The Sydney University Professor who criticised NSW Health’s emergency department (ED) software for what he saw as systemic failings, has released a new document containing a wish list of what clinical staff hope for in a new or improved system.
The document is a summary of the issues raised in interviews conducted with seven directors of NSW emergency departments.
Security is a major complaint that has been raised by administrators and staff alike, with the report claiming that staff perceive their medico-legal obligations to be under threat.
“[There are] login issues that lead to computers being left logged on so anyone can work under someone else's identity, and concomitantly where the writer of a document is not separately identifiable from the reader of a document, and letters can be changed by the non-author and there is no record of the change or the second author” Professor Patrick writes in the report.
Useability is also a major issue, with Patrick reporting that staff often find ways to work around the system, sometimes reverting to paper records as a last resort.
“Reviewing this compendium of difficulties and obstacles created for staff makes it entirely unsurprising that the patient throughput of most EDs dropped by 50% on the day FirstNet was introduced and now some years later throughputs are only just beginning to recover as staff have been able to instigate work practices to minimise the worst aspects of the system,” he says.
For example, he reports, “a different source of error in dealing with the EMR [Electronic Medical Record] occurs with the shifting display on the tracking list that can mislead staff as to which patient record they are actually working on causing them to enter content onto the wrong patient record”.
From his research, Professor Patrick has compiled a ‘wish list’ of the capabilities that emergency department staff want to see in the system that they use. This list will be mandatory reading for any ICT vendor working within the health sector.
The wishes include:
- Search functions such a free-text searches, searches by diagnosis and patient filtering;
- Recalling of historical patient views;
- Alphabetical list sequencing;
- Recognition of staff member’s roles and the change of display in accordance;
- Identification of research candidate patients;
- Nursing alerts;
- A daily issues list;
- Improved reporting functions;
- Presentation of KPI’s; and
- Rationalisation and correction of the contents of the SNOMED coding system.
In addition, Patrick claims that there is little hope amongst those he interviewed that relatively small NSW hospitals will be able to attract the attention of the software vendor, Cerner.
“Programming problems that have to be referred to the vendor are considered by our informants to be irresolvable as the small Australian user base has little influence over the vendor’s work programs compared to the demands of the large North American user base,” the report said.
However a spokesperson for NSW Health’s shared services unit Health Support Services (HSS) told Intermediumearlier in the month that contact was being made regularly with Cerner.
“We are working with Cerner on issues relating to the configuring of software to better support our clinicians and to make the system easier to use in patient assessment, treatment and documentation. We are also meeting with Cerner about future software changes and enhancements,” she said.
The spokesperson also asked that the views of the seven directors be viewed against the backdrop of 75,000 clinicians who have been trained in the system to date.
“We dispute the claim that the system is ‘widely hated by clinical staff’. We argue it has been an effectively implemented tool to speed-up diagnosis for patient care and is baseline to ongoing e-Health initiatives,” she said.
The FirstNet System forms part of the Electronic Medical Record initiative at NSW Health. There are two contracts published on tenders.nsw.gov.au for this project, one which expires in 2013 and another which expires in 2014.