One of Queensland’s largest hospitals was given the green light to upgrade its electronic medical record despite a last-minute change owing to potential patient safety risks.
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The $600 million integrated electronic medical record (ieMR) is designed to allow all clinicians at all of Queensland’s public hospitals access to patients’ medical records, regardless of which hospital they are in.
The Princess Alexandra Hospital in Woolloongabba was selected in 2014 to be a stand-out example of how the software worked, with Queensland Health investing major resources into getting the software, purchased from US medical giant Cerner, up and running.
A Brisbane Times investigation has uncovered multiple instances of clinicians raising serious patient safety risks within the integrated electronic medical record with Queensland Health.
A Queensland Health spokesman said the “complex” PA Hospital rollout of the integrated electronic medical record involved linking information between more than 50 systems.
“Integration challenges are expected and anticipated; and the appropriate action to rectify any problems through the diligent work of clinicians, technical experts and vendors is part of the well-managed process,” he said.
In February 2017, consultants Ernst & Young were contracted to complete a final check on the integrated electronic medical record's advanced modules before they “went live” in the PA Hospital.
The advanced modules involved medication management, known as MARS (medication and research support).
The final report, released under Right to Information, found the PA had a “strong culture of patient safety” and the ieMR project was clinically led and endorsed.
In a positive summary, Ernst & Young found the PA had a “high level of confidence” in the project and lessons had been learned from previous installations of the ieMR.
The report gave the rollout a “green” status as ready to go live if issues raised in the report could be resolved.
However, one component of the release – an automated drug storage cabinet in each ward that communicated with the ieMR to dispense the right medication for the right patient – was pulled at the last minute.
The automated drug cabinet, known as Pyxis, was not installed in the hospital, because the interface between it and the ieMR was not operating correctly, which the Ernst & Young report warned could be a patient safety risk.
The Queensland Health spokesman said ultimately Pyxis was not installed at the PA.
“[Pyxis] is not a component of the Digital Hospital rollout but a local project which aimed to improve stock management,” he said.
“A decision was made to reduce the impact on the hospital by not implementing two IT systems at the same time.”
Pyxis is not owned by Cerner, but is sold by another US medical technology company, BD.
Ernst & Young found there were numerous defects still to be resolved, including the issues with Pyxis, before the “go live” date six weeks after the review was conducted.
“A large number of defects were uncovered during the testing of the Pyxis interface,” the review team found.
“It is noted that the issues may not be resolved in time for the [ieMR] release go-live date.”
The report said work-arounds for not having Pyxis installed were arranged.
While Pyxis had been installed at other hospitals successfully, the Princess Alexandra was particularly complex as it required intravenous fluids and infusions to be added to the drug cabinet.
“These fluids are infused based on complex sets of calculations, failure of which can cause patient safety risks,” the report said.
Other problems with the installation included “[terminals] potentially displaying information of an incorrect patient,” and medical devices not communicating with the anaesthetics module, SurgiNet Anaesthesia, according to Ernst & Young.
“Anaesthesia and device association issues were identified before the Gateway Review and were resolved ahead of go-live by using fixed IP addresses in key areas with installed bedside monitors,” the Queensland Health spokesman said.
The hospital also needed to manually upgrade its 80 “downtime viewers”, the hospital’s back-up computers that allow doctors to access seven days’ worth of patient medical records if the servers hosting the entire ieMR shut down for any reason.
Ensuring the downtime viewers were upgraded before “go live” was critical, according to the Ernst & Young report.
The spokesman said routine maintenance and auditing of downtime viewers was conducted weekly.
The “advanced” electronic medical record modules went live at the hospital weeks later, in March 2017, under the leadership of eHealth Queensland’s then-chief executive officer Dr Richard Ashby.
Dr Ashby resigned in January this year after allegations of an improper relationship, which Queensland Health director-general Michael Walsh referred to the Crime and Corruption Commission.
The CCC was already investigating eHealth Queensland in 2018.
Ernst & Young’s review of whether the hospital was ready to “go live”, completed over four days, was delivered to Dr Ashby as the senior responsible officer for the project.
The Ernst & Young review team also found there was not enough statewide co-ordination to manage health information data – a risk that “will only increase as further sites take on [ieMR advanced]”.
A brief section in the report on the contract between Queensland Health and Cerner found there were “no substantiated issues”.
The report noted Queensland Health and Cerner had recently reviewed the contract and agreed on what had been delivered to date by Cerner, and established an “outstanding scope register”.
“The review team understands that both parties have agreed to a path moving forward up to the completion of the Digital Release,” the report said.
