Monday, June 08, 2009

Another Episode in the Series: HIT Failure

At "Indiana Power Surge" I wrote about the dangers of EHR "glitches" that do, but should not, cause catastrophic failure of clinical IT systems that clinicians are increasingly dependent upon to deliver healthcare.

Heart-lung machines, for example, do not generally have "unscheduled downtime" during surgery. It would not be tolerated.

With EHR's, though, here we go again:

June 6, 2009

Hospital stricken by computer glitch
Staff forced to keep records by hand



Concord Hospital CEO Mike Green said the hospital has been struggling for a week with computer system failures but, as of yesterday, everything was working again.

Green said the hospital was adding memory to its storage area network on May 28 and something went wrong - possibly because of faulty hardware or a bad installation. [It is remarkable that the cause seems unknown - ed.] In the days that followed, the systems that access that network began to fail.

Those used by nurses and pharmacists in the hospital and by providers to make orders for lab work [i.e., CPOE - ed.] and other tests crashed.

"People had to revert to paper processes," Green said. "It was a lot of work, particularly for pharmacists who had to do things manually that are ordinarily done by the electronic system." [The increased risk of error in the mayhem is not insignificant - ed.]

The systems that handle electronic medical records and financial information in physicians' offices weren't affected.

The hospital financial system, which processes about $1.5 million in charges each day, was briefly offline but quickly repaired, Green said.

He said staff members were working around the clock to correct the problems and to ensure that the quick shift to manual processes posed no safety concerns for patients [as I've written before, HIT crashes NEVER, EVER seem to present safety concerns - see "Health IT Failure Never Puts Patients at Risk" - ed.]

The systems are new, some installed within six months, and are state of the art for the industry.

"It's remarkable how quickly you become reliant on that technology," he said. [I'm not so sure what's remarkable about it when you get rid of paper. Clinicians have to record their orders, findings and observations, etc. somewhere - ed.]

Green said the issues highlighted the fact that some nurses at the hospital have only ever used electronic processes for keeping patient charts and don't have the experience of using manual systems to fall back on when the systems crash. The hospital plans to create training and procedural standards for what to do in case that this happens again. [Why in god's name wasn't it done before?- ed.]

Green did not have an estimate for how much the computer crash would cost the hospital, though he said it was something that would be accounted for through minor adjustments in the organization. He said patients were not likely aware of the problems.

"This was a painful learning experience," he said. "Between dealing with H1N1 and dealing with this, I am very confident in saying we are the best prepared hospital in the state to deal with any disaster." [This seems a bit of a non-sequitur. They apparently don't really know what went wrong with the IT, and they claim they're prepared to deal with any disaster? - ed.]

This organization recently won an award for IT excellence:

Concord Hospital’s Michael Green nationally awarded for leadership and commitment to utilize information technology to enhance patient care

January 22nd, 2009

Michael B. Green, president and CEO of Concord Hospital, has been selected as one of three winners of the CEO IT (Information Technology) Achievement Award by Modern Healthcare magazine and Healthcare Information and Management Systems Society. [HIMSS - ed.]

A panel of judges consisting of two CEOs and three chief information officers or IT experts chose three winners from a pool of 48 nominees. This year’s winners will be spotlighted in the February 16th issue of Modern Healthcare. Green is one of 18 winners of the award since its creation in 2003.

Concord Hospital’s Michael Green nationally awarded for leadership and commitment to utilize information technology to enhance patient care

This hospital is an IT award winner. I fear what's going to happen at hospitals with far less IT savvy deal when they deal with this increasingly complex and critical technology in coming years.

-- SS

6/19 Addendum:

I've had an exchange with Concord Hospital's CIO, Deane Morrison RPh, which I am posting here with permission. He wrote me a polite letter expressing concern that my post was downplaying Concord's HIT accomplishments. We had this exchange:

Deane,

I believe you misconstrue my post. I am an HIT supporter - but in recent years have concerns the field has moved too fast.

I am pointing out that your hospital won an award for IT excellence, reproducing a paragraph about that, yet still has problems with the technology. I do this in the context of my concerns about what will happen at hospitals without the IT savvy yours has in future years. In that sense, I am complimenting your organization, with a few nitpicks that, believe me, are relatively minor compared to your competitors.

I am an HIT expert going back many years (see my bio page in the link below), was a CMIO in both hospital and pharma serttings, and know that there are universal problems in both clinical IT and research IT. I also spent time at Comdisco working on disaster recovery and business continuity solutions for hospitals and know the complexities of that.

As to risk/benefit, I have written volumes at the 10-year-old website now hosted at Drexel, again at the link below [link -ed.] My concerns are that HIT can finally produce the benefits long claimed (decades!) for it, and in fact have achieved those benefits in projects I led - with a caveat - only if done well. There is a lot of meaning as I'm sure you well know behind those two words, from vendor origins to implementation to lifecycle management.

It sounds like you've done HIT very well (I hear really terrible stories from my colleagues and grad students in operational HIT positions almost daily these days), but yet you are still faced with the unexpected events predicted by those in the field of social informatics with any ICT (information & communication technology) - the unthinkable and chaotic things that find a way to happen despite good planning.

Again, my concern is about the hospitals who are not award winners and yet who are being rushed into HIT by the provisions in the ARRA.

If you would like me to add a comment or address some specific concern, please let me know.

CIO Morrison then wrote me back:

Scot,

Thank you for your reply. I clearly misconstrued the intent of your blog. I very much agree with you that our society as a whole and the leadership of our country do not understand how hard it is to successfully implement clinical IT technology.

At Concord I've never contended that what success we've had has been related to the systems we have choosen. Rather I've tried to emphasize for our leadership that its the people (It & clinicians) who work on the projects that make the difference. We have invested in a CMIO (Dr. Joel C. Berman). He has three other MD's working part time. We have a 4 person nursing informatics team. And we have a very large IT department. And even with that we are still vulnerable to the hiccups that come with increasong reliance on technology. So all in all I believe that well installed IT technology will result in a better healthcare system but I aslo very much agree with you that we can not underestimate the amount of hard work its going to take to get us there.

Deane Morrison, RPh
CIO
Concord Hospital
Concord, NH

It is a pleasure to communicate with CIO's who understand what's strategic and what's tactical in healthcare and HIT. I replied:

Deane,

Thanks. You've made an interesting comment:

"... Rather I've tried to emphasize for our leadership that its the people (IT & clinicians) who work on the projects that make the difference."

Indeed. I expressed this years ago by observing that "healthcare IT projects are complex medical/social projects that happen to involve computers, as opposed to complex IT projects that happen to involve clinicians."

You are way ahead of many of your competitors in pointing out to your leadership what's strategic in IT (the right people with the right skills) vs. what's transient and tactical (the right package, platform etc.). Technologic determinism prevails (i.e., computers solve problems, automatically, and people are interchangeable cogs in an IT project).


In my opinion we as a nation need more CIO's in hospitals who share these insights about people.

-- SS

4 comments:

Anonymous said...

I noticed that billing seemed to stay up for both the hospital and doctors. We all have our priorities.

Steve Lucas

Anonymous said...

Steve--

You took the words right out of my mouth.

Melody

David Smith said...

At the risk of repeating myself, we're just not ready for prime time.

Can we hope for "caveat emptor"?

MedInformaticsMD said...

Can we hope for "caveat emptor"?

I believe the sages of past centuries would say "primum non nocerum", not "let's hope."

-- SS