healthy4u: Meditech

"Computer problems" force docs back to paper charts at Memorial Hospital - From June 11 until at least June 24?

More on the wonders and dependability of commercial health IT, as implemented in hospitals, which are generally an IT backwaters: <div class="entry-content story_body"><a href="http://www.bnd.com/2013/06/17/2660472/computer-problems-force-docs-back.html"> </a> <blockquote class="tr_bq"><a href="http://www.bnd.com/2013/06/17/2660472/computer-problems-force-docs-back.html"> </a><a href="http://www.bnd.com/2013/06/17/2660472/computer-problems-force-docs-back.html">Computer problems force docs back to paper charts at Memorial Hospital</a> Published: June 17, 2013  BELLEVILLE (Illinois) — Computer problems have caused Memorial Hospital (<a href="http://www.memhosp.com/Pages/Home.aspx">http://www.memhosp.com/Pages/Home.aspx</a>) staff back to the old days of using paper to chart patients' treatments. The hospital's computer system, Meditech, went down late on Tuesday, June 11 and is not expected to be fully restored until at least Monday, June 24, according to the hospital. In the meantime, staff will be recording patients' medical records unto traditional paper charts. "While the duration of this down time is unfortunate, all hospital services continue utilizing the backup process we have in place for occasions such as this," Memorial President Mark Turner said in a prepared statement. "I am extremely proud of the way our employees and medical staff have pulled together to maintain quality care and patient safety." Once the system is up and running again, the information from the paper charts will be transferred into each patient's electronic medical record. The same standards for patient confidentiality and safety are being met, according to the hospital. The computer problems are believed to result from upgrades added to the system in preparation for a major upgrade in July. </blockquote> "The duration of this down time is unfortunate?"  This mission-critical system went down June 11 and won't be fully restored until June 24?  How is this even possible?  What, exactly, were their maximal-uptime, redundancy, disaster recovery and business continuity strategies?  Was there a natural disaster in that area I don't know about? Regarding the hospital President's statement that: <blockquote class="tr_bq">"I am extremely proud of the way our employees and medical staff have pulled together to maintain quality care and patient safety."</blockquote> I would translate that to read: <blockquote class="tr_bq">"Our IT incompetence is all on you, clinicians.  You're liable for any patient harm that results in the messy transitions from IT to paper, and back from paper to IT."</blockquote> -- SS Addendum - a question I've asked before - if everything is just fine, business as usual, with no safety impediments after reverting to paper due to emergency ... then why spend $100 million+ on EHRs? </div><div style="color: black; font: 10pt sans-serif; height: 1px; overflow: hidden; text-align: left; text-transform: none; width: 1px;"> Read more here: http://www.bnd.com/2013/06/17/2660472/computer-problems-force-docs-back.html#storylink=cpyA</div>

"Computer problems" force docs back to paper charts at Memorial Hospital - From June 11 until at least June 24?

More on the wonders and dependability of commercial health IT, as implemented in hospitals, which are generally an IT backwaters: ...

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Boulder Community Hospital computer records back on line - but something does not add up

