Thank you, Madam Chair and committee members, for the opportunity to speak before the Standing Committee on Health today. I'd like to first take a moment to introduce myself. My name is Branden Shepitka. I'm a registered nurse by training, with a clinical background in emergency and trauma care. Currently I'm the emergency department electronic health record project lead at Health Sciences North, Ramsey Lake Health Centre. In this role, I'm responsible for the development and implementation of an electronic health record within our hospital's emergency department.
I also maintain a clinical practice as a sexual assault nurse examiner with our hospital's violence intervention and prevention program, and I'm clinical faculty with the Laurentian University school of nursing. I have previous experience as a board of directors' member of the Canadian Nurses Association and have been previously the president of the Canadian Nursing Students' Association.
Health Sciences North, Horizon Santé-Nord, is a 454-bed academic health sciences centre based in Sudbury, Ontario, affiliated with the Northern Ontario School of Medicine, Laurentian University, Cambrian College, and Collège Boréal. Our emergency department is one of the busiest in the province, providing care to approximately 63,000 patients each year, and is one of only 11 hospitals in the province of Ontario designated as a lead trauma centre.
Our facility is also a founding partner of the North Eastern Ontario Network, which is a consortium of 22 hospitals within the North East Local Health Integration Network, who share an integrated patient record strategy to allow seamless delivery of health care services within northeastern Ontario.
As part of this vision, each facility has adopted the MEDITECH electronic health record system. While system-wide cost savings have been realized through our participation in the North Eastern Ontario Network, there have been a number of areas where significant cost has been incurred or will be incurred in the future related to our transition to an electronic health record.
Our current implementation is happening in two phases. Our phase one originally was supposed to go live last month. However, we've delayed until the fall. That includes nursing documentation and clerical documentation. Phase two will occur next spring, spring of 2014. That will involve physician documentation as well as computerized physician order entry.
I'd like to highlight a few areas where we have incurred additional costs that were not expected at the beginning of the project. The first of such areas is in physical infrastructure. Although our facility only opened in March 2010, it has become evident through our implementation process that the facility was not designed for electronic practice. Our emergency department lacks ethernet connections and power outlets for additional computer workstations, and we're now having these installed post-construction at significant cost over what would have been incurred if installed during initial construction. These additional costs take into consideration the need for work to occur during nighttime hours to limit interruption to department operations and stringent infection control procedures required during construction in a patient care environment.
Related to physical infrastructure is also the ability to implement clinical tools to support electronic practice. A systematic review of the literature published in 2009 in the Journal of the American Medical Informatics Association supported the use of mobile, handheld technology in facilitating rapid response, medication error prevention, and data management and accessibility. Our original implementation plan included the deployment of wireless devices for use by physicians and nursing staff for bedside documentation and patient data access. However, through an analysis of our infrastructure, we determined that our facility did not have a clinical-grade wireless system and that a multi-million dollar investment, approximately $2 million to $3 million, would be required to upgrade even just the emergency department to be able to have a wireless network and actually use handheld devices. We're now having fixed computer workstations installed throughout the department, which is a barrier to clinical adoption by both our nursing staff and our physicians.
As part of our implementation of electronic documentation, as I mentioned, we're also proceeding with a computerized provider order-entry system, where physicians and nurse practitioners enter their own orders in the computer, negating transcription and interpretation errors.
A study published in the 2006 Journal of Healthcare Information Management examined the effects of implementing computerized provider order entry and nursing documentation on emergency department nursing workflow. It found that a majority of nursing staff felt positively about the efficiency provided by electronic documentation templates, leaner processes for non-nursing interventions such as diagnostic imaging, and increased clarity of physician orders. However, nurses also commented on additional required functionality that would improve workflow. These solutions increase clinical adoption of the system but also have the potential to incur substantial capital and ongoing maintenance costs, in terms of both the software and hardware implementations and human resources.
At our facility we're currently investigating a number of solutions, including third-party clinical content to enhance documentation, interfacing systems to integrate patient vital sign information directly into the patient record without it having to be entered separately by the nurse, solutions to allow for proximity-based computer sign-on to secure patient information, order sets to improve clinical workflow, and evidence-based patient discharge instructions to improve continuity and quality of patient care.
Through implementation we've discovered that while many of these systems require a significant investment in order to implement within one department of an organization, only a small additional investment in comparison is required to expand the implementation throughout the entire facility. However, mechanisms and funding are not currently in place to support these capital purchases throughout the organization.
Another area of cost that we've encountered is in software cost. In addition to our expected costs—the capital purchase of our electronic health record module and software licensing fees—we've had many unforeseen costs. These costs are for items including software upgrades to medication-dispensing machines to allow integration with an electronic medication administration system, and custom functionality requests from our health record vendor. These custom requests were extremely unexpected. Our initial thought was that when we purchased the health record module it would allow us a great deal of the functionality we required. However, as we began building and testing the system, we found a number of areas where a lack of functionality in the system posed a threat to either clinical adoption or patient safety.
Canada Health Infoway has been a key driver of Canada's transition to electronic health record systems; however, areas for growth in the world of health informatics in Canada exist. Even within individual institutions, a divide continues to exist between health informatics, clinical and information technology staff, and between the teams managing individual modules of the electronic health record. Essentially, we are still functioning in silos, although the clinical users and the IT users really do need to work together to make a system that both works on the back end for data collection, data analysis, as well as being functional for clinical end users.
Mechanisms should be advocated for that allow for collaboration and best practice sharing between individuals across organizations, and also a more integrated strategy must exist both internal to and external between organizations in their development of electronic patient records in order to ensure continuity of care both within institutions and between communities.
Additionally, funding should be targeted toward supporting capital purchases by organizations to upgrade infrastructure related to electronic practice, so that transitioning to this practice model does not lead to inefficiencies, increase in workload, and disruption of workflow for health care practitioners.
The benefits of electronic health record systems are numerous, but a large amount of funding for capital purchases and human resources are required for a proper implementation to meet clinical needs.
Thank you again for this opportunity to speak.