healthy4u: Athens Regional Medical Center

Masters of the Obvious at Athens Regional Medical Center: Lack of clinician input, training, common sense created problems with Athens Regional electronic records system - but mostly lack of common sense

<div style="text-align: center;">(Note: also see my earlier May 26, 2014 post at <a href="http://hcrenewal.blogspot.com/2014/05/i-could-not-make-this-up-if-i-tried.html">http://hcrenewal.blogspot.com/2014/05/i-could-not-make-this-up-if-i-tried.html</a>)</div> My early medical mentor, Dr. Victor P. Satinsky, had disdain for those whom he called "Masters of the Obvious", who proffered profound words of wisdom that were in fact common-sensical or well-accepted, as if they'd invented those words personally. I think it's fair to say that after countless publications dating back decades, pointing out the essential role of clinical leadership in the development of clinical tools such as healthcare information technology systems, that such involvement is now a standard of care that reasonable hospital leadership would mandate when spending tens of millions of dollars on potentially injurious or lethal systems. Yet the physician revolt at Athens Regional Medical Center appears to be a result of its most senior leadership not keeping IT leadership on an appropriately short leash (a phenomenon that falls under the topical heading of "severe mismanagement"): <blockquote class="tr_bq"><a href="http://onlineathens.com/local-news/2014-06-14/lack-input-training-created-problems-athens-regional-electronic-records-system">http://onlineathens.com/local-news/2014-06-14/lack-input-training-created-problems-athens-regional-electronic-records-system</a>  Lack of input, training created problems with Athens Regional electronic records system By Kelsey Cochran Athens Banner-Herald Updated Sunday, June 15, 2014  More input in the way Athens Regional Health Systems’ electronic health records system was implemented should have come from the clinicians who use it every day, and fewer decisions should have been made by the hospital’s information technology department, a top hospital administrator and two vice presidents of system vendor Cerner Corp. said this week, in the wake of criticism of the system by a number of physicians. ... Although some daily users of the system were involved in the planning and design process from the beginning, Cerner Vice President Michael Robin, who has worked closely with ARMC since the deal was first made, said his team noticed midway through its implementation that the hospital system’s IT team was leading the project, which is "atypical" of Cerner clients like ARMC, he said. </blockquote> First, I don't think that IT team control of health IT projects is all that unusual.   Clinicians, even medical informaticists with cross-disciplinary expertise, rarely are more than "internal consultants" who may be ignored, as opposed to true leaders with executive presence and authority (e.g., control of budgets, grants of authority, and IT staff performance evaluation, hire and fire authority). Second, where was the Board of Directors?  They were ultimately responsible for allowing the IT leadership in at a level beyond their collective heads. Third, it's just a bit odd that the leader of the (failed) $20 billion National Programme for IT in the NHS, Richard Granger, said almost exactly the same thing about listening to end-users ca. 2007 (see <a href="http://hcrenewal.blogspot.com/2007/07/clinical-it-mayhem-is-good-for-it.html">http://hcrenewal.blogspot.com/2007/07/clinical-it-mayhem-is-good-for-it.html</a>).  I as well as numerous other authors had similar observations, in some cases dating to the 1960's.  For example,  see my essays, some dating to the late 1990s at <a href="http://cci.drexel.edu/faculty/ssilverstein/cases/?loc=cases">http://cci.drexel.edu/faculty/ssilverstein/cases/?loc=cases</a>, and Dr. Donald Lindberg's quotes from 1969 at the page below from Morris Collen's book "A History of Medical Informatics in the United States 1950-1990." <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcn4aLX1NGS_wG4FsSop81xaYmy9OeDKeiW-6qndwAvRWTmR6Sa4pwXyBuG02j4jKhifXdjSbcCcLcFngrkv6lYcip-V6DQvXzAsPCHdqMity4UopLN1lptK4OjgvBQIMUurTDLVb4l7Jr/s1600/collen168.