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 H3 { margin-bottom: 0.08in; }H3.cjk { font-family: "Droid Sans Fallback"; }H3.ctl { font-family: "Lohit Hindi"; }P { margin-bottom: 0.08in;"We’ve resolved 6,036 issues…

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

<div style="text-align: center;"><span style="font-size: x-small;">(Note: also see my June 16, 2014 followup post at <a href="http://hcrenewal.blogspot.com/2014/06/masters-of-obvious-aat-athens-regional.html">http://hcrenewal.blogspot.com/2014/06/masters-of-obvious-aat-athens-regional.html</a>)</span> </div><br />Maybe hospital management gurus could address these computer problems BEFORE turning them loose on patients?<br /><br />Physicians in Georgia seem to have more guts than their colleagues elsewhere.  Rather than letting patients be guinea pigs for the naive fantasies of hospital executives about health IT, these physicians said "get these [expletive] computer systems out of our hospital"...<br /><br />Then they started <i>resigning their appointments: </i><br /><br /><blockquote class="tr_bq"><b>Athens Regional addressing new computer system problems encountered by doctors</b><br /><br />By Donnie Z. Fetter<br />Friday, May 23, 2014<br /><br /><a href="http://onlineathens.com/health/2014-05-22/athens-regional-addressing-new-computer-system-problems-encountered-doctors">http://onlineathens.com/health/2014-05-22/athens-regional-addressing-new-computer-system-problems-encountered-doctors</a><br /><br />Doctors affiliated with Athens Regional Medical Center (<a href="http://www.athenshealth.org/">http://www.athenshealth.org/</a>) have expressed concerns that<b> a computer system installed this month at the hospital endangers patients.</b></blockquote><br />Not "may endanger patients."  "Endangers patients."  That's quite direct. <br /><br /><blockquote class="tr_bq">However, the hospital's chief executive said Athens Regional is taking "swift action" to address those concerns.</blockquote><br />I'm not impressed.  The executives should perhaps have done due diligence and taken action <b>BEFORE this bad health IT was set loose on live, unsuspecting patients</b>.<br /><br />It's not as if the issues are unknown (as Google or anyone who actually knows what they're doing regarding health IT will easily demonstrate).  Further, those executives have the legal obligation to maintain a safe healthcare environment.<br /><br /><blockquote class="tr_bq">In a letter dated May 15 and provided to the Athens Banner-Herald this week, multiple doctors noted such concerns as<b> “medication errors ... orders being lost or overlooked ... (emergency department) patients leaving after long waits; and of an inpatient who wasn’t seen by a physician for (five) days.”</b></blockquote><br />Any of these issues and the multitude more I can predict exist can lead to severe injury or death, especially in fragile patients and the elderly.  Trust me, I know both professionally and personally... <br />  <br /><blockquote class="tr_bq">The letter was addressed to ARMC President and CEO James G. Thaw and <b>Senior Vice President and CIO Gretchen Tegethoff.</b> It was signed by more than a dozen physicians, including Carolann Eisenhart, president of the medical staff; Joseph T. Johnson, vice president of the medical staff; David M. Sailers, surgery department chair; and, Robert D. Sinyard, medicine department chair.<br /><br />The doctor who provided the letter to the Banner-Herald<b> refused a request to openly discuss the issues with the computer system and asked to remain anonymous at the urging of his colleagues.</b></blockquote><br /><b>Refused a request to openly discuss the issues with the computer system and asked to remain anonymous at the urging of his colleagues ... </b>due to fear the executives would then return the doctor's concerns with genuine love and appreciation, and give him or her a generous promotion and pat on the back, no doubt.  (Actually, quite likely was a fear of retaliation, e.g. sham peer review as at <a href="http://www.aapsonline.org/index.php/article/sham_peer_review_resources_physicians">http://www.aapsonline.org/index.php/article/sham_peer_review_resources_physicians</a>.)<br /><br />Note the educational background of CIO Gretchen Tegerhoff, the executive with fiduciary obligations to implement health IT of the highest quality and to have robustly researched all of the issues involved (and whom the Board should have thoroughly vetted as to required background for health IT leadership):<br /><br /><blockquote class="tr_bq">University of Georgia<br />Terry College of Business, Executive Program, Finance<br />2014 – 2014 (expected)<br /><br />The George Washington University - School of Business<br />Master of Science, Information Systems Technology<br />2001 – 2003<br /><br />West Virginia University<br />BS, Medical Technology<br />1993 – 1997 </blockquote><br />Note the career progression that is the envy of, say, someone who's completed the rigors of medical training (premed, medical school, internship/residency, clinical postdocs) and beyond that, completed an additional PhD, MS or post-doctoral fellowship in Medical Informatics at unknown universities such as Harvard, Yale, Stanford, Johns Hopkins, Columbia, etc. (reverse chrono):<br /><br /><blockquote class="tr_bq">Technical Analyst<br />STG (9 months)<br />[Provided U.S. Department of State with systems support and application maintenance.]