Wednesday, June 11, 2014

Canada: Province-wide electronic medical record computer system 'glitch' causing patients to be turned away from care

This story describes a very bad scenario for sick Canadians.  I offer just a few pithy comments, as not much more than that is needed:
System failure has docs, patients upset

By Gillian Slade on June 10, 2014

Many patients were turned away from their doctor’s office Monday because a province-wide electronic medical record computer system had collapsed.

Province-wide.  Stunning.  A very big argument against centralization of EHR resources.

“This is the third straight week of issues with the TELUS Wolf system,” said Dr. Donovan Nunweiler at Southlands Medical Clinic. “We feel we were encouraged by government to switch to Wolf and now it’s not working.”

I wonder when someone in the Canadian government is  going to issue that now-famous slogan "but patient safety has not been compromised"...

A year ago 202 physician clinics across Alberta using TELUS Wolf were unable to access patient records for most of the day.

More than 200 physician clinics are blind, deaf and dumb?  Wonder what happens to acute patients on days like that.

On Monday patients arrived only to be told the electronic patient files were not accessible making it impossible to see test results, past medical history and medications.

Paper never goes on strike.  Perhaps elimination of paper completely is not such a good idea?

“This is affecting me big time and affecting my income,” said Ken Hoeppner, a patient at HealthWORX Medical clinic, who had waited 15 days for his appointment. “Every time government touches something they wreck it. Our health care used to be good here before Alberta Health Services took over.”

No comment.

At HealthWORX, office manager Carel Liebenberg said the office was doing what it could to reschedule people. One patient had driven three hours to be there for his appointment early Monday.

It's just a "glitch", sir or madam.  Stop complaining. (

At Health Matters Medical Clinic, staff confirmed they too were dealing with no access to patients’ records on TELUS’s Wolf system.

Originally to encourage physicians to move to electronic medical records, the government gave a monetary incentive. Alberta Health selected TELUS Health Solutions Wolf EMR after a request for proposals in 2008.

There was a requirement for the service to be available 99.9 per cent of the time between 6 a.m. and midnight with financial penalties for failure to do so.

“There is no longer any government support,” said Nunweiler. “We (Southlands Medical Clinic) pay $2,000 a month for this. Who is going to hold TELUS accountable now? The government has abandoned us. Cost and issues switching patient data, when systems are not compatible, prevents us from going somewhere else.”

Seems to be this TELUS:  Sounds like a monopoly to me.

On that page:

TELUS Electronic Health Records (EHR) provides a better way to share, access and consolidate information.

Without quick, secure access to complete and reliable information, healthcare provision can be inefficient, preventing patients from receiving the best care possible.

How ironic.

Liebenberg reached TELUS at 9 a.m. Monday.

“They said they had just become aware of the issue and that their data technicians were in a meeting discussing the problem,” said Liebenberg. “Last week the system was extremely slow, taking 15 minutes for a physician to simply renew a prescription.”

Data technicians were in a meeting?  Sounds like a fantastic way to respond to a Province-wide medical emergency.

Nunweiler said he’d made notes on paper as he struggled to manage the snail’s pace of the system last week. Monday he would be adding to those notes and envisaged several hours at night entering the data to make it current.

Paper never goes on strike.

Liebenberg said the need to re-schedule appointments reflects badly on the clinic and some patients don’t understand it’s a system failure beyond the clinic’s.

That's just great for patient-physician relations.

Dr. Franz Yonker said HealthWORX had been using JonokeMed but the government endorsed TELUS Wolf and physicians were encouraged to switch.

“I think this is really bad for a government-backed system,” said Yonker.

"Wolf" is a somewhat humorous name considering these problems.  As in, a predatory EHR ... one wonders just how much better the others are.

Becky Nelson arrived for her appointment to refill prescriptions and was concerned about how long it would take to get another appointment.

“The government needs to get this on track. We are suffering the consequences,” said Nelson.

I wonder if any patients will suffer the ultimate consequence.  (Hint to Canadians:  never become too dependent on the Government.  Stuff like this happens.)

Donna Schneider brought her mother Vernie Ferguson in for results of some tests. Ferguson said she was not at all well.

“There is nowhere else to go and get my test results,” said Ferguson.

Held medical hostage to bad health IT.  How horrible.

The News requested an interview with TELUS but there was no response on Monday afternoon.

The News requested information from Alberta Health but that was not available on Monday.

Perhaps they're busy, in meetings discussing how to fix the problem.

-- SS


Anonymous said...

One of the significant problems with hiring a telecom provider to provide HIT solutions is that their business sense overrides the clinical solution. The realities of Telus's operations in the HIT field provide a stark reality to even Epic or Cerner's game.
Just because the support for a system is inadequate is not a reason for having a single common data model and infrastructure within the province, and the opposite has proven to be somewhat disastrous in Ontario.

John Austin said...

Another thing to note is that these systems are much better than the stupid paper systems they replace. It is the loss of service that is intolerable not the EHR itself.

