28 Sep 2022

Radiologist warns unreliable IT systems interfering with ability to diagnose

12:34 pm on 28 September 2022
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An internal report to Health New Zealand has highlighted poor reporting of radiology scans throughout the lower half of the North Island which is endangering people's lives. Photo: 123RF

A radiologist says IT systems vital to accurate scanning for patients are shutting down several times a day in at least one central region hospital.

"If you are trying to report the scans on a patient who has been brought in by helicopter after flying through the windscreen at 100kpm and currently has no blood pressure, to have to say, 'just shutting down and restarting my workstation' isn't acceptable," the consultant said.

The consultant, who RNZ has agreed not to name, said it was difficult to comment on the system without using rude "four-letter" words.

"If I had a dollar for every time I have flagged an error on this system, I could retire early," he said.

In an internal report on 12 September, doctors told Te Whatu Ora Health NZ the IT problems were interfering badly with diagnosing serious conditions, posed life-threatening risks, were longstanding and mitigations had not worked.

RNZ inquiries into those IT failings have revealed that radiology services at Palmerston North Hospital were suspended over a year ago.

"This is a staffing shortage and not an information technology issue," Health NZ responded.

Health NZ initially said no radiology services had been suspended at the hospital "in any way, shape or form" but then said they had been suspended last June, though patients were still getting scans because the work was being outsourced to private providers, paid for by the taxpayer.

International Accreditation New Zealand (IANZ) imposed the suspension and another one, at Southland Hospital radiology. That has been in place since 2014 "for multiple reasons" but not IT ones.

Though IANZ inspects and accredits radiology and medical testing labs it did not secure a copy of the report detailing high risks in radiology until after RNZ asked about it.

The report describes how radiology staff are so "jaded" some are resisting any upgrades because previous changes have not worked.

The consultant radiologist told RNZ they were all forced to invent "work-arounds" in a system that kept crashing.

"If you bought a car which periodically stopped while driving and had to be shut down and restarted to get it going again, you would take it to the dealer and say I want my money back," he said.

"But to have an imaging review and report dictation system which periodically stops working and requires total shut down and reboot several times per day is somehow acceptable."

He described spending five to 10 minutes reporting an IT problem and "then nothing happens".

"Thus all of us have developed work-arounds, all of which are slower than ideal, but work, albeit slowly," he said.

There were not enough skilled people to sort the IT problems, he added.

Waikato Hospital is introducing the same IT system as the central region.

"This technology is proven at scale internationally," Health NZ said, adding it was working closely with the vendor to implement and maintain the system.

Its internal report describes "alarming" risks where radiologists frequently see only some scans in the IT system, and not all of them for each individual patient, as well as IT logjams and barriers put in the way of specialists and GPs getting full scan reports.

Health NZ said it was working hard to fix the "flaws" in the central region RIS.

Sources told RNZ the RIS frequently failed to bring up previous scans from the archive, adding Wellington had had the worst problems.

Health NZ said a centralised platform had been rolled out in Wellington "with no disruption" though the region had problems. Integration work at Hutt and Wairarapa hospitals RIS has now been put on hold.

IANZ, referring to RNZ's reporting, said: "What is not being considered are the back-up systems and risk mitigation actions that have been put in place to offset the failures in the regional RIS project."

'Laborious and ineffective'

So how are the risks being mitigated?

Health NZ said on Friday that "any" risks to patients were being mitigated by "the tireless work of our clincial staff".

Yet its own report stated that for four out of the five clinical risks, the mitigation had been "ineffective".

Even where there was significant gain made in the last several months - to make up for lack of reporting - the work-around was "laborious and ineffective", the report said.

It relied on doctors "being vigilant" and "noticing" if scans for areas of a body were missing but they simply could not manually monitor "every referral and every request".

This was even more complicated if reporting on scans was outsourced to private providers.

"Even with sufficient resource, it would be laborious and ineffective as it relies on extended concentration on a high level of detail. The risk remains high.

"The underlying functional issues remain and we currently do not have a clinically safe resolution."

IANZ said if any one system failed it was "essential" to have support systems to ensure patient care was not compromised.

It said it needed to be satisfied that effective risk assessment and mitigation was in place with escalation to top executives, effective back-up solutions were available, risk monitoring was continuous and effective and progress was being made on fixing the problems.

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