Saving My Mother Again. EMR Problems? No, They're Merely Anecdotal; the Truth Must Be That I Attract Bad Electrons and Stale Bits

My relative, who suffered a major cerebral injury in 2010 contributed to by an EMR's interference with clinicians, fell the other day in the bathroom.

The fall was hard; she struck her back and knocked out one of the mounting posts for the bathroom tissue - completely out of the wall, the wallboard now with a large gaping hole in it.

In an elderly person, falls can result in injuries such as this one, a painful hematoma on her back.

She went to a local hospital, a suburban branch of a large one, where x-rays were done; aside from a large bruise and hematoma (collection of blood under the skin) over her back at the point of impact, miraculously nothing was broken.

At triage I went over her medication list in great detail, ensuring both the data input to the EMR and the resultant triage printout record of her meds were complete and precise. She went home.

The very next day, in mid afternoon she had sudden onset of speech difficulty (expressive aphasia) and right sided weakness, symptoms of possible loss of blood flow to the left side of the brain, while sitting in a chair talking on the phone. The aphasia was the same symptom that led to her May 2010 presentation at the parent hospital and then her travails, with accidental cessation of a critical medication that somehow became "de-listed" in the EMR and thus not administered. This resulted in severe complications, domino-style, including brain hemorrhage.

So into the hospital she went via ambulance again. The ambulance crew copied her meds off a list I keep on my relative's refrigerator onto a scrap of paper. In the hospital the ED nurse reviewed the meds with me from the scrap, but I informed the ED nurse that doing so was not necessary since I'd just carefully checked the ED EMR med list at triage less than 24 hours earlier at the triage station.

The ED nurse then replied - "we're not using the ED EMR med lists right now, the system's been 'glitchy' today."

Me - " 'Glitchy?' What does that mean?"

ED nurse - "Sometimes the EMR pulls up the patient's meds, sometimes it doesn't." (direct quote).

Needless to say, these were not exactly words I enjoyed hearing.

My relative was believed to be having a repeat of the ischemia to the brain or "TIA" (transient ischemic attack, i.e., threatening to have a stroke), only this time the ED EMR itself was also having a TIA.

[As it turned out, it later became apparent she was actually having low-grade seizures from the brain injury of May 2010, and was put on an anti-seizure medication - ed.]In this progressive "paperless" setting, I was the sole conduit of accurate information about her meds. However, not every elderly patient has an advocate with my background...

My relative's TIA symptoms improved somewhat and she went to ICU, and was set up for a slew of tests to see what should be done, but these "every time I enter a hospital" EMR problems are getting a bit beyond what I consider as mere personal bad luck.

She was then transferred to a tertiary care hospital's critical care floor for neurological problems. Before transfer, I asked to see the results of her neck and brain scans.

A doctor brought them up on the computer screen, but rapidly scrolled down to the impression section. The doctor hoped I didn't see what was at the top of the radiological report. But I did. I saw a statement like this:

"A duplicate medical record number, previously unknown, was discovered for this patient."

Out of exasperation, I did not raise a commotion, but I can only wonder what data might have gone into that "previously unknown" silo.

After transfer to the tertiary hospital, the commercial EMR on a cart on wheels ("COW") outside my relative's room was displaying the EMR main screen, with a "patient worklist" window also open in the screen's center.

(The GUI appeared, by the way, to be that of obsolete Windows 2000 or NT 4.0, although possibly it could have been XP set to display the older GUI appearance, but the icon appearance suggested the former possibility).

Superimposed over the central patient worklist window, though, was a dreaded Microsoft crash window, exactly like this one from the Web:

An error window like this was superimposed on the EMR screens being used to manage my relative's care. Click to enlarge.

In asking the RN about this, I was told this window popped up a lot, and was simply dismissed by users with one of the two buttons. The IT dept. had told clinical staff the problem was due to users "loading illegal software on the hospital computers." (This COW, incidentally, lacked any portals for thumb drives, floppies, etc.) It sounded like IT would fix it when they managed to get around to it. The nurses went about their business, ignoring this screen when it popped up unpredictably but regularly.

Somehow, this did not inspire within me great confidence in the integrity of that EMR and its data, especially the admonition that:

"If you were in the middle of something, the information you were working on might be lost."

As an aside, I remember hearing a story like this over ten years ago in a past life as CMIO of a large hospital, in the Cath Lab as I detailed here:

... The informaticist [a.k.a. me - ed.] first asked to see what had been installed in the cath lab by MIS. The informaticist found workstations running the application under Windows 3.1, an unreliable platform especially unsuited for critical care environments, because "Windows NT and other OS's such as UNIX were not supported by MIS." When shown a short demo of data entry by a nurse after a cardiac cath case, the workstation crashed, displayed a "general protection fault" error and hexadecimal debugging data. It had to be rebooted, with resultant time and data loss.
The informaticist asked the nurse about the crash and was told it happened frequently, up to several times per day per workstation. When the informaticist asked if MIS had requested a detailed log be kept of the crashes and error messages to help resolve the problem, the answer was no. MIS felt diagnosis and repair was the vendor's responsibility. When the informaticist asked the nurse exactly what had been explained to clinicians about the crashes, the nurse replied that cath lab staff had been told by MIS "don't worry about it, you can't understand it, we'll make it better."
The informaticist remembered, from medical school and residency, being told never to say such a thing to patients as it was considered inappropriate and too paternalistic in the modern age of medicine, especially with the elderly. This was an ironic and somewhat perverse scenario for a critical care area, the informaticist thought.

I find the repeat of a story like this simply stunning.

As probably 2/3 of my healthcare-worker students have related stories of EMR-induced clinical problems in their organizations in the past several courses I've taught [typical examples of student stories are at this link], and other mentees with worse tales in their CMIO roles, and now with my own experiences getting more and more theatre-of-the-absurdish, I offer this thought:

Perhaps my experiences are merely anecdotal, due to some bad karma that causes me to attract bad electrons and stale bits, disrupting EMR operations.

Yes, that must be it.

-- SS