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Nova Scotia

Nova Scotia hospitals move to fully computerized health records with One Patient One Record

The Nova Scotia government is spending $364.5 million to purchase a fully computerized clinical information system that the Secretary of Health says will “transform the way healthcare is delivered in Nova Scotia.”

Oracle Cerner Canada has been awarded a 10-year contract after five years of bidding with two shortlisted bidders. Cerner will design, implement and maintain an electronic patient record system called “One Patient One Record” or OPOR at IWK Children’s Hospital and all provincial hospitals.

It is expected to take two years for the first three hospitals to convert to OPOR.

Dartmouth General, Cobequid Community Health Center and the yet to open Bayers Lake Ambulance will be the first hospitals to receive the system. However, the ability for a doctor anywhere in Nova Scotia to access a single program to view their patient’s X-ray or test results from a Halifax hospital could be up and running within 10 months.

OPOR was officially launched on Wednesday, and Health Secretary Michelle Thompson was keen to detail some of the “rewiring” changes.

“For years, doctors and nurses and allied health professionals have been telling the government that the current models for collecting and sharing information rob them of valuable time that they could be spending with patients,” Thompson said.

“And for years, patients have complained that they have to go through their medical histories and medication lists with multiple providers on multiple occasions in the same hospital on the same day. You are both right. Unfortunately, we use 20th-century methods such as the telephone and fax machine and paper documents to record and share patient information. And many of the IT systems are old and fail or cannot communicate 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 proposed investing in.

Over the next 10 months, healthcare professionals at major hospitals in the Halifax area will be trained on how a single clinical information system can be used to replace nearly 100 programs or apps that are currently running.

A white male with gray hair, glasses and a dark suit is asking questions in a conference room.
dr Steve Lownie Credit: Jennifer Henderson

dr Steve Lownie grew up in Nova Scotia and was educated at Dalhousie Medical School before moving to Ontario to complete his residency in neurosurgery.

“I worked in Ontario for 37 years and returned to Nova Scotia in July 2020. I had left what happened to be a Cerner system at the London Health Sciences Center and I was grieving. I felt like I was going back in time,” Lownie told reporters.

“I had to use different apps on the hospital network to look at x-rays and lab results. There were delays, I was held up in my work, it was stressful. But I learned and am now back to using a system like the one I used in London almost 20 years ago.”

“I’m probably one of the few doctors in the room who saw the introduction of CT scans, the introduction of MRI in 1989. This is the biggest thing since the MRI. This is a turning point that will be great for the people of Nova Scotia.”

Lownie said patients will be at less risk of medical error once handwritten notes by doctors to record their case and prescribe medications are eliminated. Lownie claimed the medical error rate dropped by 50% during his time at the hospital in London, Ontario.

A paper with handwritten notes and a photo of two ambulances in front of a hospital.
An example of a doctor’s notes. Credit: Jennifer Henderson

Restrictions for the brave new world

For at least the first two years of the planned four-year rollout, GPs and patients will have limited access to OPOR. Think of it as kind of a one-way street. For example, GPs and online doctors working at Virtual Care Nova Scotia will have standardized online forms available through OPOR for referral to specialists and ordering X-rays.

Nursing practitioners and physicians at collaborative community clinics and at walk-in clinics can enroll in a single OPOR program to view a patient’s bloodwork or MRI test results. Currently, they need multiple passwords to access multiple programs, which is a time saver.

But what general practitioners with OPOR for several years cannot and will not do is input their own horoscope observations and patient comments.

“We know that GPs will not be in this initial phase of implementation with OPOR, but I can say that this will be the desired state going forward,” said Dr. Christy Bussey, Executive Medical Director for Central Zone (HRM). ).

“We have to stop working on paper. We need to get into a digital way of care. The importance of OPOR right now is that our acute care systems are failing. We know that and as doctors we experience it every day.”

According to information from Nova Scotia Health at Wednesday’s briefing, hospitals — and doctors and nurses — have had 18 days of downtime over the past year due to outages of computerized applications that OPOR will replace.

Add to that the staff (IT support) time and money required to maintain “more than 30 systems considered critical or in poor condition” that are at risk of crashing or being hacked .

Nova Scotia is the ninth of ten provinces where Oracle has implemented Cerner Canada OPOR. His experience in similarly sized regions suggests that the time savings resulting from fully computerized health information should result in a 10 percent reduction in the average length of hospital stay. If this 10% reduction is realized, it could free up enough hospital beds to treat an additional 7,000 to 9,000 patients.

Nova Scotia Health also predicts that time savings after implementing OPOR at all Nova Scotia hospitals could improve outpatient clinic access for an additional 500,000 patients per year.

No system is perfect

Oracle Cerner claims it is the world’s largest provider of electronic medical record systems for hospitals. The Nova Scotia Secretary of Health and a team from Nova Scotia Health visited Vancouver General Hospital last November to see firsthand what happens on day one as a major hospital transitions from paper to electronic medical records. Cerner provided the clinical information system.

According to Thompson, “It was quiet” and uneventful, helping her convince her that with the right preparation and leadership, an effective transition could take place here.

Of course, like any company, regardless of size, Oracle Cerner is not infallible. Over the past two years, Cerner’s electronic medical record system installed at several Veterans Affairs-run hospitals across the United States has experienced repeated problems.

“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 September 8, 2020 and June 10, 2022,” read the August release Article.

The EHR system was only fully offline for 40 hours but had “incomplete functionality” for 930 hours. The FedScoop article states that Veterans Affairs was responsible for at least a third of those outages, while Oracle Cerner was responsible 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 the introduction of OPOR will be a key tool in recruiting much-needed doctors and nurses who are used to working in hospitals with modern clinical information systems. Nova Scotia is one of only two provinces where emergency rooms still rely on paper maps.

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