$100 million Epic install dampens Lifespan Rhode Island Healthcare's credit

Lifespan Rhode Island Healthcare System's Siemens EHR was apparently causing thousands of electronically-generated prescriptions to become scrambled, as I posted in Nov. 2011 here: <a href="http://hcrenewal.blogspot.com/2011/11/lifespan-rhode-island-yet-another.html">http://hcrenewal.blogspot.com/2011/11/lifespan-rhode-island-yet-another.html</a>.<br /><br />Due to this "glitch" - and other factors, I surmise - they switched to Epic.<br /><br />Here are the current results:<br /><br /><blockquote class="tr_bq"><b>$100 million Epic install dampens Lifespan's credit</b><br /><a href="http://www.modernhealthcare.com/article/20140606/NEWS/306069948">http://www.modernhealthcare.com/article/20140606/NEWS/306069948</a><br /><br /><span class="mh_tags"><span class="mh_tags">By <a href="mailto:bherman@modernhealthcare.com">Bob Herman</a></span></span><br /><br /><div class="mh_body_12px">Posted: June 6, 2014 - 5:45 pm ET</div><br />A multimillion-dollar <a href="http://www.modernhealthcare.com/section/articles?tagID=975">electronic health-record</a> system installation is eroding the cash flow, and bond rating, of Rhode Island's largest health system.<br /><br />Moody's Investors Service downgraded the rating of <a href="http://www.modernhealthcare.com/section/articles?tagID=2479">Lifespan</a>, Providence, R.I., to Baa2—<b>only two notches away from junk-level status</b>. The ratings agency also <a href="https://www.moodys.com/research/Moodys-downgrades-Lifespan-Rhode-Island-Obligated-Group-RI-to-Baa2--PR_300980">gave the system</a>, which operates four acute-care hospitals and one children's hospital, a negative outlook.<br /><br />... <b>At the heart of the downgrade is Lifespan's new health IT system. </b>In March 2013, Lifespan chose to implement an Epic platform, a system spokeswoman said. Lifespan expects to go live with Epic's EHR by the spring of 2015. <b>Moody's analysts noted the investment will cost $35 million this year and $100 million total over the next several years.</b><br /><br />This has slammed Lifespan's operating performance, Moody's analysts wrote. Lifespan is projecting a 2.8% operating cash flow margin for fiscal 2014, which is far below the Baa2 median of 8.8%. The operating margin is predicted to hover around -1.7%. And it's not likely to get better soon—executives told Moody's they don't expect to post improved results until 2016.<br /><br />“The thin performance provides little cushion during a period of increased capital spending and the installation of a new IT system with short-term implementation risks that could disrupt cash flow,” the report said</blockquote><br />They're a year from going "live" and they've already damaged their financials.  (This does not account for the losses from abandoning an older system.)<br /><br />$100 million is not an unusual cost for a commercial EHR, as I noted elsewhere, e.g., <a href="http://hcrenewal.blogspot.com/2006/10/70-million-for-electronic-medical.html">http://hcrenewal.blogspot.com/2006/10/70-million-for-electronic-medical.html</a>.  An entire hospital or large hospital wing can be built with that much money...not to mention the hiring of quite a lot of human health information management professionals.<br /><br />Hospital executives have bought the <i>"EHRs will save massive amounts of money, eliminate medical errors, and heal the sick"</i> marketing hype hook, line and sinker (as opposed to the more sober "improve healthcare somewhat when implemented expertly").  They are so eager to have this unregulated technology, NOW, that they will place their organizations - and patients - into jeopardy to get it. (As to patient risk, see <a href="http://hcrenewal.blogspot.com/2014/04/fda-on-health-it-risk-reckless-or.html">http://hcrenewal.blogspot.com/2014/04/fda-on-health-it-risk-reckless-or.html</a> and its hyperlinks).<br /><br />I find this phenomenon stunning, and even more so the cognitive dissonance and refusal to believe the actual evidence when the starry-eyed predictions of Cybernetic Medical Nirvana just don't come true.<br /><br />-- SS

$100 million Epic install dampens Lifespan Rhode Island Healthcare's credit

Lifespan Rhode Island Healthcare System's Siemens EHR was apparently causing thousands of electronically-generated prescriptions to beco...

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In Fixing Those 9,553 EHR "Issues", Southern Arizona’s Largest Health Network is $28.5 Million In The Red

At my Nov. 9, 2013 post <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>"<b>We’ve resolved 6,036 issues and have 3,517 open issues" </b>(<a href="http://hcrenewal.blogspot.com/2013/11/weve-resolved-6036-issues-and-have-3517.html">http://hcrenewal.blogspot.com/2013/11/weve-resolved-6036-issues-and-have-3517.html</a>) I wrote about "issues" (i.e., "glitches" including potentially injurious or deadly bugs and malfunctions) the organization was having with a new EHR at University of Arizona Health System.<br /><br />Now we know part of the cost of resolving those 9,553 "issues."<br /><br /><blockquote class="tr_bq"><a href="http://azstarnet.com/news/science/health-med-fit/tucson-area-s-largest-area-network-racks-up-nearly-million/article_44d05d04-0acf-5fbc-8561-68d4bef3b577.html">http://azstarnet.com/news/science/health-med-fit/tucson-area-s-largest-area-network-racks-up-nearly-million/article_44d05d04-0acf-5fbc-8561-68d4bef3b577.html</a><br /><b>Tucson area's largest health network racks up nearly $30 million in losses</b></blockquote><div class="publish-meta clearfix"><blockquote><div class="date left"><span class="pubdate">June 01, 2014 </span> •  <span class="byline">By <a class="open-tooltip" href="http://azstarnet.com/users/profile/Emily%20Bregel">Emily Bregel</a>, <a class="open-tooltip" href="http://azstarnet.com/users/profile/Stephanie%20Innes">Stephanie Innes</a></span></div></blockquote><div class="date left"><blockquote><span class="byline"> <style type="text/css">P { margin-bottom: 0.08in; }A:link { }</style> </span><br /><div style="margin-bottom: 0in;">Southern Arizona’s largest health network <b>is $28.5 million in the red so far this fiscal year, and officials say a costly electronic medical records system is largely to blame.</b></div><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">The operating loss is unprecedented for the four-year-old University of Arizona Health Network, which includes two local hospitals.</div><div style="margin-bottom: 0in;"></div></blockquote><br />Stellar management was clearly responsible for this wonderful outcome.  When will the layoffs start, I ask? That's the usual managerial solution for financial losses, and in this case I feel particularly worried about employees who did not obey the "suggestion" to only use "<b>Words that Work</b>" about this EHR (see <a href="http://hcrenewal.blogspot.com/2013/10/words-that-work-singing-only-positive.html">http://hcrenewal.blogspot.com/2013/10/words-that-work-singing-only-positive.html</a>). <br /><br /><blockquote class="tr_bq"><div style="margin-bottom: 0in;">The electronic records system, from Wisconsin-based Epic Systems, has cost an estimated <b>$115 million</b>, including <b>$32 million in unbudgeted costs for the first eight months of the fiscal year,</b> which ends June 30, financial documents show. The extra costs are due primarily to a delay in getting the system live and funding additional training and support, officials said. It was supposed to be up and running by Sept. 1, but wasn’t operational until Nov. 1.</div></blockquote><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">$32 million to fix 9,553 "issues", most likely due to implementation incompetence, plus some that perhaps the seller should have at least been partially responsible for...such as these:</div><div style="margin-bottom: 0in;"><br /></div><blockquote class="tr_bq"><ul><li>Pharmacy Medication Mapping Errors <span style="color: red;"></span></li></ul><ul><li>Microbiology Results Mapping Incorrectly </li></ul></blockquote><blockquote class="tr_bq"><ul><li>Prescription printing bugs</li></ul><ul><li>Errors transmitting prescriptions </li></ul></blockquote><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">I note that real, live patients were the unwitting experimental subjects in this little software debugging project.</div><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">I also note that $115 million <b>could have paid for an entire new hospital or wing</b> - and these startup costs are just the beginning... </div><div style="margin-bottom: 0in;"><br /></div><blockquote class="tr_bq"><div style="margin-bottom: 0in;">... There are other reasons for the network’s weak finances. UA Health Network officials say uninsured patients aren’t getting health insurance coverage through the federal Affordable Care Act as quickly as they’d anticipated, resulting in $11 million less than expected in patient revenue through February.</div><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">The network also lost federal dollars from a program that helped bridge the funding gap created by Medicaid rate cuts and a rise in uninsured patients. The Safety Net Care Pool, which also included Maricopa Integrated Health System and Phoenix Children’s, pumped $33 million into the UA hospitals for the first six months of the fiscal year. But that infusion ended Dec. 31 to coincide with greater health insurance availability through the Affordable Care Act.</div></blockquote><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">It's not like these events were entirely unpredictable.  Perhaps priorities could have been rearranged, rather than dumping millions into a known money pit, the implementation of enterprise clinical information technology?</div><blockquote class="tr_bq"><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">... “The issue is more about where we are going and what things are in place to change the trajectory,” Lynn said. “It was an especially difficult time financially because of Epic, there was no choice in the matter. That period of time has fortunately passed and now we can do much better.”</div></blockquote><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">There certainly was "choice in the matter."  I also suggest to Mr. Lynn that the "trajectory" might end up being a ballistic one.</div><div style="margin-bottom: 0in;"><br /></div><blockquote class="tr_bq"><div style="margin-bottom: 0in;">... A financial report presented to the network’s board of directors on April 24 says the Epic system’s higher-than-expected expenses this fiscal year were due to “implementation delays, additional training support and planned schedule reductions.” Some of the expenses were originally supposed to be in the prior fiscal year.