Over 100 members gathered online and in person recently to hear updates on Cerner and CST: how it has rolled out at VGH, UBC Hospital, and various clinics, as well as its future. Dr. Raheem Kherani, chair of the VPSA CST Task Group, Dr. Eric Grafstein, the chief medical information officer for Vancouver Coastal Health and Providence Health Care, and Dr. Vinay Dhingra, the physician lead for CST at VCH-Vancouver, gave presentations, followed by a Q&A session. Other members of VCH’s CST team were on hand to help answer questions including Dr. David Wilton, Dr. Stephen van Gaal, and Laura Mc Evoy.

VMDAS/VPSA President Dr. Ka Wai Cheung started off the meeting by noting that this CST focus was at the request of members and thanked everyone who submitted questions ahead of the meeting. These were forwarded to the CST team for inclusion in their presentations.

VPSA CST Task Group update – Dr. Raheem Kherani

Dr. Kherani reviewed the task group’s past and current activities. Committee members continue to meet monthly with VCH CST medical leadership and channel VMDAS members’ concerns to them for action. He noted that everyone is working co-operatively to move things forward.

The task group’s upcoming activities include supporting the deployment at GF Strong. Members are also advocating for the establishment of a digital health committee. This will help in the long-term sustainment of CST. The group will continue to collect and solicit feedback for improving CST and will also keep leveraging our communication streams to build awareness of tools and supports available to improve the medical staff’s experience with CST.

These activities tie in with VPSA’s new strategic plan. For instance, providing meals during deployment at GF Strong along with optimization sessions will meet the goal of promoting a thriving and healthy work environment to enhance member well-being. Likewise, establishing a digital health committee will improve member engagement and influence with VCH leadership.

Dr. Kherani invited feedback from in-person and online attendees during his presentation. Using the audience interaction tool Slido, the following information was revealed:

• 65 per cent of respondents had used Cerner prior to VGH’s go-live date.
• 59 per cent use Cerner across more than one site (e.g., acute facility, ambulatory clinic).

CST and the end of the beginning presentation – Dr. Eric Grafstein

Dr. Grafstein began with a look back at all that has been accomplished. CST Cerner has now rolled out to 50 sites and 400 clinics. After Richmond Hospital’s go-live, more than 50,000 users will have been trained and provisioned. Each month, approximately 900,000 provincial lab results are pulled into CST Cerner patient charts and about 4.1 million patient records have been brought into our EHR system.

He remarked that the VGH and UBC go-live events have been largely successful and the implementation relatively easy thanks to medical staff who worked hard to make this happen.

Current provider priorities for the system are:

• Communications – a strategy is needed.
• FESR – it is missing the mark and not effective enough.
• Image capturing

All three of these areas are being addressed. He acknowledged users concerns and angst but expects members to be happy with the solutions.

Dr. Grafstein said that while we may be at the end of the beginning, we’re actually just at the starting line. In the near future we will see the impact of generative AI on health care including easier document creation, ordering, and scheduling. These will make a fundamental change to the way electronic charts exist.

Status update: Problems, Governance & Engagement – Dr. Vinay Dhingra

Dr. Dhingra began by expressing his heartfelt thanks to VMDAS/VPSA for their assistance with the CST rollouts. He described the collaboration as a partnership guided by shared principles. Dr. Dhingra got involved with the project in the first place because he believes it is important to have physician voices at the table.

Clinical informatics specialists played an important role in deployments to date and Dr. Dhingra hopes to see these people embedded in our system; they are VCH employees and are here for the long term. They assist with:

• Troubleshooting and investigating issues from VCH staff.
• Escalating issues for decisions.
• Requirement gathering, design, learning, and adoption at upcoming VCH sites.
• Support workflow optimization, care pathways and localization effort.
• Translation of requirements to design.
• Options analysis related to design requirements.

They have responded to 7,635 VGH special issue tickets and a further 659 at UBCH. Over 7,200 of the VGH tickets have been resolved, with 429 open and in progress. Only 69 tickets at UBCH remain open and in progress; the rest have been resolved. Questions continue to be submitted as the system is sustained.

CST is a standing agenda item at the monthly Vancouver Medical Advisory Committee meetings. Other ongoing meetings include the Specialty Working Group, CCOAT, Clinical Informatics Steering Committee, CST Clinical Steering Committee, CST Provider Working Group, and the Medical Informatics Council.

Providers seeking additional training with Cerner can take advantage of four types of in-person classroom sessions that are available weekdays between 8:30 am and 4 pm. These include a one-hour general workflow review, a one-hour specialty-specific workflow review, 30-minute to one-hour ad hoc learning sessions, and a half-hour personalization session. You can sign up for sessions here.

 Q&A session

Attendees were asked to input their questions via Slido and to upvote questions others had listed that were also a priority for them.

The need for better training was identified or at least to reassess how training is done. Right now, it is site specific, but specialty specific may be more effective. Dr. Grafstein commented that the team is thinking of a new strategy to meet needs. Dr. Dhingra added that more thought also needs to be put into how new staff are onboarded.

A desire for greater flexibility to make changes was expressed. Dr. Dhingra reminded people that there is already a lot of personalization available that most people aren’t using. There has been a lack of optimization in this area system wide.

A top concern was updates to FESR. Dr. Grafstein apologized, especially to psychiatrists, and said it has taken far too long to implement improvements. Other systems are being considered but he is not sure at this time how much a difference they will make. He is committed to finding something this year to make lives better or to at least to demonstrate that every effort has been made.

The CST team is collating all the questions including those that were not addressed during the meeting and will endeavour to answer them all.

The next VMDAS quarterly meeting will be Monday, May 13.

Attendee survey report summary

Twenty-one of the approximately 100 members who attended the event completed a post-event survey.

• 95% agreed that the meeting met its two objectives:
  • For CST leadership to provide an update regarding the progress of CST.
  • To provide a venue for medical staff to a have a dialogue with CST leadership to convey questions and comments.
• The event earned a -9.52 net promoter score.
• Comments included a desire for there to have been more time for questions and answers.