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcn4aLX1NGS_wG4FsSop81xaYmy9OeDKeiW-6qndwAvRWTmR6Sa4pwXyBuG02j4jKhifXdjSbcCcLcFngrkv6lYcip-V6DQvXzAsPCHdqMity4UopLN1lptK4OjgvBQIMUurTDLVb4l7Jr/s1600/collen168.jpg" width="210" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">EHR pioneer Dr. Donald A.B. Lindberg (<a href="http://www.nlm.nih.gov/od/roster/lindberg.html">http://www.nlm.nih.gov/od/roster/lindberg.html</a>), 1969:  "Computer engineering experts per se have virtually no idea of the real problems of medical or even of hospital practice, and furthermore have consistently underestimated the complexity of the problems ... in no cases can these jobs be done, simply because they have not been defined with a physician as the continuing major contributor and user of the information." (Click to enlarge)</td></tr></tbody></table> The essential nature of clinicians actually having input (and at a leadership level) into the design and implementation of clinical tools such as health IT is patently obvious.  Only in the perverse control-mentality of business information technology (a.k.a. MIS or management information systems, see <a href="http://hcrenewal.blogspot.com/2008/05/seedie-society-for-exorbitantly.html">http://hcrenewal.blogspot.com/2008/05/seedie-society-for-exorbitantly.html</a> for the possible pre-electronic computer, tabulator-based roots of that culture) could such a precept even be questioned, let alone ignored. <blockquote class="tr_bq"> ... Moore, who took over as administrative lead on the electronic health record system after Thaw resigned, said some of the issues outlined in the physicians’ letter were real, and some were “theoretical.”</blockquote> Translation: some of the complaints were accidents waiting to happen. <blockquote class="tr_bq">..."To the best of our knowledge, there was not patient harm or patient death.” </blockquote> In other words, this is yet another story where the common, feel-good and ignorant refrain "but patient care has not been compromised" has reared its ugly head.  (I've made this type of claim a topical header at this blog.  See query link <a href="http://hcrenewal.blogspot.com/search/label/Patient%20care%20has%20not%20been%20compromised">http://hcrenewal.blogspot.com/search/label/Patient%20care%20has%20not%20been%20compromised</a> for others.) Assuming that's true - note that the impact of bad health IT can be delayed due to delayed effects of bad or missing information - this statement is, let me be impolite, vacuous on its face. <div class="headword" id="headword"><blockquote class="tr_bq"><h2>vac·u·ous (<a href="http://www.merriam-webster.com/dictionary/vacuous">http://www.merriam-webster.com/dictionary/vacuous</a>)</h2>adjective \ˈva-kyə-wəs\ </blockquote><div class="ld_on_collegiate"><blockquote><div class="bottom_entry">: having or showing a lack of intelligence or serious thought : lacking meaning, importance, or substance</div></blockquote></div></div> It seems some simple facts apparently need to be explained to these geniuses.   I'll put it in caps just to make sure they understand some basic issues: <ul><li>A HOSPITAL IS NOT A PLACE FOR RISKY INFORMATION TECHNOLOGY EXPERIMENTATION.   UNNECESSARY RISK IN HEALTHCARE IS A VERY, VERY BAD THING. </li></ul><ul><li>THE GOAL OF HOSPITALS IS NOT TO SUBJECT PATIENTS TO RISK VIA MISMANAGEMENT OF HEALTHCARE IT, AND THEN PROCLAIM "NOBODY WAS INJURED OR KILLED" AFTER THE PERPETRATORS OF THE MISMANAGEMENT ARE UPROOTED. </li></ul><ul><li>CLINICIANS DO NOT TOIL IN HOSPITALS TAKING CARE OF SICK PATIENTS SO THAT INFORMATION TECHNOLOGY PERSONNEL CAN HAVE COMFY JOBS AND COOL COMPUTERS.</li></ul> One wonders if these points might be above the intellectual pay grade of those running hospitals - including boards - in 2014. If nobody was injured or killed, it was due to happenstance, not due to appropriate due diligence and adherence to the standards of care essential in this healthcare sector - that is, healthcare information technology. Depending on happenstance is not a good healthcare management strategy. -- SS

Masters of the Obvious at Athens Regional Medical Center: Lack of clinician input, training, common sense created problems with Athens Regional electronic records system - but mostly lack of common sense

(Note: also see my earlier May 26, 2014 post at http://hcrenewal.blogspot.com/2014/05/i-could-not-make-this-up-if-i-tried.html)My early medical mentor, Dr. Victor P. Satinsky, had disdain for those wh…

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16 Jun 2014

Athens Regional Medical Center: Hospital management is "addressing computer problems" AFTER patients are put at bodily risk, not before, only in response to irate clinicians; then claiming everything will be fixed soon while doctors resign.

