healthy4u: computer unreliability

A technical note on computer unreliability, and a series of followup critical questions relative to health IT: I run Windows 7 Professional on one of my computers, a very unspecial 4-5 year old <a href="http://www.microcenter.com/">Micro Center</a> machine, the <a href="http://www.powerspec.com/systems/system_specs.phtml?selection=6001">PowerSpec 6001</a>, using conventional components. The machine was upgraded with 2 Gb RAM and an ATI Radeon 9600 series video card, to run the <a href="http://en.wikipedia.org/wiki/Windows_Aero">Aero</a> "eye candy." It has run satisfactorily since I installed Windows 7 Professional (32-bit version) on it last year. I am not a <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/biography.htm">computer amateur</a>. [I do, however, admit to being a <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/medinformatic1/ham.htm">Radio Amateur</a> - Extra class - ed.] Further, I meticulously keep the machine current with Microsoft security patches, use Symantec anti-virus which I also keep updated, check my disk for errors, and only visit major well-known, nationally prominent websites using the machine. So yesterday, <a href="http://technet.microsoft.com/en-us/library/ff817622%28WS.10%29.aspx">Windows 7 Service Pack 1</a> appeared in my "Software updates" list from Microsoft, after being released to the general public. It was explained that this Service Pack improves performance, reliability and security [i.e., it is intended to update all the many, many bugs, unreliabilities and security holes of the operating system since its inception - ed.] I confirmed my machine met the specs for it, and allowed the computer to download and install Service Pack 1. That was my mistake. After installation, the machine could no longer reboot Windows. The flying color patches of the first screen appeared ... and then the machine suffered a hard reboot (going back to the BIOS-initiated memory checks and screens, etc.), as if I'd pressed the front panel hardware RESET button this machine has. An automated "wizard" that came up and tried to figure out why the machine would not restart failed to do so. I asked the machine, therefore, to roll back to the state it was in prior to the Service Pack 1 (SP1) "upgrade" via a "Restore Point", a feature Windows permits using the "system restore" capability. The SP1 installation automatically creates a Restore Point (image of the prior state of the OS) on the machine just before installing itself. The machine works again, but ... (and that is a big "but"): <ul><li>The Service Pack is not installed. Therefore I am not running the latest protections, and do not know what will happen in the future with respect to patches and upgrades. Maybe the Service Pack will get its own Service Pack at some point to fix it, so it can fix my computer; </li></ul><ul><li>The Service pack installation, without warning and rather rudely, erased my prior computer Restore Points of the past few weeks, leaving only the Restore Point it created just before inflicting itself on my machine. Just to thumb its nose at me, it also left two Restore Points from back in November, which would require me to then re-install a lot of software and updates at the very least. I cannot even try a Restore Point of, say, last week after other updates;</li></ul><ul><li>I attempted to view the system error logs to determine what caused the failed Service Pack Install. Surprise! The Event Viewer and Task Scheduler management consoles I use to review system operation no longer operated, instead producing this lovely, extremely explanatory message: "MMC cannot initialize the snap-in", followed by hexadecimal gibberish that any doctor or citizen can easily decipher:</li></ul> <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipsrNjV6W0ounPrqZiWBK-To0gEljWXmtc6AGgXhgHy9AO8hoI5b1W0cOeDs_KFXhH4mMkEL02pVhp7fDGZIzJ17BdRymASYeIkadc4VSU4_BoHBEiyWHBa-TkM8yFpdYeLCisPp_-Y4BW/s1600/mmc.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5577303822912380578" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipsrNjV6W0ounPrqZiWBK-To0gEljWXmtc6AGgXhgHy9AO8hoI5b1W0cOeDs_KFXhH4mMkEL02pVhp7fDGZIzJ17BdRymASYeIkadc4VSU4_BoHBEiyWHBa-TkM8yFpdYeLCisPp_-Y4BW/s320/mmc.jpg" style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 320px; height: 224px;" /></a>Such explanatory error messages! "MMC cannot initialize the snap-in. The snap-in might not have been installed correctly. Name: Event viewer. CLSID: FX: {b05566ad-fe9c-4363-be05-7a4cbb7cb510}." Click to enlarge. </div> <ul><li>Attempts to look up the error on the Web produce gobs and gobs of amateurish "legible gibberish", indirection, misdirection, guesswork, and speculation, some of it from Microsoft itself;</li></ul><ul><li>To add insult to injury, typical of poor user interaction design, I could not copy-and-paste the error, but had to type it (partially, fortunately, thanks to Google); </li></ul><ul><li>Much of the material was in very broken English (where's those language translators promised to us for some 50 years now by computer scientists?)