Wednesday, September 18, 2013

A Diary of EHR-Initiated Tragedy

"What you cannot anticipate, you cannot dread." - The Fire Rose

I've realized that these past posts, when integrated for an upcoming investigation, tell a story that is probably not uncommon in hospitals today. They form a sort of Diary of EHR-Initiated Tragedy.

I fear that these problems will become far more commonplace under the government "incentives" and penalties for "non-meaningful" users of "certified" health IT.

(Definitions: certified = 'the IT has the features we mandate to gather the data we want, not that the features have to work well, or that the IT is safe'; incentives = 'take our meager dollars and use this IT the way we mandate, or we will punish you by cutting your Medicare reimbursement, even though your quality of care might be equal to or better than those using IT.')

Here are the posts, in chronological sequence as they were written:

1. "On EHR Warnings", http://hcrenewal.blogspot.com/2011/07/on-ehr-warnings-sure-experts-think-you.html

2. "The Issues at This Site, Started in 1999, Are Not Academic or Theoretical. My Own Mother Was Maimed by a Health IT-Related Problem Last Year", http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=bcs

3. "Saving My Mother From Being Maimed Twice. MAUDE Adverse Event Report - Life Threatening; Hospitalization Required", http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/detail.cfm?mdrfoi__id=1729552

4. "Saving My Mother Again. EMR Problems? No, They're Merely Anecdotal; the Truth Must Be That I Attract Bad Electrons and Stale Bits", http://hcrenewal.blogspot.com/2011/01/ehr-problems-no-theyre-merely.html

5. "Saving My Mother yet Again. EHR Legible Gibberish - Another Example, the ED EHR Allergy List - And Legal Threats for Exposing Problems", http://hcrenewal.blogspot.com/2011/03/ehr-legible-gibberish-another-example.html

6. "My mother passed away", http://hcrenewal.blogspot.com/2011/06/my-mother-passed-away.html

7. Aftermath (part 1, more surely to come) - "There Are Still Some Medical Watchdog Organizations That Call a Spade a Spade", http://hcrenewal.blogspot.com/2011/10/there-are-still-some-medical-watchdog.html

8. [added 11/14/2011] "EMR Defects That Injure and Kill, and Litigation: A Hospital Is Paying a Huge Hourly Rate for This?", http://hcrenewal.blogspot.com/2011/11/emr-defects-that-injure-and-kill-and.html


This is a cautionary tale regarding one of the biggest non-informed consent-grounded medical experiments in history.

-- SS

4 comments:

Anonymous said...

Indeed, these are deadly experiments paid for by your tax dollars.

Live IT or live with IT said...

If the government is the cause of the exuberance, are they also liable for the results?

Brett Mello said...

This sounds like a case of a singular bad configuration of an EMR. It could also be a just a poor solution from a vendor. Do you know if it was even a certified application? I would like to suggest not painting all EMR implementations and the overall value of EMR’s from a single, albeit tragic, example. A well implemented EMR, configured in collaboration with an organization’s physicians, has been repeatedly proven to reduce medical and medication errors. Why would any educated person, including legislators and executives, support the use of a tool that would increase harm, not safety. Education aside, we will all be patients at some point so our innate need for self preservation would seem contrarian to arbitrary investments in useless technology to manage our care. Our current health delivery method produces far more harm than the new technology being implemented to address it. We need to embrace technology and make it work for us than putting our heads in the sand. Take the following quote as an example:

"That it will ever come into general use, notwithstanding its value, is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble, both to the patient and to the practitioner because its hue and character are foreign and opposed to all our habits and associations." - The London Times, 1834 commenting on the "stethoscope"

InformaticsMD said...

Brett Mello said:

This sounds like a case of a singular bad configuration of an EMR. It could also be a just a poor solution from a vendor.

Curious you omit more likely causes. Can we agree that software defects and bugs, orphaned records, data corruption, etc. are not just possible, but likely? See work of Dr Jon Patrick at U. Sydney.

Do you know if it was even a certified application?

Do you have a clue what "certification" means with regard to patient safety? Can we agree you seem naive on that point? Go look it up.

I would like to suggest not painting all EMR implementations and the overall value of EMR’s from a single, albeit tragic, example.

I agree. Maybe you need to read more of this blog and my academic site on HIT failure, though. Can we agree if these problems are not "single, tragic examples" that there may be a more widepread problem?

Why would any educated person, including legislators and executives, support the use of a tool that would increase harm, not safety.

Can we agree that perhaps it;s because they are unfamiliar with the issues, subjected to marketing propaganda, or even taking payoffs or otherwise benefiting from such support?

Our current health delivery method produces far more harm than the new technology being implemented to address it.

Can we agree you provided no references to back up this remarkable assertion, therefore making it not highly credible?

We need to embrace technology and make it work for us than putting our heads in the sand.

Can we agree that in medicine, ethical practice calls for not "embracing technology" until it is proven safe and effective?

The London Times, 1834 commenting on the "stethoscope"

Can we agree this is a bad analogy, i.e., that there is a world of difference between a stethoscope in 1834, that was not really capable of much harm, and massive systems that govern and orchestrate the provision of care, namely, clinical IT, in 2011?

-- SS