<div style="text-align: center;">(Note: also see my June 16, 2014 followup post at <a href="http://hcrenewal.blogspot.com/2014/06/masters-of-obvious-aat-athens-regional.html">http://hcrenewal.blogspot.com/2014/06/masters-of-obvious-aat-athens-regional.html</a>) </div> Maybe hospital management gurus could address these computer problems BEFORE turning them loose on patients? Physicians in Georgia seem to have more guts than their colleagues elsewhere.  Rather than letting patients be guinea pigs for the naive fantasies of hospital executives about health IT, these physicians said "get these [expletive] computer systems out of our hospital"... Then they started resigning their appointments: <blockquote class="tr_bq">Athens Regional addressing new computer system problems encountered by doctors By Donnie Z. Fetter Friday, May 23, 2014 <a href="http://onlineathens.com/health/2014-05-22/athens-regional-addressing-new-computer-system-problems-encountered-doctors">http://onlineathens.com/health/2014-05-22/athens-regional-addressing-new-computer-system-problems-encountered-doctors</a> Doctors affiliated with Athens Regional Medical Center (<a href="http://www.athenshealth.org/">http://www.athenshealth.org/</a>) have expressed concerns that a computer system installed this month at the hospital endangers patients.</blockquote> Not "may endanger patients."  "Endangers patients."  That's quite direct. <blockquote class="tr_bq">However, the hospital's chief executive said Athens Regional is taking "swift action" to address those concerns.</blockquote> I'm not impressed.  The executives should perhaps have done due diligence and taken action BEFORE this bad health IT was set loose on live, unsuspecting patients. It's not as if the issues are unknown (as Google or anyone who actually knows what they're doing regarding health IT will easily demonstrate).  Further, those executives have the legal obligation to maintain a safe healthcare environment. <blockquote class="tr_bq">In a letter dated May 15 and provided to the Athens Banner-Herald this week, multiple doctors noted such concerns as “medication errors ... orders being lost or overlooked ... (emergency department) patients leaving after long waits; and of an inpatient who wasn’t seen by a physician for (five) days.”</blockquote> Any of these issues and the multitude more I can predict exist can lead to severe injury or death, especially in fragile patients and the elderly.  Trust me, I know both professionally and personally...   <blockquote class="tr_bq">The letter was addressed to ARMC President and CEO James G. Thaw and Senior Vice President and CIO Gretchen Tegethoff. It was signed by more than a dozen physicians, including Carolann Eisenhart, president of the medical staff; Joseph T. Johnson, vice president of the medical staff; David M. Sailers, surgery department chair; and, Robert D. Sinyard, medicine department chair. The doctor who provided the letter to the Banner-Herald refused a request to openly discuss the issues with the computer system and asked to remain anonymous at the urging of his colleagues.</blockquote> Refused a request to openly discuss the issues with the computer system and asked to remain anonymous at the urging of his colleagues ... due to fear the executives would then return the doctor's concerns with genuine love and appreciation, and give him or her a generous promotion and pat on the back, no doubt.  (Actually, quite likely was a fear of retaliation, e.g. sham peer review as at <a href="http://www.aapsonline.org/index.php/article/sham_peer_review_resources_physicians">http://www.aapsonline.org/index.php/article/sham_peer_review_resources_physicians</a>.) Note the educational background of CIO Gretchen Tegerhoff, the executive with fiduciary obligations to implement health IT of the highest quality and to have robustly researched all of the issues involved (and whom the Board should have thoroughly vetted as to required background for health IT leadership): <blockquote class="tr_bq">University of Georgia Terry College of Business, Executive Program, Finance 2014 – 2014 (expected) The George Washington University - School of Business Master of Science, Information Systems Technology 2001 – 2003 West Virginia University BS, Medical Technology 1993 – 1997 </blockquote> Note the career progression that is the envy of, say, someone who's completed the rigors of medical training (premed, medical school, internship/residency, clinical postdocs) and beyond that, completed an additional PhD, MS or post-doctoral fellowship in Medical Informatics at unknown universities such as Harvard, Yale, Stanford, Johns Hopkins, Columbia, etc. (reverse chrono): <blockquote class="tr_bq">Technical Analyst STG (9 months) [Provided