Our South Island MSA Quarterly Meeting is coming up next week, and we’re looking forward to having a great conversation with the IHealth team. We’ve submitted the following questions to them, which they’ll address at the meeting. If you have other questions, let us know or join the meeting. RSVP here.
Is there an opportunity to introduce a component of CPOE like medical imaging prior to medication?
- Staff can experience some wins with CPOE and not become overwhelmed with too much change at once.
- Based on an informal meeting with Mary Lyn Fyfe, this may be possible (Jan 31 conversation). The Emergency Working Group has considered this, and has flagged that unforeseen problems could set a negative tone for the whole rollout.
- It can also be argued that identifying and fixing problems in advance would enhance the changes of success with the full roll-out.
- There’s an opportunity to leverage Nanaimo’s work here: It is already up and running, and would not be a big change for local implementation.
- IHealth specialty leads for MI (Jeffery Hu) and Emergency Medicine (Drew Digney) would need to be on board.
What is the education and support plan for physicians who work intermittently in the hospital setting?
- Locums and FPs who do not have much opportunity to use CPOE may require re-education if they work one week every 12.
- This is an issue of retention: Locums who find themselves overwhelmed by CPOE may choose to not return to Island Health sites.
What will the education and onboarding of new physicians look like?
- A year in, some physicians are still relying on ClinDoc refreshers.
What is the basis for not allowing NUAs to enter orders as proposed orders for physicians to sign off on?
- If nurses can submit a proposed order, why couldn’t NUAs do it also?
- Currently in Emerg, verbal orders are entered by NUAs. This is not currently the case on the wards where verbal orders need to be entered by nursing.
- If NUAs aren’t allowed to, they will have to rely on RNs, who are already working hard.
- Enabling NUAs to enter proposed orders will lighten the load on locums, who would otherwise be highly challenged by CPOE.
Will there be enough PharmTechs?
- IHealth has been given the green light to hire more PharmTechs to support the CPOE rollout at RJH and VGH. Our understanding is that they have based the number of techs required on the model used in Nanaimo
- Posting is an important step and we are grateful that this concern was heard but it is possible there will not be enough applicants to fill these positions.
What kind of elbow-to-elbow support can we expect when we go live?
- In Nanaimo, go-live supports were computer savvy and could help connect to a printer, but knew nothing about healthcare or Cerner.
- We need people who understand the context, who can support physicians to create orders, and who can sort problems out quickly.
What will surgery cancellations look like in anticipation of Go Live?
- Surgeons need to know ASAP so they can make alternate arrangements.
- The desired 85% hospital capacity will not be possible here.
We need to know more about the two-site plan, especially for the Hospitalists, ICU, and Surgery teams.
- How will transfers to and from other hospitals happen?
- Will the MAR be sent in a way that is up to date?
- There is an added level of complexity with transfers from community facilities, such as Seven Oaks.
How long will support be provided for?
- We hope there is recognition that the current environment and staffing levels will mean that the timeframe for a successful rollout will likely be longer and harder than ideal.
What are the plans for workstation maintenance?
What hardware requirements have been determined?
- When consultants come to the ED, all the computers are being used by ERPs and learners. What can be done to support consultants?
- What about physicians who are on call in various parts of the hospital?
What about WiFi bandwidth?
- If people need to bring their own computer, WiFi needs to be reliable in all places in the hospital. Will this be upgraded? How do we let you know about dead zones?
How do we handle differing expectations and assumptions with respect to lab orders?
- There was an issue in Nanaimo with respect to ordering urine samples, those being canceled by the Lab because nobody triggered collection of a sample.
- There have been examples where adding Ca+ to a bloodwork order triggers a new order, rather than adding the test on to an existing blood sample.
- Can we see pending orders?
How are the current Health Human Resources challenges being considered?
- What contingencies are in place for physicians, nurse, allied care provider, and IHealth team member attrition
Overall, what is planned in case things don’t go smoothly?
Will scribes be available? This may be a good approach for infrequent users. Would a telephone service work? What was used in the Lower Mainland?
How can we suggest improvements for ClinDoc? There is still room for improvement in ClinDoc in terms of user friendliness and system improvements.
Will dictation continue? It would be helpful for certain types of consults.