<br /><br />Clinical Systems Analyst<br />George Washington University Hospital (3 years 8 months)<br /><br />Technical Support Specialist/Installer<br />Intellidata, Inc. (9 months)<br /><br />Clinical Research Associate<br />QUINTILES, INC. (9 months)<br /><br />Information Specialist<br />THE EMMES CORPORATION (1 year 8 months)<br /><br />Writer/Editor<br />ASPEN SYSTEMS CORPORATION (7 months)<br /><br />Medical Technologist<br />PROVIDENCE LABORATORY ASSOCIATES (8 months) </blockquote><br />This background led directly to:<br /><br /><blockquote class="tr_bq">Chief Information Officer<br />George Washington University Hospital (6 years 8 months) </blockquote><br />and then the current role:<br /><br /><blockquote class="tr_bq">Athens Regional Health System<br />Vice President and Chief Information Officer<br />Athens Regional Health System</blockquote><br />If you believed that the qualifications required for medical practice - let alone medical leadership roles - is at least an order of magnitude more robust, you'd not be mistaken.<br /><br />Perhaps even worse, business-IT amateur meddlers in clinical affairs sell the "best practices" that lead to debacles like this, and perhaps to IT-related patient injury and death, via their alphabet-soup "leadership" organizations.  This CIO also holds this credential:<br /><br /><blockquote class="tr_bq"><style type="text/css">H3 { margin-bottom: 0.08in; }H3.cjk { font-family: "Droid Sans Fallback"; }H3.ctl { font-family: "Lohit Hindi"; }P { margin-bottom: 0.08in; }</style> <br /><div class="western">Faculty</div><div class="western">CHIME Healthcare CIO Boot Camp (8 months) </div></blockquote><br />It should be noted, and scandalously so considering the negligence that leads to patient endangerment and this kind of physician revolt from the outset, that IT-related patient harms are not uncommon.  For example, per the Harvard community's med mal insurer CRICO, see "<b>Malpractice Claims Analysis Confirms Risks in EHRs</b>" at<br /><a href="http://hcrenewal.blogspot.com/2014/02/patient-safety-quality-healthcare.html">http://hcrenewal.blogspot.com/2014/02/patient-safety-quality-healthcare.html</a>, the ECRI Institute, see "<b>ECRI Deep Dive Study of Health IT harms</b>" at <br /><a href="http://hcrenewal.blogspot.com/2013/02/peering-underneath-icebergs-water-level.html">http://hcrenewal.blogspot.com/2013/02/peering-underneath-icebergs-water-level.html</a> as well as "<b>ECRI Institute's 2014 Top 10 Patient Safety Concerns for Healthcare Organizations</b>" at <br /><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>, "<b>FDA Internal Memo on H-IT risks - for internal use only</b>" (uncovered by investigative reporter Fred Schulte) at <a href="http://hcrenewal.blogspot.com/2010/08/smoking-gun-internal-fda-memorandum-of.html">http://hcrenewal.blogspot.com/2010/08/smoking-gun-internal-fda-memorandum-of.html</a>, and others as posted at this blog.<br /><br /><blockquote class="tr_bq">“From the moment our physician leadership expressed concern about the Cerner I.T. conversion process on May 15, <b>we took swift action and significant progress has been made toward resolving the issues raised</b>,” Thaw wrote Thursday in an email. “Providing outstanding patient care is first and foremost in our minds at Athens Regional, and we have dedicated staff throughout the hospital to make sure the system is functioning as smoothly as possible through this transition."</blockquote><br />This raises several questions: <br /><br /><ul><li>How about the moments <i><b>from the time of decision to acquire the technology?  What safety consideration were in effect during that time?</b></i><i><b> </b></i></li></ul><i><b></b></i><br /><ul><li><i><b>What if the "significant progress" is insufficient to prevent a patient from being maimed or killed due to toxic effects of bad health IT?  Who's responsible?