U.S. Department of State with systems support and application maintenance.] Clinical Systems Analyst George Washington University Hospital (3 years 8 months) Technical Support Specialist/Installer Intellidata, Inc. (9 months) Clinical Research Associate QUINTILES, INC. (9 months) Information Specialist THE EMMES CORPORATION (1 year 8 months) Writer/Editor ASPEN SYSTEMS CORPORATION (7 months) Medical Technologist PROVIDENCE LABORATORY ASSOCIATES (8 months) </blockquote> This background led directly to: <blockquote class="tr_bq">Chief Information Officer George Washington University Hospital (6 years 8 months) </blockquote> and then the current role: <blockquote class="tr_bq">Athens Regional Health System Vice President and Chief Information Officer Athens Regional Health System</blockquote> If you believed that the qualifications required for medical practice - let alone medical leadership roles - is at least an order of magnitude more robust, you'd not be mistaken. Perhaps even worse, business-IT amateur meddlers in clinical affairs sell the "best practices" that lead to debacles like this, and perhaps to IT-related patient injury and death, via their alphabet-soup "leadership" organizations.  This CIO also holds this credential: <blockquote class="tr_bq"><style type="text/css">H3 { margin-bottom: 0.08in; }H3.cjk { font-family: "Droid Sans Fallback"; }H3.ctl { font-family: "Lohit Hindi"; }P { margin-bottom: 0.08in; }</style> <div class="western">Faculty</div><div class="western">CHIME Healthcare CIO Boot Camp (8 months) </div></blockquote> It should be noted, and scandalously so considering the negligence that leads to patient endangerment and this kind of physician revolt from the outset, that IT-related patient harms are not uncommon.  For example, per the Harvard community's med mal insurer CRICO, see "Malpractice Claims Analysis Confirms Risks in EHRs" at <a href="http://hcrenewal.blogspot.com/2014/02/patient-safety-quality-healthcare.html">http://hcrenewal.blogspot.com/2014/02/patient-safety-quality-healthcare.html</a>, the ECRI Institute, see "ECRI Deep Dive Study of Health IT harms" at <a href="http://hcrenewal.blogspot.com/2013/02/peering-underneath-icebergs-water-level.html">http://hcrenewal.blogspot.com/2013/02/peering-underneath-icebergs-water-level.html</a> as well as "ECRI Institute's 2014 Top 10 Patient Safety Concerns for Healthcare Organizations" at <a href="http://hcrenewal.blogspot.com/2014/04/in-ecri-institutes-new-2014-top-10.html">http://hcrenewal.blogspot.com/2014/04/in-ecri-institutes-new-2014-top-10.html</a>, "FDA Internal Memo on H-IT risks - for internal use only" (uncovered by investigative reporter Fred Schulte) at <a href="http://hcrenewal.blogspot.com/2010/08/smoking-gun-internal-fda-memorandum-of.html">http://hcrenewal.blogspot.com/2010/08/smoking-gun-internal-fda-memorandum-of.html</a>, and others as posted at this blog. <blockquote class="tr_bq">“From the moment our physician leadership expressed concern about the Cerner I.T. conversion process on May 15, we took swift action and significant progress has been made toward resolving the issues raised,” Thaw wrote Thursday in an email. “Providing outstanding patient care is first and foremost in our minds at Athens Regional, and we have dedicated staff throughout the hospital to make sure the system is functioning as smoothly as possible through this transition."</blockquote> This raises several questions: <ul><li>How about the moments from the time of decision to acquire the technology?  What safety consideration were in effect during that time? </li></ul> <ul><li>What if the "significant progress" is insufficient to prevent a patient from being maimed or killed due to toxic effects of bad health IT?  Who's responsible? </li></ul> <ul><li>Perhaps most importantly from the human rights perspective - are patients being provided informed consent about these "issues raised" and are they afforded the opportunity to seek care elsewhere until the "swift progress" is completed?  </li></ul> One wonders if the executives were aware of analytic work on Cerner ED systems such as performed by U. Sydney professor Jon Patrick at "A study of an Enterprise Health information System",  <a href="http://sydney.edu.au/engineering/it/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146">http://sydney.edu.au/engineering/it/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146</a>; or this site on health IT difficulties:  <a href="http://cci.drexel.edu/faculty/ssilverstein/cases/">http://cci.drexel.edu/faculty/ssilverstein/cases/</a>, or this blog and others. It's not as if a simple Google search won't find them, such as <a href="https://www.google.com/search?q=healthcare+IT+failure">https://www.google.com/search?q=healthcare+IT+failure</a>.  