Canada is late to the table in uptake of EHR systems because Canadians are more risk averse than Americans. The one payer system is better than the US system but it adapts at a glacial pace. The old US system employs more clerks than doctors and makes money for accountants.

InformaticsMD said...

Anonymous at June 11, 2014 at 2:52:00 PM EDT wrote:

Just because the support for a system is inadequate is not a reason for having a single common data model and infrastructure within the province

I am going to presume you meant to write "is not a reason for NOT having a single common data model and infrastructure within the province"

Did you ever wonder why it is (or at least used to be) that those accepted to medical school were generally the best and brightest? The answer is that muddled thinking like you just proffered can kill patients. As in, "critical thinking always, or - your patient's dead" (Victor P. Satinsky, MD.)

The 'data model' is independent of centralization or support. It can be uniform without centralization of any kind.

However, the obvious weakness of centralization of computer resources that supply a service - e.g., an EHR-related service - is just what the citizens of this province are experiencing - a mass outage.

The strength of the Internet is that it is based not only on common technical communications protocols and other standards, but that it is a decentralized system by design.

If an entire province or state were transported to another planet by space aliens (hypothetically, of course, as in the Outer Limits episode where an entire community, homes, infrastructure and all, were abducted and teleported to the alien's homeworld), the Internet would not go down nationwide or worldwide.

Its decentralization prevents that.

Centralization of a crucial resource such as EHR-based clinical command-and-control systems, making an entire population dependent on centralized "support", is simply a bad idea - on its face - considering the domain. It is too fragile an architecture for a field like healthcare.

The current scenario is rather strong proof of that. There's nothing to debate.

This outage is bad enough. Imagine this outage occurring during - or because of - a natural disaster like a hurricane, widespread earthquake, or worse.


-- SS

Steve Lucas said...

This study shows no efficiency improvements for EMR’s:

In terms of a single payer system I think the problems in Ontario where politicians have control of the medical system speaks for itself. Contracts have gone to political friends for such things as medical transportation and the drive to cut cost has left many patients without the care they need.

Our VA is showing the result of a single payer system with the wrong incentives.

Steve Lucas

InformaticsMD said...

Re: Comments from "Profile unavailable" at June 11, 2014 at 9:31:00 PM EDT:

Another sign of muddled and narrow-minded thinking is when one parrots a party line uncritically.

Re: "Another thing to note is that these systems are much better than the stupid paper systems they replace."


And reports such as the ECRI Deep Dive study at, the Top Ten Healthcare Technology Risks for 2014 at and the FDA Internal Memo on H-IT Risks at, to name a few sources repeatedly mentioned here, are what, chopped liver?

The results of "glitches" such as at the multiple posts at, that would not happen with paper, are simply to be dismissed?

That other mass casualty scenarios such as at that could never happen en masse like that with paper records, or the theft of thousands or millions of patient records en masse that also could never happen with paper (you'd need a fleet of trucks) are just acceptable little "downsides?"

That IOM and FDA and others admit we just don't know the risks and harms being caused by IT at this moment in history, and yet the cybernetic systems are simply "better"?

That many physicians and nurses alike find these systems not helpful and in fact disruptive and destructive, e.g.,,, and numerous other situations aggregated at this blog, is just a sign of Luddite whiners?

I'd say a blanket statement that "these systems are much better than the stupid paper systems they replace" is just a bit premature, and certainly does not reflect critical thinking on a very harsh master - reality in the field. Rather, it reflects technological determinism and cybernetic mysticism, and willful blindness - all of which are alien to the domain of "critical thinking" and to modern medicine generally.

Canada is late to the table in uptake of EHR systems

Compared to whom, exactly?

Canadians are more risk averse than Americans.

If that were true - then perhaps you need to elect a different government that doesn't put entire Provinces at risk through bad health IT whose centralized nature makes it prone to mass outages.

-- SS

Steve Lucas said...

Dumb paper.

Through the years I have know, and been married to an attorney, and there is one thing they all have said; if it is not written down, it does not exist.

My wife had to explain to the German government that first she did not have an assistant and that second she had no way to produce a typed mailing label for the original paper documents they demand when dealing with a legal case.

The 30 something computer geek that took over as head of their department pulled the only working typewriter for 160 people because computers were the way to do things. So my wife ended up hand addressing envelopes. First, they could not believe a government attorney did not have an assistant, and second that a State would allow documents to go out without the proper addresses.

I have to wonder how many doctors office staff would love to have a manual typewriter to write a note for patients from scrap paper to remind them of phone numbers, or other information that is often lost.

Call Dr. Smith after 1:00 on Wednesday at 000 000 0000 could save a lot of confusion, especially for those who are having issues with memory and this simple note will help the caregiver know what is going on.

Yep, dumb scrap paper and a manual typewriter. Think of what you could do.

Steve Lucas

Anonymous said...

It seems from the comments above that some IT defenders are chirping in reaction to indefensible life threatening HIT failure.