Sunday, November 17, 2013

Another 'Survey' on EHRs - Affinity Medical Center (Ohio) Nurses Warn That Serious Patient Complications "Only a Matter of Time" in Open Letter

I've written previously about substantial problems nurses at Affinity Medical Center, Ohio ( and other organizations are having with EHRs, and how hospital executives were ignoring their complaints.  The complaints have been made openly, I believe, in large part due to the protection afforded by nurses' unions.

See for example my July 2013 post "RNs Say Sutter’s New Electronic System Causing Serious Disruptions to Safe Patient Care at East Bay Hospitals" at (there are links there to still more examples), and my June 2013 post  "Affinity RNs Call for Halt to Flawed Electronic Medical Records System Scheduled to Go Live Friday" at, along with links therein to other similar situations.

Particularly see my July 2013 post "How's this for patient rights? Affinity Medical Center manager: file a safety complaint, and I'll plaster it to your head!" at, where a judge had to intervene in a situation of apparent employee harassment for complaints about patient safety risks.

Here's the latest at Affinity Medical Center - an open letter to the Chief Nursing Officer (CNO) dated August 15, 2013.  Images and text below:

Page 1 - click to enlarge (text is below)

Page 2 - click to enlarge (text is below)

The letter to the CNO states (emphases and comments in red italics are mine):

August 15, 2013

Mr. Osterman,

Nurses at Affinity Medical Center are pleased to see that you have responded to our request and provided additional Cerner education classes, but education was only one of many concerns. [I note that education cannot compensate for the toxic effects of bad health IT that is poorly designed and/or poorly implemented, and that it's legally the responsibility of a hospital to ensure all apparatuses implemented and the environment of care are themselves safe - ed.]

Since the implementation nurses throughout the hospital have brought many serious concerns to the attention of both yourself and other supervisors.  When nurses have reported these concerns they have been either ignored or dismissed. It is distressing that Affinity would so blatantly disregard the concern of their RN staff surrounding issues that concern patient safety.  It is clear to direct-care RNs that many of the problems that exist with Cerner are a direct result of the failure to include nurses in the planning stages. [Exclusion of enduser domain experts from health IT development, in 2013, is grossly negligent IMO - ed.]

Some of the concerns that nurses have brought to the attention of management include:

  • Medication errors/scanning issues - perhaps the biggest concern of all RNs 
  • RNs unable to access patient records for hours at  a time
  • Incorrect descriptors and inaccurate drop-down menus
  • Incorrect calculations in the I&O [fluid input and output, especially important in very ill patients - ed.] and MAP [mean arterial pressure, used to calculate drip rates of potent drugs that raise or lower blood pressure in critical care, among other things - ed.] portions of the chart 
  • Inaccurate medication times and the inability of RNs to ensure medications are scheduled correctly
  • Endless loops of computer prompts that are unable to be dismissed by RNs in an emergency 

[It should be apparent that these 'issues' - some due to fundamental design flaws - are quite serious in terms of the harm they can cause, even with the exceptional and stressful RN hyper-vigilance their presence necessitates- ed.]
These threats to patient safety cannot continue.  It is only a matter of time before a communication error or a medication error lead to a serious complication for a patient.  These types of errors have the ability to harm every patient and must be addressed immediately. 

[This is not theoretical or unlikely.  Such an error led to my own mother's crippling injuries and death, and to injuries and deaths in numerous other cases of which I am aware through my legal work - ed.]

We ask that you set up a meeting with a delegation of RNs from our Facility Bargaining Council to discuss the concerns that nurses have documented on 'Technology Despite Objection' forms [complaint forms about use of technology with objections - ed.] and make a plan to fix these life-threatening problems.

You may set up a meeting by contacting Pam Gardner, RN at [redacted] or our National Representative  Michelle Mahon, RN.  [For the National Nurses United labor union,, with close to 185,000 members nationwide - ed.]  We look forward to hearing from you.

The letter is followed by the signatures of about 70 nurses.

I am informed by a Union rep in mid-November 2013, 3 months after the date of this letter, that (emphasis mine):

Nurses there are continuing to document the problems and concerns that they are experiencing.  I have attached a letter sent to the CNO at Affinity signed by nearly 70 RNs.  This is a pretty significant number of nurses especially in light of the fact that managers stole the circulating letter two times to prevent nurses from signing on.  The response to this letter was…….nothing.  The nurses have been ignored yet again. [Ellipsis in the original, I did not redact - ed.] 

It is clear the administration of this healthcare system has been explicitly put on notice of likely if not imminent danger to patients by multiple qualified experts, its own RNs.  If they do not act and patient harm occurs, it is my belief criminal negligence charges could be merited.

I also highly doubt patients are informed of these EHR system 'issues' and have been afforded the opportunity to give informed consent to the use of these computer systems in their care, or to go elsewhere for treatment.

These problems are repeating themselves over and over across this country and others, but many clinicians, especially those not protected to some degree by a labor union, do not speak out due to fear of retaliation.

Let's hope the nurses who signed this letter don't get their complaints plastered to their foreheads, as some were threatened with as in the aforementioned post.

-- SS


Anonymous said...

The nurses and the doctors, being forced to use these instruments of care, are defacto guinea pigs for the vendor, as are the patients.

It has been a standard established by early software producers such as $msft to put out their stuff and let the users (for free, and out of frustration) complain about the bugs and flaws which give the vendor the ideas needed to further experiment in the design.

That was not life threatening for word documents, but it is for hospitals that are using software run ordering devices for critically ill patients.

The nurses are being exploited by the vendor. They need to look at the mobey flow between vendor and hospital and its admin.

Anonymous said...

The vendors are howling that regulation by the FDA would stifle innovation. Yet, based on what is described above, the vendor has demonstrated little to zero innovation despite not being regulated from the beginning.

The only solution to address the HIT devives' defects, design flaws, poor usability, and the deaths, injuries, and near misses is FDA regulation.

InformaticsMD said...

Anonymous November 17, 2013 at 6:39:00 AM EST writes:

The nurses are being exploited by the vendor.

Indeed. They are providing onsite beta testing. So are the patients - again, without any consent in place.

-- SS

Steve Lucas said...

Once again we see how government is unable to supervise large IT projects. EMR’s and are examples of politicians setting the standards with no professional background and relying on vendor input vendors whose only driver is profit.

We really need politicians who can step back and allow professionals to supervise and implement these projects, and quit thinking that with a little more sales effort they can convince the American people how good their idea is and how all that wasted tax money is simply an investment.

Steve Lucas

Anonymous said...

Insightful artcle.