Perhaps they need to read more...or hire experts BEFORE go-live. Back to the article: <blockquote class="tr_bq">The intended goal of the system designed by health care information technology company Cerner is to improve efficiency and connectivity by providing doctors, nurses and other medical professionals with a shared data set and to eventually allow patients online access to their medical records, Athens Regional executives previously said.</blockquote> Good intentions or not, badly designed and/or implemented technology harms or kills, and those harmed, or the dead, really don't care what the system is 'intended to do.'  Patients are not guinea pigs towards an IT company's or hospital's experiments with computers - regarding which the executives are usually in to at a level way over their collective heads. <blockquote class="tr_bq">But doctors noted the new system often proved too cumbersome to be effective at the time the letter was written. “The Cerner implementation has driven some physicians to drop their active staff privileges at ARMC,” noted the letter. “This has placed an additional burden on the hospitalists, who are already overwhelmed. </blockquote> That's just horrendous for safety. Joint Commission, where are you?   <blockquote class="tr_bq">Other physicians are directing their patients to St. Mary’s (hospital) for outpatient studies, (emergency room) care, admissions and surgical procedures. ... Efforts to rebuild the relationships with patients and physicians (needs) to begin immediately.”</blockquote> Doctors voted with their feet.  Bravo. I suggest they consider the following remedies as well if appropriate, from my post at <a href="http://hcrenewal.blogspot.com/2012/03/doctors-and-ehrs-reframing-modernists-v.html">http://hcrenewal.blogspot.com/2012/03/doctors-and-ehrs-reframing-modernists-v.html</a>: <blockquote class="tr_bq">... When a physician or other clinician observes health IT problems, defects, malfunctions, <a href="http://www.tinyurl.com/hostileuserexper">mission hostility</a> (e.g., poor user interfaces), significant downtimes, lost data, erroneous data, misidentified data, and so forth ... and most certainly, patient 'close calls' or actual injuries ... they should (anonymously if necessary if in a hostile management setting): (DISCLAIMER:  I am not responsible for any adverse outcomes if any organizational policies or existing laws are broken in doing any of the following.) <ul><li>Inform their facility's senior management, if deemed safe and not likely to result in retaliation such as being slandered as a "<a href="http://www.jpands.org/vol9no3/huntoon.pdf">disruptive physician</a>" and/or or being subjected to sham peer review (<a href="http://www.aapsonline.org/index.php/article/sham_peer_review_resources_physicians/">link</a>).</li></ul><ul><li>Inform their personal and organizational insurance carriers, in writing. Insurance carriers do not enjoy paying out for preventable IT-related medical mistakes. They have begun to become aware of HIT risks. See, for example, the essay on Norcal Mutual Insurance Company's newsletter on HIT risks<a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=norcal"> at this link</a>. (Note - many medical malpractice insurance policies can be interpreted as requiring this reporting, observed occasional guest blogger <a href="http://hcrenewal.blogspot.com/search/label/Dr.%20Scott%20Monteith">Dr. Scott Monteith</a> in a comment to me about this post.)</li></ul><ul><li>Inform the Joint Commission (or similar national accreditor of hospital safety if not in the U.S.) via their complaint site at <a href="http://www.jointcommission.org/report_a_complaint.aspx">http://www.jointcommission.org/report_a_complaint.aspx</a> . Also consider writing the JC senior officers (<a href="http://www.jointcommission.org/about_us/joint_commission_officers.aspx">link to officer's list</a>), whose awareness of HIT issues I can personally attest to via our correspondences.</li></ul><ul><li>Inform the FDA (or similar healthcare regulator if not in the U.S.) via the FDA Medwatch Form 3500 reporting site at <a href="https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm">https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm</a>. An example of such an adverse event report I filed myself (when the involved hospital refused) is <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/Detail.CFM?MDRFOI__ID=1729552">at this link</a> in the FDA MAUDE (Manufacturer and User Facility Device Experience) database.</li></ul><ul><li>Inform the State Medical Society and local Medical Society of your locale.</li></ul><ul><li>Inform the appropriate Board of Health for your locale.