Cerner: "It’s in the DNA of our company to have the vision and passion to fix what’s broken in health care." Maybe they should fix their software first?

I point out this hyper-exuberant piece on health IT in the St. Louis Post-Dispatch.

Clearly someone at Cerner thinks they're going to cure the world with "population health" and their computer software:

With its Healthy Nevada initiative, Cerner Corp. cultivates a culture of health
St. Louis Post-Dispatch
Diane Stafford,  Kansas City Star
May 11, 2014

http://www.stltoday.com/news/special-reports/mohealth/updates/with-its-healthy-nevada-initiative-cerner-corp-cultivates-a-culture/article_8cc3168f-fd9f-5e7e-ba80-cc05dd6a35f9.html

Cerner Corp. employees started visiting Nevada, Mo., in 2011, looking to adopt a community as a testing ground for theories to control skyrocketing medical costs.

At the outset, “our discussions were marked by a lot of confusion,” recalled City Manager John David Kehrman. “We thought of Cerner as a data company. We didn’t understand what they wanted.”

The North Kansas City-based company, grown to global prominence by selling health care information technology to hospitals and doctors, aimed to reach a broader audience with a message: You have to take more responsibility for your own health.

... the company’s bigger evolution is that it’s investing millions in its next-generation software, dubbed Healthe Intent, which tracks individual and group health and treatment results. It re-imagines jobs in the health care industry and eventually will reach into patients’ homes.

If the initiatives blossom, Cerner executives believe they will boost the company’s revenue by billions of dollars a year ... “Cerner’s founders never saw themselves being a health care IT company,” Swindells asserted. “They saw themselves fixing health care.”

Wow.  That's a neat trick for a health IT company.

(As I asked of health IT company CEOs making similar statements back at a 1997-or-so Microsoft Healthcare Users Group meeting, "How are you going to revolutionize healthcare when you and nearly everyone at this meeting has no actual healthcare experience?"  They had no rational answer.  See "Broken Chord", Healthcare Informatics, Feb. 1999, archived at this link.)

I won't comment further on the content of the St. Louis Post-Dispatch piece, which is marketing agitprop.  It's their right to produce such material, after all.  Read it for yourself and learn of our glorious Cerner-driven health utopia.

I will comment, however, on one line in the piece, namely:

... “It’s in the DNA of our company to have the vision and passion to fix what’s broken in health care,” said Matthew Swindells, Cerner’s head of population health and global strategy.

Considering the broken health IT this company introduces into the market upon unsuspecting physicians, nurses and patients [e.g., see notes 1-6], perhaps they should consider fixing what's broken in health IT before releasing to market, and certainly before attempting to tackle the infinitely harder task of "fixing what's broken in health care."

-- SS

Notes:

[1]  November 17, 2013. "Another 'Survey' on EHRs - Affinity Medical Center Nurses Warn That Serious Patient Complications 'Only a Matter of Time' in Open Letter", http://hcrenewal.blogspot.com/2013/11/another-survey-on-ehrs-affinity-medical.html
  
[2] January 19, 2012. "[British MP] Bacon calls for halt on [Cerner] Millennium", http://www.ehi.co.uk/news/acute-care/7471/bacon-calls-for-halt-on-millennium

[3]  January 21, 2011.  "MAUDE and HIT Risks: What in God's Name is Going on Here? [Cerner health IT defects reports]", http://hcrenewal.blogspot.com/2011/01/maude-and-hit-risk-mother-mary-what-in.html

[4]  March 4, 2011. "A study of an Enterprise Health information System [Cerner Firstnet]", Prof. Jon Patrick, Univ. of Sydney, http://sydney.edu.au/engineering/it/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146

[5] Oct. 20, 2010.  "Medical center has more than 6000 "issues" with Cerner CPOE system in four months", http://hcrenewal.blogspot.com/2010/10/medical-center-has-more-than-6000.html

[6] 2009.  "The National Programme for IT in the NHS: Progress since 2006 - Public Accounts Committee" [on Lorenzo and Cerner Millenium], UK National Programme for Health IT in the NHS (now defunct), http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/153/15304.htm

This EHR "glitch" killed three-year-old Samuel Starr - but patient safety was not compromised

Actually, safety was compromised.