</div><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">The report attributes $6.8 million of the current year’s losses to physicians spending enough time training to use the new system that they couldn’t see as many patients between November and January. Schedules were back to normal as of February.</div></blockquote><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">One wonders just how much increased stress and pressure there is on clinicians with the new system in place.   </div><div style="margin-bottom: 0in;"><br /></div><blockquote class="tr_bq"><div style="margin-bottom: 0in;">... Implementing the new system has hit the network’s finances hard, but over time it <b>should improve patient safety</b> by cutting down on unnecessary testing and medication errors, among other things, officials say. Eventually it is <b>expected to save money</b> because of its added efficiency.</div></blockquote><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">"Should?"  Considering the issues I've outlined at this blog and my Drexel University Healthcare Informatics site (<a href="http://cci.drexel.edu/faculty/ssilverstein/cases/">http://cci.drexel.edu/faculty/ssilverstein/cases/</a>), this seems a type of wishful-thinking due diligence performed by those who believe in fairy tales and bargain sales of bridges like the one at <a href="http://www.distancesfrom.com/us/Brooklyn-Bridge-latitude-longitude-Brooklyn-Bridge-latitude-Brooklyn-Bridge-longitude/LatLongHistory/24244.aspx"><span id="MC_GMD_lblLatitude">latitude 40.7045096 N, longitude </span></a><span id="MC_GMD_lblLongitude"><a href="http://www.distancesfrom.com/us/Brooklyn-Bridge-latitude-longitude-Brooklyn-Bridge-latitude-Brooklyn-Bridge-longitude/LatLongHistory/24244.aspx">73.99480549999998 W</a>.</span></div><div style="margin-bottom: 0in;"></div><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">Let me make a realistic projection:  No money will be saved, e.g., see the opinions from Wharton at <a href="http://hcrenewal.blogspot.com/2009/06/wharton-on-healthcare-it-can-i-go-home.html">http://hcrenewal.blogspot.com/2009/06/wharton-on-healthcare-it-can-i-go-home.html</a>.  </div><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">Another projection:  safety will be adversely affected, e.g., see the <b>ECRI Deep Dive study</b> 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>, the <b>Top Ten Healthcare Technology Risks for 2014</b> 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> and the FDA Internal Memo on H-IT Risks 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>, to name a few sources repeatedly mentioned here.</div><div style="margin-bottom: 0in;"><br /></div><blockquote class="tr_bq"><div style="margin-bottom: 0in;">At the UA Medical Center’s south campus, the Epic system has taken doctors from paper charts and uncoordinated computer records to having all patient information — from angiogram and CT scan results to billing updates — in one place, accessible via iPhone.</div></blockquote><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">Try doing medicine on an iPhone screen area...</div><div style="margin-bottom: 0in;"><br /></div><blockquote class="tr_bq"><div style="margin-bottom: 0in;">“This is the future. We have to have electronic medical records,” said Dr. Kwan S. Lee, a cardiologist who is medical director of the UA Medical Center’s south campus.</div></blockquote><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">"This is the future!!  We just <i><b><u>have</u> </b></i>to do it!!"  Dr. Lee, I admire your exceptionally well-reasoned and thorough budget justification for putting your healthcare system $30 million in the red.  Congratulations!</div><div style="margin-bottom: 0in;"><br /></div><blockquote class="tr_bq"><div style="margin-bottom: 0in;">... Lee cited a recent case where a patient who had been previously treated at Tucson Medical Center came to the UA Medical Center’s emergency room, having an acute heart attack. The standard of care in such cases is opening the artery within 90 minutes. In a rush against the clock, Lee was able to click on the patient’s record from TMC and see the area where the patient had prior surgery.</div><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">“The patient had consented to share information from Tucson Medical Center and it helped us immensely,” Lee said. “We would have possibly wasted a lot of time. The patient did very well.”</div></blockquote><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">A far, far less expensive document image management system could have accomplished exactly the same goal.</div><div style="margin-bottom: 0in;"><br /></div><blockquote class="tr_bq"><div style="margin-bottom: 0in;">One con is that the system is <b>“a little overly complicated”</b> because it tries to be all things to all people, he said.  “It was painful ... <b>A lot of us are technophobes,</b>” he said. “But there was no way we could move forward without adopting it.” </div></blockquote><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">"A little overly complicated?"  Gee, I guess that's why physicians at Athens Regional Medical Center revolted as 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>.  The system was just "a little overly complicated!"</div><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">"A lot of us are technophobes?"  How about "A lot of us are not EHR hyper-enthusiasts, but pragmatists?" (<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>).</div><div style="margin-bottom: 0in;"><br /></div><blockquote class="tr_bq"><blockquote class="tr_bq"><div style="margin-bottom: 0in;">Chief Information Officer Critchley agreed, saying that with the infrastructure in place, the system will be improved as needed over time.</div><div style="margin-bottom: 0in;"><b><br /></b></div><b></b><br /><div style="margin-bottom: 0in;"><b>“For better or worse</b>, only when it’s live are you going to get the doctors and staff to engage and do the fine tuning <b>of what it really means</b>, and what they want to see happen,” Critchley said.</div></blockquote></blockquote><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">This is a political statement at best.  The assumption here is that this technology itself is some sort of miracle worker, just needing "fine tuning" to reveal its miracles.  In fact, most medical inefficiencies and dangers have nothing to do with documentation at all (e.g., see "<b>Is healthcare IT a solution to the wrong problem?</b>" at <a href="http://hcrenewal.blogspot.com/2010/12/is-healthcare-it-solution-to-wrong.html">http://hcrenewal.blogspot.com/2010/12/is-healthcare-it-solution-to-wrong.html</a>).</div><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;"><b>The only miracle so far has been to put the system $30 million in the red</b>, with more to follow.</div><blockquote class="tr_bq"><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">... The UA Health Network, which began its Epic implementation in 2012, receives a little over $1 million per year in incentive payments, Critchley said.</div></blockquote><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">That's nice.   They spent $115 million to qualify for a $1 million annual incentive?  Makes perfect sense to me ...</div><div style="margin-bottom: 0in;"><br /></div><blockquote class="tr_bq"><div style="margin-bottom: 0in;"><b>Adoption of electronic records is voluntary</b>, but hospitals that don’t make the switch by October face Medicare payment cuts of about 1 percent, and increasing reductions each year.</div></blockquote><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">At least one reporter reports this factoid accurately.  Hospital and industry execs are fond of misstatements that "EHRs are mandatory."</div><blockquote class="tr_bq"><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">Critchley has worked on at least four other Epic installations around the country as part of his consulting work and says <b>the UA Medical Center’s has been the least expensive</b>, with the most aggressive timeline. He has worked on projects that cost more than <b>a half billion dollars</b>.</div></blockquote><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">"Least expensive?"  "Half a billion dollars?"  It sounds like first class care for every underserved person in the United States could have been paid for instead of dumping the money into an unproven, experimental computer technology...</div><div style="margin-bottom: 0in;"><br /></div><blockquote class="tr_bq"><div style="margin-bottom: 0in;">At Tucson Medical Center, a $31 million upgrade to its electronic medical records system — also the Epic system — began to reduce expenses <span style="color: red;"><i><b>[overall net expenses, or just on a limited per-account, cherry-picked basis?  I suspect the latter - ed.]</b></i></span> almost immediately after it went live in 2010. TMC is among 3 percent of hospitals nationwide at the highest stage of electronic records adoption, based on an electronic records ranking system.</div><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">“We started to see efficiencies the first day,” said Frank Marini, TMC’s chief information officer. <b>Transcription expenditures dropped by half, as doctors who had previously dictated patient notes instead documented them directly into the electronic record, he said.</b></div></blockquote><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">And they had to type and/or manually edit the results of Dragon or some other VR software.  That's wonderful!  Save money by firing transcriptionists and <i>making the physicians spend their valuable time and attention on clerical work.</i>  Fine business!</div><blockquote class="tr_bq"><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">TMC began its push to upgrade its partial electronic records system in 2009. The hospital’s early investments in infrastructure, starting in 2002, lowered the cost of adopting a comprehensive system, he said.</div></blockquote><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">Thus, in fact, overall expense was probably <i><b>several times the $115 million quoted.  Say, perhaps, half a billion dollars?</b></i></div><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">To any U. Az healthcare employee reading this - remember, if you are experiencing EHR difficulties, only use Words that Work!</div></div><div class="date left"></div><div class="date left"><span class="byline"><br /></span></div><div class="date left"><span class="byline">-- SS</span></div><div class="comment-count right"></div><div class="comment-count right"></div><div class="comment-count right"></div></div>