This post is in followup to my March 20, 2013 post "<a href="http://hcrenewal.blogspot.com/2013/03/boulder-community-hospital-computer.html" target="_blank">Boulder Community Hospital computer system crash: Either you're in control of your information systems, or they're in control of you</a>". At a March 24, 2013 Denver Post article "<a href="http://www.denverpost.com/news/ci_22858267/boulder-community-hospital-computer-records-back-line" target="_blank">Boulder Community Hospital computer records back on line</a>" the following statements are made: <blockquote class="tr_bq"> The computer system that Boulder Community Hospital uses to manage patient records, which had been down for almost two weeks, is now up and running again, hospital officials said Saturday. Meditech, the system used by the hospital to manage patient records, went down March 12 and affected the hospital, its Foothills campus, eight laboratories and six imaging centers. It was put back into full service at about 3 p.m. Friday, according to hospital spokesman Rich Sheehan. Sheehan said an investigation showed the outage was a result of a malfunction in one of the main computer servers ... the hospital has replaced the hard drives for the server that failed and are inspecting the remaining servers ... [the failure] resulted in the system being unable to access patient information. The malfunction affected both the primary server and a backup server kept off-site.</blockquote> <div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">A hard drive failure led to a two-week outage of an entire EHR system and its offsite backup server?  A mission-critical system in a hospital is so fragile that a hard drive failure caused a two week outage? If so, that itself shows, at best, poor overall system design with regard to reliability and redundancy (any server worth its salt has hard drives in a failure-tolerant configuration e.g., <a href="http://en.wikipedia.org/wiki/RAID" target="_blank">RAID</a>), but also is not quite credible on its face.  A remote server should not be taken down by the failure of a local server.  I suspect the failure was more than just a hard drive failure, including software bugs or configuration errors, mass hardware and/or network failure, or even sabotage.</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">The following statement also lacks believability on its face:</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"><blockquote class="tr_bq">... All patient data was recovered except for an eight-hour period the day of the outage. Sheehan said the hospital had to re-create, re-enter and validate the patient information for that eight-hour period before the system could resume normal operations.</blockquote><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">If an information system is down for two weeks, there's two weeks worth of data lost.</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><blockquote class="tr_bq"><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">... Sheehan said the hospital has replaced the hard drives for the server that failed and are inspecting the remaining servers. The hospital is also now doing data backups every four hours as opposed to every six hours, and is planning on doing hourly backups by the end of the week.</div></blockquote><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> Replacing a failed hard drive is an inadequate precaution.  A 'system redundancy makeover' seems in order for when the next hard drive fails.   Hard drives have a very well known MTBF (<a href="http://en.wikipedia.org/wiki/Mean_time_between_failures" target="_blank">mean time between failure</a>) and annual failure rate.  (The very Seagate ST3750528AS hard drive in the PC I am typing this blog post on has an Annualized Failure Rate of 0.34%, per the manufacturer's publicly-available literature.)  <blockquote class="tr_bq">... An independent consulting firm also has been hired to conduct an investigation. The hospital said it expects a report within a few weeks. </blockquote> As other organizations are using Meditech products, Joint Commission Safety Standards (as I wrote in a 2009 JAMA letter to the editor "Health Care Information Technology, Hospital Responsibilities, and Joint Commission Standards" available <a href="http://jama.jamanetwork.com/article.aspx?articleid=184302" target="_blank">at this link</a>) call for sharing the results of that report with other organizations.  I had discussed this letter numerous times with senior Joint Commission leadership.</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> Will sharing of the independent consultant firm's report happen?  Probably not. However, rest assured the Plaintiff's attorneys of Colorado will request it in malpractice suits that arose during the time period of outage. </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">-- SS</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div>

Boulder Community Hospital computer records back on line - but something does not add up

This post is in followup to my March 20, 2013 post " Boulder Community Hospital computer system crash: Either you're in control of...

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Boulder Community Hospital computer system crash: Either you're in control of your information systems, or they're in control of you

