Soaring costs, scarce resources and recurring system failures are stunting the progress of Manitoba's electronic health systems, say new documents that show the project could cost an extra $450 million and take up to 20 years to complete.
Documents obtained through a freedom of information request reveal Manitoba eHealth is "lagging" behind on its mandate to upgrade and co-ordinate existing health-care computer systems and implement electronic health records. The electronic records are expected to improve patient safety and make health care more efficient by making a patient's hospital, diagnostic and immunization information available through one record.
While the provincial government initially committed $150 million toward eHealth when it launched it in 2007, internal documents show the projected cost has nearly quadrupled to "$500 to $600 million and that this journey will take us between 10 and 20 years."
Internal status reports also raise concerns about recurring system failures that led to an estimated 187 hours of unplanned network shutdowns between October 2008 and September 2009.
A number of outages affected computers in "critical" patient-care areas, including emergency departments, radiology, home care and the WRHA's critical incident reporting system.
In a one-year period, documents show, there were 47 reported system breakdowns "which could have a significant impact to a service affecting patient care."
Health officials say the breakdowns were an inconvenience, but did not have any detrimental effects on patient treatment or care.
"It's going to take us an awful long time," said Manitoba eHealth chief information officer Roger Girard. "No one is happy with the timelines, but I for one don't believe at this particular time we could go any faster."
Girard said upgrading and implementing new technology are more expensive and time-consuming than they initially thought, in part because staff and resources are "scarce" in both health care and eHealth. Since they can only introduce new systems in pieces, Girard said they decided some old electronic systems will be used until they are completely at the end of their lifespan.
He said staff are prioritizing system upgrades in areas such as emergency, where they are working to create a single record so staff will know if a patient previously presented to two or three other ERs, for example.
Reports reveal only 46 per cent of eHealth applications are up to date, and a total of 30 per cent are outdated since "we do not have the money" to bring them up to date or someone decided not to upgrade them.
Girard couldn't specify which systems are out of date, but said they are generally "lower-priority" areas.
"The nurses and doctors that are working in the system are quite busy, and quite frankly only have the capacity to adopt change in bite-size chunks," Girard said. "Then we do have the problem of technical people having insufficient qualified people that actually do the work."
Dr. Diamond Kassum, eHealth's chief medical information officer, said health-care staff are concerned when computer systems unexpectedly shut down, since they have to revert back to manual systems. Kassum said staff practise using manual systems so they know what to do when outages occur.
He said there are procedures in place to avoid critical incidents if computer systems fail, and that he doesn't know of any detrimental impacts on patient care reported during outages.
"It's really just an inconvenience when it goes down, they have to go back to whiteboards and a manual system for triage," Kassum said. "It just slows down the processes in the emergency department."
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When did eHealth start?
The provincial government initially committed $150 million toward eHealth when it launched it in 2007.
What did the documents reveal?
Documents obtained through a freedom of information request show Manitoba eHealth is "lagging" behind. It is now estimated it could cost between $500 and $600 million and up to 20 years to finish the project.
What did officials have to say?
Manitoba eHealth CIO Roger Girard said the province is in the "middle of the pack" compared to other jurisdictions. Girard said Manitoba has only been working on eHealth projects for just a few years, while Ontario started work on similar projects 10 years ago.
Girard said implementing new technology is time-consuming and expensive, especially since staff and resources are "scarce" in health care and in Manitoba eHealth.
"We now believe that was a little understated," Girard said of the initial estimates. "It's expensive and you can't afford to do everything at once."
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What is eHealth?
A project to upgrade and co-ordinate computer systems to improve patient safety and make health care more efficient. For example, a patient's hospital, diagnostic and immunization information will eventually be available through one electronic record.
Without electronic records, a national non-profit group (Canada Health Infoway) estimates for every 1,000 hospital admissions,
- 75 people will suffer an adverse drug event;
- patients with an ambulatory encounter, 20 will suffer a serious drug event;
- laboratory tests performed, up to 150 will be unnecessary;
- emergency room visits, 320 patients will have an information gap, resulting in an average increased stay of 1.2 hours.
Autor(en)/Author(s): Jen Skerritt
Quelle/Source: Winnipeg Free Press, 29.06.2010
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