</li></ul><ul><li>If applicable (and it often is), inform the Medicare Quality Improvement Organization (QIO) of your state or region. Example: in Pennsylvania, the QIO is "<a href="http://www.qipa.org/Home.aspx">Quality Insights of PA</a>."</li></ul><ul><li>Inform a personal attorney.</li></ul><ul><li>Inform local, state and national representatives such as congressional representatives. Sen. Grassley of Iowa is aware of these issues, for example.</li></ul><ul><li>As clinicians are often forced to use health IT, at their own risk even when "certified" (<a href="http://hcrenewal.blogspot.com/2012/02/hospitals-and-doctors-use-health-it-at.html">link</a>), if a healthcare organization or HIT seller is sluggish or resistant in taking corrective actions, consider taking another risk (perhaps this is for the very daring or those near the end of their clinical career). Present your organization's management with a statement for them to sign to the effect of:</li></ul><blockquote>"We, the undersigned, do hereby acknowledge the concerns of [Dr. Jones] about care quality issues at [Mount St. Elsewhere Hospital] regarding EHR difficulties that were reported, namely [event A, event B, event C ... etc.] We hereby indemnify [Dr. Jones] for malpractice liability regarding patient care errors that occur due to EHR issues beyond his/her control, but within the control of hospital management, including but not limited to: [system downtimes, lost orders, missing or erroneous data, etc.] that are known to pose risk to patients. We assume responsibility for any such malpractice. With regard to health IT and its potential negative effects on care, Dr. Jones has provided us with the Joint Commission Sentinel Events Alert on Health IT at <a href="http://www.jointcommission.org/assets/1/18/SEA_42.PDF" style="font-style: italic;">http://www.jointcommission.org/assets/1/18/SEA_42.PDF</a>, the IOM report on HIT safety at <a href="http://www.modernhealthcare.com/Assets/pdf/CH76254118.PDF" style="font-style: italic;">http://www.modernhealthcare.com/Assets/pdf/CH76254118.PDF</a>, and the FDA Internal Memorandum on H-IT Safety Issues at <a href="http://www.scribd.com/huffpostfund/d/33754943-Internal-FDA-Report-on-Adverse-Events-Involving-Health-Information-Technology" style="font-style: italic;">http://www.scribd.com/huffpostfund/d/33754943-Internal-FDA-Report-on-Adverse-Events-Involving-Health-Information-Technology</a>. CMO __________ (date, time) CIO ___________ (date, time) CMIO _________ (date, time) General Counsel ___________ (date, time) etc."</blockquote><ul><li>If the hospital or organizational management refuses to sign such a waiver (and they likely will!), note the refusal, with date and time of refusal, and file away with your attorney. It could come in handy if EHR-related med mal does occur.</li></ul><ul><li>As EHRs remain experimental, I note that indemnifications such as the above probably belong in medical staff contracts and bylaws when EHR use is coerced.</li></ul> These measures can help "light a fire" under the decision makers, and "get the lead out" of efforts to improve this technology to the point where it is usable, efficacious and safe.</blockquote> More from the article: <blockquote class="tr_bq">Doctors called the time line to install the EHR system too “aggressive” and said there was a “lack of readiness” among the intended users.</blockquote> For financial incentive reasons in part, I'm sure.  Computers, after all, seem to have more rights than patients...or than physicians and nurses. <blockquote class="tr_bq">Since receiving the letter, Thaw said Athens Regional has added "specialized staff" to meet daily with physicians to discuss computer system and safety issues.</blockquote> Again, the key word is "AFTER."   A good move, considering the hospital will be up to its head in defections, accreditation inspections and hearings, and possible medical malpractice and corporate liability lawsuits otherwise. <blockquote class="tr_bq">"Regardless of what system we are using, our focus on patient safety is unwavering, and we will never put a system ahead of doing what is right for our patients," Thaw said. "Our team is working around the clock to resolve any remaining issues, and we remain dedicated to delivering outstanding patient care every step of the way."</blockquote> Feel-good executive boilerplate and an outright lie on its face.  If the focus on safety was unwavering, this problems would not now need emergency remediation.  As I had written many years ago here: <a href="http://cci.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=Cardiology%20story">http://cci.