Wednesday, August 28, 2013

Setback for Sutter after $1B EHR crashes (in followup to post "RNs Say Sutter’s New Electronic System Causing Serious Disruptions to Safe Patient Care at East Bay Hospitals")

At my July 12, 2013 post "RNs Say Sutter’s New Electronic System Causing Serious Disruptions to Safe Patient Care at East Bay Hospitals" ( I reproduced a California Nurses Association warning about rollout of an EHR at Sutter:

RNs Say Sutter’s New Electronic System Causing Serious Disruptions to Safe Patient Care at East Bay Hospitals

Introduction of a new electronic medical records system at Sutter corporation East Bay hospitals has produced multiple problems with safe care delivery that has put patients at risk, charged the California Nurses Association today.

Problems with technology are not unique to health care ...  [What is unique to healthcare IT is the complete lack of regulation - ed.]

In over 100 reports submitted by RNs at Alta Bates Summit Medical Center facilities in Berkeley and Oakland, nurses cited a variety of serious problems with the new system, known as Epic. The reports are in union forms RNs submit to management documenting assignments they believe to be unsafe.

Patient care concerns included computerized delays in timely administration of medications and contact with physicians, ability to properly monitor patients, and other delays in treatment.  Many noted that the excessive amount of time required to interact with the computer system, inputting and accessing data, sharply cuts down on time they can spend with patients with frequent complaints from patients about not seeing their RN.  [Note: patients are not given the opportunity for informed consent about the risks, nor opt-out of EHR use in their care - ed.]

In related posts I'd observed such concerns being ignored by hospital management.  See header of the aforementioned post.

Now we have this:  a major system crash.

Healthcare IT News
Setback for Sutter after $1B EHR crashes
'No access to medication orders, patient allergies and other information puts patients at serious risk'
Worse, clinicians must now serve their Cybernetic Master to perfection, or be whipped (apparently to improve morale):

... "We have been on Epic for 5 months now, and we can no longer have incorrect orders, missing information or incorrect or missing charges. Starting on September 1st, errors made in any of the above will result in progressive discipline," according to another hospital memo sent to staff.

In the setting of dire warnings by the nurses of EHR dangers several months back that were likely largely ignored, if any patient was harmed or killed as a result of this latest fiasco, the corporate leadership has literally begged to be sued for negligence, in my view.

However I'm sure a press release soon will claim that "patient care has not been compromised."

Of course this includes now and moving forward, even with informational gaps all over the place.

-- SS

Aug. 29, 2013 additional thought:

The punishment for not being a 'perfect' user of this EHR is the ultimate "blame the user" (blame the victim?) game, considering the pressures of patient care in hospitals in lean times - partly due to EHR expense! - and EHRs that have not been formally studied for usability and are poorly designed causing "use error" (that is, a poor user experience promotes even careful users to make errors).  Cf. definition of bad health IT:

Bad Health IT ("BHIT") is defined as IT that is ill-suited to purpose, hard to use, unreliable, loses data or provides incorrect data, causes cognitive overload, slows rather than facilitates users, lacks appropriate alerts, creates the need for hypervigilance (i.e., towards avoiding IT-related mishaps) that increases stress, is lacking in security, compromises patient privacy or otherwise demonstrates suboptimal design and/or implementation.

The study of usability is getting underway only now via NIST but will likely be done in an industry-friendly way due to health IT politics.

-- SS

Aug. 29, 2013 addendum

There have been numerous comments over at HisTalk (at defending the outage as not EPIC's fault.   From the point of view of clinicians - and more importantly, patients - it doesn't matter what component of the hospital's entire "EHR" (an anachronistic term used for what is now a complex enterprise clinical resource and clinician command-and-control system) went down. 

Aside from all the EPIC issues the nurses have been complaining about (see earlier July 12, 2013 post linked above), the larger problem is that IT malpractice occurred.  The term "malpractice" is used in medical mishaps; I see no reason why it does not apply to major outages of mission critical healthcare information technology systems.

IT malpractice in healthcare kills.

These are the types of nurses I'd want caring for me and mine.  Letting this kind of snafu go "anechoic" does not promote proper management remedial education on Safety 101 and on health IT risk, two areas of education that management appears to desperately need in hospitals.

-- SS


Anonymous said...

I bet the admin declared that patient care was not affected, as they have been scripted to do by the vendors.

Anonymous said...

Tis very frightening. The memo from admin shows their clear lack of care for patient safety

Anonymous said...

The experiment continues without IRB approval, in violoation of the Helsinki Accords.

There needs to be investigation of every case at Sutter for adverse events as a result of the mayhem and delays from the crash.

Epic should be called out on this incomepetence.

Nationally, there needs to be required reporting for every outage, even if for 5 minutes.

Doctors and nurses have time sensitive work to do, and lives turn on seconds of delays.

Roy M. Poses MD said...

Note that the Sutter Health CEO was on the list (here: ) of most influential people in health care (see this post: ).

So I ask again: is the person who ought to account for the situation described by InformaticsMD above the sort of person who ought to be so influential in US health care?

Anonymous said...

Obama should read this, to learn of the competence of his health IT program.

What a waste of lives and money.

There had to be deaths at Sutter from this debacle.

They do not occur right away, sometimes weeks later. They occur at a distance from the index catastrophe, as the delays of treatment result in a cycle of deterioration.

InformaticsMD said...

Anonymous August 29, 2013 at 9:46:00 AM EDT writes:

They do not occur right away, sometimes weeks later. They occur at a distance from the index catastrophe, as the delays of treatment result in a cycle of deterioration.

Agree, but understanding this requires an ability to think temporally and critically, and understand medicine's complexities as well, skills that seem increasingly uncommon, or muted by politics.

-- SS

Anonymous said...

Hospital management and HIT vendor routinely depreciate the complaints and those who complain about the mayhem caused by unreliable HIT systems. So what else is new?

Anonymous said...

Whatever happened to REBOOT?. Any response from Sebilius?

Anonymous said...

The statement by the Sutter admin is more descriptive than the usual line they script that "patient care was not affected" (when all records of all patients disappeared at once).

It is commendable of them that they did not blame human error.

How is "downtime" defined anyway?

In other words, how many hours does a system have to be unavailable before it is declared an official downtime?

Steve Lucas said...

What I have found interesting is posts and comments on other blogs supporting Scot’s position. The doctors on these blogs post about poor notes and their employers efforts to up code a patient, not realizing they are taking a position on the lack of a proper EMR interface.

One doctor commented it took three minutes to log in and then three minutes to log out of their system and each patient had to be handled as a separate transaction. Being older and not a typist, a poor use of a physician’s time, meant that he used the cut and paste and check the box to try and keep up.

There are a great deal more problems with EMR’s than being reported and we need to listen to the doctors and nurses who are stating they have problems, but are not filing reports, or know the computer language. It does not work is a fair statement that deserves additional investigation by those who are running a system.

Forcing the user to define the problems in computer language is the ultimate blame the victim.

Steve Lucas