In Fixing Those 9,553 EHR "Issues", Southern Arizona’s Largest Health Network is $28.5 Million In The Red

At my Nov. 9, 2013 post " We’ve resolved 6,036 issues and have 3,517 open issues" ( http://hcrenewal.blogspot.com/2013/11...

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EHR Go-Lives Are Often Chaotic; One Area To Be Explored Is If This Go-Live Led To This Tragedy

<span style="font-size: small;">EHR "go-lives" are particularly chaotic as staff adjusts to the new cybernetic governor of care.  Could the distractions have caused or contributed to the following tragedy? </span><br /><br /><blockquote class="tr_bq"><span style="font-size: small;"><a href="http://www.cnn.com/2013/12/17/health/california-girl-brain-dead/" target="_blank">http://www.cnn.com/2013/12/17/<wbr></wbr>health/california-girl-brain-<wbr></wbr>dead/</a></span><br /><span style="font-size: small;"><br /></span><span style="font-size: small;"><b>Family wants to keep life support for girl brain dead after tonsil surgery</b></span><br /><span style="font-size: small;">By Tom Watkins and Mayra Cuevas, CNN</span><br /><span style="font-size: small;">updated 4:32 PM EST, Wed December 18, 2013 </span><br /><span style="font-size: small;"><br /></span><span style="font-size: small;">The mother of 13-year-old Jahi McMath, who was declared brain dead Thursday, three days after undergoing surgery to remove her tonsils, said Tuesday that the family should make the call.</span><br /><span style="font-size: small;"><br /></span><span style="font-size: small;">... The surgery, which occurred December 9 <span style="color: red;"><i><b>[at Children's Hospital & Research Center in Oakland, California - ed.]</b></i></span>, initially appeared to have gone well, said Sandy Chatman, Jahi's grandmother who is herself a nurse and saw the girl in the recovery room. "She was alert and talking, and she was asking for a Popsicle because she said her throat hurt," Chatman said.</span><br /><span style="font-size: small;"><br /></span><span style="font-size: small;">But Jahi was then moved to the intensive-care unit, and her relatives were denied access to the eighth-grader for 30 minutes; when they finally were allowed to see her, they knew something was wrong. "Upon entry, they saw that there was way too much blood," Chatman said.</span><br /><span style="font-size: small;"><br /></span><span style="font-size: small;">"We kept asking, 'Is this normal?'" Sealey said. "Some nurses said, 'I don't know,' and some said, 'Yes.' <b>There was a lot of uncertainty and a lack of urgency."</b></span><br /><span style="font-size: small;"><br /></span><span style="font-size: small;"><b>Sealey said that when Chatman noticed that her granddaughter's oxygen levels were dangerously low, she called for help.</b></span><br /><span style="font-size: small;"><br /></span><span style="font-size: small;">But Jahi went into cardiac arrest. The medical staff performed chest compressions to revive her and gave her clotting medications, but nothing worked.</span></blockquote><span style="font-size: small;"><br /></span><span style="font-size: small;">The girl's brain was severely injured by lack of oxygen.  I am not commenting on the reported dispute regarding removing life support.</span><br /><span style="font-size: small;"><br /></span><span style="font-size: small;">I am commenting on my concern about a possible contributory role of a new EHR.</span><br /><span style="font-size: small;"><br /></span><span style="font-size: small;">At my Jan. 2, 2014 post <b>"Doctors' Dissatisfaction With EHRs May Be Early Warning of Deeper Quality Problems" </b>(<a href="http://hcrenewal.blogspot.com/2014/01/doctors-dissatisfaction-with-ehrs-may.htm">http://hcrenewal.blogspot.com/2014/01/doctors-dissatisfaction-with-ehrs-may.htm</a>l) I wrote of the distractions that physicians reported were caused by EHR systems such as:</span><br /><br /><blockquote class="tr_bq"><span style="color: black; font-family: arial; font-size: small;"><span style="background-color: transparent;"><span style="color: black; font-family: arial;"><span style="background-color: transparent;">... current EHR technology interferes with face-to-face discussions with patients; requires physicians to spend too much time performing clerical work; and degrades the accuracy of medical records by encouraging template-generated doctors' notes.</span></span></span></span> </blockquote><span style="font-size: small;"><br /></span><span style="font-size: small;">I had also noted nurse's concerns of "inevitable" patient injury due to EHR distractions, such as at:</span><br /><br /><ul><li><span style="font-size: small;"> My July 12, 2013 post <b>"RNs Say Sutter’s New Electronic System Causing Serious Disruptions to Safe Patient Care at East Bay Hospitals"</b> (<a href="http://hcrenewal.blogspot.com/2013/07/rns-say-sutters-new-electronic-system.html">http://hcrenewal.blogspot.com/2013/07/rns-say-sutters-new-electronic-system.html</a>),</span></li></ul><ul><li><span style="font-size: small;">my May 30, 2013 post "<b>Marin General Hospital's Nurses are Afraid a Defective EMR Implementation Will Harm or Kill Patients</b>" at <a href="http://hcrenewal.blogspot.com/2013/05/marin-general-hospitals-nurses-are.html">http://hcrenewal.blogspot.com/2013/05/marin-general-hospitals-nurses-are.html</a>, </span></li></ul><ul><li><span style="font-size: small;">my June 19, 2013 post <b>"Affinity RNs Call for Halt to Flawed Electronic Medical Records System Scheduled to Go Live Friday"</b> (<a href="http://hcrenewal.blogspot.com/2013/06/affinity-rns-call-for-halt-to-flawed.html">http://hcrenewal.blogspot.com/2013/06/affinity-rns-call-for-halt-to-flawed.html</a>),  </span></li></ul><ul><li><span style="font-size: small;">and at other posts citing similar nursing complaints. </span></li></ul><span style="font-size: small;"><br /></span><span style="font-size: small;">The cases cited above involve the "EPIC" EHR, but similar issues arise will most of the current EHR sellers' products, which are unregulated.  </span><br /><br /><span style="font-size: small;">For instance see the <b>ECRI Institute's Deep Dive study of EHR risk</b> 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>. In a volunteer study (i.e., only a fraction of true incidents reported) of 36 ECRI PSO hospitals, 171 EHR-related "events" serious enough to cause harm were voluntarily reported in just 9 weeks.  8 of the "health IT events" were reported to have resulted in patient harm, and 3 were possibly related to patient deaths.  </span><br /><br /><span style="font-size: small;">From a press release from nurses at Affinity Medical Center (Ohio) on the nature of the problems:</span><br /><br /><blockquote class="tr_bq"><span style="font-size: small;">... The programs are often <b>counterintuitive, cumbersome to use, and sometimes simply malfunction.</b> Nurses are finding that the technology is <b>taking time away from patients and fundamentally changing the nature of nursing.”</b> ... I’m concerned that the manner in which this technology is being implemented <b>may pose serious disruptions in patient care.”</b></span></blockquote><span style="font-size: small;"><br /></span><br /><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;"><span style="font-size: small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbLHw1SqBJZglTMVlAh9MtKitlKiiVpouL8TTAbtNJwQqXGHGwRLj6imsuWMcqjMftyUM4ywqBSJV8uZ5i0Tqa1jrpxoC178PC40kaaNQww_88NhLwDu4E7UjBNzO82rJzxoX72tNs8yVZ/s1600/affinity_page1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbLHw1SqBJZglTMVlAh9MtKitlKiiVpouL8TTAbtNJwQqXGHGwRLj6imsuWMcqjMftyUM4ywqBSJV8uZ5i0Tqa1jrpxoC178PC40kaaNQww_88NhLwDu4E7UjBNzO82rJzxoX72tNs8yVZ/s320/affinity_page1.jpg" width="247" /></a></span></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">An open letter from nurses at an Ohio hospital, Affinity, on EHR "threats to patient safety."  <b>Click to enlarge.</b></span></td></tr></tbody></table><span style="font-size: small;"><br /></span><span style="font-size: small;"><br /></span><span style="font-size: small;">The EPIC EHR apparently had just recently "gone live" at Children's Hospital Oakland.</span><br /><br /><span style="font-size: small;">From  </span>"<b>Children's Oakland completes Phase 1 of $89 million electronic records system</b>", Nov 20, 2013 (<a href="http://www.bizjournals.com/sanfrancisco/blog/2013/11/childrens-oakland-89m-emr.html">http://www.bizjournals.com/sanfrancisco/blog/2013/11/childrens-oakland-89m-emr.html</a>):<br /><br /><blockquote class="tr_bq">Children's Hospital & Research Center Oakland has completed the first phase of an $89 million Epic Systems Corp. electronic health records system that links inpatient operations and an oncology/hematology clinic.<br /><br />Other outpatient clinics are expected to come online in March or April, spokeswoman Melinda Krigel told the Business Times.<br /><br />... The project's overall cost, $89 million, includes hardware, software and other implementation costs, including a separate SoftLab system that interfaces with the main electronic medical records system, Krigel said.<br /><br /><b>The official "go-live" date was Nov. 5.</b> </blockquote><br /><span style="font-size: small;">See also the Children's Hospital Oakland Annual Report at <a href="http://www.chofoundation.org/assets/files/2012-annual-report.pdf" target="_blank">http://www.chofoundation.org/<wbr></wbr>assets/files/2012-annual-<wbr></wbr>report.pdf</a>.  On page 21: </span><br /><span style="font-size: small;"><b> </b></span><br /><blockquote class="tr_bq"><span style="font-size: small;">... The Epic system will launch in <b>November 2013</b> at Children’s inpatient facilities as well as in the Operating Room, the Emergency Department, the Day Hospital, and the Oncology/ Hematology Clinic. </span></blockquote><br /><span style="font-size: small;">I believe the possibility of clinicians being so distracted by computer data entry duties, and/or communications being impaired by the system's outputs, that this patient was left anoxic for a crucial period of time needs to be investigated.</span><br /><br /><span style="font-size: small;"><span style="font-size: small;"> In my view, in the differential diagnosis of clinical chaos in 2014, the chaos caused by healthcare IT needs to be a consideration.</span> </span><br /><span style="font-size: small;"><br /></span><span style="font-size: small;">My concerns may be shown unfounded in this case (I hope they are), and the injuries the result of other factors.  In consideration of the reported complaints from other organizations, however, not conducting an impartial investigating of a role of the new EHR in this tragedy would be, in my opinion, cavalier.</span><br /><span style="font-size: small;"><br /></span><span style="font-size: small;">-- SS </span><br /><br /><b><span style="font-size: small;">Jan. 5, 2014 Addendum:</span></b><br /><br /><span style="font-size: small;">From a court document cached here:  <a href="http://www.cci.drexel.edu/faculty/ssilverstein/1230rrr.pdf">http://www.cci.drexel.edu/faculty/ssilverstein/1230rrr.pdf </a>, the following is written at p. 11-12:</span><br /><blockquote class="tr_bq"><br /><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles></xml><![endif]--><!--[if gte mso 10]><style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style><![endif]--><span style="font-size: small;">... Originally the surgery was uneventful and MCMATH awoke from sedation in the recovery room speaking with hermother, Petitioner LATASHA WINKFIELD asking for a popsicle.  MCMATH <b>was taken to the ICU</b> and her mother was told to wait several minutes while they fixed her IV.</span><br /><span style="font-size: small;"><br /></span><span style="font-size: small;">After being told several times that it would be just another 10 minutes, approximately 25-45 minutes after MCMATH was brought into the ICU, WINKFIELD went back and found her daughter sitting up in bed bleeding from her mouth.  It was evident that this had been transpiring for some time.  The nursing staff said “it was normal” and the mother stayed at the bedside as the bleeding grew increasingly worse.  <b>The nurses gave WINKFIELD a cup/catch basin for MCMATH to bleed from her mouth into.</b>  WINKFIELD asked for assistance and was told that this was normal and was given paper towels to clean the blood off herself and MCMATH.</span><br /><span style="font-size: small;"><br /></span><span style="font-size: small;">The bleeding intensified to where <b>copious amounts of blood were being expelled from MCMATH’s mouth and then nose</b>.  MCMATH’s stepfather was also present and assisted in the attemps to stem/collect the blood.</span><br /><span style="font-size: small;"><br /></span><span style="font-size: small;">Again, WINKFIELD asked for assistance, and a doctor, <b>and was only given a bigger container to collect the blood and, later, a suction device to suction the increasing volume of blood.</b>  The stepfather continued to suction while the mother went and got her mother, a nurse, to take over for her.  The grandmother saw what was happening and made multiple requests, and then a loud demand, for a doctor.</span><br /><span style="font-size: small;"><br /></span><span style="font-size: small;">MCMATH shortly thereafter suffered a heart attack and fell into a comatose state.  She later was pronounced “brain dead”… </span></blockquote><br /><span style="font-size: small;">"Heart attack" (i.e., primary myocardial infarction) in a 13-year-old sounds far less likely than exsanguination to the point</span> of hypovolemic shock, severe hypotension, and cardiac arrest.  That such events transpired in an ICU, with family present and calling for help, suggests there were major clinician distractions of some sort at play.<br /><br />A reader wrote me wondering if a new CPOE component could have caused delays in evaluation and treatment. When someone is dying, you simply cannot waste time 'clicking away', they wrote.<br /><br /><span style="font-size: small;">A reader also wrote me wondering if an EHR crash occurred at the time this patient was left with family to exsanguinate, causing clinical chaos.</span><br /><br /><span style="font-size: small;">That is a particularly interesting thought.  See the multiple posts at <a href="http://hcrenewal.blogspot.com/search?q=ehr+crash">http://hcrenewal.blogspot.com/search?q=ehr+crash</a>. </span><br /><br /><span style="font-size: small;">In my opinion, these issues require investigation. </span><br /><span style="font-size: small;"><br /></span><span style="font-size: small;">-- SS</span>

EHR Go-Lives Are Often Chaotic; One Area To Be Explored Is If This Go-Live Led To This Tragedy

EHR "go-lives" are particularly chaotic as staff adjusts to the new cybernetic governor of care.  Could the distractions have caus...

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"We’ve resolved 6,036 issues and have 3,517 open issues": Extolling EPIC EHR Virtues at University of Arizona Health System