</li></ul><ul><li>My attempts at repairing the damage by running the command "SFC /scannow" (system file check) to check and repair critical windows files showed that the Service Pack "Upgrade" also corrupted a number of critical Windows system files - despite the "Restore Point" rollback. Great Scott! </li></ul><ul><li>SFC repaired the files and produced a log of gibberish that's thousands of pages long for me to ferret out what got damaged (ironically, just like the records from a few weeks of a relative's EMR-error-related hospitalization, at appx. 2,900 pages of legible gibberish); </li></ul><ul><li>The repair did not restore the missing functionality;</li></ul><ul><li>Attempts to reinstall supporting packages such as .Net framework also do not restore the functionality;</li></ul><ul><li>Attempts to reinstall the Service Pack produce the same results, a crash on initial restart after the installation and need to roll back, erasure of several Restore Points I manually created, along with re-corruption of the critical system files previously repaired by the SFC /scannow command. </li></ul><ul><li>I have no way of knowing what else is broken or may malfunction; </li></ul><ul><li>While not rigorous, reports on the web show a significant percentage of <a href="http://downloadsquad.switched.com/2011/02/23/ask-dls-how-did-your-windows-7-sp1-upgrade-go/">others having problems with the "Service Pack"</a> as well. Russian Roulette, anyone? </li></ul> <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipL1D9biQcJq6e-TiLm6QnxoMKHg9o9_h4i864qw7g-V6kzjlzi8DkwmpWebiiAS3M0Xnw2cNWfTfvI3C_B5pnLDee6oRjtj7wzaKX8KI0iNyeKLDNMB4ir1xdNIVMD48t02E88FAtzjjf/s1600/russian-roulette.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5577305996290114098" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipL1D9biQcJq6e-TiLm6QnxoMKHg9o9_h4i864qw7g-V6kzjlzi8DkwmpWebiiAS3M0Xnw2cNWfTfvI3C_B5pnLDee6oRjtj7wzaKX8KI0iNyeKLDNMB4ir1xdNIVMD48t02E88FAtzjjf/s320/russian-roulette.jpg" style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 219px; height: 124px;" /></a>Russian Roulette, anyone? </div> All this was after many months of Microsoft "Beta testing" the Service Pack. (Perhaps it was really "Alpha testing?") Similar issues occurred with the former Microsoft OS, Windows XP (now in its third major service pack since its release in 2002, with patches still coming on an almost weekly basis). Fortunately, I have backup images of my entire disk, but the inconvenience and time wasted is quite irritating - and I will still not have the latest security patches after I roll back my machine to my latest disk image. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeSaa1WOoygz87TemZb4uPh1FuYD2Yi8yhOcNDLSH0_JQzFQ6fWuvaB8H6eGHxmDDFtWNkslzbtWNABRsXvr98W33cPpILBu6JoynOZUFt_VtKsJBcWhtc27kyIVqkpSznDWRpB_5Wi5NF/s1600/bang_head_here.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5577345249233565298" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeSaa1WOoygz87TemZb4uPh1FuYD2Yi8yhOcNDLSH0_JQzFQ6fWuvaB8H6eGHxmDDFtWNkslzbtWNABRsXvr98W33cPpILBu6JoynOZUFt_VtKsJBcWhtc27kyIVqkpSznDWRpB_5Wi5NF/s320/bang_head_here.jpg" style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 229px; height: 244px;" /></a> One should note that these "glitches" are just in the Operating System (OS) itself. Third-party applications (such as EMR and CPOE sytems, middleware, interfaces, etc.) suffer the same type of problems...for instance, the life-and-limb-threatening "glitches" that occurred at <a href="http://hcrenewal.blogspot.com/2010/08/huffington-post-investigative-fund-fda.html">Trinity Healthcare after an EMR "upgrade."</a> Further, OS "glitches" can cause unexpected application "glitches", and vice versa. Complexity on top of complexity... Note that machines running similar software are on the "servers" that are the heart of major enterprise systems such as EMR's and CPOE's, that communicate with enduser workstations. Now, several simple questions: <ul><li>Who knows what other "glitches" the Service Pack introduced to my machine, that will "bite me" (or patients) later?