Tuesday, May 12, 2009

Dangerous Health IT Mismanagement, Spin Control and the World's Longest Teething Pains

I've written about a physician who documents the HIT travails Down Under that parallel the ones we have here - and are going to have a lot more of in a mad rush to universal health IT supposedly by 2014.

Staff in an Australian Hospital's ED basically revolted against a new system that totally failed ... twice in three days. The two accounts of the incident are interesting regarding the incompetence level that hospital IT departments are permitted and that is widely tolerated as if they were a priesthood, and the spin control often used as CYA for events that carry great potential for patient harm.

Physicians should only have it one hundredth as well as IT personnel.

Account 1:

Hospital records system fails twice in one week
ABC (Australian Broadcasting Company) News
Posted Fri May 8, 2009 7:37am AEST
Emergency doctors at Nepean Hospital in Sydney's west are scaling back a new electronic records system because of two failures in the space of four days.
Hospital management says there was a slowdown in the system for two hours on Tuesday, following a widespread outage on Saturday.
Staff at the Nepean Hospital have now stopped using some parts of the system, saying they have lost confidence in it. Medics will in some cases go back to using pen and paper to record patients' progress.
The chief executive of the Sydney West Area Health Service Professor Steven Boyages has apologised to staff, but says the problems could continue for a year and a half, while the technology is being rolled out.
"Like in every other industry, whether its banking or retail or travel, teething problems do occur," he said.
"Whenever you experience a computer slowdown it's enormously frustrating. Particularly if you're dealing with patients."
But Professor Boyages says patient safety has not been compromised. "The important thing to re-assure your listeners is that we have very effective back up systems in place," he said. [That's what's known as "spin control" - ed.]

This raises several questions:

  • Computer systems that are up 24/7 are fairly common, including health IT systems. Who, exactly, is having "teething pains?" Surely not the entire healthcare or health IT industry, unless one considers the possibility of a baby that has thirty years worth of little teeth coming in. Perhaps it's incompetent IT department leaders who are doing the teething, at patient and physician expense?
  • A year and a half of more problems expected during "rollout?" [That's simply insane -ed.] What in hell is being rolled out?
  • Why, exactly, did the system slow down and then fail? Who was in charge of the project and of system architecture and redundancy? What sanctions do they face as a result of this debacle?
  • In the often chaotic environment of emergency medicine, disruptions to record keeping, even short lived ones, run the risk of irreversible error or catastrophe. Evidence of the concern of staff is their rejection of the system. How can the chief executive state that safety has "not been compromised?"
  • "Very effective backup systems in place?" Since the computer system went down, clearly this exec is not talking about IT. Perhaps the "backup system" is good, old fashioned paper and pencil?

Others share my concerns, as well as concerns that these systems can be more of a hindrance than a help if designed improperly (the identity of the system is not mentioned, unfortunately).

Account 2 of same story:

Electronic medical records putting patients at risk – Nepean Hospital

Posted 07/05/2009 at 05:12 PM by StreetCorner.AU

Staff in the Nepean Hospital Emergency Department have banned the use of the new electronic medical records system after it failed for the second time in three days on Tuesday, putting patients at risk, Shadow Minister for Health Jillian Skinner said today.

According to Jillian Skinner, medical officers have revealed the latest shut down at the Nepean Hospital ED on Tuesday lasted for two hours, leading to staff deciding on Wednesday they no longer had faith in the new system.

“Staff report the electronic medical records system is so cumbersome that senior medical officers who previously saw 8-10 patients in a shift, are only getting through 5-7 because they spend so much time trying to access or enter information” said Mrs Skinner [a.k.a. a mission hostile user experience, itself potentially deadly in an emergency department - ed.]

“When the system failed again on Tuesday it meant there were no records of what a patient was there for, no record of treatment so far, no record of tests ordered, no record of test results and no record about what medication may have been given. Skinner reported that emergency staff at Nepean Hospital decided yesterday to pull the pin on using electronic records and are now working with pen and paper because they don’t trust electronic medical records system.

A situation in an ED where "there are no records of what a patient was there for, no record of treatment so far, no record of tests ordered, no record of test results and no record about what medication(s) may have been given" would seem to my medical mind to reflect a risk to patient safety. Fortunately there are some in the press who report such issues in a credible manner.

It also seems this system either presented a Mission Hostile User Experience, or a Blue Screen of Death User Experience to clinical users.

Considering the contractual blackout that exists in the U.S. on information regarding health IT failures, one wonders how many situations of failure "that don't compromise patient safety" occur on a daily basis on this side of the equator.

At some point, hospital IT departments and leaders will need to be subject to the same rigor as other key hospital employees. Letting them act as an unaccountable priesthood who, when they screw up, are given absolution by executives equally complicit in defending the mediocre, rather than being subjected to Darwinian forces, must end before patients get killed.

-- SS


Anonymous said...

"...before patients get killed."??
Pardon me but patients have already been killed (sic); but the deaths are covered up by contractual obligations. The cover up process involves such methods as threatening retaliation against or inflicting punishment on the doctors who know why their patient died, medical conferences by hospital employees who are paid to produce the made up real truth, and hospital autopsy pathologists who adjust the cause of death to protect their employers. Whether the county crime prosecutor (DA) is paid off may be a real possibility that should be investigated. Nasty stuff happening in certain hospitals.

Spero melior said...

"Teething pains" in banking, retail, and travel rarely kill people, and when they do (i.e., airplane crashes), they are highly publicized. Furthermore, there are regulatory oversight bodies for banking and travel (for banking alone there are the Federal Deposit Insurance Corporation, the Federal Reserve Board, the Office of the Comptroller of the Currency, and the Office of Thrift Supervision), but not for HIT.

Yes, the reliable backup system can only be pen and paper. Did the person quoted really think he was sly?

InformaticsMD said...

Yes, the reliable backup system can only be pen and paper. Did the person quoted really think he was sly?

Either that, or that his audience is really stupid.