Analysis calls for greater clinical role in e-health
23 March 2011
A survey of IT experts by the University of Sydney lends further weight to calls to halt the rollout of the NSW Clinical Information System FirstNet, with a review finding the system should be spearheaded by an IT-savvy clinician.
The findings from Health Information Technology Research Laboratory director Professor Jon Patrick are based on interviews with software performance experts with experience of FirstNet. They build on previously released issues raised by the heads of seven NSW emergency departments (EDs).
Among a list of recommendations emanating from his study, Professor Patrick says the rollout of FirstNet should stop, problems with the software addressed and solved where possible, and IT-savvy clinicians given a greater role in developing NSW's e-health.
"If this situation is not rectified then the promise of the gains of the IT age for clinical care and a patient-centred service will be well and truly squandered," he says.
Professor Patrick, from the School of Information Technologies, says problems in areas such as ED workflow have arisen from FirstNet because the software was developed by engineers with limited understanding of its end use.
The configurability of the software makes it unnecessarily complicated, Professor Patrick says. "FirstNet's ability to be configured into numerous interfaces gives rise to unwarranted variability and confusion. A formally defined interface is required to ensure processes operate correctly and consistently, and the system retains data. It should properly record and present entries to users, and confirm completion of transactions."
Software experts also believe vendor FirstNet's vendor Cerner deals with bugs in the system by patching them up, without addressing their underlying cause, Professor Patrick says. They also call for more thorough validation of data imported from external sources such as medicine descriptions, through double entry keying and storage of information in a database management system that checks the veracity of input data.
Professor Patrick says the case of a patient being prescribed excessive insulin demonstrates the need for greater clinical input. "Electronic ordering should contain safety mechanisms such as the use of clinically accepted item descriptions, not definitions set by IT specialists.
"These findings don't discount the value of software engineering but the system needs a more singular focus on clinicians, who should be treated as the system's clients."
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