I have written repeatedly that the term "glitch", an often-seen euphemism (usually accompanied with the phrase "but patient care/patient safety was not compromised"), is really a term for life-threatening health IT bugs and malfunctions.  See query link http://hcrenewal.blogspot.com/search/label/glitch for examples of health IT "glitches" (retrieves multiple posts).

Here's a "glitch" that tragically killed this boy:

Three-year-old boy dies after new NHS computer system delays heart treatment

Mar 05, 2014
By James Tute

http://www.mirror.co.uk/news/uk-news/samuel-starr-death-nhs-computer-3209365

Coroner Maria Voisin rules that new booking system meant he did not receive life-saving treatment

A three-year-old boy died in his parents' arms after a new NHS computer system failed to schedule him for a vital heart scan, a coroner has ruled.

Samuel Starr was born with a congenital cardiac defect and needed surgery not long after he was born in 2010.

Although he made a good recovery doctors said he would need regular tests to check on his progress.

But he did not have a scan until 20 months after his first major operation because of a delay following the introduction of a new computer system, Cerner Millennium.

When he finally had the appointment doctors found Samuel needed open heart surgery. During the procedure, Samuel had a stroke.

A month later, after further complications, he died in the arms of his devastated parents, Catherine Holley and Paul Starr, at Bristol Royal Hospital for Children.

There are some in my field who would (and have) called incidents like this "anecdotes" or "bumps in the road."

Yet, as I've recently posted, an internationally-renowned healthcare safety tester, ECRI Institute (http://hcrenewal.blogspot.com/2013/02/peering-underneath-icebergs-water-level.html), and the medical malpractice insurer of the Harvard medical community, CRICO (http://hcrenewal.blogspot.com/2014/02/patient-safety-quality-healthcare.html), have confirmed cases like this are no mere anecdotes.  I estimate from their numbers, and from cases known to me personally and from descriptions of others, that on the order of ten thousand (that's likely low) patients annually are being injured and/or die as a result of bad health IT in the U.S. alone.  Lack of transparency about such incidents impairs knowing the true numbers.

Ms Holley wept as she told the hearing of the moment she kissed her son goodbye, saying: "He was a kind and gentle boy with a great understanding of the world.

"As we read Samuel his favourite stories, he died in our arms."

Avon Coroner Maria Voisin, recording a narrative conclusion, ruled the booking system meant Samuel was not seen and did not receive treatment.

This case somewhat reminds me of the case of a newborn whose x-ray test was done, but never looked at due to a bug in the software that scheduled films to be read, see http://hcrenewal.blogspot.com/2011/06/babys-death-spotlights-safety-risks.html, case #2

Concluding a three-day inquest at Flax Bourton Coroner's Court in North Somerset, Ms Voisin said: "Samuel Starr was born with a complex cardiac disease. "He required surgery and regular check-ups at outpatients to manage his conditions.  "Due to the failure of the hospital outpatients booking system there was a five month delay in Samuel being seen and receiving treatment. "Samuel's heart was disadvantaged and he died following urgent surgery."

Just a "glitch."

Doctors diagnosed that Samuel had a restricted pulmonary artery - causing blood to easily flow away from his heart to his lungs - during a 20-week scan in pregnancy ... On March 3, 2010, Samuel underwent open heart surgery at Bristol Royal Hospital for Children. He was discharged six days later and referred to the Paediatric Cardiac Clinic at the Royal United Hospital (RUH) in Bath for check-ups.

In October 2010, Samuel had his first check-up, in which an echocardiogram, also known as an "echo", was carried out. Ms Holley said she was told the procedure would be next carried out early in the new year.

