The Nova Scotia government is spending $364.5 million to buy a fully computerized clinical information system the health minister said “will transform the way health care is delivered in Nova Scotia.”
Oracle Cerner Canada has been awarded a 10-year contract after a five-year courtship the province had with two short-listed bidders. Cerner will design, implement, and maintain an electronic health record system known as “One Patient One Record” or OPOR at the IWK Children’s Hospital and all provincial hospitals.
It’s expected to take two years before the first three hospitals switch over to OPOR.
Dartmouth General, Cobequid Community Health Centre, and the yet-to-open Bayers Lake Outpatient Clinic will be the first hospitals to get the system. However, the capability for a doctor anywhere in Nova Scotia to access a single program where they can view their patient’s x-ray or test results from a Halifax area hospital could be up and running within 10 months.
OPOR officially launched Wednesday and Health Minister Michelle Thompson was eager to describe some of the “re-wiring” changes.
“For years, doctors and nurses and allied health care professionals have been telling government that the current models for collecting and sharing information are robbing them of valuable time they could be spending with patients,” Thompson said.
“And for years, patients have complained they have to go over their medical history and their list of medications, with multiple care providers on multiple occasions in the same hospital on the same day. They’re both right. Regrettably, we’re using 20th century methods like the phone and fax machine and paper charting to record and share patient information. And many of the IT systems are old and failing or incapable of communicating with each other.”
OPOR is “one of the most important tools we have to improve patient care and patient outcomes,” Thompson said, adding it’s also one of the data-driven tools the federal government has suggested it could be willing to invest.
Over the next 10 months, health care professionals in major hospitals in the Halifax area will receive training on how to use a single clinical information system to replace close to 100 programs or apps currently running.
Dr. Steve Lownie grew up in Nova Scotia and trained at Dalhousie Medical School before moving to Ontario to do his residency in neurosurgery.
“I worked in Ontario for 37 years and I came back to Nova Scotia in July 2020. I had left a system that happened to be a Cerner system at the London Health Sciences Centre and I was grieving. I felt like I was going back in time,” Lownie told reporters.
“I had to use several different apps on the hospital network to look at x-rays, to look at lab results. There were delays, I was held up in my work, it was stressful. But I learned and I am now back working with a system like I used in London almost 20 years ago.”
“I am probably one of the few doctors in the room that saw the introduction of CT scans, the introduction of MRI in 1989. This is the biggest thing since MRI. This a game changer that will be great for people in Nova Scotia.”
Lownie said that patients will be at less risk of a medical error once handwritten doctors’ notes to chart their case and prescribe drugs are eliminated. Lownie claimed the rate of medical error dropped by 50% during his time at the London, Ontario hospital.
Limitations to the brave new world
For at least the first two years of what’s targeted to be a four-year rollout, family doctors and patients will have limited access to OPOR. Think of it as a type of one-way street. For example, standardized online forms to make referrals to specialists and order x-rays will be available through OPOR to family doctors and online doctors working at Virtual Care Nova Scotia.
Nurse practitioners and doctors at collaborative community clinics and those at walk-in clinics will be able to log in to a single OPOR program to view a patient’s bloodwork or MRI test result. Currently they need several passwords to access several programs so that’s a time saving.
But what family doctors can’t and won’t be able to do with OPOR for several years is input their own chart observations and patient comments.
“We know that family doctors aren’t going to be in this first implementation phase with OPOR, but I can say that will be the desired state in the future,” said Dr. Christy Bussey, the executive medical director for Central Zone (HRM).
“We need to get out of working on paper. We need to get into a digital way of delivering care. The importance of OPOR right now is that our systems in acute care are failing. We know that and as doctors we experience that every day.”
According to information supplied by Nova Scotia Health at Wednesday’s briefing, hospitals — and doctors and nurses — experienced 18 days of downtime last year due to failures of computerized applications that OPOR will replace.
Then there’s the staff time (IT support) and money it takes to maintain “30-plus systems considered to be in critical or poor condition” at risk of crashing or being hacked.
Nova Scotia is the ninth of 10 provinces where Oracle Cerner Canada has implemented OPOR. Its experience in regions of similar size suggest the time savings that flow from a fully-computerized health information should result in a 10% drop in the average length of a hospital stay. If that 10% drop is realized, enough hospital beds could be freed up to treat 7,000 to 9,000 additional patients.
Nova Scotia Health is also projecting that once OPOR is implemented at all Nova Scotia hospitals, the time savings could improve access to outpatient departments for another 500,000 patients a year.
No system is perfect
Oracle Cerner claims it is the largest provider of electronic health record systems to hospitals in the world. Nova Scotia’s health minister and a team from Nova Scotia Health visited the Vancouver General hospital last November to see firsthand what happens on the first day when a major hospital makes the switch from paper to electronic patient records. Cerner provided the clinical information system.
According to Thompson, “it was quiet” and uneventful and helped convince her that with proper preparation and leadership, an effective transition could happen here.
Of course, Oracle Cerner, like any company regardless of size, is not infallible. Over the past two years, Cerner’s Electronic Health Records system installed at several United States hospitals run by Veterans Affairs has had some repeated issues.
“A dataset obtained by FedScoop through a Freedom of Information Act request shows that the Oracle Cerner EHR system had a total of 498 major incidents between Sept. 8, 2020 and June 10, 2022,” said this article published last August.
The EHR system was completely offline for only 40 hours but experienced “incomplete functionality” for 930 hours. The FedScoop article says Veterans Affairs was responsible for at least one-third of these outages while Oracle Cerner was to blame for the others. A more recent glitch at a Veterans Affairs hospital occurred last month.
Bussey and Dr. Leisha Hawker, the president of Doctors Nova Scotia, told reporters that launching OPOR will be a key tool in recruiting desperately needed doctors and nurses accustomed to working in hospitals with modern clinical information systems. Nova Scotia is one of only two provinces where emergency departments still rely on paper charts.