More pain for Fiona Stanley Hospital as AMA lashes ICT
A senior doctor and Australian Medical Association WA branch representative has lashed the ICT capability of Fiona Stanley Hospital (FSH), telling a parliamentary inquiry that the electronic patient record frequently crashes, support for IT applications is inadequate and discharge summaries being issued to GPs are “appalling”.
Ian Jenkins, an intensive care specialist at FSH, director of ICU at Fremantle Hospital and chair of the AMA (WA) inter-hospital liaison committee, said there were also grave concerns over inadequate bed numbers, inadequate staff and a lack of stability in management positions at the hospital and within WA Health.
In a written submission to the parliamentary inquiry into the transition and operation of services at FSH, Dr Jenkins outlined the findings of a survey of 668 doctors about aspects of the commissioning and operation of the hospital.
Almost 60 per cent said the commissioning had been handled poorly or very poorly, with 71 per cent saying the resolution of operational issues that have arisen since its opening have been handled poorly or very poorly.
Sixty-seven per cent of senior doctors and 55 per cent of junior doctors felt that new systems at the hospital have led to patient care and safety being compromised.
Sixty-eight per cent said they did not feel that IT systems were assisting in providing efficient, high-quality care to patients and only 26 per cent felt that the outpatients department was functioning to a desirable standard.
The submission follows the findings of an independent review of the operational and clinical care at FSH, carried out by the Australian Commission on Safety and Quality in Health Care (ACSQHC) and MMK Consulting and released last month.
It found that IT systems such as the the patient entertainment system, cardiac telemetry system and clinical and administrative software were causing problems for clinicians and patients, with the BOSSnet digital medical record (DMR) taking up to 15 minutes to open up the applications required and the outpatients booking system also causing problems.
Dr Jenkins' submission named IT as the first area of concern, saying that BOSSNet had caused a “significant reduction” in efficiency.
“It is untried in major Australian hospitals, is supported by a relatively small company, does not interface as installed with all the other applications and frequently crashes or freezes on users,” he wrote.
“Should the vendor not be able to continue to support there is severe clinical risk, as transfer of information to a new application will be difficult, time-consuming and expensive.”
Dr Jenkins said support for IT applications through the “interwoven labyrinth” of Serco, the outsourced provider that is in charge of non-clinical IT, Health Information Network, the WA Health agency in charge of clinical IT, and ICT infrastructure provider BT “is often tedious to obtain and slow to produce results”.
“There was inadequate training in use of the new systems and inadequate support on site during commissioning.
“Outages are extremely frequent – when notifications of 'planned' outages are given it is with 15 minutes to about eight hours' warning – hardly planned.
“A review of the Health Department's ability to provide modern effective healthcare applications to new and redeveloped sites is desperately needed.”
Dr Jenkins also harshly criticised the lack of engagement with GPs, saying there had been “a shameful neglect” of the vital role primary care plays in keeping patients with chronic disease out of hospital.
“[No] engagement with the primary care sector in the catchment area and the issuing of appalling discharge summaries – appalling because of poor ICT applications and because of enormous workload thrust upon junior medical staff,” he wrote.
“The AMA would welcome meaningful engagement and dialogue in this area – it can only reduce costs, reduce admissions and improve patient safety and outcomes.”
WA Health Minister Kim Hames told the ABC that while there still some problems with the ICT, he believed the problems raised by Dr Jenkins had been addressed.
"But as soon as they happen, they are high priority, fixed straight away and it's not an issue for the staff," Dr Hames said.
"I think the efficiency of the [IT] system is 80 to 90 per cent and that it's working very well in most instances."
Under a stabilisation strategy developed by WA Health earlier this year, the same systems will be rolled out at the new Perth Children's Hospital and other redevelopments. The new Midland Hospital, due to open in November to replace Swan District Hospital, is using different systems.
BOSSnet, developed by Adelaide-based Core Medical Solutions, has been used successfully by Barwon Health in Victoria for many years and has also been rolled out at Epworth Healthcare in Melbourne.
Fiona Stanley was originally planned to be Australia's first fully digital hospital, but the complexity of its best-of-breed IT systems and their estimated 158 different interfaces not only delayed the opening of the hospital but have had to be significantly scaled back.
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