Bungled $35m e-health system RIVeR contributed to closure of birthing services in Cooktown, union claims
“Alternate solutions” will be considered to replace a bungled $35m Queensland Health IT project, amid claims the “debacle” contributed to the loss of medical expertise across Cape York and the closure of Cooktown’s birthing services.
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“Alternate solutions” will be considered to replace a bungled $35m Queensland Health IT project, amid claims the “debacle” contributed to the loss of medical expertise across Cape York and the closure of Cooktown’s birthing services.
A joint initiative between the Torres and Cape Hospital and Health Service (TCHHS) and the Cairns and Hinterland Hospital and Health Service, the Regional Information Via Electronic Record (RIVeR) system was funded in 2014 with the goal of providing a single, integrated electronic health record system for regional Far North Queensland – one of the most complex and complicated health care settings in the country.
But the project was beset by problems and controversies.
According to one doctor who quit their TCHHS posting in frustration, the software finally chosen to run RIVeR “was so flawed it could not be used as a single source of truth for patient care, resulting in parallel and duplicate clinical records”.
The doctor, who wished to remain anonymous, said Communicare – the platform ultimately used for the RIVeR project – was a significant factor in their decision to leave the TCHHS.
They said Communicare resulted in “huge patient safety risk”, “unacceptable medico-legal risk” and “significant workload increase on an already critically understaffed and fatigued medical team”.
They also said a toxic executive management team was unable to accept feedback or engage in good faith with clinicians over their concerns with Communicare.
“The debacle of Communicare was the last straw for me,” the doctor said.
In mid-2021, TCHHS chief executive Beverley Hamerton twice defended the rollout of the program, declaring it “fit for purpose”.
Earlier this month, the TCHHS board “supported in-principle the exploration of alternative solutions to RIVeR”.
According to an internal staff memo, that process is now under way, with eHealth Queensland now assisting the health service to engage a provider to prepare an Implementation Planning Study.
“A decision on a preferred alternative solution will not be made until the necessary consultation and consideration has occurred.”
However, it’s too little too late, according to Together Queensland senior vice president Dr Sandy Donald.
“The RIVeR project started with the best of intentions,” Dr Donald said.
Dr Donald said once the rollout began, it quickly became apparent that Communicare made already excessive medical workloads impossible.
“The software caused substantial delays in patient consultations, and demonstrated multiple flaws and omissions that had previously been identified,” he said.
“Key concerns were the inability to see a patient’s previous medical history, large numbers of investigations not being review, changes to patient prescriptions, and difficulty tracking what different healthcare workers had done.
“It was also noted that the software was sufficiently distracting and unhelpful in acute situations to create a real danger to patients.”
Dr Donald said it had taken an “extraordinarily long time to reach a point where the software had been officially recognised as unsuitable”, and that it had never been explained why software used by clinicians in the northern (Torres) section of the health service could not be rolled out in the southern region.
“The Communicare software, along with a frequently unsupportive and sometimes hostile management response has contributed significantly to the loss of so many experienced doctors from Cooktown,” he said.
“This in turn led to the cessation of birthing services in Cooktown.
“Together hopes that the Department of Health will ensure that replacement of the existing medical record is expedited, if necessary with the interim installation of the software used in the Torres.”
RIVeR was initially supposed to be delivered to 58 sites from the Cassowary Coast to the tip of Cape York, but was only ever rolled out to 28.
According to TCHHS acting chief executive Dean Davidson, recently-conducted site assessments confirmed the introduction of RIVeR had resulted in a number of positive outcomes at some sites, particularly for sites that moved from a paper-based patient record.
This was also the finding of an independent report by multinational advisory firm KPMG.
But the KPMG report also said stakeholders at more complex sites with increased interdisciplinary care, interaction and documentation were less satisfied with RIVeR.
A key example of that, the report said, was Cooktown.
Mr Davidson said each health service was planning a response to the results of the site assessments.
He also said employees would be kept informed as the TCHHS worked through the process of finding an alternative solution to RIVeR.
Cooktown birthing services update
TCHHS was unable to provide a definitive date for when birthing services will return to Cooktown, after they were suspended in February.
Mr Davidson said the health service understood the continuing suspension of birthing services at Cooktown Multipurpose Health Service was a stressful time for expectant mothers and their families.
“We are continuing to recruit to fill vacant clinical positions that led to the suspension of birthing services in February this year so we can reinstate a service that is safe and sustainable,” Mr Davidson said.
“While we are committed to returning birthing services to Cooktown, at this stage, we cannot provide a definitive date for the reopening of birthing services there.”
Mr Davidson said access to midwifery and medical staff for maternity services had been a statewide issue across Queensland and indeed, right across Australia.
He said all health services had faced significant challenges recruiting such clinicians, but said the TCHHS was using “every resource and network at our disposal to find suitable candidates”.
He said in the meantime, the dedicated staff at Cooktown had continued to provide unwavering support and a commitment to maintain continuity of care to the community.
“Antenatal and post-natal maternity services at Cooktown continue to be provided unchanged,” Mr Davidson said.
“The safety of mums and their babies is always our top priority.
“Birthing services will be reinstated at Cooktown when we can ensure the safe provision of care from a multidisciplinary clinical team for mothers and their babies.”
Mr Davidson said he wished to thank families in the Cooktown area for their understanding.
“Until birthing services can be resumed, women will be supported and recommended to relocate to Cairns or elsewhere for birthing,” Mr Davidson.
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Originally published as Bungled $35m e-health system RIVeR contributed to closure of birthing services in Cooktown, union claims
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