general Tim Smyth denied the claims.
"We now have one of Australia's largest electronic medical record systems installed and it is part of a 10-year strategy," Smyth told ABC News.
"With all IT system installations, some people find it more difficult to use because they are used to the old system. That is just part of change in the health system."
Study author and University of Sydney Professor Jon Patrick said Smyth should explain the "26 pages of text" in the two-year study [zip file] that collated the experiences of seven emergency department directors with the FirstNet system written by US vendor Cerner.
"Somehow he has to explain [that]," Patrick told iTnews. "He's in denial."
Experiences
Only one of the directors surveyed in the study released at the weekend rated FirstNet's five-year rollout a "success" -- and that was because his Area Health Service managed its own deployment instead of relying on the software customised by NSW Health.
Directors complained it was overly complex, supplied no useful reports and led staff to short-circuit data-entry processes to spend time on patients.
"The time-critical aspect of completing all tasks in the emergency department is paramount in the clinical staff's eyes," the study found.
"They feel the FirstNet system wastes their time and adds a higher risk to the care of the patients without providing any gains."
Problems with FirstNet led hospitals to revert to paper records for clinical documentation "after many years of capturing this information electronically in their previous" iSoft EDIS system.
"FirstNet is much slower than EDIS v6, and it is even slower than doing it on paper," a director told the study.
Another said: "Now as they have gotten used to the system, [staff] have gotten faster, however they would be much faster if they didn't have it at all".
The report's theme was that EDIS was replaced with clunky IT that failed hospitals but that NSW Health and its IT shared services division, Health Support Services, did not care.
"NSW Health has made sure that [FirstNet] serves their needs," another director said.
"They operate on a mental heuristic that the system couldn't be as bad as the clinicians report or they make counter claims."
Directors complained of systematic failures: that the user interface was too cluttered; that it was easy to make data input errors that could take days for a team of specialist IT staff to rectify; and that system downtime was scheduled for weekends – the busiest time of the week for a hospital emergency department.
Other issues described by directors included:
- That trainers advised staff to "never use the save button" due to the errors it introduced. The vendor was allegedly unable to remove the button when asked.
- The system log doesn't differentiate between the writer of a patient record and a reviewer, making it difficult "to identify who actually saw the patient".
- It broke down patterns of work learned over many years – for example, the way pathology results were presented.
- Pathology reports have ended up in the wrong staff accounts – or at the wrong hospitals.
- Not being engaged in the definition of requirements for the FirstNet system. And directors said that Health Support Systems "had a strategy of convening meetings at short notice and then stonewalling requests so as to disenfranchise them". However, this was denied by NSW Health.
Directors interviewed for the study disputed the suggestion that critics of the system were "a group of recalcitrants who won't come in from the non-technological cold", saying their experience did not support that.
The study concluded the directors were "serious about doing the best they can at their jobs".
"[Health Support Services] on the other hand appears to have behaved in a manner that decries any respect for these sensibilities and any need for the ongoing development of methods and practice of evidence based medicine in Emergency Departments in NSW," the study found.
Read on to page two for Professor Patrick's proposed IT architecture overhaul.
Rigid IT
The study criticised the application of enterprise-wide IT systems in clinical settings, believing such systems were not flexible enough to deal with the different ways that clinical units worked.
"In clinical settings a crucial mistake is to assume staff can be coerced to do some particular work process," the study said.
"If it negatively affects their strategies for caring for the patient they will workaround it. So an enterprise system will fail if it doesn't serve the clinical need.
As enterprise systems technology is currently defined by relatively fixed ways of work processing they inevitably will be circumvented."
Professor Patrick said that part of the issue was a "clash of cultures" between NSW Health and clinical staff, although there was also a "deeper" IT architectural issue at work.
"There's definitely a real difference in attitude between Health and all the clinicians," he said, noting that other parts of the clinical community had also complained about FirstNet.
The study suggested an IT architectural overhaul via the creation of what he called a Generative Clinical Information Management System.
Such a system was "one where all information systems are generated from the one system and all data is known and understood across all generated systems.
"Under such architecture an emergent property is interoperability, that is, the system doesn't have to be designed for it. It is intrinsically achieved in each local system, which has the capacity to know about all information in all other systems when it is passed to them," the study noted.
Such a system also potentially dovetailed into another of Patrick's research focuses – natural language processing for clinical content.
"What we're trying to do is embed our language processing technology into clinical information systems," he said. "Otherwise, people can't use [these systems]."
In the meantime, Patrick saw the potential for the creation of an "inbetween world" for Health.
"If people are prepared to recognise issues with the current IT rollout, what they can do is improve them in the interim before we go onto the next quality improvement in technology," he said.
"[But] I think that's an open question."