The public may believe that, in healthcare, only the Obamacare insurance exchange website has lots of bugs.  On those, see my Oct. 10. 2013 post <b>"Drudge Report, Oct. 10, 2013, 9 AM EST: All that needs to be said about government, computing and healthcare"</b> at <a href="http://hcrenewal.blogspot.com/2013/10/drudge-report-oct-10-2013-9-am-est-all.html">http://hcrenewal.blogspot.com/2013/10/drudge-report-oct-10-2013-9-am-est-all.html</a>.<br /><br />Another pillar of the Affordable Care Act, electronic medical records (promoted with incentives for adopters and with penalties for non-adopters via the HITECH section of the 2009 economic recovery act or ARRA) are pretty damn bad themselves.  Only, those systems don't make it hard to find insurance.  Through bugs and other features of bad health IT, they directly interfere with safety and provision of quality care:<br /><br /><blockquote class="tr_bq"><span style="font-family: inherit;"><span style="color: black;"><b>Bad Health IT</b> ("BHIT") is ill-suited to purpose, hard to use, unreliable, loses data or provides incorrect data, is difficult and/or prohibitively expensive to customize to the needs of different medical specialists and subspecialists, causes cognitive overload, slows rather than facilitates users, lacks appropriate alerts, creates the need for <span class="SpellE">hypervigilance</span> (i.e., towards avoiding IT-related mishaps) that increases stress, is lacking in security, compromises patient privacy or otherwise demonstrates suboptimal design and/or implementation.<span style="mso-spacerun: yes;">  </span></span></span></blockquote><br />At my Oct. 20, 2010 post <b>"Medical center has more than 6000 'issues' with Cerner CPOE system in four months - has patient harm resulted?"</b> (<a href="http://hcrenewal.blogspot.com/2010/10/medical-center-has-more-than-6000.html">http://hcrenewal.blogspot.com/2010/10/medical-center-has-more-than-6000.html</a>) I observed:<br /><br /><blockquote class="tr_bq">From the October 2010 "<i>News for Physicians affiliated with Munson Medical Center</i>" newsletter, a large medical center in Northern Michigan, about <span style="font-weight: bold;">more than six thousand</span> <span style="font-weight: bold;">"issues"</span> with their Cerner CPOE.<br /><br />... One wonders how many of those 6,000, and how many of the 600 remaining "issues" <a href="http://hcrenewal.blogspot.com/2009/03/draft-patient-rights-statement-and.html">fall into categories of</a> "<b>likely to cause patient harm in short term if uncorrected</b>" or "<b>may cause in patient harm in medium or long term</b>."<br /><br />I note that Cerner CPOE is <b><i>not a new product</i></b>, <i><b>nor are similar products from other vendors also afflicted with long lists of "issues."</b></i> That there could be more than 6,000 "issues" at a new site suggests deep rooted, severe problems with CPOE specifically and health IT design and implementation processes in general. </blockquote><br />Here's another such multi-"issue"-laden EHR, this at University of Arizona Health Network.  Image of frequent periodic "EHR Update" below.<br /><br /><br /><br /><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/AVvXsEhgZkzPXU8Sfpv_3NWc4TPK2B79BvEEnxLU1_Y6OAXuVdcPoJYfHmde-XQXkeW7gO1iLUDVxRtzTpO7be0qDVU4nCD88O45plTy_9168SBdVJ2EiVBb9yChYToK_5OQJfDRSOyh6NF-HqUv/s1600/U_Az2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgZkzPXU8Sfpv_3NWc4TPK2B79BvEEnxLU1_Y6OAXuVdcPoJYfHmde-XQXkeW7gO1iLUDVxRtzTpO7be0qDVU4nCD88O45plTy_9168SBdVJ2EiVBb9yChYToK_5OQJfDRSOyh6NF-HqUv/s1600/U_Az2.jpg" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">"We’ve resolved 6,036 issues and have 3,517 open issues."</td></tr></tbody></table><div class="separator" style="clear: both; text-align: center;"></div><br />[Ignore the 'kewl dark sunglasses' worn by the hipsters at the top of this announcement.  Not sure if this has something to do with EPIC, but I consider the wearing of dark sunglasses by clinicians or any other staff in a hospital setting - where people are sick and/or dying - to be in exceptionally bad taste.]<br /><br />The text starts:<br /><br /><blockquote class="tr_bq"><b>ISSUES UPDATE as of 4:00 p.m., Nov. 8</b><br /><b>We’ve resolved 6,036 issues and have 3,517 open issues.</b></blockquote><br />That's a total of nearly ten thousand "issues."  As of now, that is.  "Issue" is a euphemism for "glitch" a.k.a. "software defect" and/or "implementation error", see <a href="http://hcrenewal.blogspot.com/search/label/glitch">http://hcrenewal.blogspot.com/search/label/glitch</a>.<br /><br />These "issues" are  in a supposedly "mature" product for which this organization has spent enormous sums of money, that has undergone "innovation" for several decades now - in an environment free from regulation, I might add.<br /><br />Many of the "issues" reduce patient safety, and could or already may have resulted in patient harm.  Such items on this listing, seen below, which is updated frequently, include:<br /><ul></ul><blockquote class="tr_bq"><ul><li>Pharmacy Medication Mapping Errors – Making good progress: watch for further notices.  <span style="color: red;"><i><b>[Perhaps these should have been tested and fixed before go-live? - ed.]</b></i></span></li></ul><ul><li>Microbiology Results Mapping Incorrectly <span style="color: red;"><i><b>[does that mean "mapping" to the wrong patient? - ed.]</b></i></span>  – all known errors fixed, monitoring and working on enhancements. <span style="color: red;"><i><b>[As above, perhaps these should have been tested and fixed before go-live? - ed.]</b></i></span><span style="color: red;"><i><b></b></i></span></li></ul><ul><li>Prescription printing - output for prescription printing has been fixed</li></ul><ul><li>Refill requests for providers will be routed to the CLIN SUPPORT In Basket pool for the provider’s department.  This was a decision made by UAHN leadership. <span style="color: red;"><i><b>[Not sure why this is being done; perhaps for approval by managers? - ed.]</b></i></span>  </li></ul><ul><li><b>Errors transmitting prescriptions</b> will also be sent to the CLIN SUPPORT In Basket. <span style="color: red;"><i> <b>[Errors transmitting prescriptions? That's not reassuring regarding data integrity.  See ECRI report below  - ed.]</b></i></span></li></ul></blockquote><ul></ul><br />This is not to mention that all of the <b>"reminders"</b> that follow are a distraction to clinical personnel, who cannot be expected to remember all of them.<br /><br />Bad as this is, at<b> my April 1, 2012 post "University of Arizona Medical Center, $10 million in the red in operations, to spend $100M on new EHR system" </b>(<a href="http://hcrenewal.blogspot.com/2012/04/university-of-arizona-medical-center-10.html">http://hcrenewal.blogspot.com/2012/04/university-of-arizona-medical-center-10.html</a>) I observed that:<b><br /></b><br /><blockquote class="tr_bq">... $100 million+ is probably enough to pay for AN ENTIRE NEW HOSPITAL or hospital wing ... or a lot of human medical records professionals. </blockquote><br />To add more bitter icing to this cake, I wrote about a campaign for clinicians to speak only in wonderful terms about the new U. Arizona Health System EHR<b> at my Oct. 3, 2013 post "Words that Work: Singing Only Positive - And Often Unsubstantiated - EHR Praise As 'Advised' At The University Of Arizona Health Network."  </b>I<b> </b>observed the following about the "words that work" is the shameless 'suggested' script:<br /><br /><blockquote class="tr_bq">• <span style="color: red;"><b><i>Efficient</i></b></span> - see aforementioned links as well as "Common Examples of Healthcare IT Difficulties" at <a href="http://cci.drexel.edu/faculty/ssilverstein/cases/">http://cci.drexel.edu/faculty/ssilverstein/cases/</a><br /><br />• <span style="color: red;"><b><i>Convenient</i></b></span> - as above.  According to whom?  Compared to what?  Pen and paper?<br /><br />• <span style="color: red;"><b><i>Improves patient safety and quality</i></b></span> - see IOM report post at <a href="http://hcrenewal.blogspot.com/2011/11/iom-report-on-health-it-safety-nix-fda.html">http://hcrenewal.blogspot.com/2011/11/iom-report-on-health-it-safety-nix-fda.html</a> .  We as a nation <b>are only now studying safety of this technology</b>, and the results are not looking entirely convincing, e.g.<b> ECRI Deep Dive Study</b> of health IT safety 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>.  171 health IT mishaps in 36 hospitals, voluntarily reported over 9 weeks, with 8 reported injuries and 3 reported possible deaths is not what I would call something that "improves patient safety and quality" without qualifications.<br /><br />• <i><span style="color: red;"><b>The Cadillac of its kind</b></span></i> - according to whom?<br /><br />• <i><span style="color: red;"><b>Patients at hospitals using this system love it</b></span> </i>-  Do most patients even know what it, or any EHR, looks like?  Have they provided informed consent to its use?<br /><br />• <span style="color: red;"><i><b>Exciting </b></i></span>- clinician surveys such as by physicians at <a href="http://hcrenewal.blogspot.com/2010/01/honest-physician-survey-on-ehrs.html">http://hcrenewal.blogspot.com/2010/01/honest-physician-survey-on-ehrs.html</a> and by nurses at <a href="http://hcrenewal.blogspot.com/2013/07/candid-nurse-opinions-on-ehrs-at.html">http://hcrenewal.blogspot.com/2013/07/candid-nurse-opinions-on-ehrs-at.html</a> shed doubt on that assertion.<br /><br />• <span style="color: red;"><i><b>The best thing for our patients</b></i></span> - again, according to whom?<br /><br />• <b><span style="color: red;"><i>Sophisticated new system</i></span></b> - "New"?  Not so much, just new for U. Arizona Health.  "Sophisticated", as if that's a virtue?  Too much "sophistication" is in part what causes clinician stress and burnout, raising risk</blockquote><br />Considering the near 10,000 issues, the new ECRI Institute report <b>"Top Ten Technology Hazards in Healthcare"</b>, 2014 edition comes to mind (<a href="https://www.ecri.org/Press/Pages/2014_Top_Ten_Hazards.aspx">https://www.ecri.org/Press/Pages/2014_Top_Ten_Hazards.aspx</a>).  Named in that report, as has been the case for the past several years, is <b>healthcare IT. </b><br /><br />This year's problem description is:<br /><br /><blockquote class="tr_bq"><b>#4. <span class="UserContent">Data Integrity Failures in EHRs and other Health IT Systems</span></b></blockquote><br />"Data integrity failures" include "issues" (per the bad health IT description) such as: data loss, data corruption, data attributed to the wrong patient, etc.<br /><blockquote class="tr_bq"><br />ECRI Institute, a nonprofit organization, dedicates itself to bringing the discipline of applied scientific research to healthcare to discover which medical procedures, devices, drugs, and processes are best to enable improved patient care. As pioneers in this science for 45 years, ECRI Institute marries experience and independence with the objectivity of evidence-based research. Strict conflict-of-interest guidelines ensure objectivity. ECRI Institute is designated an Evidence-based Practice Center by the U.S. Agency for Healthcare Research and Quality. ECRI Institute PSO is listed as a federally certified Patient Safety Organization by the U.S. Department of Health and Human Services. For more information, visit <a href="http://www.ecri.org/">www.ecri.org</a>.</blockquote><br />ECRI also produced the 2012 Deep Dive Study of Health IT Risk (<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>), where in a volunteer study at 36 member PSO hospitals, 171 health IT "mishaps" were reported in just 9 weeks, 8 of which caused patient injury and 3 of which may have contribute to patient death.<br /><br />In summary, The University of Arizona Health System, with components in the red, is spending hundreds of millions of dollars on an EHR system, that has had decades to mature. Yet, they are finding 10,000 "issues" already, a number of which reduce patient safety and are unresolved, with many more likely to be found.<br /><br />They are also 'advising' their staff to speak in glowing, unsubstantiated terms to patients about an EHR system that has 10,000 issues, and not seeking patient consent to its use in mediating and regulating their care - or giving elective patients the information that might allow them to choose another less "buggy" hospital.<br /><br />If (when) patient harm results from such cavalier hospital (mis)management, the juries are going to just love the dark sunglasses, I bet.<br /><br />-- SS

"We’ve resolved 6,036 issues and have 3,517 open issues": Extolling EPIC EHR Virtues at University of Arizona Health System

The public may believe that, in healthcare, only the Obamacare insurance exchange website has lots of bugs.  On those, see my Oct. 10. 2013...

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Words that Work: Singing Only Positive - And Often Unsubstantiated - EHR Praise As "Advised" At The University Of Arizona Health Network

