Wednesday, November 12, 2014

What in God's Name is Going on With Healthcare IT at Cambridge University Hospitals?

This story about a  UK hospital that recently "went live"with an American electronic health record/enterprise command-and-control system (EPIC) was not only predictable, but expected considering the sorry state of the health IT industry in terms of clinical leadership and regulation.

(It appears this was a "big bang" rollout, see, an implementation method better suited for warehouses and widget suppliers than major hospitals.)

Addenbrooke’s staff blame blood shortage on new eHospital
By CambridgeNews  |  Posted: November 05, 2014

By Freya Leng

Members of staff at Addenbrooke's [hospital,] have voiced their concerns about the new IT system which has been blamed for a blood shortage.

Cambridge University Hospitals' eHospital went live on October 26 and is designed to improve the quality of care for patients by allowing clinicians and frontline staff to access patient information wherever they are, at the click of a button.

I must put to rest this lie once again.  The unregulated, generally terrible software being sold by the so-called EHR vendors is NOT simply software to allow clinicians to  "access patient information wherever they are."  

This is enterprise clinician and clinical resource command-and-control software, through which increasingly each transaction related to care must pass.  In other words, ERP packages to manage patient care, as one might manage inventory and shipping in a merchant enterprise:

Enterprise resource planning (ERP) is a business management software—usually a suite of integrated applications—that a company can use to collect, store, manage and interpret data from many business activities

Unfortunately, the reductionist assumptions behind the conception, design, authoring and implementation of such ERP software - that hospitals and healthcare are linear, predictable processes - are both deadly wrong, and the beliefs of fools and the recklessly cavalier.

To wit:

But since the launch, the News has been contacted by a senior member of staff at Addenbrooke's who said the new IT system was having "serious consequences" on the "operational running of the service".

In a letter, the staff member who does not want to be named [due to potential for retaliation - ed.], said: "The hospital has very little blood available due to transfusion lab technical failures. Truth - the new IT system is responsible."

The letter also states the impact the shortage of blood has had on the hospital including the cancellation of all elective surgery until November 8 as well as impacting on any procedure that holds a risk of blood transfusion and organ transplantation.

"I believe sufficient risk has been placed upon all patients under care of Addenbrooke's," the staff member said. "Someone needs to be responsible for the implementation of the new IT system."

In my experience, the non-clinical executives who often select this technology, and the IT personnel who then implement the technology (often ignoring clinicians), do need to be held responsible for bad outcomes - in the courtroom.

The News also understands the whole system went down for six hours at the weekend with staff reverting back to paper and all major trauma cases diverted elsewhere.

There are numerous cases on this blog of disruptive and patient-endangering EHR system outages.  These are simply inexcusable regarding life-critical computing. The unexpected transitions back and forth between paper endanger patients.

A doctor, who also did not want to be named, said the wifi system which supports all the ward rounds is "unfit for purpose" and is leading to gross inefficiency.

If this is true, it once again represents the cavalier nature of those technologists rarely held accountable for mistakes that, of they occurred in other critical industries (e.g., aviation, nuclear energy) might leave smoldering ruins and radioactive clouds that would result in the end of their the very least.  Unfortunately, individual injured and dead patients are not quite as visible to the public.

"The general feeling on the ground is that they could not have implemented the system any worse than they have done and without any doubt it has already significantly affected patient care." they said.

This is consistent with my own personal experience with hospital IT departments in the U.S., where mistakes that I could not even have conceived of making, were regularly made - leaving me to have to point out and clean up the mess, at risk to my own career due to the reactions of the non-clinical IT leaders and staff to being shown their own inadequacy regarding clinical affairs.  (This was, of course, an odd reaction by people who'd never gone to medical school, let alone had doctoral or postdoctoral study, research and development experience in Medical Informatics.)

A CUH spokesman said: "eHospital gives our staff more time with patients at the bedside, many of whom are frail, elderly and have complex conditions.

Right, just those patients who are most vulnerable to IT debacles and the cascading errors that can result.

"However, unlike banks, shops or travel agents, we cannot close our doors or stop our services to the hundreds of thousands of people we treat every year. So it was always going to be a challenge to implement such a massive change.

That is a very poor excuse for IT malpractice.  It makes the reader believe everything possible in due diligence was done, that others' experience was completely paid attention to, etc.  The results give me great doubt about that...

"Pathology was affected early last week, which led to a brief reduction in the number of tests, but we are increasingly operating as normal. We did carry out a successful 're-boot' of the system early on Sunday morning.

There we go once again  the typical bureaucratic spin that "the malfunctions were minor, nothing to see here, move along, patient safety was not compromised"  (a recurrent refrain with its own index term on this blog, see the 25+ posts at - while at the same time these systems are represented as revolutionizing medicine - except when they malfunction, at which time they have no meaningful effects on care.

"The much bigger challenge we face is that the Trust is incredibly busy and we have limited numbers of beds available, and which need to be kept free for emergency cases. Operations will continue to be rescheduled until the community care for those who no longer need a hospital bed is in place. We do sympathise with the frustration that people feel and apologise for the delay they are experiencing."

In my opinion, patients put at risk, and injured and dead patients need and deserve more than apologies for information technology malpractice.

Especially at Cambridge University, where in my opinion, this whole affair is truly a world-class embarrassment.

-- SS


Anonymous said...

Is this not the Epic EHR device that ran the care of the Dallas ER that missed the case of Ebola and sent the patient home?

The two hospitals ought to sharebtheir war stories.

Anonymous said...

From things Scot has revealed earlier, it's quite probable that they CANNOT share their stories (non-disclosure clause written into their purchase contract). We wouldn't want the users to actually KNOW how badly the program works!