Health authorities have been warned behind closed doors that poor radiology reports across the central region are putting people’s lives at risk.
By Phil Pennington of rnz.co.nz
A new internal Health NZ report, obtained by RNZ, lists five common failures that threaten treatment, including serious conditions like cancer.
He says not once but four times:
“Probability of the event occurring – Certain. This event occurs frequently in the region.
“Impact/Outcome – High – Patient death or life-altering treatment delay could occur.”
In the report earlier this month, radiologists describe how dysfunctional computer systems lose information, fail to link vital reports together or become blocked, and how some staff are so “blasé” that they now resist “upgrades” because they never worked before. .
The problem comes from the radiological information systems (RIS) used by hospitals. These often fail to link all of a patient’s scans – which can mean the difference between a low-risk or high-risk diagnosis, doctors have reported.
The “alarming” risks have persisted for years in central Wellington, Hawke’s Bay and Manawatū, covering one million people, the report said.
Most other regions use a different type of RIS.
The radiologists told Health NZ that to their knowledge errors had always been detected and had not yet caused a “serious incident” – but that Te Whatu Ora needed to address them.
For the four main risks, all attempts at remediation have so far been ‘ineffective’.
“We currently have no clinically safe resolution,” the report said.
This is an example of legacy technology from the public health system playing out now; official reports said it would cost over $2 billion to fix nationwide.
RNZ has been told that hospitals in some cases have not helped themselves.
“The main problem is that the DHB (mainly Capital and Coast) has not brought its IT infrastructure online and has not done so for years,” a source said.
“They are not interested in potential improvements”
Technicians take the scans and use the RIS to send them in an electronic package to a radiologist.
This doctor relies on obtaining a complete set of analyzes to produce a unique and crucial report on what is wrong.
The report says each of the following events “occurs frequently in the area” and each is life threatening:
- Missing clinical results – multiple scans are taken of different areas of a patient’s body – but not all of them show up in the RIS. “No clinical results would be created/sent and therefore missed pathologies/diseases/traumas.” An example was given of a doctor who just noticed a chest scan that was not uploaded next to an abdomen scan; a lung nodule on its own only warrants inclusion on the six-month checklist – but paired with a tumor in the abdomen, the threat of cancer “changes significantly”.
- Delayed or missed communication of clinical results – Reports do not reliably and accurately reach the referring clinician and GP, leading to ‘confusion’ and possibly ‘delayed/missed treatment decisions’. Hawke’s Bay and MidCentral manually print each patient’s report, twice, at a cost of perhaps “hundreds of thousands of dollars” a year. Wellington Hospital is now manually searching reports from other districts on “every patient” to make sure everyone gets them.
- Outsourcing is stuck – Public hospitals rely on private providers to read and report scans, especially after hours and on weekends, but are too slow and uncoordinated to make deals – or bring down prices: “We are currently negotiating and have separate agreements across all districts with the same private providers.”
A fourth life-threatening risk that is listed as unreported, but nevertheless “certain”, is that:
- End users don’t speak – “The districts that have been on the [regional] RIS for a long time is extremely blasé and does not raise clinical risks which they claim have been clarified on several occasions “dealt with extremely long and unacceptable loading times for years without a solution.”
At Hawke’s Bay and MidCentral, clinical and operational managers had balked at a possible upgrade to a system (PACS) that is a subset of RIS: “They are not interested in potential improvements because, from their point of view, they’ve had nothing but bad experiences in ‘upgrades’ or changes.”
A fifth problem, the RIS slowing down or stopping, adds to the long public waiting lists. This contributes to scanners sitting idle, which is made worse when there aren’t enough radiologists to report results.
IT issues were making it much more difficult for Wellington to rely on private providers to do after-hours and weekend reporting, which could be hugely helpful, sources said.
Only one “somewhat effective” mitigation is listed, in an attempt to increase capacity; however, the remedy, “doing more in less time to catch up,” could not be sustained, the report warned.
The public system is faltering even as the private health-tech sector is booming, generating an estimated $2.85 billion in 2020.
Risks “mitigated by the tireless work of our clinical staff” – Te Whatu Ora
Te Whatu Ora declined to be interviewed, but in a statement said an “intensive effort” was underway to resolve the “flaws”.
“While some of the issues identified have proven difficult to resolve, any risk to patients has been mitigated by the tireless work of our clinical staff who manually check work lists and distribute patient reports,” said Jaco van der, director of the clinical radiology network of the central region. Walt.
“We are not aware of any adverse patient outcomes that may have resulted from the issues identified with the regional RIS.”
Health NZ acting regional director Russell Simpson said the problems largely emerged during a recent deployment in Wellington of shared regional RIS systems.
This goes against the radiologists’ report stating, “These risks have been present for a long time in many districts.”
Simpson echoed the report when he noted some recent gains made in system performance – although the report goes on to say that the approach to securing gains “is not effective” in an intense pressure environment.
Regional deployment to increase shared information has been suspended at Hutt and Wairarapa hospitals until the issues are resolved, Simpson said.
International Accreditation New Zealand (IANZ) accredits hospitals and can suspend them if services are not up to standard.
Chief executive Brian Young said he was aware of the clinical risks posed by RIS in the region, but he did not say when asked whether IANZ had accredited the various hospitals anyway. .
“Reviewing a provider’s RIS is a central part of all of our radiology assessments,” Young said.
“IANZ understands and respects the need to provide timely diagnostic images to all patients and, in the interest of safe patient care, works cooperatively with all providers to ensure effective management of potential nonconformities. before they reach the suspension threshold.
“It goes without saying that the ultimate desired outcome for everyone involved, including IANZ, is the safe and accurate delivery of results and the best possible outcome for patients.”
The region’s RIS is largely provided by Philips Health Systems, part of its legacy technology developed by Carestream, which sold its global health information systems to the Dutch multinational in 2019.
In a statement, a Philips spokesperson said it worked closely with Te Whatu Ora and clinical teams to resolve the issues.
“We are pleased that system upgrades and improvements are being prioritized and view this as a positive step towards mitigating these issues in the future.
“Patient safety and well-being are at the heart of everything we do at Philips. We will continue to support our customers and clinicians to ensure critical radiology services meet patient needs.