When clinicians are told to promote a technology in no uncertain terms, that puts a chilling effect on critical thinking and discourse.  In effect, when under orders to only speak positively about a hospital or its technology, saying anything bad could very likely get clinicians labeled as 'troublemakers' or 'disruptive clinicians.'  Sometimes - in a sadly real example at Affinity Health - it may even get threats of having complaints plastered to one's forehead (see <a href="http://hcrenewal.blogspot.com/2013/07/hows-this-for-patient-rights-affinity.html">http://hcrenewal.blogspot.com/2013/07/hows-this-for-patient-rights-affinity.html</a>), a threat answered to by a judge.<br /><br />The 'disruptive' label usually does not have a good effect on one's evaluations and job (or, for doctors, even career) longevity.  See, for example, the resources 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> on <b>sham peer review.</b><br /><br />At <a href="http://www.uahealth.com/">University of Arizona Health Network (UAHN)</a>, clinicians are being told to promote the EPIC EHR.<br /><br />The campaign is under the aegis of executives who know, should know, or should have made it their business to know the mayhem caused at other medical centers by EPIC and other major clinical IT systems (see for example query links <a href="http://hcrenewal.blogspot.com/search/label/EPIC">http://hcrenewal.blogspot.com/search/label/EPIC</a> and <a href="http://hcrenewal.blogspot.com/search/label/healthcare%20IT%20difficulties">http://hcrenewal.blogspot.com/search/label/healthcare%20IT%20difficulties</a>).<br /><br />Here's what clinicians are bring told in the Oct. 3, 2013 "Weekly update for UAHN employees":<br /><blockquote class="tr_bq"><br /><h1 style="color: #606060 !important; display: block; font-family: Helvetica; font-size: 40px; font-style: normal; font-weight: bold; letter-spacing: -1px; line-height: 125%; margin: 0; text-align: left;"> <span style="font-size: 18px;"><span style="color: #1c3e71; font-family: verdana, 'helvetica neue', helvetica, sans-serif; line-height: 18px;">Words that Work </span></span></h1><div style="color: #505050; line-height: 13px;"><br />Talking positively to our patients about our new Electronic Health Record system is important! Here are some key words and phrases you can use to emphasize the many benefits of the new system:</div><ul><li style="color: #505050; line-height: 13px;"> Electronic health record (not ‘Epic’ or ‘EHR’)</li><li style="color: #505050; line-height: 13px;"> One comprehensive record</li><li style="color: #505050; line-height: 13px;"> Coordinated care</li><li style="color: #505050; line-height: 13px;"> Improves patient safety & quality</li><li style="color: #505050; line-height: 13px;"> Convenient, easy patient portal </li><li style="color: #505050; line-height: 13px;"> Private and secure</li></ul><div style="color: #505050; line-height: 13px;"><a href="https://www.uahealth.com/pdf/Epic_Words_That_Work.pdf" style="color: #1c3e71; font-weight: normal; text-decoration: underline; word-wrap: break-word !important;" target="_self"><b>Click here</b></a> for more words and behaviors to inspire confidence in our patients (and ourselves) as we transition to this new system.</div></blockquote><br />The link to "more words" produced this PDF:<br /><br /><br /><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/AVvXsEj_OOVivF_6D2GEFgUm6ujfKdJjMf4UMwoxX7ZECU7351gCph46CpKY7tryUY2qq63Q7Snl9fy1SNKk9QOxUyXfhgON7lm2W2MO_Sgin5pPxl4Rf6OR78MIdzjuQrxPDCBQ4ri6BeN3YxKn/s1600/words+that+work.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_OOVivF_6D2GEFgUm6ujfKdJjMf4UMwoxX7ZECU7351gCph46CpKY7tryUY2qq63Q7Snl9fy1SNKk9QOxUyXfhgON7lm2W2MO_Sgin5pPxl4Rf6OR78MIdzjuQrxPDCBQ4ri6BeN3YxKn/s400/words+that+work.jpg" width="311" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><b>"Words that Work"</b> - If I worked there, I would be concerned that that using "words that don't work" about a project that probably cost hundreds of millions of dollars would likely injure my career. <b> Click to enlarge.</b></td></tr></tbody></table><br />This is shameless.  Many of these claims are unsubstantiated or in significant doubt in the literature.<br /><br />First:<br /><br />They left out issues such as these:<br /><br /><blockquote class="tr_bq">• The software is tested and validated for safety by nobody, including traditional medical device safety testers.<br /><br />• No postmarket surveillance for problems, either.<br /><br />• Transparency about problems that can cause patient harm is severely impeded by systematic impediments to information flow (as per <b>IOM's 2012 study of health IT safety</b> 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>, <b>FDA via their leaked Internal Memo</b> on HIT safety as 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>, the <b>Joint Commission in their Sentinel Events Alert on Health IT </b>as at <a href="http://hcrenewal.blogspot.com/2008/12/joint-commission-sentinel-events-alert.html">http://hcrenewal.blogspot.com/2008/12/joint-commission-sentinel-events-alert.html</a>, and others.)<br /><br />• Problems known are only the <b>"tip of the iceberg"</b> (FDA, ECRI Institute), as at <a href="http://hcrenewal.blogspot.com/2010/02/fda-on-health-it-adverse-consequences.html">http://hcrenewal.blogspot.com/2010/02/fda-on-health-it-adverse-consequences.html</a> and <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> </blockquote><blockquote class="tr_bq"><b>(Mar. 2014 addendum:</b> add to that list the revelations of med mal insurer CRICO, that EHR technology has contributed to a substantial fraction of the medical malpractice suits in Massachusetts: <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>)</blockquote><br />Of the claims they do make:<br /><br /><blockquote class="tr_bq">• <span style="color: red;"><b><i>Efficient</i></b></span> - see aforementioned links as well as "Common Examples of Healthcare IT Difficulties" at <a href="http://cci.drexel.edu/faculty/ssilverstein/cases/">http://cci.drexel.edu/faculty/ssilverstein/cases/</a><br /><br />• <span style="color: red;"><b><i>Convenient</i></b></span> - as above.  According to whom?  Compared to what?  Pen and paper?<br /><br />• <span style="color: red;"><b><i>Improves patient safety and quality</i></b></span> - see IOM report post at <a href="http://hcrenewal.blogspot.com/2011/11/iom-report-on-health-it-safety-nix-fda.html">http://hcrenewal.blogspot.com/2011/11/iom-report-on-health-it-safety-nix-fda.html</a> .  We as a nation <b>are only now studying safety of this technology</b>, and the results are not looking entirely convincing, e.g.<b> ECRI Deep Dive Study</b> of health IT safety 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>.  171 health IT mishaps in 36 hospitals, voluntarily reported over 9 weeks, with 8 reported injuries and 3 reported possible deaths is not what I would call something that "improves patient safety and quality" without qualifications.<br /><br />• <i><span style="color: red;"><b>The Cadillac of its kind</b></span></i> - according to whom?<br /><br />• <i><span style="color: red;"><b>Patients at hospitals using this system love it</b></span> </i>-  Do most patients even know what it, or any EHR, looks like?  Have they provided informed consent to its use?<br /><br />• <span style="color: red;"><i><b>Exciting </b></i></span>- clinician surveys such as by physicians at <a href="http://hcrenewal.blogspot.com/2010/01/honest-physician-survey-on-ehrs.html">http://hcrenewal.blogspot.com/2010/01/honest-physician-survey-on-ehrs.html</a> and by nurses at <a href="http://hcrenewal.blogspot.com/2013/07/candid-nurse-opinions-on-ehrs-at.html">http://hcrenewal.blogspot.com/2013/07/candid-nurse-opinions-on-ehrs-at.html</a> shed doubt on that assertion.  </blockquote><blockquote class="tr_bq">(<b>Addendum:</b> also see what nurses think about these systems at "<b>Another 'Survey' on EHRs - Affinity Medical Center (Ohio) Nurses Warn That Serious Patient Complications Only a Matter of Time in Open Letter</b>", <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>)<br /><br />• <span style="color: red;"><i><b>The best thing for our patients</b></i></span> - again, according to whom?<br /><br />• <b><span style="color: red;"><i>Sophisticated new system</i></span></b> - "New"?  Not so much, just new for U. Arizona Health.  "Sophisticated", as if that's a virtue?  Too much "sophistication" is in part what causes clinician stress and burnout, raising risk; see this summary of a new, not-free JAMIA article "<b>Electronic medical records and physician stress in primary care: results from the MEMO Study</b>", J Am Med Inform Assoc amiajnl-2013-001875 at <a href="http://www.beckershospitalreview.com/healthcare-information-technology/the-relationship-between-emrs-and-physician-stress.html">http://www.beckershospitalreview.com/healthcare-information-technology/the-relationship-between-emrs-and-physician-stress.html</a>.   From that summary:<br /><br /><blockquote class="tr_bq">... Compared with physicians at clinics with low-function EMRs,<b> physicians at clinics with moderate-function EMRs experienced significantly more stress and had a higher rate of burnout. </b>Additionally, physicians at clinics with moderate- or high-function EMRs felt less satisfied with their current position overall. </blockquote>and:<br /><blockquote class="tr_bq">... Results also showed a significant relationship between time pressure and physician stress in the cohort with high-function EMRs, and only in this cohort, <b>suggesting physicians at these clinics may be particularly pressured for time during patient encounters in the face of a large number of EMR functions</b>. "This 'made sense' to us in thinking about the possibility that those in the high-use group had more to do in the EMR" [say the authors].<b> </b></blockquote><br />• <span style="color: red;"><b><i>Smartest program out there</i></b></span> - "Smartest" meaning what, exactly?  According to whom?  Who performed the comparison?<br /><br />• <i><b><span style="color: red;">Streamlined</span></b> </i>- compared to what?<br /><br />• <b><span style="color: red;"><i>Thank you for your patience</i></span></b> - even if the effects on clinicians gets you or your loved ones maimed or killed?<br /><br />• <span style="color: red;"><b><i>Safe and secure network</i></b></span> - really?  No break ins, ever, considering multiple breach stories like those at <a href="http://hcrenewal.blogspot.com/search/label/medical%20record%20privacy">http://hcrenewal.blogspot.com/search/label/medical%20record%20privacy</a>?<br /><br />• <span style="color: red;"><b><i>Keeping you informed is our priority</i></b></span> - informed of what?<br /><br />• <span style="color: red;"><b><i>Specially trained staff</i></b></span> - like these:  <a href="http://hcrenewal.blogspot.com/2010/08/epics-outrageous-recommendations-on.html">http://hcrenewal.blogspot.com/2010/08/epics-outrageous-recommendations-on.html</a>?</blockquote><br />and this:<br /><br /><blockquote class="tr_bq">• <span style="color: red;"><i><b>Take Responsibility</b></i></span> - I ask, should clinicians "take responsibility" for IT-related disruptions that impair care such as "use error" (as opposed to user error), i.e., what the National Institute of Standards and Technology has called operator error due to poor usability and other features of bad health IT?  (See "<b>NIST on the EHR Mission Hostile User Experience</b>" at <a href="http://hcrenewal.blogspot.com/2011/10/nist-on-ehr-mission-hostile-user.html">http://hcrenewal.blogspot.com/2011/10/nist-on-ehr-mission-hostile-user.html</a>.)  What about <b>"glitches"</b> and bugs that corrupt or lose data?  Should clinicians also 'take responsibility' for those?  (See for example the posts on the wild things that happen when IT malpractice leads to clinical mayhem at <a href="http://hcrenewal.blogspot.com/search/label/glitch">http://hcrenewal.blogspot.com/search/label/glitch</a>.)</blockquote><br />It appears to me that this vendor is using its client hospitals' management to enforce an "acceptable point of view" clinicians must proffer to patients about EHRs (which they must call "health" records), despite well-known contradictory findings.  This is, in effect, forced marketing of a device.<br /><br />Trying that for a drug or a conventional medical device (e.g., a particular stent) would be on its face unethical and likely illegal.<br /><br />Finally, critical thinking is what keeps patients alive and safe.  Marketing measures like this (some might call it "propaganda"), espousing and enforcing 'EHR exceptionalism', in my opinion, damage critical thinking and expression, and are thus unacceptable to push on clinicians and on patients.<br /><br />I add that requiring clinicians to promote deceptive propaganda the clinicians themselves know is untrue, from painful experience, is degrading, intimidating and destroys morale.  It is axiomatic that clinicians (or anyone) operating under such conditions cannot perform at their best.<br /><br />Thus the management geniuses who came up with these instructions (if not outright vendor-ghostwritten as at the Aug. 2012 "<b>Health IT Vendor EPIC Caught Red-Handed: Ghostwriting And Using Customers as Stealth Lobbyists</b>", <a href="http://www.tinyurl.com/epic-stealth">http://www.tinyurl.com/epic-stealth</a>) are by their actions increasing risk of patient harm. <br /><br />The nurses' unions at at <a href="http://hcrenewal.blogspot.com/2013/07/rns-say-sutters-new-electronic-system.html">http://hcrenewal.blogspot.com/2013/07/rns-say-sutters-new-electronic-system.html</a> have it right, in my view:  complain about the disruptions this technology causes, and complain loudly, if at the very least to make sure the problems are out in the open.<br /><br />-- SS<br /><br /><b>Note: </b>also see the followup Nov. 2013 post "<b>We’ve resolved 6,036 issues and have 3,517 open issues: extolling EPIC EHR virtues at University of Arizona Health System</b>" at <a href="http://hcrenewal.blogspot.com/2013/11/weve-resolved-6036-issues-and-have-3517.html">http://hcrenewal.blogspot.com/2013/11/weve-resolved-6036-issues-and-have-3517.html</a><br /><br />

Words that Work: Singing Only Positive - And Often Unsubstantiated - EHR Praise As "Advised" At The University Of Arizona Health Network

When clinicians are told to promote a technology in no uncertain terms, that puts a chilling effect on critical thinking and discourse.  In ...

