Island Health System Struggling with Cerner Transition

Health administrators in the province of British Columbia are struggling to implement Cerner’s electronic health records (EHR) system amid concerns about functionality and patient safety.

The British Columbia Ministry of Health has released a new report on the Vancouver Island Health Authority’s Cerner saga, which began with a formal agreement between the health system and company in 2012. Cerner tailored a version of Millenium for the health system’s needs, calling it IHealth, but its early years have been plagued with physician complaints and controversy.

The new report, conducted by consulting firm EY, interviewed dozens of front-line staff and considered hundreds of written feedback submissions and official documents. It also included a clinical panel of other Canadian health officials that have implemented Cerner technologies successfully in their institutions.

One of the major concerns had to do with drug ordering: It was too easy. Computerized physician order entry was supposed to be a major feature of IHealth, but early on hospital staff realized anyone with access could quickly order potentially dangerous doses of potent medications.

The new report included a survey of over front-line 600 staff, almost half of whom were nurses, is included in the new report. A majority reported that use of the system decreased the likelihood of safe patient outcomes, with more than a quarter (26%) saying it did so “significantly.” Combined, only 23% said the system “somewhat” or “significantly” increased the likelihood of a safe outcome.

Usability was another issue, and more than 50% reported that the system either “significantly” (30%) or “somewhat” (26%) decreases their personal productivity.

Not long after launch, many staff members spoke to media outlets about their dissatisfaction with the technology. In 2016, some physicians reported returning to pen and paper out of frustration and concern for patient safety, and in early 2017, the administration temporarily halted use of the system altogether.

While IHealth is in use at 2 other institutions—long-term care facility Dufferin Place and primary/urgent care center Oceanside Health Centre—much of the report and the complaints that prompted it center around Nanaimo Regional General Hospital (NRGH), a large acute care facility. Nearly 9 in 10 survey respondents worked at NRGH.

EY points to a strained relationship between NRGH staff and the Island Health administration as a factor exacerbating the issues. The report describes a “contentious relationship” over “service delivery models, funding allocations, autonomy, as well as previous challenges with implementing change at NRGH.” The president of the hospital’s Medical Staff Association reportedly said the system “was in a poor state of readiness” when the Cerner system was activated.

The project may run over budget, as well: initially a $50 million contract with another $124 million allotted for hardware and training, the system estimates it may need at least $50 million more to complete the project.

“While Cerner Millennium can be complex to use, it is accepted within the industry that it is one of the two leading advanced EHR system,” the report states. “An EHR is a tool, and other organizations have seen more broadly measureable benefits using Cerner Millennium after a stabilization period.”

Just across the border from British Columbia, the Department of Defense (DoD) and Department of Veterans Affairs (VA) are attempting to begin their transition to Cerner’s Millenium system at their facilities in the Pacific Northwest. At least 2 DoD facilities in Washington State have made the switch, and in November, VA officials requested a substantial appropriation of funds to follow suit. Unlike the DoD’s arrangement, however, the VA contract still hasn’t been finalized. Concerns about cost and interoperability are apparently holding up the deal.

Cerner announced the appointment of former Philips executive Brent Shafer as its new CEO last week. The company didn't immediately respond to a request for comment for this story.