Queensland Health rejects call to pause electronic medical record rollout

Doctors group meets with department over concerns

The head of Queensland Health has rejected calls by a doctors group to pause the rollout of a digital health record system across the state’s hospitals.

ABC reporter Josh Bavas revealed today that the Australian Medical Association of Queensland (AMAQ) had called for the rollout of the Integrated Electronic Medical Record (ieMR) to be put on hold while concerns over its operation are addressed.

In a statement sent to Computerworld, the AMAQ said it continued to be supportive of the digitisation of hospitals and health services.

“However, we have voiced concerns about the roll-out of Queensland Health’s Integrated Electronic Medical Record (ieMR) across public hospitals,” the statement said. “These concerns have been reported to us by doctors working in the public health system.”

The AMAQ said its e-health working group had raised its concerns with Queensland Health as they have arisen over the past 12 months, most recently during a discussion about the ieMR system with the department.

“These concerns centred on ieMR placing extra strain on an already overloaded IT framework, potentially impacting the delivery of health services and patient safety,” the group said.

“AMA Queensland has recommended Queensland Health pause the roll-out of ieMR to allow for doctors’ concerns around productivity and patient care to be resolved.”

A Queensland Health spokesperson said that independent research across hospitals already using the ieMR found the rollouts so far “have been a major success”.

“Since the ieMR was first rolled out, it has reduced the average length of stay, unplanned readmissions, and the number of serious falls and pressure injuries for Queensland Health patients,” the spokesperson said. “There has also been a notable reduction in medication errors.”

Queensland Health is working with the AMAQ to address concerns about the system, the spokesperson said.

“During the latest meeting on Monday 25 March, concerns raised by the AMAQ were either noted as resolved, required further clarification, or assurances/feedback was provided regarding the claims,” they added.

Patient safety and care have not been compromised, the spokesperson said.

It is not the first time that concerns over the ieMR, which is based on software supplied by US company Cerner, have been raised by Queensland health professionals. Last year 9 News reported that although a 2017 outage of the system was attributed to a ransomware outbreak, there was no evidence that was the case.

Earlier this week representatives of the AMAQ met with Professor Keith McNeil, assistant deputy director-general and chief clinical information officer, Clinical Excellence Queensland and Bruce Linaker, the acting chief executive of eHealth Queensland.

Following that meeting, Michael Walsh, the director-general of Queensland Health, penned a letter to the AMAQ, in an effort to address the concerns raised by the group.

In the letter, which has been sighted by Computerworld, Walsh responded to five concerns raised by the AMAQ. The director-general said that there had been a “significant investment” in Queensland Health’s network infrastructure “resulting in very high availability (99.99%), resilience and redundancy”.

“Ageing and end-of-life components have been replaced and by working with our carriers, round trip latency sits at a maximum of 100ms,” Walsh wrote. “Conservative thresholds have been set resulting in pre-emptive alerts being set off well ahead of any problems being experienced.”

All current ieMR sites have been upgraded prior to the system being rolled out, and on average the Cerner ieMR application is using 30 per cent of total capacity.

There have been no reported issues, such as capacity or latency problems, reported to eHealth Queensland over the last six months, Walsh wrote.

When it comes to alleged system lags and network failures the Queensland Health head said the department could not find any information in regards to an example raised by the AMAQ

Walsh wrote that an AMAQ council member who had reported problems had “been unable to provide any further details,” Walsh wrote. He said that Queensland Health would “commit all necessary resources to investigate” the problems when it receives details.

Walsh also addressed the issue of data lost in the Cerner Enterprise Schedule Management (ESM) system. He wrote that the issue had been “raised and resolved 3 years ago”.

“It was as a result of a table that was incorrectly marked for periodic purging,” Walsh wrote. “This table is no longer marked for purging and to our knowledge this issue has not reoccurred.”

He noted, however, that the AMAQ council member disagreed with this and said Queensland Health would investigate any “further specific information” he could provide.

The other two issues involve the loss of data from critical databases and a lack of visibility of digital safety alerts by frontline clinicians.

The loss of data was not addressed at the meeting between the department and the AMAQ.

“The Queensland Health technical experts are unclear as to what is actually being referred to,” Walsh wrote. “All data committed to a patient’s file remains in the file for life. All data is stored in the same database structure and run and maintained as one production integrated system. There are no separate databases.”

In respect to alerts he wrote that “any and all System Alerts are available to the treating clinicians, although are not distributed to individual clinicians as such”.

“Any alerts issued are distributed to [hospital and health service] digital distribution and clinical governance groups that are managed by the respective HHS,” Walsh wrote. “Professor McNeil has agreed to look further into his issue from the safety and clinical governance perspectives.”

Walsh said there was not any pressure for a site to go-live with the ieMR in a specific timeframe.

“Patient safety is our number one priority and indeed we have delayed some go-lives by a few days and up to several months where the HHS felt that they were not ready,” Walsh wrote. “The decision to go-live sits completely with the HHS and their staff.”

Queensland Health says it is on track to deliver an “ieMR with advanced capability” to 27 sites by June 2020. Currently it has 10 sites classed as “advanced” and three classed as “basic” or “intermediate”.

Earlier this year Queensland eHealth chief executive Dr Richard Ashby resigned, following allegations of an undeclared relationship involving an individual linked to the replacement of the state’s Patient Administration System (PAS). The PAS is separate to the ieMR, according to Queensland Health.

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