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Setback for Sutter after $1B EHR crashes (in followup to post "RNs Say Sutter’s New Electronic System Causing Serious Disruptions to Safe Patient Care at East Bay Hospitals")

At my July 12, 2013 post "RNs Say Sutter’s New Electronic System Causing Serious Disruptions to Safe Patient Care at East Bay Hospitals" (<a href="http://hcrenewal.blogspot.com/2013/07/rns-say-sutters-new-electronic-system.html">http://hcrenewal.blogspot.com/2013/07/rns-say-sutters-new-electronic-system.html</a>) I reproduced a California Nurses Association warning about rollout of an EHR at Sutter:<br /><br /><blockquote class="tr_bq"><b>RNs Say Sutter’s New Electronic System Causing Serious Disruptions to Safe Patient Care at East Bay Hospitals</b><br /><br />Introduction of a new electronic medical records system at Sutter corporation East Bay hospitals has produced multiple problems with safe care delivery that has put patients at risk, charged the California Nurses Association today.<br /><br />Problems with technology are not unique to health care ...  <span style="color: red;"><i><b>[What is unique to healthcare IT is the complete lack of regulation - ed.]</b></i></span><br /><br /><b>In over 100 reports</b> submitted by RNs at Alta Bates Summit Medical Center facilities in Berkeley and Oakland, nurses cited a variety of serious problems with the new system, known as Epic. <b>The reports are in union forms RNs submit to management documenting assignments they believe to be unsafe.</b><br /><br />Patient care concerns included<b> computerized delays in timely administration of medications and contact with physicians, ability to properly monitor patients, and other delays in treatment. </b> Many noted that the <b>excessive amount of time required to interact with the computer system, inputting and accessing data, sharply cuts down on time they can spend with patients </b>with frequent complaints from patients about not seeing their RN.  <span style="color: red;"><i><b>[Note: patients are not given the opportunity for informed consent about the risks, nor opt-out of EHR use in their care - ed.]</b></i></span></blockquote><br />In related posts I'd observed such concerns being ignored by hospital management.  See header of the aforementioned post.<br /><br />Now we have this:  a major system crash.<br /><br /><blockquote class="tr_bq">Healthcare IT News<br /><a href="http://www.healthcareitnews.com/news/setback-sutter-after-1b-ehr-system%20crashes">Setback for Sutter after $1B EHR crashes</a><br /><div class="top">'No access to medication orders, patient allergies and other information puts patients at serious risk'</div><div class="top"><span class="submitted">SACRAMENTO, CA | August 28, 2013</span></div><div class="top"></div><div class="top"><span class="submitted">The nearly $1 billion electronic health record system at Sutter Health in Northern California crashed early this week,<b> leaving nurses and clinical staff unable to access any patient information for a full day. </b><br />he Epic EHR was down Aug. 23 due to a planned upgrade for eight hours during which nurses and other clinical users could read medication orders and patient histories but had to record new data on paper to then be re-entered into the system later, according to reports from the California Nurses Association, part of National Nurses United, the largest nurses union in the U.S. <br /><br />Then, on the morning of Aug. 26 at approximately 8 a.m.,<b> the system crashed completely, at which time nurses, physicians and hospital staff had no access to patient information, including what medications patients were taking or required to take and all vital patient history data.  </b><br />  <br />The Epic EHR went dark at several Sutter Health locations, including Alta Bates Summit Medical Center, Eden Medical Center, Mills-Peninsula Hospital, Sutter Delta, Sutter Tracy, Sutter Modesto and numerous affiliated clinics. <br /><br />"This incident is especially worrisome," said Bonnie Castilla, RN, CNA legislative director, in a news release. <b>"No access to medication orders, patient allergies and other information puts patients at serious risk.</b>  These systems should never be relied upon for protecting patients or assuring the delivery of the safest care."  </span><span class="submitted"><span class="submitted"><i><b><span style="color: red;">[This is no exaggeration.  My mother was nearly killed by such a problem when caused by an EHR defect (</span><a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/detail.cfm?mdrfoi__id=1729552">link</a><span style="color: red;">) that I averted at the last minute by happenstance of showing up at the right time, while she recuperating from another EHR-related disaster - ed.]  </span></b></i></span></span> </div></blockquote><blockquote class="tr_bq"><div class="top"><span class="submitted">Some RNs also reported that Sutter <b>failed to provide adequate support during the blackout and didn't implement adequate backup planning. <br /> </b><br /><b>"All information such as medication administration records and patient histories was outdated by two to three days,</b>" said Mike Hill, Alta Bates Summit RN, in a news release. "There were no orders that could be seen of any kind through the day so nurses called for what they needed."<br /><br />Kevin Sweat, an emergency room RN at Eden Medical Center, a Sutter affiliate, also weighed in on the blackout, saying that in his 12 years as an RN he has never seen a system crash like this.  <br />   </span></div></blockquote>Worse, clinicians must now serve their Cybernetic Master to perfection, or be whipped (apparently to improve morale):<br /><br /><blockquote class="tr_bq">... "We have been on Epic for 5 months now, and we can no longer have incorrect orders, missing information or incorrect or missing charges. Starting on September 1st, <b>errors made in any of the above will result in progressive discipline,</b>" according to another hospital memo sent to staff. </blockquote><br />In the setting of dire warnings by the nurses of EHR dangers several months back that were likely largely ignored, if any patient was harmed or killed as a result of this latest fiasco, the corporate leadership has literally begged to be sued for negligence, in my view.<br /><br />However I'm sure a press release soon will claim that "<a href="http://hcrenewal.blogspot.com/search/label/Patient%20care%20has%20not%20been%20compromised">patient care has not been compromised</a>."<br /><br />Of course this includes now and moving forward, even with informational gaps all over the place.<br /><br />-- SS<br /><br /><b>Aug. 29, 2013 additional thought:</b><br /><br />The punishment for not being a 'perfect' user of this EHR is the ultimate "blame the user" (blame the victim?) game, considering the pressures of patient care in hospitals in lean times - partly due to EHR expense! - and EHRs that have not been formally studied for usability and are poorly designed causing "use error" (that is, a poor user experience promotes even careful users to make errors).  Cf. definition of bad health IT:<br /><blockquote class="tr_bq"><br /><span style="color: black; font-family: Arial; mso-bidi-font-weight: bold;"><b>Bad Health IT</b> ("BHIT") is defined as IT that is ill-suited to purpose, hard to use, unreliable, loses data or provides incorrect data, causes cognitive overload, slows rather than facilitates users, lacks appropriate alerts, creates the need for <span class="SpellE">hypervigilance</span> (i.e., towards avoiding IT-related mishaps) that increases stress, is lacking in security, compromises patient privacy or otherwise demonstrates suboptimal design and/or implementation.</span></blockquote><br />The study of usability is getting underway only now via NIST but will likely be done in an industry-friendly way due to health IT politics.<br /><br />-- SS<br /><br /><b>Aug. 29, 2013 addendum</b><br /><br />There have been numerous comments over at HisTalk (at <a href="http://histalk2.com/2013/08/27/news-82813/">http://histalk2.com/2013/08/27/news-82813/</a>) defending the outage as not EPIC's fault.   From the point of view of clinicians - and more importantly, patients - it doesn't matter what component of the hospital's entire "EHR" (an anachronistic term used for what is now a complex enterprise clinical resource and clinician command-and-control system) went down.  <br /><br />Aside from all the EPIC issues the nurses have been complaining about (see earlier July 12, 2013 post linked above), the larger problem is that <b><i>IT malpractice</i></b> occurred.  The term "malpractice" is used in medical mishaps; I see no reason why it does not apply to major outages of mission critical healthcare information technology systems.<br /><br />IT malpractice in healthcare kills.<br /><br />These are the types of nurses I'd want caring for me and mine.  Letting this kind of snafu go "anechoic" does not promote proper management remedial education on Safety 101 and on health IT risk, two areas of education that management appears to desperately need in hospitals.<br /><br />-- SS<br /><br />

Setback for Sutter after $1B EHR crashes (in followup to post "RNs Say Sutter’s New Electronic System Causing Serious Disruptions to Safe Patient Care at East Bay Hospitals")

At my July 12, 2013 post "RNs Say Sutter’s New Electronic System Causing Serious Disruptions to Safe Patient Care at East Bay Hospitals...

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RNs Say Sutter’s New Electronic System Causing Serious Disruptions to Safe Patient Care at East Bay Hospitals

Add the following from <b>Sutter East Bay Hospitals</b> to nurses' and physicians' complaints at<b> Marin General Hospital </b>(<a href="http://hcrenewal.blogspot.com/2013/05/marin-general-hospitals-nurses-are.html">http://hcrenewal.blogspot.com/2013/05/marin-general-hospitals-nurses-are.html</a>), <b>Affinity Medical Center </b>(<a href="http://hcrenewal.blogspot.com/2013/06/affinity-rns-call-for-halt-to-flawed.html">http://hcrenewal.blogspot.com/2013/06/affinity-rns-call-for-halt-to-flawed.html</a>), <b>Contra Costa County</b> (<a href="http://hcrenewal.blogspot.com/2012/08/contra-costas-45-million-computer.html">http://hcrenewal.blogspot.com/2012/08/contra-costas-45-million-computer.html</a>), <b>San Francisco Department of Public Health </b>(<a href="http://hcrenewal.blogspot.com/2010/11/avatar-fails-no-not-cameron-movie-but.html">http://hcrenewal.blogspot.com/2010/11/avatar-fails-no-not-cameron-movie-but.html</a>), and others: <br /><br /><blockquote class="tr_bq"><b>For Immediate Release </b><br /><b>July 11, 2013</b><br /><i>Contact-  Charles Idelson, 510-273-2246</i><br /><h2>RNs Say Sutter’s New Electronic System Causing Serious Disruptions to Safe Patient Care at East Bay Hospitals</h2>Introduction of a new electronic medical records system at Sutter corporation East Bay hospitals has produced multiple problems with safe care delivery that has put patients at risk, charged the California Nurses Association today.<br /><br />Problems with technology are not unique to health care – pilots of the ill fated Asiana airline that tragically crashed at San Francisco International Airport July 6 told federal investigators that an automatic throttle failed to keep the jetliner at the proper speed for landing, the Los Angeles Times reported July 9.  <span style="color: red;"><i><b>[What is unique to healthcare IT is the complete lack of regulation - ed.]</b></i></span><br /><br /><b>In over 100 reports</b> submitted by RNs at Alta Bates Summit Medical Center facilities in Berkeley and Oakland, nurses cited a variety of serious problems with the new system, known as Epic. <b>The reports are in union forms RNs submit to management documenting assignments they believe to be unsafe.</b><br /><br />Patient care concerns included<b> computerized delays in timely administration of medications and contact with physicians, ability to properly monitor patients, and other delays in treatment. </b> Many noted that the <b>excessive amount of time required to interact with the computer system, inputting and accessing data, sharply cuts down on time they can spend with patients </b>with frequent complaints from patients about not seeing their RN.  <span style="color: red;"><i><b>[Note: patients are not given the opportunity for informed consent about the risks, nor opt-out of EHR use in their care - ed.]</b></i></span><br /><br />"EPIC is a system that is so cumbersome to use for nurses and physicians, that we often feel as though we are caring for a computer, not a patient,” said Thorild Urdal, an RN at Alta Bates Summit’s hospital in Berkeley. “It delays care and treatment, the program is naturally counter-intuitive and<b> it was clearly not designed in concert with nurses and physicians</b>." <span style="color: red;"><i><b>[Clinicians end up caring for an "iPatient", as others have noted - ed.]</b></i></span><br /><br />"The Epic program developed and implemented by Sutter is neither nurse or patient friendly,” said Alta Bates Summit Oakland RN Mike Hill. “Epic does not enhance my ability to chart instead it takes time away from the bedside and my patients and preventing me from providing the absolute best care that they and I expect from me as a nurse."<br /><br />Sutter CEO Pat Fry last year told the San Francisco Business Times that Sutter will spend $1 billion on Epic, a system that has sparked controversy at several other hospitals, including a Contra Costa facility where several RNs cited serious medical errors in testimony to county supervisors last August.<br /><br />At Alta Bates Summit specific incidents directly related to Epic problems included:<br /><br />• A patient who had to be transferred to the intensive care unit due to delays in care caused by the computer.  <span style="color: red;"><i><b>[It's happenstance they did not have to be transferred to the morgue - ed.]</b></i></span><br />• A nurse who was not able to obtain needed blood for an emergent medical emergency.<br />• Insulin orders set erroneously by the software.<br />• Missed orders for lab tests for newborn babies and an inability for RNs to spend time teaching new mothers how to properly breast feed babies before patient discharge.<br />• Lab tests not done in a timely manner.<br />• Frequent short staffing caused by time RNs have to spend with the computers.<br />• Orders incorrectly entered by physicians requiring the RNs to track down the physician before tests can be done or medication ordered.<br />• Discrepancies between the Epic computers and the computers that dispense medications causing errors with medication labels and delays in administering medications.<br />• Patient information, including vital signs, missing in the computer software.<br />• An inability to accurately chart specific patient needs or conditions because of pre-determined responses by the computer software.<br />• Multiple problems with RN fatigue because of time required by the computers and an inability to take rest breaks as a result.<br />• Inadequate RN training and orientation.<br /><br /></blockquote>These "incidents" are certainly capable of causing harms or fatalities.  One wonders if hospital executives are providing the usual refrain that these are just <b>"glitches" </b>(<a href="http://hcrenewal.blogspot.com/search/label/glitch">http://hcrenewal.blogspot.com/search/label/glitch</a>) and that <b>patient care has not been compromised</b> (<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>).<br /><br />A bit more background follows: <br /><br /><blockquote class="tr_bq">... Hospitals nationally are spending tens of billions of dollars on technology systems, especially on electronic health records (EHR) programs for which they also receive federal financial incentives. <br /><br />EHR programs are paraded as a panacea for reducing medical errors and cutting costs, but in life the promise is falling short in both areas.<br /><br />A RAND corporation analysis earlier this year said visions of savings and improved efficiency in patient care have had what the New York Times called “mixed results, at best.”<br /><br />The U.S. Food and Drug Administration has acknowledged getting hundreds of reports of problems involving health information technology including numerous patient injuries and deaths.<br /><br />Some examples seen at hospitals across the country:<br /><br />• At Marin General Hospital in Northern California, RNs called on the Marin Healthcare District board to delay implementation of their EHR system. "Orders are being inadvertently passed to the wrong patients. People have gotten meds when they've been allergic to them. This is dangerous," Marin RN Barbara Ryan said in comments reported by the Marin Independent Journal.<br />• In Chicago, the Chicago Tribune in 2011 reported on a patient death at Advocate Lutheran General hospital after an automated machine prepared an intravenous solution containing a massive overdose of sodium chloride — more than 60 times the amount ordered by a physician.<br />• At Affinity Medical Center RNs in Massillon, Oh. RNs in June raised multiple objections to the hurried introduction of an EHR system. Subsequently, they have cited medication errors, delays in care, problems with documentation, computers crashing, and other concerns.</blockquote><br />I am simply the reporter here.<br /><br />-- SS