</b></i><i><b> </b></i></li></ul><i><b></b></i><br /><ul><li><i><b>Perhaps most importantly from the human rights perspective - are patients being provided informed consent about these "issues raised" and are they afforded the opportunity to seek care elsewhere until the "swift progress" is completed? </b></i> </li></ul><br />One wonders if the executives were aware of analytic work on Cerner ED systems such as performed by U. Sydney professor Jon Patrick at <b>"A study of an Enterprise Health information System", </b> <span class="Apple-style-span" style="font-size: x-small;"></span><a href="http://sydney.edu.au/engineering/it/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146">http://sydney.edu.au/engineering/it/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146</a>; or this site on health IT difficulties:  <a href="http://cci.drexel.edu/faculty/ssilverstein/cases/">http://cci.drexel.edu/faculty/ssilverstein/cases/</a>, or this blog and others.<br /><br />It's not as if a simple Google search won't find them, such as <a href="https://www.google.com/search?q=healthcare+IT+failure">https://www.google.com/search?q=healthcare+IT+failure</a>.  Perhaps they need to read more...or hire experts BEFORE go-live.<br /><br />Back to the article:<br /><br /><blockquote class="tr_bq">The intended goal of the system designed by health care information technology company Cerner is to improve efficiency and connectivity by providing doctors, nurses and other medical professionals with a shared data set and to eventually allow patients online access to their medical records, Athens Regional executives previously said.</blockquote><br />Good intentions or not, badly designed and/or implemented technology harms or kills, and those harmed, or the dead, really don't care what the system is 'intended to do.'  Patients are not guinea pigs towards an IT company's or hospital's experiments with computers - regarding which the executives are usually in to at a level way over their collective heads.<br /><br /><blockquote class="tr_bq">But doctors noted the new system<b> often proved too cumbersome to be effective at the time the letter was written.</b><br /><br />“The Cerner implementation <b>has driven some physicians to drop their active staff privileges at ARMC,</b>” noted the letter. “<b>This has placed an additional burden on the hospitalists, who are already overwhelmed.</b> </blockquote><br />That's just <i>horrendous</i> for safety.<br /><br /><b>Joint Commission, where are you?</b><br /><b> </b> <br /><blockquote class="tr_bq">Other physicians are directing their patients to St. Mary’s (hospital) for outpatient studies, (emergency room) care, admissions and surgical procedures. ... Efforts to rebuild the relationships with patients and physicians (needs) to begin immediately.”</blockquote><br />Doctors voted with their feet.  Bravo.<br /><br />I suggest they consider the following remedies as well if appropriate, from my post at <a href="http://hcrenewal.blogspot.com/2012/03/doctors-and-ehrs-reframing-modernists-v.html">http://hcrenewal.blogspot.com/2012/03/doctors-and-ehrs-reframing-modernists-v.html</a>:<br /><br /><blockquote class="tr_bq">... When a physician or other clinician observes health IT problems, defects, malfunctions, <a href="http://www.tinyurl.com/hostileuserexper">mission hostility</a> (e.g., poor user interfaces), significant downtimes, lost data, erroneous data, misidentified data, and so forth ... and most certainly, patient 'close calls' or actual injuries ... they should (anonymously if necessary if in a hostile management setting):<br /><br />(DISCLAIMER:  I am not responsible for any adverse outcomes if any organizational policies or existing laws are broken in doing any of the following.) <br /><br /><br /><ul><li>Inform their facility's senior management, if deemed safe and not likely to result in retaliation such as being slandered as a "<a href="http://www.jpands.org/vol9no3/huntoon.pdf">disruptive physician</a>" and/or or being subjected to sham peer review (<a href="http://www.aapsonline.org/index.php/article/sham_peer_review_resources_physicians/">link</a>).</li></ul><ul><li>Inform their personal and organizational <span style="font-weight: bold;">insurance carriers</span>, in writing. Insurance carriers do not enjoy paying out for preventable IT-related medical mistakes. They have begun to become aware of HIT risks. See, for example, the essay on Norcal Mutual Insurance Company's newsletter on HIT risks<a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=norcal"> at this link</a>. (Note - many medical malpractice insurance policies can be interpreted as <span style="font-style: italic; font-weight: bold;">requiring</span><span style="font-weight: bold;"> </span>this reporting, observed occasional guest blogger <a href="http://hcrenewal.blogspot.com/search/label/Dr.%20Scott%20Monteith">Dr. Scott Monteith</a> in a comment to me about this post.)</li></ul><ul><li>Inform the Joint Commission (or similar national accreditor of hospital safety if not in the U.S.) via their complaint site at <a href="http://www.jointcommission.org/report_a_complaint.aspx">http://www.jointcommission.org/report_a_complaint.aspx</a> . