Friday, May 17, 2013

Marin General Hospital nurses warn that new computer system is causing errors, call for time out

- Posted on the Healthcare Renewal Blog May 17, 2013 -

Of course, the ever-present euphemism for life-threatening EHR malfunctions and defects, i.e., "glitches" are the cause (

Marin General Hospital nurses warn that new computer system is causing errors, call for time out

By Richard Halstead
Marin Independent Journal
Posted:   05/15/2013 04:07:49 PM PDT

Nurses at Marin General Hospital have asked administrators to put implementation of a new computerized physician order entry system on hold until glitches can be worked out and more training provided to nurses and doctors who use it.

Nearly a dozen nurses attended the regularly scheduled meeting of the Marin Healthcare District board Tuesday night at Marin General to voice their concerns. The district board oversees Marin General, but it does not involve itself in the hospital's day-to-day operations.

"Orders are being inadvertently passed to the wrong patients
. People have gotten meds when they've been allergic to them. This is dangerous," said Barbara Ryan, a Marin General registered nurse, who works in pediatrics and the intensive care nursery. "We're not asking you to get rid of it. We're asking you to place it on hold."

Orders passed to wrong patients?  No problem, just a glitch!  Meds people are allergic to?  Just a glitch.  Dangerous?  No way.  It's just a glitch!

But Lee Domanico, who serves as the CEO of both Marin General and the Marin Healthcare District, said, "I'm confident that in spite of the implementation issues, we have a system today that is safer for patients than our old paper system, and it will get even safer as we gain experience with it and work to fix some of the glitches we've experienced."

Where's the data backing up that assertion, I ask?  The actual risks of paper records don't seem to be robustly documented anywhere.

Ryan, who serves as the California Nurses Association/National Nurses United representative, was one of four Marin General nurses who spoke during the public comment portion of the meeting. Ryan said the nurses warned in advance of the system's roll-out on May 7 that nurses and doctors had insufficient knowledge of the system. Ryan said due to problems with the software nurses had been unable to open the program at home to practice using it.

And yet the rollout happened anyway?  That seems to me to be reckless indifference to the concerns of clinicians.

"Lo and behold the problems that we were worried about have happened," Ryan said. "We're looking at two-hour preps for surgery and two- to three-hour discharges; skilled nursing facilities calling back saying, this really doesn't make sense; the wrong meds ordered on the wrong patients and then given to the wrong patients; the inability for nurses to be able to see what the doctor ordered and double-check it."

Of course, I might add, patient safety was not compromised, the other common refrain of EHR glitch-excusers ... see below.

Ryan said nurses have and will continue to file "assignment despite objection" forms due to the system. Nurses file the forms to document formal objections to what they consider an unsafe, or potentially unsafe, patient care assignment.

"We will take patients but we will object to the assignment because it is unsafe," Ryan said. "This system is making it unsafe."

These will be exceptionally helpful in court to any patients injured or killed as a result of these "glitches" and EHR rollout that occurred despite direct warnings from clinical experts.

Marin General nurse Susan Degan said, "This is not about resistance to change. It's about accountability. My most important role is that of patient advocate. I am held accountable when errors are made."

Domanico acknowledged there have been some technical problems with the Paragon system, including making it possible for nurses to open from home. And he said the software is not faster than the old paper system.  [Considering it's acknowledged all the way up to the highest levels of HHS that current EHR's slow physicians down, one wonders if anyone in this organization thought an EHR would actually increase speed? - ed.]

About the "resistance to change" canard, see my essay "Doctors and EHRs: Reframing the 'Modernists v. Luddites' Canard to The Accurate 'Ardent Technophiles vs. Pragmatists' Reality" at .

"So yes," Domanico said, "it is causing stress for nurses who have heavy workloads, who are learning how to use it, particularly in areas where we need to speed up the computer."

What?  "Speed up the computer?"  They've spent tens if not hundreds of millions for an EHR, and the computer's too slow?

Actually, I think what this CEO in an obvious display of health IT ignorance is trying to say is that we have to do something about the system's poor usability, which sort of mimics what the Board Chair of the American Medical Assocation just said (

Also - clinician stress promotes error.

But Domanico challenged the suggestion that patient safety at Marin General had been compromised.

In fact, there is no way the issues described above cannot be compromising patient safety, on its face. (

"I would have no hesitation about entering this hospital tonight," he said.

As a VIP, of course, this CEO would get special treatment.  Thanks a lot.

I would NOT want to be a patient there under these conditions, unless perhaps I had a 24x7 medically-skilled advocate/bodyguard.

Board member Ann Sparkman, who previously served as in-house counsel at Kaiser Permanente, said nurses at Kaiser struggled at first when a new computer system was introduced there.

Sparkman said, "It's just to be expected."

This seems a rather bizarre appeal to common practice (

The stunning ignorance of this board member about proper mission-critical IT safety testing and implementation, such as performed in pharma, aerospace, etc. is, quite frankly, shocking.

Further, an attitude that life-threatening "glitches" are "just to be expected" by a member of the Board of Directors, with fiduciary responsibilities regarding hospital operations, is grossly negligent in my opinion, and completely ignores patient's rights.


One wonders if any formally-trained medical informatics experts were in leadership roles in this project.

-- SS


Anonymous said...

This is what happens when MBAs run healthcare and the CIO doesn't have a clinical background. Instead of listening to caregivers, those folks are immediately labeled as hostile to the hospital leadership.

I spent 13 years for a major Midwest hospital in IT (not clinical IT) and saw concerns get disregarded quite frequently. Wrong medication? No big deal. Wrong patient info in the EMR? "Glad the doctors caught it!"

Absolutely disgusting.

InformaticsMD said...

Anonymous said...

Absolutely disgusting.

Depends on your point of view. If you're a plaintiff's attorney, it's not disgusting, it's opportunity.

Unfortunately that opportunity only arises when someone is injured or killed - regarding which this hospital seems to have no fear.

I hope they can struggle through the so-called "glitches" to prevent that.

-- SS

Anonymous said...

MGH is doing great on paper. What's on paper? Money figures. But wait how about the patients? After all isn't this a hospital? What effects patient care is adequate staff, cleanliness of the hospital and necessary equipment, including the computer. Anyone looking at these?

Anonymous said...

Physicians lost any patient safety advocacy authority when they and their milquetoast professional organizations rolled over, played dead, and acquiesced to blue collar redesignation as "providers".
Hospitals (and increasingly practices) are controlled by business minded and trained stuffed shirts. "Empty authorities" to paraphrase Richard Feynman. Slick but none too intellectually impressive for the most part.

Anonymous said...

15 minutes from start to finish to give a pain medication the other day. Thank you EHR.