RNs Say Sutter’s New Electronic System Causing Serious Disruptions to Safe Patient Care at East Bay Hospitals

Add the following from Sutter East Bay Hospitals to nurses' and physicians' complaints at Marin General Hospital ( http://hcrenewa...

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Clouded "Visionary" Leadership - Wake Forest Baptist Medical Center's EPIC "Business Cycle Disruptions"

A typical excuse for the multi-million dollar compensation now enjoyed by many leaders of health care organizations is these leaders' supposed brilliance.<br /><br />For example, in 2011 we <a href="http://hcrenewal.blogspot.com/2011/05/million-dollar-plus-hospital-ceo.html">noted  </a>that the total compensation of Dr John McConnell, the CEO of Wake Forest Baptist Medical Center, a non-profit teaching hospital, rose from over <b><i>$700,000</i></b> in 2008-2009 to over <b><i>$1.6 million</i></b> in 2009-2010.  Other top executives in the system made nearly one million a piece.  An official statement from the hospital system claimed that this level of compensation was needed to "retain skilled executives and <b><i>visionary leaders</i></b> for the medical center."  Furthermore, in 2012 we <a href="http://hcrenewal.blogspot.com/2012/05/more-rising-compensation-for-executives.html">noted </a>that in 2010-2011 Dr McConnell's compensation had grown to nearly <b><i>$2.5 million</i></b>, while other top executives received from over $900,000 to over $1.1 million.  <br /><br />Recent events, however, suggest that the "visionaries" may need new glasses.<br /><br /><b>An EPIC Challenge </b><br /><br />Last month, the Winston-Salem Journal <a href="http://www.journalnow.com/business/business_news/local/article_c2801866-9e0c-11e2-bf84-0019bb30f31a.html">reported</a> that Wake Forest Baptist Medical Center is facing some unexpected fiscal challenges, especially from its new electronic health record (EHR):<br /><br /><span class="paragraph-0"></span><br /><blockquote class="tr_bq">Wake Forest Baptist Medical Center’s <i>struggles to implement its <a href="http://hcrenewal.blogspot.com/search/label/EPIC">Epic electronic records system</a></i> <i>contributed to additional costs and lost revenue</i> during the first half of its fiscal year 2012-13.<br /><span class="paragraph-1"> <br />The center provided the information in a second-quarter financial report submitted to bond agencies in which it also reported <i>a $49.6 million operational loss</i> and a gain of $7.4 million in overall excess revenue.<br /> </span></blockquote><br />That is interesting.  There have been many criticisms of EHRs, particularly for how they may <a href="http://hcrenewal.blogspot.com/search/label/healthcare%20IT%20difficulties">impede</a>, rather than help health professionals, and more importantly for their risks of causing <a href="http://hcrenewal.blogspot.com/search/label/healthcare%20IT%20dangers">adverse effects</a> affecting patients, in the absence of clear data from controlled clinical trials that they provide benefits that outweigh their potential harms to patients.  Some of these problems may stem from design and implementation that prioritizes benefits to managers and institutional finances over effects on patients and doctors.  As InformaticsMD <a href="http://hcrenewal.blogspot.com/2013/05/ama-says-ehrs-create-appalling-catch-22.html">noted</a>, even the AMA now admits that<br /><br /><blockquote class="tr_bq"> As the healthcare industry moves to EHRs, t<b>he medical record has essentially been reduced to a tool for billing, compliance, and litigation that also has a sustained negative impact on doctors' productivity,</b> according to Steven J. Stack, MD, chair of the American Medical Association’s board of trustees. </blockquote><br />Yet in this case, a well known commercial EHR did not even help out the hospital system's finances.<br /><br />Furthermore,<br /><br /><blockquote class="tr_bq">Wake Forest Baptist said it spent as of Dec. 31 about $13.3 million directly on the Epic electronic-record system, which went live in September.</blockquote><br />And,<br /><br /><blockquote class="tr_bq"> The center also cited $8 million in 'other Epic-related implementation expense' that it listed among '<i>business-cycle disruptions (that) have had a greater-than-anticipated impact on volumes and productivity</i>.' Also listed was $26.6 million in lost margin <i>'due to interim volume disruptions during initial go-live and post go-live optimization</i>.'</blockquote><br />Note that InformaticsMD frequently criticizes proponents of commercial health care information technology for glossing over potentially bad effects on patients and practice with management-speak (e.g., as "glitches," or "hiccups.").  Here is a great example of an attempt to gloss over bad effects on finance with management-speak. <br /><br /><b>Bond Downgrades and Furloughs, Wage Reductions, Hiring Freezes, Retirement Contribution Reductions, and Bonus Eliminations</b><br /><br />As a consequence,<br /><br /><blockquote class="tr_bq"> On March 20, <i>Moody’s Investors Service downgraded the center’s long-term debt rating below the lowest level of high-grade investment quality.</i> The downgrade to A1 from Aa3 affects $597.2 million of rated debt outstanding.</blockquote><br />The rationale was clear,<br /><br /><blockquote class="tr_bq"> Moody’s said the A1 rating 'reflects the unexpected decline in financial performance through the first half of fiscal 2013, largely due to the installation of a new information technology platform (Epic), encompassing 95 percent of all revenue components of the enterprise.'</blockquote>You know when you see bond downgrade by rating agencies that  financial matters are really going badly.   <br /><br />By May, 2013, month, the problems were evidently still not solved, and the hospital was forced to take more drastic measures.  As again <a href="http://www.journalnow.com/business/business_news/local/article_0cb3b3a8-b33d-11e2-a80f-0019bb30f31a.html">reported</a> by Richard Carver writing for the Winston-Salem Journal, <br /><br /><span class="paragraph-0"> </span><br /><blockquote class="tr_bq">The workforce at Wake Forest Baptist Medical Center is <i>paying a paycheck price to make up for the financial shortcomings to date of its Epic electronic records system</i>.<br /><br /><span class="paragraph-1"> The center said in a statement Thursday it has begun <i>another round of cost-cutting measures</i> that will last through at least June 30, the end of its 2012-13 fiscal year.<br /> </span> <br /><br />The measures include attempts at <i>volunteer employee furloughs and hour-and-wage reductions, a hiring freeze, a reduction in employer retirement contributions, and elimination of executive incentive bonuses for 2013.</i></blockquote><br /><br />Management made clear that the cuts were in response to the Epic debacle,<br /><br /><br /><blockquote class="tr_bq">Even though management said Thursday the center is making progress with fixing the Epic revenue issues, it acknowledged it 'will not meet projected financial targets for the current fiscal year.'<br /><br />'Wake Forest Baptist has identified immediate multimillion-dollar savings with a series of short-term measures that impact personnel,' according to the statement.</blockquote><br />To give credit where it is due, at least the cuts will apparently not affect line clinical employees:<br /><br /><blockquote class="tr_bq"> Those primarily affected by the volunteer furloughs and hour-and-wage reduction requests are nonclinical full-time employees, including administrative staff. They can volunteer to work as few as 30 hours a week with no loss of health or dental benefits for May and June. In the memo, management said employees can volunteer to continue the reduced-hour work week into fiscal year 2013-14.</blockquote><br />However, it seems likely that they will affect many employees, including some proportion who likely had not responsibility for the problems with Epic.<br /><br /><b>When in Doubt, Lobby the Government </b><br /><br />What the hospital system did not seem to be cutting was lobbying and public relations.  Perhaps this was a response to its unexpected inability to manage its own commercial health care information technology?  What bad management can lose, maybe government can supplant.  Once again Richard Carver had <a href="http://www.journalnow.com/news/state_region/article_1aee766e-b5e1-11e2-bba7-001a4bcf6878.html">the story</a> for the Journal:<br /><br /><span class="paragraph-0"> </span><br /><blockquote class="tr_bq">Stung by a series of unusual setbacks at the General Assembly, the North Carolina hospital industry is <i>launching a public relations campaign</i> aimed, in part, at protecting revenues and staving off competition from lower cost surgery centers.<br /><br /><span class="paragraph-1"> In a social media initiative targeted at lawmakers and their constituents, the N.C. Hospital Association says hospitals are 'fighting for their economic survival.' [It was not said whether they were fighting in part because they had already managed to shoot themselves in their economic feet - Ed]<br /><br /> </span> <br />The association and some of the state’s bigger hospitals also are hiring more GOP lobbyists to make inroads with the Republicans who control the state House, Senate and governor’s mansion.<br /><br />The hospital association recently began promoting a new website — <a href="http://www.healthyhospitalsnc.org/">www.healthyhospitalsnc.org</a> — that describes an array of financial threats.</blockquote><br />Wake Forest Baptist is a big part of this initiative:<br /><br /><blockquote class="tr_bq">When asked about its lobbying efforts, Wake Forest Baptist spokeswoman Paula Faria said last week that the center’s Office of Government Relations monitors proposed legislation and regulations at both the federal and state levels.<br /><br />'It informs North Carolina’s congressional delegation, members of the General Assembly and their staff about how proposed language could impact the day-to-day operations of the medical center.'</blockquote><br />Maybe they should be first worrying about the impact of badly chosen, designed, or implemented commercial health care information technology on "day-to-day operations of the medical center" first. <br /><br /><b> Summary</b><br /><br />So the top executives of Wake Forest Baptist Medical Center have seen compensation rising at a rate greater than inflation and than the general public's income over the last few years.  In particular, the CEO has seen his compensation go up three and one-half times in three years!  The hospital system administration has justified this extraordinary increase by referring to supposedly "visionary" leadership.  Yet over this time frame these "visionaries" decided to implement an EHR whose first effects were to lose the hospital system a lot of money.  Based on previous anecdotes about the Epic system, it is quite possible it had other adverse effects.  For example, InformaticsMD <a href="http://hcrenewal.blogspot.com/2012/09/in-addition-to-nurses-doctors-now-air.html">discussed</a> a case in which an EPIC system apparently lead to a large disruption in patient workflow and hence large increases in waits for acute care, and <a href="http://hcrenewal.blogspot.com/2012/08/contra-costas-45-million-computer.html">lead to errors</a> that could have adversely affected patients.  So this underscores some important lessons:<br /><br />So beware that "visionary" behind the curtain. As we have noted repeatedly, top health care managers can now easily make themselves rich.  They, their boards of directors (who may be their cronies), and their public relations flacks often justify their exorbitant compensation by their supposed brilliance, if not visionary status.  Such claims are rarely further explained, and mostly seem be be humbug, for want of a better term.  It seems that most top leaders of health care organizations have participated in the managers' coup d'etat, and become at least manager nobility, if not manager-kings  At least, the public should know that their compensation is what they can grab, and its justification is often nonsense. <br /><br />Note that contrary to a red herring argument often made, outrageous compensation is important not so much because of how much money it drains out of health care, although that can be large in the aggregate.  It is important because it reflects a system that is no longer accountable, and leaders who follow perverse incentives.<br /><br />Such management compensation is almost never revisited to determine whether it turned out to be justified.  Instead, the public, watchdog organizations, health care professionals, and even politicians ought to demand accountability of health care management, good  justification for their compensation, and rationality for the incentives they are provided.  True health care reform would encourage well-informed, competent, mission-focused, honest, responsible, accountable and transparent management, leading organizations of manageable size.  But as long as things stay the same, expect the craziness to continue.    <br /><br /><br />