Yet another health IT crash, "prolonged" this time, from some unspecified "<a href="http://hcrenewal.blogspot.com/search/label/glitch" target="_blank">glitch</a>": <blockquote class="tr_bq"><a href="http://www.dailycamera.com/news/boulder/ci_22819319/boulder-community-hospital-computer-system-crash-frustrates-patients.html" target="_blank">Boulder Community Hospital computer system crash frustrates patients</a> Officials say it could take until Friday for outage to be resolved By Brittany Anas Camera Staff Writer Posted:   03/18/2013 07:23:23 PM MDT Updated:   03/18/2013 07:24:16 PM MDT A prolonged computer system outage is preventing Boulder Community Hospital from accessing patient records -- making it difficult for people to schedule surgeries, get test results and make appointments for routine blood work. Meditech, the system used by the hospital to manage patient records, went down in the middle of last week. It could take the hospital until Friday to get the system back up, said Rich Sheehan, spokesman for Boulder Community. </blockquote> That fits my definition of "prolonged." <blockquote class="tr_bq">While information technology officials are investigating what caused the outage, Sheehan said patient records are protected and hospital officials don't believe they've been hacked.  </blockquote> That's not very reassuring, considering the length of the outage. <blockquote class="tr_bq">The outage affects the hospital, its Foothills campus, eight laboratories and six imaging centers.  </blockquote> Patients are on its face put at-risk ... for example, I know of several deaths of infants and adults from delayed x-ray reports alone ... but the clinicians, not the IT seller or hospital IT staff, are liable. <blockquote class="tr_bq">"We know medical care is important to people, so we understand the concerns those in the community have," Sheehan said. "We have a lot of people working on this, doing the best they can to solve this problem in a safe manner and as quickly as possible."  </blockquote> "We know medical care is important to people?"  No, really? <blockquote class="tr_bq"> In the meantime, the hospital is using manual paper record-keeping systems and traditional paper charts for its inpatients. Hospital officials say the system allows them to continue treating patients, provide diagnostic services and collect important clinical information that will be entered later into each patient's electronic health record. But that concerns Eroca Lowe, whose mother was in the hospital Thursday through Sunday with gallbladder pain. Lowe said the outage made it extremely difficult for doctors and nurses to do their jobs while hunting down lab results. She criticizes the hospital for not having a backup computer system and resorting to paper records. "That's not a hospital in 2013," she said. </blockquote> It's a good bet the paper records and HIM personnel managing them are not what they used to be pre-computer. <blockquote class="tr_bq"> ... Dina Huber said it took her and her significant other six days to schedule an appointment for a hernia surgery because the system used for scheduling is down. "If they can't keep their computer system running, how can we trust them to perform surgery?" Huber said. </blockquote> Fortunately, surgeons perform surgery ... not computers, IT staff or management.  Doctors, as the enablers of healthcare, don't need computers to save lives. However, making their job harder is not a good idea. <blockquote class="tr_bq">A physician who works at Boulder Community Hospital, speaking on the condition of anonymity, said he doesn't think the outage is compromising the health or safety of patients. But, he said, the backup response "seems a little haphazard, and it's not an organized plan." He said physicians are left chasing down records. </blockquote> If a prolonged outage "is not compromising safety", then why did the hospital spend tens of millions on computers? <blockquote class="tr_bq">Sheehan said the hospital is prioritizing accuracy and patient safety while getting the records system up and running. </blockquote> Once it's running again, there is significant risk of data now recorded manually being lost, thus again increasing error risk. <blockquote class="tr_bq">"We apologize for the delays, but this was an unavoidable situation," Sheehan said. </blockquote> ("We apologize for the chilly water, but this was an unavoidable situation." - Captain of the HMS Titanic?) If an injury occurs, how will that sound to a jury? Let me answer that:  like bull***.   My response to Mr. Sheehan and Meditech, and the IT personnel involved:  "Either you're in control of your information systems, or they're in control of you." It seems the latter clearly applies here. I pray nobody gets injured ... and that the principals don't end up before plaintiff attorneys I've educated on the issues of bad health IT. -- SS

Boulder Community Hospital computer system crash: Either you're in control of your information systems, or they're in control of you

Yet another health IT crash, "prolonged" this time, from some unspecified " glitch ": Boulder Community Hospital compute...

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Socky the Meditech Sockpuppet on Vacation?

