Sunday, September 18, 2011

Blake Medical Center (Bradenton, Fla.) Ignores Health IT Warning Letter From 100 Staff Physicians

In an article in the Bradenton Herald, Bradenton, FL, I found the following passage I bolded below truly striking:

Digital doctors: Will technology help or harm?
Sept. 4, 2011

BRADENTON -- At Blake Medical Center, the prognosis for pen and paper is poor: Doctors’ traditional tools for tracking cases and ordering medications and procedures are being phased out in favor of computers.

... Blake [Medical Center], which has been building its EHR system for years, launched a feature in April for doctors to enter their daily progress notes electronically. In June, it added a feature for ordering medications and procedures via computer. It’s part of a national push, called hCare, by Blake’s parent company HCA.

But many doctors were reluctant to give up their pens. More than 100 staff physicians signed a letter asking for the computerization project to be put on hold, saying the system is cumbersome and likely to induce errors.

Wow. Physicians with guts.

If I were an executive at this hospital, I'd make sure I were fully insured and my assets were in my spouse's name, especially in lawsuit-happy Florida.

If a patient injury or death occurs related to the EMR issues addressed in the letter from 100 staff physicians, which would/should seriously concern if not absolutely alarm any reasonable person, there could be charges of negligence, including criminal negligence, against the administration.

Criminal negligence: The failure to use reasonable care to avoid consequences that threaten or harm the safety of the public and that are the foreseeable outcome of acting in a particular manner ... Criminal negligence is negligence that is aggravated, culpable or gross.

A jury will not be happy with the letter being ignored, either.

... The project’s supporters acknowledge doctors and nurses have made mistakes as they learn the system, though they are unaware of any resulting in harm to patients. [Is that how you want your healthcare to proceed? - ed.]

In other words, no patient exposed to this experiment and its risks (a key issue here) was known to "hit the jackpot" - yet:

The EHR Slot Machine of Risk. Click to enlarge. (From my March 2011 post "On an EMR Forensic Evaluation by Professor Jon Patrick from Down Under: More Thoughts.") Congratulations! You've hit the EHR mis-processing jackpot! Perhaps today is a good day to die...

But they contend that, in the long run, an electronic system will be safer than using paper records -- something critics grudgingly admit.

Still, even as a $27 billion federal program is encouraging hospitals and doctors to launch EHR systems, no regulatory agency tests or regulates them. So a crucial question remains unanswered: Does it truly improve care? [Nobody really knows - e.g., see recent post here, and literature list here - ed.]

Critics readily admit health IT has the potential to improve healthcare, but that the technology is not yet nearly ready to do so, especially on a national basis, and is experimental. Far more work is needed. For example, according to the National Research Council of the United States:

Current efforts aimed at the nationwide deployment of health care information technology (IT) will not be sufficient to achieve medical leaders' vision of health care in the 21st century and may even set back the cause, says a new report from the National Research Council. The report, based partially on site visits to eight U.S. medical centers considered leaders in the field of health care IT, concludes that greater emphasis should be placed on information technology that provides health care workers and patients with cognitive support, such as assistance in decision-making and problem-solving.

... In the long term, success will depend upon accelerating interdisciplinary research in biomedical informatics, computer science, social science, and health care engineering.

Critics also readily admit that organizations experimenting with this technology without patient informed consent, on the basis of some future good, need lessons on the ethics of human experimentation.

Risk to patients seems to be of little concern to this industry.

It also now seems that hospital executives have become so arrogant that they fail to recognize the risks to themselves in ignoring their own medical staffs on HIT issues.

Perhaps they think they will be able to simply blame the physicians, using clinicians as scapegoats, but with official sites like this now coming online ... I think that excuse will rapidly lose traction.

-- SS

Sept. 19 addendum:

A major motivator for ignoring the physicians' warnings at this HCA (Hospital Corp. of America) hospital may be financial. See my Aug. 2011 post "Why EHR's Are Mission Hostile."

-- SS


Anonymous said...

I feel bad for the doctors there. They have got to be struggling to protect their patients from the life threatening dangers of the CPOE device.

As has happened at other hospitals that deploy CPOE, there have had to have been at least several unexpected deaths, likely from neglect, delays, confusion, and misidentifications associated with CPOE.

I suspect that Blake tightened up the section in its Medical Staff By Laws entitled "Code of Conduct for Medical Staff", enabling the administration and HCA to rid the business of anyone who calls out the deaths and injuries.

And if they were called out, the administration will invariably blame the user, as is standard in this industry.

It is no surprise that the CEO has not heard of the problems.

The doctors and nurses of Blake, rather than "venting" to each other, must create their own data base recording the adverse events and near misses associated with the deployment and use of the CPOE device. Capture the screen shots on paper showing the dysfunction.

They should publish them in a peer reviewed journal (or Health Care Renewal), report them to the FDA, CMS, the news media, and criminal authorities, when indicated.

Report HIPAA breaches (and they are common) to the Human Rights Section of HHS.

Good luck, Blake doctors.

InformaticsMD said...

Re: Anonymous September 18, 2011 8:17:00 PM EDT

Let's hope there is no retaliation against the 100.

-- SS

Afraid said...

Those docs will be gone soon and will likely not be able to practice elsewhere.

And by the way, a patient can't normally tell if they have been harmed by an EHR unless the hospital tells them they were.

Fat chance that.