IT issues highlighted in home isolation deaths

eHealthNews.nz: Covid-19

Sunday, 28 November 2021

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NEWS - eHealthNews.nz editor Rebecca McBeth

Lack of integration and IT systems that are not fit for purpose are highlighted in a report into the “potentially preventable” deaths of two people in home isolation after contracting Covid-19.

The Northern Region Health Coordination Centre (NRHCC) commissioned the report into the Community Supported Isolation and Quarantine (CIQ) system in consultation with the Ministry of Health after a man died at home in Auckland on November 3. A second person died on November 5.

An independent review panel found there were “missed opportunities” that contributed to the deaths and the IT systems supporting the home isolation of Covid-19 patients , “have suffered from being unable to be either linked or effectively reconfigured to meet the priority needs”.

Also, “escalation pathways did not occur or function as planned, either for unclear reasons or due to software design issues”, the report says.

It recommends considering a “virtual ward round” model for the highest risk patients isolating at home and the NRHCC says it has since launched a Hospital in the Home initiative across all three DHBs, for cases needing a lot of health support.

The report says connectivity between all parts of the system is essential and clinical, welfare and other information that informs risk should be visible by the whole system from a common source.

“Supporting IT systems must be rapidly made fit for purpose with a focus on assessing and meeting clinical and welfare risks and needs,” the report says, adding that IT systems must ensure Māori particularly are not further disadvantaged.

"There is an absence of connectivity between the organisations providing different care and assessment functions," it says, describing each agency as 'blind' to the information in the other agencies systems.

It recommends that health information held in the Northern Region’s Clinical Portal and in general practice clinical records should be accessible to the clinicians and other teams doing an initial assessment of Covid-19 patients and ongoing health checks when they are isolating at home.

“Clinical support decision making tools should be embedded in the systems being used for screening of both inbound and outbound calls,” the review panel recommends.

A clinical acuity assessment tool has been reviewed and endorsed by the regional Clinical Technical Advisory Group and the panel says it should be urgently implemented.

The report says the re-emergence of Covid-19 in Auckland in August 2021 made community self-isolation “imperative and urgent” and the rapid increase in patients needing the service far exceeded planning and expectations, leading to the service being overwhelmed.

The report says the emphasis on technologies such as SMS, home oximetry, video conferencing and website-based information links is challenging for some patients who may struggle to access it due to low health literacy and lack of data or connectivity.

Patients isolating at home are given pulse oximeters to measure their oxygen saturation levels. However, one of the patients who died had difficulty using it, despite being given training while in hospital.

The Northern region chose to use the Border Clinical Management System (BCMS) software platform to manage patients isolating at home, but this was new to COVID Healthline staff and resulted in the loss of well-established “failsafe” features in the normal COVID Healthline platform called Odyssey.

“The COVID Healthline clinical decision software has been adapted for telephone consultation and the inability to use their familiar software (Odyssey) reduces the efficacy of the triage,” the report says.

There is no clinical decision software in BCMS to assess the severity of symptoms for patients with Covid-19 and the BCMS queue management system doesn’t automatically transfer details across to the nurses call back queues, posing a risk that call-backs could be missed, it says.

Northern Region Health Coordination Centre Lead Fepulea’l Margie Apa says the NRHCC accepts the findings of the report, which shows that more could have been done and needs to be done.

“The main lesson is the need for improvement, which is what we are all committed to achieve,” she says.