Adrian Dix, British Columbia’s minister of health, speaks about recent report regarding the status of IHealth at a press conference in Nanaimo on Jan. 12. (Nicholas Pescod/NEWS BULLETIN)

UPDATE: Report finds ‘deep mismanagement’ of IHealth project

Minister of Health Adrian Dix was at Nanaimo Regional General Hospital discussing IHealth review

B.C. Health Minister Adrian Dix has announced he’ll appoint a mediator to help Island Health and medical employees at Nanaimo Regional General Hospital address issues with the controversial IHealth system.

“This is not a case of people having input and the health authority deciding,” he said, during a press conference Friday on findings of a review into IHealth. “The health authority will be a stakeholder in this process and it will be my expectation that people will come together and work through the issues here.”

The review by Ernst and Young is the second done by the province into IHealth and was launched last year to look at the costs, benefits and problems of the electronic record system that rolled out at NRGH in 2016.

A press release from the province said it’s clear there was deep mismanagement of the project, which was not properly planned or implemented with issues thought to be preventable if the health authority had leveraged advice from other Canadian experiences. It also stated the project is significantly delayed and facing serious financial pressures.

There have been concerns about IHealth by members of the Nanaimo Medical Staff Association since it began, including around patient safety and efficiency. A previous probe was done in 2016 and recommended improvements.

The observations of Ernst and Young in the latest report is that hospital stakeholders were not sufficiently engaged, consulted or trained to use the IHealth system and the hospital was in a “poor state of readiness from a people and process perspective” when the system was activated. A perceived “win at all costs” approach along with poorly executed implementation also caused users to react strongly against the system, according to the review, which states problems with the system cannot be solved without addressing “critical issues” with organizational culture and governance issues at the health authority and IHealth levels.

It also acknowledged there have been patient safety concerns, and determined the approved capital budget for the project was not fully funded with a shortfall of about $20 million.

The health authority expects it will cost $54.1 million beyond the original $174 million budget to finish the full project, although Ernst and Young believe the forecasted costs are based on assumptions that aren’t appropriate given the challenges experienced.

There are nine recommendations, including that IHealth continue at NRGH, but the report also says that until “NRGH is stabilized, a reasonable level of user satisfaction and acceptance has been achieved, and leadership has made meaningful progress towards addressing the cultural and governance issues, Island Health’s resources should be focused on NRGH rather than new acute sites.”

Island Health has intended to roll out the electronic health record system to other Island hospitals, including four acute care sites in 2018, but the review report says it cannot afford to have another activation like Nanaimo.

Dix describes the review as “quite devastating” and highly critical of how the system has been implemented in Nanaimo and Vancouver Island and told media that he accepts all of the recommendations.

A mediator will be named on Tuesday for a process that Dix calls a new way of doing business at NRGH.

“What’s changed is it’s not top down here. I am expecting people to work together and to come to solutions because I think what you see in this report is a sense that people had serious concerns that weren’t listened to and that the previous communications, regardless of who’s to blame … wasn’t working well,” he said.

Island Health administration, nurses, doctors and health sciences professionals will be brought together and with the help of a mediator, resolve problems identified in the review and reach consensus on how to move forward.

In an e-mailed statement, Island Health interim president and CEO Kathy MacNeil said the health authority agrees with the findings and recommendations of the review and supports the decision to appoint a mediator. She also pledged Island Health will do better by working with staff, physicians and other partners and that it’s committed to collaboratively addressing other recommendations with stakeholders.

“The review is clear that the system is not at the stage of implementation it should be, and it identifies areas where Island Health did not live up to our commitments – commitments to staff and physicians and, most importantly, commitments to our patients and their families,” she said. “There is no one person responsible – this is about the health authority as a whole. It simply wasn’t good enough.”

Dr. David Forrest, president of the Nanaimo Medical Staff Association, said the report validates the concerns medical and allied health staff have had about IHealth and most important to him is the offer to develop a mediated process to address fundamental issues, such as the relationship between staff, the health authority and ministry.

What he said is not known to him is how the system is going to be fixed and also made better to roll out elsewhere.

“I am not sure how the mediated process is going to lead to fundamental changes to IHealth, but I am hopeful that there will be some good, certainly, that comes out of this in terms of that relationship and addressing the culture,” he said.

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