[Note: this post is written semi-satirically, but the issues it addresses are dead serious.] It seems Socky the HIT Sockpuppet, a.k.a. anonymous heckler and physician-ridiculer “IT Guy” here as well as "Programmer" at the <a href="http://www.histalk.com/">HIStalk</a> blog, whose <a href="http://www.military.com/ContentFiles/techtv_update_PSYOPS.htm">psyops</a> appeared to emanate from Massachusetts HIT company <a href="http://www.meditech.com/">Meditech</a> ("over 2,200 customers worldwide"), has disappeared. I imagine that my post "<a href="http://hcrenewal.blogspot.com/2010/01/more-on-perversity-in-hit-world.html">More on Perversity in the Healthcare IT World: Is Meditech Employing Sockpuppets?</a>" had something to do with the sudden silence. <div class="commenttxt">I'd conducted a forensic exercise in that post using the publicly accessible <a href="http://www.sitemeter.com/stats.asp?site=s20hcrenewal">Sitemeter</a> access logs for this blog. The analysis pointed straight to that company. <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLWs8g5NYl1iJ1O6ieGfPklg_kmkSgU0wb4_O47ZWRn_RtrWSFr4QcVkct3xGW1bZBUzcS1Bd54rdBY9q8DEHjfSThYKySROxkD9ex3sfJbbccd2MfbBPEltrD47_l6SnEMibUXhcUOSBj/s1600-h/sockpuppet2.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5424054698608473634" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLWs8g5NYl1iJ1O6ieGfPklg_kmkSgU0wb4_O47ZWRn_RtrWSFr4QcVkct3xGW1bZBUzcS1Bd54rdBY9q8DEHjfSThYKySROxkD9ex3sfJbbccd2MfbBPEltrD47_l6SnEMibUXhcUOSBj/s320/sockpuppet2.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 153px; height: 176px;" /></a>Health IT Expert Socky the Sockpuppet! That HIT company-based trolls would resort to psyops to support diffusion of tools that are eliciting widespread complaints from physicians — about the tool’s interferences with patient care, in fact — and ridicule those physicians is perverse, whether company-sanctioned or not.It is not uncommon for company competitive intelligence and corporate communications personnel to monitor blogs. Aggregators actually sell information about what's being said in blogs and other new media back to the companies themselves, for enhancing market awareness among other purposes. It would not at all surprise me if companies were resorting to anonymous online harassment of those whose views they do not like. In the case of HIT, however, everyone reading this could one day be a victim, or have loved ones who could be a victim, of defective health IT. Imagine, say, <a href="http://www.freep.com/article/20100107/NEWS06/1070452/1319/Abdulmutallab-faces-life-in-prison-for-Flight-253-plot">Northwest Airlines</a> conducting online psyops to discourage and discredit those fighting for better security screening of passengers. Would that be perverse enough to attract attention?By the way, it was rather unthoughtful for the perpetrator to have carried out these activities considering that I had conducted <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/content/documents/FINAL_Healthcare%20IT%20Failure_Oct_19_2006.ppt">this research</a> (PPT) a few years ago, a fact they might have been aware of if they had bothered to follow the HIT literature.Anyone listening in the U.S. Senate or House of Representatives? (The visitation logs of this blog also show "hits" from those IP's.) Perhaps you should perform some health IT vendor forensics of your own. -- SS 1:00 PM Addendum: Socky, ya still out there? We'd love to hear from you! <blockquote> Domain Name (Unknown) IP Address 12.11.157.# (Medical Information Technology) [Meditech - ed.] ISP AT&T WorldNet Services Location Continent : North America Country : United States (Facts) State : Massachusetts City : Milford Lat/Long : 42.1544, -71.521 (Map) Language English (U.S.) en-us Operating System Microsoft WinXP Browser Internet Explorer 6.0 Mozilla/4.0 (compatible; MSIE 6.0; Windows NT 5.1; SV1; GTB6.3; .NET CLR 1.1.4322; .NET CLR 2.0.50727; .NET CLR 3.0.04506.30; .NET CLR 3.0.04506.648; MS-RTC LM 8) Javascript version 1.3 Monitor Resolution : 1024 x 768 Color Depth : 16 bits [Who uses 1024x768 @ 16 bit color depth anymore? Can't this rich HIT company afford better? - ed.] Time of Visit Jan 7 2010 11:28:16 am Last Page View Jan 7 2010 11:36:41 am Visit Length 8 minutes 25 seconds Page Views 2 Referring URL Visit Entry Page <a href="https://exchangeweb.drexel.edu/owa/redir.aspx?C=01329f424a1b4b5e92323f9b80e72025&URL=http%3a%2f%2fhcrenewal.blogspot.com%2f2010%2f01%2fsocky-meditech-sockpuppet-on-vacation.html" target="_blank">http://hcrenewal.blogspot.com/2010/01/socky-meditech-sockpuppet-on-vacation.html</a> Visit Exit Page <a href="https://exchangeweb.drexel.edu/owa/redir.aspx?C=01329f424a1b4b5e92323f9b80e72025&URL=http%3a%2f%2fhcrenewal.blogspot.com%2f2010%2f01%2fmore-on-perversity-in-hit-world.html" target="_blank">http://hcrenewal.blogspot.com/2010/01/more-on-perversity-in-hit-world.html</a> Out Click News 1/6/10 | HIStalk <a href="https://exchangeweb.drexel.edu/owa/redir.aspx?C=01329f424a1b4b5e92323f9b80e72025&URL=http%3a%2f%2fhistalk2.com%2f2010%2f01%2f05%2fnews-1610%2f" target="_blank">http://histalk2.com/2010/01/05/news-1610/</a> Time Zone UTC-5:00 Visitor's Time Jan 7 2010 11:28:16 am Visit Number 645,750</blockquote> /sarc -- SS </div>

Socky the Meditech Sockpuppet on Vacation?