But it did not happen until April 2011 and an echo was not performed.  Paediatric cardiologist Dr Andrew Tometzki told the inquest he did not "deem it necessary" on that day to carry out the echo scan. Dr Tometzki then ordered a further review - where an echo scan would be carried out - in nine months' time.

Samuel's parents did not receive information about the check-up and raised their concerns with community children's nurse Clare Mees.

Ms Mees, who works for Sirona Lifetime Services, said she would chase up the matter with Dr Tometzki's secretary.

Medical secretary Annabelle Attridge insisted she had taken details and forwarded them on to a dedicated appointments team.

However, the inquest heard "glitch problems" with a new booking system meant the appointment was not logged. 

Apparently not due to human fault:

Paediatric clinic co-ordinator Donna McMahon said while Samuel's medical records had been created on the new Millennium computer programme, no appointments had been transferred across.

Just a "glitch."  Just a "bump in the road."

Ms McMahon said she was first aware of the appointment delay when she received an email from nurse Ms Mees in May 2012.

Samuel did not have the vital check-up until June 21.

Coroner Ms Voisin added: "This overall failure led to a five month delay in Samuel being seen by his cardiologist.

"This meant Samuel had not been seen for five months and had not had an echo for 20 months."

His parents were horrified when Dr Tometzki informed them Samuel required heart surgery that spring.

Just a "glitch."  Just a "bump in the road."

... "Just hours before his operation Samuel was dancing around the ward and telling the nurses all about Spiderman - we had to remind him to quieten down," Ms Holley said.

Samuel's chest was closed on August 8. As he was brought out of sedation on August 9, he suffered a stroke and cardiac arrests.

"It is clear that if the surgery had been performed earlier, the procedure would have been the same," Ms Voisin said.

But she said expert evidence found that as time went on "the more complicated the surgery is, as the more disadvantaged the heart is and the more difficult it is to get over the operation".

Delays in care of fragile patients - in this case a young child, but in many other cases, ED and ICU patients of all ages - is very unwise.

Samuel's condition continued to deteriorate and on September 6 his parents were recommended for treatment to be withdrawn after he had a second cardiac arrest.

The coroner said she would not write a report making recommendations to the hospital, as changes had already been implemented.

Likely, workarounds to bad health IT, inviting future catastrophe.

In my view, many cases such as this never make headlines, as the findings ignore the role of the IT and blame people, cases are settled with gag clauses, patients (who survive) or family are never told of the role of the IT, or lawsuits prove too expensive or too unpleasant to pursue.

But patient safety is never compromised by "glitches", and regulation will just stifle innovation.

My condolences to the parents.  I've suffered a death in my own family as a result of health IT, and I'm a specialist in the field.  Laypeople have no chance.

One should pray the next child affected in this way is not one's own.

-- SS

Mar. 25, 2014 addendum:  

Also see these related posts, the first mentioning "teething problems", another euphemism for potentially-deadly EHR malfunctions:

Cerner's Blitzkrieg on London: Where's the RAF?
 http://hcrenewal.blogspot.com/2010/08/cerners-blitzkrieg-on-london-wheres-raf.html 

North Bristol Hits Appointment Problems: Another "Our Lousy IT Systems Screwed Up, But Patient Safety Was Never Compromised" Story
http://hcrenewal.blogspot.com/2012/01/another-our-crappy-computers-screwed-up.html

-- SS

Monetary losses and layoffs from EHR expenses and EHR mismanagement

More on monetary losses and layoffs from EHR expenses and EHR mismanagement:

1.  Layoffs to balance the budget...

http://www.news-record.com/news/local_news/article_da765340-d912-11e2-9eac-001a4bcf6878.html

... Wake Forest University Baptist Medical Center [Winston-Salem, NC] said in November 2012, that it would cut 950 jobs — 6 percent of its total staff.

