E-health revolution; Island doctors and nurses first in B.C. to have instant access to patients' histories

Times Colonist (Victoria)
Wed Dec 23 2009

Byline: Richard Watts

A state-of-the-art medical-information system is speeding up service and improving care for patients across Vancouver Island.

Doctors and nurses on the Island are the first in B.C. to have the ability to instantly access a patient's medical history, including hospital visits and prescriptions, through an electronic healthrecords system that, after a year of being in use, is saving time and money, and improving care.

If you've spent time in a Vancouver Island hospital since 2002, the e-health system will have a record of it. If you've had a medical test performed in a lab attached to one of those hospitals, the results will be there. In fact, if you've been treated at any of the 138 Vancouver Island Health Authority facilities on the Island (from hospitals to health units and seniors' care centres), doctors and nurses can pull up your history on a computer station.

"This electronic health-care record is a one-patient, one-record solution," said Catherine Claiter, chief information officer for the Vancouver Island Health Authority. It "contains all lab results,diagnostic images [X-rays] and records, transcribed documents like [consultation] reports,[operating-room] notes, discharge summaries, a complete medication profile."

It means that instead of a patient's medical history being stored on paper charts at various facilities -- with bits and pieces in each place -- the entire file is now accessible via computer at every facility.

Gone are the days when a doctor might have to interpret a patient's explanation about a previous visit to a different hospital. A patient might say, "I don't know what they did. They put me in a tube."

But now the electronic chart can tell the doctor the patient had a CT scan, not an MRI, and can even provide the resulting images.

"So many people have complex medical histories and they can't keep this information," said emergency room physician Dr. Jim Goulding, who says the system has improved his abilities "infinitely."

Previously, "you had to wait for an old chart and that old chart might be volumes of old charts and it could take you a half hour to find one piece of paper." The e-health system is unmatched by anything in the other four B.C. health regions.

None of them have one centralized records system, said Claiter and chief medical information officer Dr.Mary-Lyn Fyfe. Instead, data systems are often fragmented between communities and even individual hospitals have differing systems that can't link up.

Still, it hasn't come cheaply -- to date, it has cost about $67 million. The system began in 2001,with a project named VYSTA. After five years of software development and hardware purchases costing about $50 million, the VYSTA project had linked up the four South Island hospitals: Victoria General, Royal Jubilee, Saanich Peninsula and Lady Minto.

The subsequent rollout to the rest of the Island finished up in 2008 and cost $17 million.

While VIHA won't put a price tag on how much money has been saved through the e-health system -- VIHA chief executive officer Howard Waldner has only said it saves "millions of dollars" -- it is making a clear difference to staff workload. In particular, it frees up nurses to provide more direct care to patients -- studies show nurses spend at least 30 per cent of their days on the phone, chasing paper, or tracking people down looking for information.

Donna Saltman, operations manager for the emergency room at the Victoria General and a registered nurse, described the new bundling of information into one system as a "huge step forward."

"It helps plan the care in the emergency room, and it may influence in the future," said Saltman. Claiter and Fyfe also credit the system for eliminating "doubling up" of tests in separate facilities. If new tests are ordered, their results can be compared with older results.

And the system also works seamlessly with the provincial PharmaNet program, introduced in 1995 to link every pharmacy in the province and record all medications handed out.

"That's a big deal," said Claiter. "Oftentimes patients come in unconscious or they are not able to report to us what medications they're actually using, and now we can get one-click access.

"Previously it was phone calls, trying to get hold of a community pharmacy -- 'Can you look up on PharmaNet?' -- or even calling in a pharmacist to come and look it up," she said.

And the system overcomes geographic distances.

Previously, when a general practitioner on the North Island was seeking a transfer for a patient to a specialist's care in Victoria, there could be problems of language, terminology and even perception. The specialist would be demanding various test readings while the GP was leafing through stacks of paper.

But with the e-health system, both physicians can access a patient's chart at the same time and come to a more reasoned conclusion about care.

"A specialist will say, 'Let's both go on Power Chart, let's look at it,' " said Fyfe. "And then they say, 'You know what? This person is really sick. I agree with you. I'm going to pull out all the stops to make sure this patient gets transferred.'"

Claiter points out in conversations like this, "the data tells the story."

"In the non-electronic world, what could have happened in that situation is that record, that history, would have been locked in an office on a paper chart," she said. For privacy's sake, the data system is digitally locked behind multi-step computer firewalls, requiring various passwords and authentication. And it runs from a main server, secure, in an earthquake-resistant building.

The next step will be an electronic clinical documentation project to write up ongoing care requirements, outlining things like the potential for a patient to suffer a dangerous fall. That's expected to come in 2011, first in the new patient-care tower of Royal Jubilee Hospital and then on the rest of the Island.

The system doesn't yet include information compiled by general practitioners operating in private practices, but those GPs can log in from anywhere and take a peek.

rwatts@tc.canwest.com