[Note: this post is written semi-satirically, but the issues it addresses are dead serious.] It seems Socky the HIT Sockpuppet, a.k.a. anon...

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More on Perversity in the Healthcare IT World: Is Meditech Employing Sockpuppets?

<div style="text-align: center;">(Note to readers: also see my Jan. 7, 2010 followup post "<a href="http://hcrenewal.blogspot.com/2010/01/socky-meditech-sockpuppet-on-vacation.html" style="font-family: arial;">Socky the Meditech Sockpuppet on Vacation?</a>")</div> At "<a href="http://hcrenewal.blogspot.com/2009/12/are-dissmissive-industry-and-government.html">Are Dissmissive Industry and Government Reactions to Physician Concerns about EHR's and other Clinical IT Simply Perverse?</a>" I observed that cavalier dismissals of physician reports on HIT unusability and difficulties fit quite well the definition of "perverse:" <blockquote> Merriam-Webster dictionary: <a href="http://www.merriam-webster.com/dictionary/Perverse">Perverse</a> (adj). Etymology: Middle English, from Anglo-French purvers, pervers, from Latin perversus, from past participle of pervertere Date: 14th century 1 a : turned away from what is right or good : corrupt b : improper, incorrect c : contrary to the evidence or the direction of the judge on a point of law <perverse> 2 a : obstinate in opposing what is right, reasonable, or accepted : wrongheaded b : arising from or indicative of stubbornness or obstinacy 3 : marked by peevishness or petulance : cranky 4 : marked by perversion : perverted</perverse></blockquote> In a later post, "<a href="http://hcrenewal.blogspot.com/2010/01/honest-physician-survey-on-ehrs.html">An Honest Physician Survey on EHR's</a>" I reported on the comments submitted by hundreds of physician members of the <a href="http://www.aapsonline.org/">American Association of Physicians and Surgeons</a> (an organization mainly of physicians in private practice who strongly support physician independence and other conservative views, founded in 1943) in a 2008 survey about HIT: <a href="http://aapsonline.org/surveys/hitsurveyresults.pdf" style="font-weight: bold;"></a> <blockquote><a href="http://aapsonline.org/surveys/hitsurveyresults.pdf" style="font-weight: bold;">AAPS - PHYSICIAN ATTITUDES & ADOPTION OF HEALTH INFORMATION TECHNOLOGY</a> (PDF)</blockquote> The common theme in their feedback was how HIT in its present form disrupted private practice physicians, distracted them from the physician-patient relationship and impaired their ability to properly care for patients. See the above-linked post and AAPS survey report. An anonymous, usually lively and even combative reader "IT Guy," who claims to be an IT professional at an HIT vendor, on occasion leaves comments to my HIT posts. These are typically in the form of unsubstantiated refutations of the material in the posts, and ad hominem attacks in the unmitigated defense of HIT, e.g., referring to this writer as "a teaching professor at a major university who has virtually no understanding of statistical analysis" or as a "grandstanding self-promoter" (See, for example, <a href="https://www.blogger.com/comment.g?blogID=9551150&postID=4799128165855153590&isPopup=true">here</a> at January 5, 2010 8:53:00 AM EST. Read the entire thread.) In the latest case, "IT Guy" commented on my report of the AAPS HIT survey responses <a href="http://hcrenewal.blogspot.com/2010/01/honest-physician-survey-on-ehrs.html#c2210228343379076434">as follows</a>: <a href="http://www.blogger.com/profile/15695921178556625665" onclick="window.open(this.href);return false;" rel="nofollow"></a> <blockquote><a href="http://www.blogger.com/profile/15695921178556625665" onclick="window.open(this.href);return false;" rel="nofollow">IT Guy</a> said... It's the March of the Ludites. Thanks for a very funny post. <div class="comment-timestamp">January 4, 2010 12:28:00 PM EST</div></blockquote><div class="comment-timestamp"></div> I failed to see the humor in dozens of adverse comments about HIT from private practice physicians, and replied with a link to my <a href="http://hcrenewal.blogspot.com/2009/12/are-dissmissive-industry-and-government.html">initial post about HIT industry perversity</a> mentioned above, which elicited the even more perverse response: <a