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=Cardiology%20story</a>, this type of shallow executive puffery and rhetoric only makes clinicians angrier. And while events like this go on, the industry pundits suggest all that's needed is a Health IT 'Safety Center' instead of regulation like the rest of the healthcare industry ("Feds Call For Health IT Safety Center", May 20, 2014,<a href="http://www.govhealthit.com/news/feds-call-hit-safety-center?topic=,26#.U4FVDnYsC"> http://www.govhealthit.com/news/feds-call-hit-safety-center?topic=,26#.U4FVDnYsC</a>).  This is sort of like putting the safety of our country's hospitals in the hands of Consumer Reports. That's not exactly the ticket to a rapid cure to these problems, which are more common than most physicians have the bravery (or career options in the face of retaliation) to admit. At least nurses' unions are taking action, as at<a href="http://hcrenewal.blogspot.com/2013/11/another-survey-on-ehrs-affinity-medical.html"> http://hcrenewal.blogspot.com/2013/11/another-survey-on-ehrs-affinity-medical.html</a> and <a href="http://hcrenewal.blogspot.com/2014/05/a-nurses-union-national-nurses-united.html">http://hcrenewal.blogspot.com/2014/05/a-nurses-union-national-nurses-united.html</a>. Additional thought:  at least the writer of the article did not use the customary euphemism for problems with patient-endangering bad health IT, specifically: "glitches" (<a href="http://hcrenewal.blogspot.com/search/label/glitch">http://hcrenewal.blogspot.com/search/label/glitch</a>). -- SS May 27, 2014 Addendum: The CEO has apparently resigned, see <a href="http://onlineathens.com/local-news/2014-05-23/thaw-resigns-athens-regional-ceo">http://onlineathens.com/local-news/2014-05-23/thaw-resigns-athens-regional-ceo</a>.  I also solicit physicians from the area of this hospital to contact me regarding any patient harms that did occur as a result of this debacle, via my email address located here: <a href="https://www.blogger.com/profile/03994321680366572701">https://www.blogger.com/profile/03994321680366572701</a>.  I will forward any reports through appropriate legal channels to attorneys who can take action, which in 2014 is probably the only language this industry will actually listen to. -- SS May 27, 2014 Addendum 2: The reader comments at <a href="http://onlineathens.com/health/2014-05-22/athens-regional-addressing-new-computer-system-problems-encountered-doctors">http://onlineathens.com/health/2014-05-22/athens-regional-addressing-new-computer-system-problems-encountered-doctors</a> are interesting, and distressing. -- SS May 29, 2014 Addendum: More here:  <a href="http://flagpole.com/news/in-the-loop/james-thaw-out-as-armc-ceo">http://flagpole.com/news/in-the-loop/james-thaw-out-as-armc-ceo</a> If I were that's hospital's new leadership, I'd immediately go back to whatever system (whether paper or not) was in place before this implementation, and take the time to implement new health IT properly, safely and carefully. For at this point, if patient injury or death occurs as a result of a system flaw (whether in design or implementation), I believe charges of criminal negligence against the organization and its leaders would be justified. The following is an example of one state's statute defining criminal negligence: <blockquote>''A person acts with 'criminal negligence' with respect to a result or to a circumstance described by a statute defining an offense when he fails to perceive a substantial and unjustifiable risk that such result will occur or that such circumstance exists. The risk must be of such nature and degree that the failure to perceive it constitutes a gross deviation from the standard of care that a reasonable person would observe in the situation.''</blockquote> I believe other states' statutes are similar. -- SS June 13, 2013 Addendum: My post on Athens Regional Medical Center's physician revolt was accessed today by someone at Cerner; note the referring link:  <a href="http://cerner.vertabase.com/project/document/index.cfm?&0.12455576848">http://cerner.vertabase.com/project/document/index.cfm?&0.12455576848</a> Vertabase (<a href="http://www.vertabase.com/">http://www.vertabase.com/</a>) makes project management software. Cerner.vertabase.com/project/document is some sort of password-protected document resource. I find that interesting - perhaps it's for internal communications and they are learning something from me. <table border="0" cellpadding="1" cellspacing="1" style="width: 450px;"><tbody><tr bgcolor="#F5F5E2"><td align="right" width="150">Domain Name</td><td align="center" width="10"></td><td width="290"> (Unknown) </td></tr><tr><td align="right" valign="top">IP Address</td><td align="center"></td><td>159.140.254.