</li></ul><ul><li>Are these the machines we want our doctors and nurses to depend upon, since they increasingly regulate every medical transaction that occurs?</li></ul><ul><li>Has the software become too complex to be entirely reliable, maintainable and secure?</li></ul><ul><li>Does the average hospital have the staff to effectively deal with issues such as the above?</li></ul><ul><li>Do these "glitches" raise the risk and the cost - therefore reducing the ROI, already low (see <a href="http://hcrenewal.blogspot.com/2011/02/updated-reading-list-on-health-it.html">reading list</a>) - of experimental health IT to even more unsatisfactory levels?</li></ul> Finally: <ul><li>Would the average person tolerate such behavior from their car? In their aircraft? (Oops, the brakes don't work properly in 13.5% of cars after the parts upgrade, and that altimeter is simply crazy ...) </li></ul>-- SS Feb. 24 late night addendum: Deciding to play with this mayhem, and knowing I was going to be wasting a lot of time, I first backed up my deranged machine to an external disk (~ half an hour) to preserve my files. I then restored my machine from an external disk backup image to its condition in mid-Nov. 2010 [thinking perhaps something more recent caused the SP1 to fail]. That took another half an hour. I then attempted to install the SP1 again. That took another hour or more. Same results - machine crash after the "circling window panes" display. I let the "Startup Repair" wizard run. It failed with the following informative messages. In a superb example of poor user design, I had to jot the messages down on paper, as it made no offer to print them, or load them into a thumb drive, etc. - although it did offer to send the error messages to Microsoft, a neat trick as the software components to drive the computer's wireless network adapter were not loaded: <blockquote>Problem details - System Repair Problem signature: 1- 6.1.7600.16385 2- 6.1.7600.16385 3 - unknown 4 - 21201077 5- AutoFailure 6 - 3 7 - BadPatch OS version - 6.1.7600.2.0.0 Local ID - 1033256.1 Root cause - a patch is preventing the system from starting [no fooling - ed.] Repair Action System file integrity check and repair Result = Failed. Error code = 0xa</blockquote> Then for added fun, I started the machine up in 'Safe Mode' (using the F8 key at startup). It came up, but told me it was doing a System Restore due to the failure to configure the Service Pack. After about 20 minutes of frantic disk activity, the machine rebooted - and immediately crashed as before. I am rerunning the Startup Repair wizard again, asking it to restore my system, but I predict it will do so with the original remaining problems of non-functioning components that started this whole mess - if it works at all. This is all absurd. It is a massive waste of time, a result of poor programming, uninformative, cryptic error messages (what? computers don't have enough storage for useful error messages?), poor (nonexistent) documentation, inadequate attention to the user experience, condescension of the user, inability to report the problems back to HQ automatically due to lack of forethought about a compromised machine's ability to access the network, software unreliability, and probably a host of other issues I haven't thought of yet because I'm tired after all this fritter. Not to mention, it is potentially destructive of data to those who suffer this problem but did not keep backups. They warn you beforehand - but the installation agreement you "sign" is of the Ross Koppel/David Kreda "<a href="http://jama.ama-assn.org/content/301/12/1276.extract">hold the vendor harmless</a>" variety. This experience is a metaphor for the state of health IT (with "glitches", "workarounds", unexplained errors, etc.), and of the dangers of computer worship. -- SS Feb 25 addendum - further experimentation based on web comments about SP1, such as running a pre-SP1 readiness checking utility by Microsoft, emptying the /temp folders, renaming the "software distribution" folder, clean booting, etc. all produce the same result: crash of the machine on reboot. And there's no computer doctor to call for an appointment to fix the problem. -- SS

Windows 7 Service Pack 1 "Glitches": Why Personal Computers are Problematic, and Perhaps Should Not Be Mission Critical Components in Hospitals

A technical note on computer unreliability, and a series of followup critical questions relative to health IT: I run Windows 7 Professional ...

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