Electronic records programs continue to push costs higher. The Winston-Salem Journal reported that Wake Forest’s Epic [EHR] program caused $8 million in work interruptions during the 2012-2013 year alone. Wake Forest is cutting costs at least through June 30 to make up for some of Epic’s expense. Its efforts include furloughs, wage reductions and other cuts.

2.  Cerner EHR Project Loses U.K. Hospital 18 Million Pounds

http://www.informationweek.com/healthcare/electronic-medical-records/ehr-project-loses-uk-hospital-18-million/240157036

... Royal Berkshire Foundation Trust's implementation of Cerner Millennium electronic health record system is costly to maintain and hard to use, causing patient backlogs ... British hospital's attempt to implement an electronic health record (EHR) system has been so disastrous that it has had to write off £18 million ($28 million).


... "Unfortunately, implementing the [EHR] system has at times been a difficult process and we acknowledge that we did not fully appreciate the challenges and resources required in a number of areas," said the hospital's chief executive, Ed Donald. 

In 2013, I find the statement "we did not fully appreciate the challenges and resources required in a number of areas" remarkable.

Dear Mr. Donald, please allow me to introduce you to a novel concept:

A Google search.  (Free, no less.)

Try this, for example:  https://www.google.com/search?q=healthcare%20IT%20failure

(I note that competent experts in my field, Medical Informatics, given appropriate executive presence - including hiring and firing authority, instead of the usual 'internal consultant' roles - could have prevented your organization's mistakes, and for a mere fraction of the £18 million.)

A campaign against public sector waste in Britain, The Taxpayer's Alliance, has seized on the hobbled project as an especially egregious example of bad procurement. "[NHS] trusts must work a lot harder to get a good deal for the taxpayers footing the bill," it warned.  [I guess money doesn't grow on trees in the UK as it seems to in the US -ed.]

The row comes in the same week British Parliament members expressed frustration that the funding scheme that supported other British hospitals' investment in EHRs, the controversial £9.8 billion ($15.2 billion) National Program for IT cancelled in 2011, continues to cost the country millions, with contracts in some cases not set to expire for 12 more years. [NPfIT in the NHS - see query link http://hcrenewal.blogspot.com/search/label/NPfIT - ed.]

Berkshire, however, opted out of that program in 2008 and had instead linked with the University of Pittsburgh Medical Center to help it implement Millennium.

I am merely the messenger here...

-- SS

A Right Royal Mess: EHRs and Royal Berkshire NHS Foundation Trust

Almost every theme I've written about for the past 15 years, at this blog and at my teaching site (link) regarding health IT mismanagement is present here:

A Right Royal Mess
    
ehealth INSIDER
12 February 2013

Newly released reports on Royal Berkshire NHS Foundation Trust’s implementation of Cerner Millennium show that many crucial issues were not addressed prior to go-live; and that the trust is continuing to face considerable operational and financial issues because of the system. Rebecca Todd reports.

Read it at the link above.

I feel this scenario is being repeated in many countries, including the U.S., with many different vendor products.  The industry's pathologies and self-serving memes are difficult to overcome.

As Orwell said:  "To see what is in front of one's nose needs a constant struggle."

But don't worry...you're perfectly safe.  Computers, after all, improve healthcare and are entirely beneficent, according to the pundits.  Every untoward event is a mere "anecdote."

-- SS

Addendum 2/15/13:  just to illustrate my point, there's also this:

Monitor blasts Rotherham's EPR programme
ehealth INSIDER
15 February 2013
Lis Evenstad 

The Rotherham NHS Foundation Trust has been found in significant breach of its terms of authorisation by Monitor, with its electronic patient record implementation identified as a key issue.

The trust this month admitted it was facing "persistant serious issues" with the deployment of its Meditech EPR including "clinician and staff acceptance and usability" ... “The trust has not managed EPR implementation in an effective way and significant operational and financial risks will remain until the trust has a robust and operationally effective EPR system." ... “It is unclear whether the trust has sufficient visibility over operational performance and quality issues, including incidents of patient harm,” it adds.

-- SS