href="http://www.blogger.com/profile/15695921178556625665" onclick="window.open(this.href);return false;" rel="nofollow"></a> <blockquote><a href="http://www.blogger.com/profile/15695921178556625665" onclick="window.open(this.href);return false;" rel="nofollow">IT Guy</a> said... No one is dissmissive of legitimate concerns. Luddites are a different story. Most of the "concerns" in that diatribe are of the Luddite variety. <div class="comment-timestamp">January 4, 2010 1:33:00 PM EST</div></blockquote><div class="comment-timestamp"></div> In other words, a survey of physician concerns is a "diatribe" and it is up to the "IT guys" to determine which physician concerns are "legitimate" and which are of the "Luddite" variety. "IT Guy" remains anonymous and has been so since he first started posting comments here, despite prodding to reveal his identity to better facilitate an understanding of where his/her viewpoints arose. He/she has neglected to do so. Even the blogger profile is blank, click to enlarge: <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2qfCG46u1rT-15jqP0fBkOLk9fOonO49xQ-1oDlRjVHVJ_bby2k5g90jDLYtt7kqp1FTLjT7CRAo8kbB1IrsN_sRkIZJn8Cdabsq3ioc-9ajRvdmFUDXqMcpGZsTDodu77bB4ENpu3bcP/s1600-h/itguy.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5423280702099210722" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2qfCG46u1rT-15jqP0fBkOLk9fOonO49xQ-1oDlRjVHVJ_bby2k5g90jDLYtt7kqp1FTLjT7CRAo8kbB1IrsN_sRkIZJn8Cdabsq3ioc-9ajRvdmFUDXqMcpGZsTDodu77bB4ENpu3bcP/s320/itguy.jpg" style="cursor: pointer; display: block; height: 233px; margin: 0px auto 10px; text-align: center; width: 209px;" /></a> Now, I welcome anonymous comments and have a thick skin - to a point. When the comments go ad hominem or perverse, I do consider deleting them. However, when such comments are potentially revelatory of major issues, I promote and amplify them - as now. Read on. This person also apparently uses the anonymous moniker "Programmer" at the <a href="http://www.histalk.com/">HIStalk</a> blog where he similarly attacks my comments made under my actual name S Silverstein or under MedInformaticsMD. The HIStalk site owner actually edited out defamatory comments made about me in Oct. 2009 at HIStalk comment #28 <a href="http://histalk2.com/2009/10/17/monday-morning-update-101909/comment-page-1/#comment-6240">at this HIStalk comment thread</a> and apologized for this entry on his blog: <blockquote>#28 Programmer [at HIStalk blog - ed.]October 20th, 2009 at 11:57 am <div class="commenttxt"> Yes, it’s that simple. If you select for pre-IT and post-IT data and use a large enough sample size the other factors with equal out. If the sample size is large enough you should have a relatively small margin of error. [i.e., "Programmer" -- who I soon show is also "IT Guy" -- opines that in comparing clinical adverse event rates pre- and post healthcare IT installation, all you need is a large enough sample size, which then nullifies or cancels out, for example, changes occurring over time that are not related to the intervention, and other potential confounders in a pre-post comparison. If only evaluation studies in healthcare informatics were that simple ... it is concerning that IT vendor personnel might have such beliefs - ed.]And the fact that a teaching professor at a major university has virtually no understanding of statistical analysis makes me say “at least I don’t have to worry about losing my job to one of his students." [Latter sentence was removed by HIStalk owner - ed.] </div></blockquote>Now, back at HC Renewal see <a href="https://www.blogger.com/comment.g?blogID=9551150&postID=5650114337316261515&isPopup=true">this combative comment thread</a> where "IT Guy" a.k.a. "Programmer" refers to that removal, and repeats the above statistical faux pas and ad hominem ("just to make sure I read the whole thing"), and adds another ad hominem for good measure. I let them remain. (Comment dated October 20, 2009 1:35:00 PM EDT.) HIStalk's "Programmer" and HC Renewal's "IT guy" are apparently one and the same. Getting to the core of this posting, I repeat, when such comments are potentially revelatory of major issues in HIT, I promote them - as here. The raison d'être for this posting is an interesting pattern: Before "IT Guy" posts comments at HC Renewal, "hits" appear from a major health IT vendor's IP in our publicly-accessible <a href="http://www.sitemeter.com/stats.asp?site=s20hcrenewal">Sitemeter log</a>, with outclicks to the comment sections of posts where "IT Guy's" comments then appear. For example: <blockquote>Domain Name (Unknown) IP Address 12.11.157.