Child patients exposed to a safety risk after a key warning alert proved defective; sections of patient records spontaneously duplicating; medications incorrectly named and a statewide internet shutdown are just some of the issues that affected Queensland Health’s integrated electronic medical record in 2018.
Documents, obtained by Brisbane Times under Right to Information, reveal that more than 40 safety alerts about the integrated electronic medical record (ieMR) were sent to Queensland hospitals between January 2018 and January 2019.
A Queensland Health spokesperson said patient safety and care was always the department's number one priority and the ieMR "has not compromised this".
A team established by eHealth Queensland to coordinate and manage safety risks in the ieMR issued the alerts to inform hospitals that have installed the software of the actions they should take to address the issues.
The $600 million integrated electronic medical record is designed to create an electronic medical record for all Queensland patients that is available at all hospitals statewide.
However, a Brisbane Times investigation has revealed that clinicians and medical organisations have repeatedly raised issues with the software, which was purchased from US medical giant Cerner in 2011.
"Digital Patient Safety Notices proactively identify and communicate potential patient safety risks so that action can be taken locally to mitigate these," the spokesperson said.
In a statement, Cerner said "all matters in question have been resolved and no patient safety events have been reported to-date".
"We test all of our solutions in a non-production setting and certify and validate all results with the health system before moving changes into a live environment," the statement said.
A 2014 report by an independent consultant warned that the rollout of the ieMR's radiology and pathology components could have serious consequences, but Health Minister Steven Miles in January said some issues in that report had been addressed by the state government.
"[The] Queensland Audit Office found the system is improving patient outcomes," the department's spokesperson said.
"ieMR is a system that works, and it provides patient care day in day out; with numerous patient benefits from being in the care of a digital hospital."
Mr Miles said in February there had been no patient-harm incidents linked to the ieMR.
To date, 10 hospitals across the state have the ieMR installed, with the Gold Coast hospital expected to go "live” in April.
The safety notices detail software faults and errors, many following upgrades to the software from Cerner and eHealth Queensland, with some localised and others statewide.
In a March 27 incident, 107 child patients were exposed to a “temporary defect” after a scheduled change to the ieMR unexpectedly affected an early-warning tool.
The error lasted two-and-a-half hours before being reversed, during which time the ieMR might not have alerted doctors to patient deterioration.
“The 107 patients identified as exposed to this defect will be reviewed to ensure no clinical harm occurred,” the report said.
The report said the risk was "thought to be low".
Queensland Health did not respond to a question asking if any patient suffered clinical harm.
A July 7 alert warned that the weight entered for infant patients was not entering correctly, in a “rare” issue.
“There is currently no evidence that an incorrect or outdated weight is being used for a drug calculation however this is currently being investigated,” the alert said.
A second issue with entering weights was raised on July 27, 2018, warning that special instructions in a medication order “may be misinterpreted leading to a higher dose than prescribed being administered to paediatric patients”.
Another alert on July 31 advised the issue had been resolved.
On April 10, an alert warned that 832 medications had been altered in the system after a Cerner software update “corrupted” medications.
The 832 medications had their names changed, as were whether they were intravenous or oral.
The clinical implications were “potentially incorrect medication and fluid order details leading to patient safety risk”.
The backup system storing medical records, known as Downtime Viewer, was also affected.
Queensland Health did not respond to a question asking if any patients were affected, or if the error had been corrected.
On May 17, 2018, an “unexpected and significant statewide internet outage” was reported that affected all of the ieMR.
The statewide internet outage affected orders for radiology and pathology, and logged clinicians out.
Several hospitals switched to paper for radiology and pathology orders, and to maintain medical records.
An update the next day said delays were still being reported in all outbound orders from the ieMR to radiology and pharmacy.
“The root cause of the issue is unknown,” the alert said, adding that Cerner and eHealth Queensland were investigating.
Queensland Health did not respond to a question asking what the root cause of the issue was.
The shutdown occurred almost a year after a 2017 server crash that led to a root-cause analysis investigation.
That investigation report was released by Right to Information late last year, detailing that Cerner “disengaged” from the investigation and did not supply the correct logs to assist investigators to establish the cause.
A worldwide defect in Cerner’s systems was also discovered on March 12 last year, where if a computer had more than one patient chart open it could unexpectedly switch from one chart to another.
This meant clinicians could be entering data on one patient’s record and then suddenly find themselves entering that patient’s data on another person’s record.
Initially the issue was not found in Queensland.
“A change between patient charts without the awareness of clinicians could result in significant clinical errors including incorrect diagnoses, allergies or prescriptions, or clinical activity being undertaken on an incorrect patient,” the alert warned.
On March 15, hospitals were told the defect had been discovered in Queensland at several sites.
Clinicians were told to make sure they were entering data on the right patient record, and to report any incidents.
Queensland Health did not respond to questions asking how many patients had been affected by the incident, or if the issue had been fixed.
In October last year, an issue with duplication within patient records was reported.
Every time a patient goes to hospital an "encounter" is created in their electronic medical record, in which doctors and nurses enter all of their notes, prescriptions and treatment for that visit.
The October 10 alert warned that encounters were being duplicated within patient records, meaning clinicians could put data into a false copy of the real encounter.
The next day an update told hospitals that 301 patients across the state had duplicated encounters entered into their patient record.
The duplicated encounters meant that if a patient went through emergency, was discharged, and came back, the nurse couldn’t create a new emergency report for that patient.
The issue affected Cairns, Townsville, Mackay, Lady Cilento, Royal Brisbane and Women’s Hospital, and all Metro South hospitals with the ieMR installed.
“Clinicians should be vigilant when placing orders for radiology and pathology ensuring that tests are conducted and reports are returned to the correct encounter as expected,” the alert said.
An update was sent out on October 12 saying a fix had been applied, but three days later another alert said the duplication of encounters was still happening.
Two days later, another alert said Cerner had not yet been able to identify the root cause of the issue.
On January 15 this year, three months later, the issue was escalated to Cerner as a “high priority” after hospitals reported an increase in the number of duplicated encounters.
Queensland Health did not respond to a question asking if this issue had been resolved.
Other alerts sent to hospitals warned of medications set to be withheld from patients being re-set as “live”, risking medications being administered to patients incorrectly, and medications entered into the system not showing up correctly.
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