Wednesday, October 02, 2013

Another in the "Health IT Crashed, But Patient Care Was Not Compromised" Series - NHS Greater Glasgow and Clyde

We must have health IT to prevent stupid doctors and nurses from making mistakes.  Without it, patients are at the mercy of dreaded Paper Records, which by definition cannot ever be used to provide quality care.

But when the IT goes down, Patient Care Has Not Been Compromised.  This line should be trademarked, as it's seen so often.  (I even have an indexing tag for it, see this query link: http://hcrenewal.blogspot.com/search/label/Patient%20care%20has%20not%20been%20compromised.)

Care is never, never compromised when the IT goes belly up en masse due to information technology malpractice.  Care is only compromised by paper, no matter how good the paper records and its human stewards are.

Here's the latest example that made it to the news, in Scotland:

1 October 2013
BBC News
Appointments postponed after major IT failure at NHSGGC (NHS Greater Glasgow and Clyde)

Hundreds of outpatient appointments and a number of operations had to be postponed after computer systems failed at Scotland's biggest health board.

NHS Greater Glasgow and Clyde said technicians were working through the night to fix a "major IT problem" which occurred on Tuesday morning.

It affected staff access to clinical and administrative systems.

Delaying hundreds of appointments and delaying surgeries at up to 10 major hospitals seems on its face to represent "compromised care."

The health board apologised to patients and said all appointments would be rescheduled.

In total, 288 outpatient appointments, four planned inpatient procedures, 23 day surgery cases and 40 chemotherapy sessions were postponed.

There was also some delay in calls to the switchboard being answered.

The problem may have affected up to 10 major hospitals across the health board area.

One wonders how these appointments and surgeries were triaged for delay.  Clearly the downed computer was of no help.

Here's that wonderful line:

But emergency operations were not compromised - neither were community services.

So when does computer failure actually compromise patient care?  I'd like to see some hospital executive with a spine for once admit that IT malpractice does disrupt patient care, create distractions, and thus create safety risk.  Considering the domain, however, I doubt I'll ever see that.

A spokeswoman said: "Our technical staff are working flat out to resolve this.

It should never have happened in the first place.

"The problem relates to our networks and the way staff can connect to some of our clinical and administrative systems.

Well, sick patients really appreciate that explanation.

It was not clear how long the disruption would last.

NHSGGC said if it did continue, people who were scheduled for treatment would be contacted directly.

Per a computer guru from my past:  "Either you're in control of your information systems, or they're in control of you."

In this instance, the latter clearly applies.

In healthcare, having your information systems in control of you is, sooner or later, going to be deadly.

-- SS


5 comments:

Steve Lucas said...

I enjoyed the comment that the reason the Obamacare signup computer system crashed was due to the popularity of the program, but never fear, there is a paper way to access the information and sign up.

This link shows the real price of an EMR

http://www.kevinmd.com/blog/2013/10/fighting-patientcomputer-attention-war.html


Steve Lucas

Anonymous said...

Sir, you make big conclusions from under-informed journalistic reportage. Could you be making the mistake of assuming that when IT is used as part of the healthcare pathway, it suddenly becomes omnipotent, and uniquely omniscient?

From your CV (resume) it should appear not, but your approach is rather absolute.

If an organisation has an organised business continuity plan that seamlessly moves from recording via a screen to using paper, then updates records at a later time, would you state that they don't use IT properly? ... or that paper is a poor persons computer?

Or, god forgive, that IT is not intrinsically and absolutely perfect in all regards, and therefore should never be used?

Oh! Your comments about care never being compromised through ...
Well, 1) writing the word "malpractice" is rather strong, perhaps?
2) of course, any system that is relied on in healthcare could "compromise care" if it fails. That could include the glue on sample labels melting in a sunny position where they are stored, or a biro running out of ink, or the network cable connecting the nurse's workstation being pinched when the workstation is adjusted to enable the cleaners to carry out deep cleaning. Should none of those things happen? Are they all the "IT Guy"'s fault?

Get real. Stop posting inflamatory and underinformed bile. Please!

Steve Lucas said...

Anon,

I will ask the same question I asked a couple of years ago after reading a similar comment: Did you choose this blog or did your company encourage you to make these comments? The corporate practice of attacking blogs went out of style some time ago.

I really do not know if I should be more offended by the pretentiousness or the straw man nature of your comments. I can assure you that all who frequent this blog are well aware of a CV.

Your writing style is reflective of someone very far down the marketing chain.

“If an organisation has an organised business continuity plan that seamlessly moves from recording via a screen to using paper…” is pure marketing fluff.

You may also want to use a spell checker before making these statements, or if copied from your corporate marketing materials inform them of the spelling errors in their printed material.

As far as strong language goes; get over it. We are big people.

Steve Lucas

Anonymous said...

Sickening to learn of the sham being played on the rank and file common folk.

InformaticsMD said...

Steve, thank you for beating me to an answer to Anonymous October 2, 2013 at 7:20:00 PM EDT.

My own:

re: "Or, god forgive, that IT is not intrinsically and absolutely perfect in all regards, and therefore should never be used?"

Strawman argument. See http://www.nizkor.org/features/fallacies/straw-man.html.

re: "writing the word "malpractice" is rather strong, perhaps?"

Actually, no. If you don't like the term, which is the term of art for major mishaps in medicine and other professions such as law, then I suggest you leave healthcare.

re: of course, any system that is relied on in healthcare could "compromise care" if it fails.

I think we can agree on that, and also agree that those responsible for the failure(s) should be fully accountable, which means, in practical terms, in court if harms occur - unless the event was truly out of their control (e.g., nurse pulls a network cable not knowing what it is). If you find that disagreeable, then, I repeat, leave healthcare and go into something where rigor and need for accountability is less important.

re: "Get real. Stop posting inflamatory and underinformed bile. Please!"

Argumentum ad hominem is another logical fallacy: http://www.nizkor.org/features/fallacies/ad-hominem.html.

Further, you have not answered to my concluding remarks that: "Either you're in control of your information systems, or they're in control of you. In healthcare (or, I might add, mission critical sectors such as mass transit that I used to work in), having your information systems in control of you is, sooner or later, going to be deadly."

I think we can also agree that if healthcare information technology systems are going to be unreliable (and there are numerous examples of major recent disabling and/or information-corrupting glitches and crashes on this blog), then patients should be allowed opportunity to give full informed consent to their use, and opt-out if they desire.

Again, if you disagree with this fundamental principle in modern western medicine, then you should leave the field.

-- SS