IT systems still causing a headache at Fiona Stanley Hospital
IT systems are still causing problems for clinicians and patients at WA's Fiona Stanley Hospital, with the patient entertainment system, cardiac telemetry system, slow clinical and administrative software and an overloaded IT helpdesk singled out in a new report into the flagship hospital's short but chequered history.
An independent review was commissioned into the hospital's clinical services and patient care earlier this year after a string of controversies, including claims of contamination of sterilisation equipment that saw outsourced operational partner Serco stripped of responsibilities.
There were also a series of complaints about the quality of patient care, inefficiencies in the delivery of care and an unexpected volume of patients turning up at the new hospital's emergency department.
Incredibly complex IT systems were a major reason the opening of the $2 billion facility was delayed, with what was once touted as the country's first fully digital hospital still running on a hybrid paper-electronic system.
The independent review of operational clinical and patient care at FSH, carried out by the Australian Commission on Safety and Quality in Health Care (ACSQHC), MMK Consulting and former WA Health consumer council executive director Michelle Kosky found that problems were still bugging both the clinical IT – managed by the health department – and non-clinical functions such as the helpdesk, managed by Serco.
It was taking clinicians up to 15 minutes to open up all of the applications required in the BOSSnet digital medical record (DMR) to admit and manage a patient as it has not yet been fully integrated, the review found.
BOSSnet currently provides direct data entry through eForms including an admission form, integrated progress notes, team conference/multidisciplinary team notes, nursing risk screening tools and assessment forms.
It also allows access to electronic documents received from other clinical systems used at FSH and critical alerts from the webPAS and TOPAS patient administration systems, as well as allergies alerts sources from the statewide Notifications and Clinical Summaries (NaCS) system.
“As yet, the multiple applications that form the DMR are not fully integrated so clinicians cannot easily move from one application to the next,” the review found.
“Currently, to open all applications within the DMR to admit and manage a patient takes approximately 15 minutes due to the integration issue.
“Problems were also reported with the DMR’s inability to put an alert on the system (warning about an impending potential issue e.g. a reaction to a type of drug or the need for the patient to be seen urgently); this was seen as a safety and quality issue.”
Staff also told the review team there were concerns that work on fixing some of the problems would be delayed as the same ICT staff will be needed to work at the new Perth Children's Hospital, which is due to open next year.
The children's hospital is set to open with BOSSnet as the DMR before it is replaced by a full EMR, a tender for which was released last year.
The hospital will also receive webPAS and a number of other state-wide applications as part of WA Health's stabilisation strategy, announced in May.
COWs and PES
The bedside patient entertainment system (PES) was also causing problems for patients and staff. The new PES has an iDiet software application that allows patients to order their own food.
Elderly patients and patients with disabilities found the PES difficult to use and some were unable to order meals. In a number of cases, late food orders could not be processed or patients received inappropriate food, the review found.
The bedside PES also allows clinicians to enter notes into the DMR. However, clinicians have found it difficult to navigate and most clinicians said they preferred to enter clinical data on the computer on wheels (COWS).
Technology changes are also an issue in outpatients, where it can also take in excess of 15 minutes to open all the software to manage the patient’s notes., the review found.
“One of the significant improvements for patients moving to FSH is the allocation of a specific appointment time for their outpatient treatment rather than being seen within a 4-hour session. This change has been well received by the patients and the clinicians.
“However, there appears to be no alert or triage system within the outpatient booking system to allow urgent patients to fill consultations over routine or less urgent patients. This has meant that general practitioners and specialists have had difficulty scheduling timely and appropriate consultations for the sicker more urgent patients."
There also seems to be a major problem with the cardiac telemetry system, which is intermittently failing and requires specialist nursing staff to monitor cardiac patients in person.
The hospital cannot work out whether the fault is with the network services installed by BT, electronic equipment installed and maintained by Siemens or the Philips telemetry system.
The Serco-managed helpdesk is also causing a headache. The helpdesk handles a range of services including IT support, telephony, equipment finding, maintenance management and patient and relative enquiries.
“The number of calls exceeded expectation and the complexity of the tasks required of a person unfamiliar with the hospital setting proved distressing for families, carers, staff and others trying to navigate the system.
“The load on the Helpdesk has been diminished by better internal hospital use of the hospital intranet, and internal ‘paging’ (Wi-Fi and phone calling). Staff expressed concerns that the Helpdesk was continuing to have difficulty triaging calls to the appropriate service within FSH.
"There was also a perception from both staff and patient’s relatives that the Helpdesk is overly concerned about patient confidentiality and privacy, hindering legitimate attempts to contact patients and relatives. A careful review of the confidentiality policies within FSH is suggested.”
WA Health's acting director general, Bryant Stokes, said the review highlighted areas for improvement around clinical and patient care.
Professor Stokes said he had met with the FSH executive team to discuss the problems and had been assured that work is underway to implement the recommendations as soon as possible.
“Patient care is always the top priority and this review will assist Fiona Stanley Hospital (FSH) management to improve their systems and policies,” he said.
“While I acknowledge that Fiona Stanley Hospital has had its challenges, it is a world class facility, delivering high quality and safe care for the population of Western Australia.”
Posted in Australian eHealth