Some Nova Scotia health-care workers say they feel unprepared and ill-trained for the expansion of the province’s new medical records system on Saturday, and they fear that could impact patient care in the weeks to come.
The One Person One Record (OPOR) system was launched at the IWK Health Centre in December, and is scheduled to launch this weekend at all hospitals in the province’s central zone, which includes the Halifax area, the Eastern Shore and West Hants.
OPOR combines more than 80 different programs that are used in Nova Scotia hospitals, and will impact the workflow of every employee in the health-care system. Everything from blood work records to food service requests will run through the system when it’s fully implemented across the province.
Nova Scotia Health officials say they expected a transition of this size to be bumpy, but have said there have been no serious patient harms since the records system was launched at the Halifax children’s hospital five months ago.
However staff have raised the alarm about potential patient harms, including a possible connection to the death of an unborn baby.
CBC News has spoken to a number of frontline workers about their concerns about OPOR in recent weeks, and is not identifying the employees because they fear repercussions at work. All of those who spoke to CBC News say they believe the new medical records system has potential, but they believe staff and the program aren’t ready for the expansion.
“They [Nova Scotia Health] have a deadline and they want to meet it,” said one employee. “We are more concerned about patient safety.”
CBC News has also obtained a letter through a freedom of information request, written by an IWK doctor whose name is redacted.
The letter, addressed to Health Minister Michelle Thompson, and Karen Oldfield, the interim CEO of Nova Scotia Health, said the toll on patient care after the OPOR rollout at the children’s hospital was unacceptable.
The doctor lists several examples, including a situation where staff were so unprepared, they couldn’t figure out how to use the program to transfer a woman in labour to the operating room for an urgent caesarean section.
“The patient ended up having a vaginal delivery that was contraindicated because nobody could figure out how to follow the convoluted steps in the system to ‘book an urgent CS’ and transfer the patient into the OR,” the physician wrote.
Dr. Krista Jangaard, the president and CEO of the IWK, said she could not comment on the exact scenario described by the doctor, citing patient confidentiality.
“What I can tell you—what was clearly stated when we went live and throughout the last five months—is that care comes first, so that in any case if a patient needs to have care, care is delivered and you worry about documentation later,” she said.
The doctor’s letter cites several other concerns, including unplanned downtime of the system, missing test results for group B streptococcus, and the loss of prenatal ultrasound requisitions.
“This is not acceptable,” the doctor wrote.
“I can no longer tolerate being told to ‘be patient’ if it’s at the cost of patient safety, well-being and taxpayer dollars.”
Health-care workers in the central zone describe significant gaps in training with incomplete practice modules, and virtual sessions with international trainers who do not know Nova Scotia’s health-care system.
“I’m young and technically competent and this scares me,” said one employee at the QEII Hospital in Halifax.
“The training modules were useless, they weren’t shaped to my job in any way, shape or form.”
As of Wednesday, one employee said the section to order insulin for patients had not yet been built and she could not practice the workflow.
Two health-care workers described to CBC News multiple ways to do common tasks like sending requisitions, but only one worked correctly. They said taking the wrong approach would “send the information into the abyss” and give no indication to the sender that the information wasn’t received by another department.
The NSGEU said feedback from the health-care workers it represents is so concerning, the union wants to delay the OPOR launch in the central zone. NDP Leader Claudia Chender and Liberal Leader Iain Rankin have also called for a delay.
The Nova Scotia Nurses Union, however, said it is impressed with how the system has evolved at the IWK.
Nova Scotia Health Minister Michelle Thompson is on vacation and not doing interviews. The provincial government sent a statement to CBC News, reiterating the potential of the program.
“We know the initial implementation has been challenging for physicians, teams and providers and created some concern among patients,” the health department said.
“Change is not always easy, but we have every confidence that our clinicians have the skills, resilience and persistence to achieve success.
“If there were a situation where urgent care was needed, it would be provided.”
N.S. family wants answers about baby’s death before OPOR rollout
Tanya Nixon, Nova Scotia Health’s vice-president in charge of OPOR, said significant changes have been made to training in response to feedback from IWK staff.
Nixon said Nova Scotia Health staff have access to an abundance of materials including videos, tip sheets and workflow documents to help bring staff up to speed.
“When we went live in the IWK, we were building those and creating those at the same time we went live.”
Employees wearing purple vests will be tasked with providing additional, on-the-ground support as the system rolls out.
She added that the OPOR version the province bought is not a custom model, so it’s normal to evolve. Nixon said staff can expect to see changes after it goes live. She’s encouraging staff to file IT tickets if they spot gaps or workflow issues.
“There is some level of reticence given the magnitude of the change, people are largely saying though what they know now is substantially more than what they knew 90 days ago,” Nixon said.
“Most of them are saying to us we should just press go and get started.”
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