# (Medical Information Technology) [Meditech - ed.] ISP AT&T WorldNet Services Location Continent : North America Country : United States (Facts) State : Massachusetts City : Milford Lat/Long : 42.1544, -71.521 (Map) Language English (U.S.) en-us Operating System Microsoft WinXP Browser Internet Explorer 6.0 Mozilla/4.0 (compatible; MSIE 6.0; Windows NT 5.1; SV1; .NET CLR 1.1.4322; .NET CLR 2.0.50727; .NET CLR 3.0.04506.30; .NET CLR 3.0.04506.648) Javascript version 1.3 Monitor Resolution : 1024 x 768 Color Depth : 32 bits Time of Visit Jan 4 2010 11:49:49 am Last Page View Jan 4 2010 12:55:12 pm Visit Length 1 hour 5 minutes 23 seconds Page Views 12 Referring URL Visit Entry Page <a href="https://exchangeweb.drexel.edu/owa/redir.aspx?C=5aed7d70d55e446ca5afa8ea987230d0&URL=http%3a%2f%2fhcrenewal.blogspot.com%2f" target="_blank">http://hcrenewal.blogspot.com/</a> Visit Exit Page <a href="https://exchangeweb.drexel.edu/owa/redir.aspx?C=5aed7d70d55e446ca5afa8ea987230d0&URL=http%3a%2f%2fhcrenewal.blogspot.com%2f" target="_blank">http://hcrenewal.blogspot.com/</a> Out Click 0 comments <a href="https://www.blogger.com/comment.g?blogID=9551150&postID=4799128165855153590&isPopup=true">https://www.blogger.com/comment.g?blogID=9551150&postID=4799128165855153590&isPopup=true</a> Time Zone UTC-5:00 Visitor's Time Jan 4 2010 11:49:49 am Visit Number 643,748</blockquote> At the time of the outclick, there were "0 comments" to that post, as shown in the log above. Shortly after, IT Guy's aforementioned "Funny March of the Luddites" comment appeared ... as comment #1. Likewise today, several "hits" appeared from IP 12.11.157.# with outlinks to the comment thread, for instance as seen below when only 23 comments were present, mostly from "IT Guy", Dr. Poses and myself: <blockquote>Domain Name (Unknown) IP Address 12.11.157.# (Medical Information Technology) ISP AT&T WorldNet Services Location Continent : North America Country : United States (Facts) State : Massachusetts City : Milford Lat/Long : 42.1544, -71.521 (Map) Language English (U.S.) en-us Operating System Microsoft WinXP Browser Internet Explorer 6.0 Mozilla/4.0 (compatible; MSIE 6.0; Windows NT 5.1; SV1; .NET CLR 1.1.4322; .NET CLR 2.0.50727; .NET CLR 3.0.04506.30; .NET CLR 3.0.04506.648) Javascript version 1.3 Monitor Resolution : 1024 x 768 Color Depth : 32 bits Time of Visit Jan 5 2010 9:38:07 am Last Page View Jan 5 2010 9:57:40 am Visit Length 19 minutes 33 seconds Page Views 3 Referring URL Visit Entry Page http://hcrenewal.blogspot.com/ Visit Exit Page http://hcrenewal.blogspot.com/ Out Click 23 comments <a href="https://www.blogger.com/comment.g?blogID=9551150&postID=4799128165855153590&isPopup=true" style="font-weight: bold;">https://www.blogger.com/comment.g?blogID=9551150&postID=4799128165855153590&isPopup=true</a> Time Zone UTC-5:00 Visitor's Time Jan 5 2010 9:38:07 am Visit Number 644,308</blockquote> After that, more comments from "IT Guy" appeared starting with ... #24. The pattern has remained consistent. Now, the evidence is circumstantial but it does not take a Sherlock Holmes to realize it is quite likely this commenter is an employee of a healthcare IT vendor named in the above links, <a href="http://www.google.com/search?client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&channel=s&hl=en&source=hp&q=Medical+Information+Technology%2C+Inc&btnG=Google+Search">Medical Information Technology, Inc</a>., a.k.a. <a href="http://www.meditech.com/">Meditech</a>. I am concerned that a possible employee of an HIT company - any HIT company -- might find physician concerns about HIT as serious as those expressed in the AAPS survey "funny" and "of the Luddite variety." I also am concerned that an employee might think that in situ pre-post evaluations of the technology need not take into account possible confounders. If this person is an HIT vendor employee and IT professional at this HIT company or any other -- I think it likely he/she holds such a position at some HIT company and such attitudes -- then a number of questions are raised: <ul><li>How common is this attitude among HIT vendor employees? Is this a systemic problem?