Clouded "Visionary" Leadership - Wake Forest Baptist Medical Center's EPIC "Business Cycle Disruptions"

A typical excuse for the multi-million dollar compensation now enjoyed by many leaders of health care organizations is these leaders' su...

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Financial woes at Maine Medical Center: Reading this blog might have saved them millions of dollars, and prevented massive "cost saving initiatives"

In this article, the euphemistic and almost endearing term <b>"hiccup"</b> is used instead of the more traditional "<a href="http://hcrenewal.blogspot.com/search/label/glitch">glitch</a>" to describe obvious major information technology malfunctions.  It is likely the knowledge at this blog and at my <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/">health IT dysfunction teaching site</a> could have helped prevent most of these problems:<br /><br /><blockquote class="tr_bq"><b><a href="http://www.healthcarefinancenews.com/news/financial-woes-maine-medical?topic=03,22">Financial woes at Maine Medical Center</a></b><br />New England health system facing $13 million loss, initiates plan to save $15 million<br />NEW GLOUCESTER, ME | May 2, 2013 <br /><br />In a memo to its employees last week, one of Maine’s largest health systems said it has suffered an operating loss of $13.4 million in the first half of its fiscal year.<br /><br />“Through March (six months of our fiscal year), Maine Medical Center <b>experienced a negative financial position that it has not witnessed in recent memory</b>,” Richard Petersen, president and CEO of the medical center, wrote in the memo to employees. A copy of the memo was sent to MedTech Media, publisher of Healthcare Finance News.</blockquote><br /><b>A "negative financial position" </b>(translation: we lost big money)<b> that it has not witnessed in recent memory</b>?  What are the reasons?<br /><br /><blockquote class="tr_bq">In order to bring the medical center to breakeven by year’s end, the health system’s leadership has determined $15 million needs to be saved.<br /><br />In the memo, Petersen said the operating loss is due to declines in inpatient and outpatient volumes because of the hospital’s efforts to reduce readmissions and infections;<b> “unintended financial consequences” due to the roll out of the health system’s Epic electronic health record and problems associated with being unable to accurately charge for services provided</b>; an increase in free care and bad debt cases; and continued declining reimbursement from Medicare and MaineCare, the state’s Medicaid program.</blockquote><br />That rings a familiar tune - from the <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=Insufficient%20IT%20management">mid 1990's</a> at Yale, as well as <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/DUCOM_EMR_Complaint.pdf">more recently</a>.<br /><br /><blockquote class="tr_bq">Many of the reasons for Maine Medical’s financial woes are similar to those hospitals across the country are facing.<br /><br />A recovering national economy, continued budget restrictions and restraint and the realization that, while electronic health records may have efficiencies and cost savings over time, <b>the costly transition to EHRs may take years to recoup.</b></blockquote><br /><br />Especially when not done well.<br /><br /><blockquote class="tr_bq">In his memo to employees, Petersen said the hospital has <b>identified many of the hiccups contributing to the charge capture problems</b> and a team of hospital employees and Epic technicians are working to resolve those issues. In the meantime, the <b>remaining roll out of the Epic EHR to the rest of the health system is on hold.</b></blockquote><br />Hiccups? Health IT has a euphemistic language all its own.  Only apostates would dare to call the "hiccups" for what they really are, in medical parlance:  <b>IT malpractice.</b><br /><blockquote class="tr_bq"><br />To save $15 million by year’s end, Maine Medical is immediately instituting a number of cost-saving initiatives including selective travel and <b>hiring freezes</b>, putting the <b>operating contingency budget on hold</b> and <b>reducing overtime. </b>Petersen appealed to employees to curb discretionary spending and contact management with any cost-saving ideas.</blockquote><br />All, of course, will have no impact on patient care....<br /><blockquote class="tr_bq"><br />“I’m confident that we’ll confront this <b>test,</b> beat back the issues we face, and reverse this negative financial picture,” Petersen wrote in the conclusion to the memo.</blockquote><br />Test?  Test of what, IT competence?<br /><br />Of course, "C" officers would never write that "I'm <b>not </b>confident we'll confront our <b>screwups</b>."<br /><br /><blockquote class="tr_bq">Maine Medical did not reply to an interview request by deadline. The Maine Hospital Association declined to comment for this story. </blockquote><br />Silence is golden.<br /><br />A newspaper letter from Stuart Smith, Selectman, Town of Edgecomb, St. Andrews Regional Task Force (a software developer himself) tells more:<br /><br /><blockquote class="tr_bq"><b><a href="http://www.boothbayregister.com/affiliate-post/stuart-smiths-letter-register/13586">STUART SMITH'S LETTER TO THE REGISTER</a></b><br />Wednesday, May 1, 2013 - 7:30pm<br /><b>Save St. Andrews Hospital</b><br /><br />As the Boothbay Peninsula moves forward with the effects of a MaineHealth/Lincoln County HealthCare decision <b>to close St. Andrews Hospital</b>, I have served on the 4 Town Regional Task Force. This has been an unprecedented cooperation between 4 towns in this region that has generated many continuing activities that will benefit all towns in our region.</blockquote><br />Apparently an entire hospital is closing as a result of these debacles.<br /><br /><i><b>[May 8, 2013 addendum: a family physician in Lincoln County where St. Andrews hospital is located and a member of the Board of Trustees, </b></i><i><b>Dan Friedland, M.D., writes me that the EHR had nothing to do with the hospital closing - ed.] </b></i><br /><br /><blockquote class="tr_bq">But let me get back to the MH/LCH decision. <b>We are told that MaineHealth has spent over $150 million on an Electronic Medical Records (EMR)</b> system that helps all of its “subsidiaries.” I can appreciate this because my work is in software development.<br /><br /><b>I do question the $150 million figure. I think it is extremely high and Portland has had a real failure in its implementation. </b>So much so that it looks like LCH will not have a real integrated EMR until 2015 and financial software problems exemplify a major failure of MH to create any real benefit to the State. Millions of dollars have been charged to member hospitals and staff time (salaries and mileage) over the past 2-3 years with no benefit.</blockquote><br />I'd questioned the high cost of these commercial EHR systems as far back as 2006 ("<a href="http://msnbc.msn.com/id/11693923/">Yet another clinical IT controversy: UC Davis</a>" and "<a href="http://hcrenewal.blogspot.com/2007/06/oversight-needed-for-hospital-emr.html">External oversight needed for hospital EMR implementation?</a>" - Lancaster General Hospital and "<a href="http://hcrenewal.blogspot.com/2006/10/70-million-for-electronic-medical.html">$70 million for an Electronic Medical Records system [quasi endpoint]?</a>- Geisinger).<br /><br />One might think healthcare systems have money to burn ...<br /><blockquote class="tr_bq"><br />The system failure also <b>adds operational costs going forward that were not planned for</b> and regional consolidation of finance will now be delayed. The cost to Maine Health Center is huge in improper service and supply charges. <b>Information Technology leadership has been fired</b>, but MH administration is truly accountable.</blockquote><br />For once, someone in IT leadership did not get a a <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=Cardiology%20story">promotion for failure</a>.  It is true that MH administration is accountable, however - they had the fiduciary responsibility to hire the best talent, and to oversee that talent as needed to assure success.  If "C" leadership didn't understand IT, that's their failure as well.  In my view in 2013 everyone in a position of organizational responsibility should have a good understanding of IT, which is now, after all, a commodity.<br /><br />I'm hopeful EPIC, with its apparently <a href="http://hcrenewal.blogspot.com/2010/08/epics-outrageous-recommendations-on.html">revolutionary hiring practices</a> akin to the hiring of physicians, will have the "hiccups" fixed in no time.  From <a href="http://histalk2.com/2010/08/14/monday-morning-update-81610/">this link</a> at the "Histalk" site on staffing of health IT projects, Aug. 16, 2010. Emphases mine:<br /><br /><blockquote class="tr_bq">Epic Staffing Guide<br /><br />A reader sent over a copy of the staffing guide that Epic provides to its customers. I thought it was interesting, first and foremost in that Epic is so specific in its implementation plan that it sends customers an 18-page document on how staff their part of the project.<br /><br />Epic emphasizes that many hospitals can staff their projects internally, choosing people who know the organization. However, they emphasize choosing the best and brightest, not those with time to spare. <b>Epic advocates the same approach it takes in its own hiring: don’t worry about relevant experience, choose people with the right traits, qualities, and skills, they say.</b>  The guide <b>suggests hiring recent college graduates for analyst roles</b>. Ability is <b>more important than experience,</b> it says. That includes reviewing a candidate’s college GPA and <b>standardized test scores.</b></blockquote><span style="color: black; font-size: 100%;"><br /></span> <br />I am forwarding links to this post, blog, my teaching site (begun in 1998) and additional material to Selectman Smith.<br /><br />I'd offer to help, but the management of the organization would likely find, as did <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=leadership">management at this one</a> (a major denominational chain), that I have too much experience for the organization. <br /><br />-- SS<br /><br /><span style="font-family: arial, helvetica, sans-serif; font-size: small;"></span>

Financial woes at Maine Medical Center: Reading this blog might have saved them millions of dollars, and prevented massive "cost saving initiatives"

In this article, the euphemistic and almost endearing term "hiccup" is used instead of the more traditional " glitch " ...

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