# (Cerner Corporation)</td></tr><tr bgcolor="#F5F5E2"><td align="right">ISP</td><td align="center"></td><td>Cerner Corporation</td></tr><tr><td align="right" valign="top">Location</td><td align="center"></td><td><table cellpadding="0" cellspacing="0"><tbody><tr><td>Continent</td><td> : </td><td>North America</td></tr><tr><td valign="top">Country</td><td valign="top"> : </td><td><a href="http://www.sitemeter.com/?a=stats&s=s20hcrenewal&v=100&country=US&vlr=14&pg=21&r=76" target="_blank">United States</a> <a href="http://www.sitemeter.com/?a=stats&s=s20hcrenewal&v=100&country=US&vlr=14&pg=21&r=77" target="_blank"><img border="0" height="12" src="https://blogger.googleusercontent.com/img/proxy/AVvXsEjqRg30-NBYCTvdB5xbLIeWb8pInOkPdRZk2QQR2-V1aYwwwkKPVx8XWaG3Pc8GRDYGnkcPfOIZBAzBPLDYY7EhDVN0UO6vMyU8u-Zqgv165Xdliu3lU51bGzEAUayvD-YcR61pttguytcd5RQ=s0-d-e1-ft" width="18" /></a> <a href="http://www.sitemeter.com/?a=stats&s=s20hcrenewal&v=100&country=US&vlr=14&pg=21&r=78" target="_blank">(Facts)</a></td></tr><tr><td>State</td><td> : </td><td>Kansas</td></tr><tr><td>City</td><td> : </td><td>Kansas City</td></tr><tr><td>Lat/Long</td><td> : </td><td>39.1111, -94.6904 <a href="http://www.sitemeter.com/?a=stats&s=s20hcrenewal&r=75&pg=21&vlr=14&v=100" target="_blank">(Map)</a></td></tr></tbody></table></td></tr><tr bgcolor="#F5F5E2"><td align="right" valign="top">Language</td><td align="center"></td><td>English (U.S.) en-us</td></tr><tr><td align="right">Operating System</td><td align="center"></td><td>Macintosh MacOSX</td></tr><tr bgcolor="#F5F5E2"><td align="right" valign="top">Browser</td><td align="center"></td><td>Safari 1.3 Mozilla/5.0 (Macintosh; Intel Mac OS X 10_8_5) AppleWebKit/536.30.1 (KHTML, like Gecko) Version/6.0.5 Safari/536.30.1</td></tr><tr><td align="right" valign="top">Javascript</td><td align="center"></td><td>version 1.5</td></tr><tr bgcolor="#F5F5E2"><td align="right" valign="top">Monitor</td><td align="center"></td><td><table cellpadding="0" cellspacing="0"><tbody><tr><td>Resolution</td><td> : </td><td>1440 x 900</td></tr><tr><td>Color Depth</td><td> : </td><td>24 bits </td></tr></tbody></table></td></tr><tr><td align="right">Time of Visit</td><td align="center"></td><td>Jun 13 2014 11:47:42 am</td></tr><tr bgcolor="#F5F5E2"><td align="right">Last Page View</td><td align="center"></td><td>Jun 13 2014 11:47:42 am</td></tr><tr><td align="right">Visit Length</td><td align="center"></td><td>0 seconds</td></tr><tr bgcolor="#F5F5E2"><td align="right">Page Views</td><td align="center"></td><td>1</td></tr><tr><td align="right" valign="top">Referring URL</td><td align="center"> </td><td><a href="http://cerner.vertabase.com/project/document/index.cfm?&0.12455576848" target="_blank" title="http://cerner.vertabase.com/project/document/index.cfm?&0.12455576848">http://cerner.vertabase.com/project/document/index.cfm?&0.12455576848</a></td></tr><tr bgcolor="#F5F5E2"><td align="right">Visit Entry Page</td><td align="center"></td><td><a href="http://hcrenewal.blogspot.com/2014/05/i-could-not-make-this-up-if-i-tried.html" target="_blank" title="http://hcrenewal.blogspot.com/2014/05/i-could-not-make-this-up-if-i-tried.html">http://hcrenewal.blogspot.com/2014/05/i-could-not-make-this-up-if-i-tried.html</a></td></tr><tr><td align="right">Visit Exit Page</td><td align="center"></td><td><a href="http://hcrenewal.blogspot.com/2014/05/i-could-not-make-this-up-if-i-tried.html" target="_blank" title="http://hcrenewal.blogspot.com/2014/05/i-could-not-make-this-up-if-i-tried.html">http://hcrenewal.blogspot.com/2014/05/i-could-not-make-this-up-if-i-tried.html</a></td></tr><tr bgcolor="#F5F5E2"><td align="right">Out Click</td><td align="center"></td><td></td></tr><tr><td align="right" valign="top">Time Zone</td><td align="center"></td><td><a href="http://www.sitemeter.com/?a=stats&&s=s20hcrenewal&v=100&vlr=14&pg=21&r=31" target="_blank">UTC-6:00</a></td></tr><tr bgcolor="#F5F5E2"><td align="right" valign="top">Visitor's Time</td><td align="center"></td><td>Jun 13 2014 10:47:42 am</td></tr><tr><td align="right">Visit Number</td><td align="center"></td><td align="left">1,342,222</td></tr></tbody></table>  -- SS Note: also see my June 16, 2014 followup post at <a href="http://hcrenewal.blogspot.com/2014/06/masters-of-obvious-aat-athens-regional.html">http://hcrenewal.blogspot.com/2014/06/masters-of-obvious-aat-athens-regional.html</a>

Athens Regional Medical Center: Hospital management is "addressing computer problems" AFTER patients are put at bodily risk, not before, only in response to irate clinicians; then claiming everything will be fixed soon while doctors resign.

(Note: also see my June 16, 2014 followup post at http://hcrenewal.blogspot.com/2014/06/masters-of-obvious-aat-athens-regional.html) Maybe hospital management gurus could address these computer proble…

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26 May 2014

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