</li></ul><ul><li>How do such attitudes translate into satisfying customer requests for remediation of HIT defects and problems?</li></ul><ul><li>Should HIT vendors be doing better due diligence in their hiring practices to assure they hire IT personnel with a service mentality and who understand that clinicians are the enablers of medicine, they the facilitators? (A point my graduate healthcare informatics students are taught and grasp readily.)</li></ul> At the very least, perhaps employees of HIT companies (such as the one in the logs above at Meditech, whoever they may be) should pay more attention to improving HIT, rather than spending 1 hour 5 minutes 23 seconds reading 12 posts here during business hours. "IT Guy" is welcome to continue submitting anonymous comments, but if they contain ad hominem they will be deleted. -- SS Addendum 1/5/10: A HC Renewal reader with an MBA non-anonymously relates the following (emphases mine): <blockquote>In reading this thread of comments I have to believe IT Guy is a salesperson. My only question is: Were you assigned this blog or did you choose it? We had this problem a number of years ago where a salesperson was assigned a number of blogs with the intent of using up valuable time in trying to discredit the postings. In my very first sales class we learned to focus on irrelevant points, constantly shift the discussion, and generally try to distract criticism. I would say that HCR is creating heat for IT Guy’s employer and the industry in general. I find it sad that a company would allow an employee to attack anyone in an open forum. IT Guy needs to check with his superiors to find out if they approve of this use of his time, and I hope he is not using a company computer, unless once again this attack is company sanctioned. Steve Lucas</blockquote> I think that is an interesting possibility - someone paid to disrupt. It fits, and again invoking Sherlock Holmes, there is the means, the motive and the opportunity. Time for another definition: <blockquote>Sock puppeting: "the act of creating a fake online identity to praise, defend or create the illusion of support for one’s self, allies or company." (<a href="http://www.nytimes.com/2007/07/16/technology/16blog.html?ex=1342238400&en=9a3424961f9d2163&ei=5088&partner=rssnyt&emc=rss">NY Times</a>)</blockquote> If true (unfortunately for the salesperson), I make this observation: To most of the readers of Healthcare Renewal, who find a focus on irrelevancy and irrationality to be signs of foolishness and hysteria (we clinicians have seen it all, by the way), this salesperson has nothing to sell. Another perversity also comes to mind. If what Mr. Lucas suggests is indeed occurring, a company behind such actions would be exhibiting self destructive behavior in trying to disrupt and discredit those who could actually help them to make better products and be more competitive. I remind that patients are the true "customer." It also follows that, if this analysis is true, the defamatory attacks left at HIStalk and here at HC Renewal would have been made with foreknowledge of their falsity and with malice.  I have informed the company's General Counsel of this information and hope that will be sufficient to cause the harassment from their company to cease. Defamation, I also add, is certainly not a particularly wise HIT vendor strategy with the HIT industry under investigation by US Senator Grassley (see Oct. 2009 PDF letter to a number of vendors and management consultant firms <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/grassley_erecords102409.pdf">here</a>). Having worked in pharma, however, another self-destructive industry due to its internal pathologies, I've seen worse done to critics. Incidentally, another probable blog troll/sockpuppet comment from that industry is in the <a href="http://hcrenewal.blogspot.com/2008/01/merck-and-vytorin-who-exactly-is.html#c8072942025901224211">comments</a> section at <a href="http://hcrenewal.blogspot.com/2008/01/merck-and-vytorin-who-exactly-is.html">this Jan. 2008 post</a>. -- SS

More on Perversity in the Healthcare IT World: Is Meditech Employing Sockpuppets?

(Note to readers: also see my Jan. 7, 2010 followup post " Socky the Meditech Sockpuppet on Vacation? ") At " Are Dissmissi...

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