Health NZ radiologists warn of recurring central failure

Health authorities have received warnings behind closed doors warning that poor radiology reports across the central region are putting people’s lives at risk.

A new internal report to Health NZ, obtained by RNZ, lists five frequent failures that pose a threat to treatment, including serious conditions such as cancer.

Say not once, but four times:

“Probability of an event – ​​certain. This event occurs frequently across the region.

“Impact/outcome – high – patient death may occur or life change may be delayed in treatment.”

In the report earlier this month, radiologists described how dysfunctional IT systems lose information, fail to link vital reports together or congestion occurs, and how some employees are so “overworked” that they now resist “promotions” because these Never worked before. .

The problem lies in the radiology information systems (RIS) that hospitals use. Doctors report that these often fail to link all a patient’s examinations together – which can make the difference between a low-risk diagnosis or a high-risk diagnosis.

The report said the “disturbing” risks persisted for years in the central region of Wellington, Hawkes Bay and Manawatu, covering one million people.

Most other regions use a different type of RIS.

The radiologists told Health NZ that to the best of their knowledge, errors have always been detected and have not caused a “serious accident” so far – but that Te Whatu Ora must address them.

For all four major risks, all attempts at reform to date have been “ineffective”.

“We do not currently have a clinically safe solution,” the report said.

It is an example of the old technology of the public health system at play now; Official reports said the reform would cost more than $2 billion nationwide.

RNZ has been told that hospitals in some cases have not helped themselves.

“The main issue is that DHB (mainly Capital and Coast) has not aligned with their IT infrastructure and hasn’t done so in years,” a source said.

“They are not interested in potential improvements”

Technicians take the scans and use RIS to send them in an electronic package to the radiologist.

This doctor relies on getting a full range of tests in order to produce a single, conclusive report of what’s wrong.

Each of the following events “occurring frequently across the region” and each is life-threatening, the report said:

• Clinical results are missing Multiple examinations are performed for different areas of the patient’s body – but not all are shown in RIS. “No clinical result will be generated/sent, thus disease/disease/trauma missed.” An example was given of a doctor who just happened to notice an examination of the chest that was not loaded alongside an examination of the abdomen. Lung node alone warrants being put on the six-month checklist – but with an abdominal lump, the risk of cancer is “significantly altered.”
• Delayed or lost contact with clinical findings Reports do not reach reliably and accurately to the referring physician and family physician, resulting in ‘confusion’ and possibly ‘delayed/missed treatment decisions’. Hawke’s Bay and MidCentral print each patient’s report by hand, twice, at a cost of perhaps “hundreds of thousands of dollars” per year. Wellington Hospital now manually searches other district reports on a “patient-by-patient basis” to make sure everyone gets it.
• Outsourcing crammed – Public hospitals rely on private providers to read and report checks, especially after hours and on weekends, but they are too slow and uncoordinated to secure deals – or cut prices: “We are currently negotiating and have separate agreements across all provinces with the same providers own”.

The fourth life-threatening hazard listed as unreported, but nonetheless “confirmed”, is:

• End users don’t talk – “The areas that were in [regional] RIS has for a long time been so exhausted it does not raise the clinical risks that they feel have been demonstrated so many times. “It was only a two-week period earlier this month that Hawke’s Bay radiologists declined to raise loading issues,” the report said. I have dealt with extremely long and unacceptable load times for years now without a solution.”

At Hawke’s Bay and MidCentral, clinical and operational leaders rejected a potential upgrade to a PACS that is a subset of RIS: “They are not interested in potential improvements from their point of view, they have only had bad experiences with ‘upgrades’ or changes.”

The fifth problem, that RIS is slow or stuck, adds to the long public queues. This leaves scanning machines idle, and doubles when there aren’t enough radiologists to report results.

Sources said IT issues were making it very difficult in Wellington to use private service providers for after-hours reporting and on weekends, which could help significantly.

Only one “fairly effective” dilution has been included, to attempt to increase capacity; However, the report cautioned that treatment, “doing more in less time to catch up,” could not be sustained.

The public system is faltering even as the private health tech sector booms, bringing in an estimated $2.85 billion in 2020.

The risks were mitigated by the diligent work of our clinical staff – Te Whatu Ora

Te Watu Ora declined to be interviewed but said in a statement that “intense efforts” were underway to resolve the “flaws”.

“While some of the issues identified are difficult to resolve, any risk to patients has been mitigated by the diligent work of our clinical staff who manually check work rosters and distribute patient reports,” said Jaco van der, director of the Central Region Clinical Radiology Network. Walt.

“We are not aware of any adverse patient outcomes that may have resulted from the problems identified with the regional RIS.”

New Zealand’s interim regional director of health, Russell Simpson, said the problems emerged largely during the rollout of the joint regional RIS systems in Wellington.

This contradicts the radiologists’ report that stated: “These risks have been present for a long time in many areas.”

Simpson echoed the report when he noted some of the recent gains in system performance – although the report went on to say that the gains-locking approach was “not effective” in an environment of extreme stress.

Simpson said the regional rollout of increased shared information has been put on hold at Hutt and Wairarapa hospitals until the issues are resolved.

International Accreditation New Zealand (IANZ) accredits hospitals and can suspend them if services are not doing well.

CEO Brian Young said he was aware of the clinical risks RIS poses in the area, but did not say, when asked, whether IANZ had accredited the different hospitals anyway.

“Provider RIS review is an essential component of all of our radiology evaluations,” Young said.

“IANZ understands and respects the need for timely provision of diagnostic imaging to all patients, and in the interest of safe patient care works collaboratively with all providers to ensure that potential non-compliances are effectively managed before they reach the suspension threshold.

“It goes without saying that the desired end result for all involved, including IANZ, is to deliver results safely, accurately, and the best possible outcome to patients.”

RIS in the region is largely provided by Philips Health Systems, and some is from legacy technology developed by Carestream, which sold Global Health Information Systems to the Dutch multinational in 2019.

In a statement, a Philips spokesperson said they were working closely with Te Whatu Ora and clinical teams to address the issues.

“We are pleased that systems upgrades and improvements are being prioritized and see this as a positive step towards mitigating these issues in the future.

“Patient safety and well-being is at the heart of everything we do at Philips. We will continue to support our customers and clinicians to ensure critical radiology services meet patients’ needs.”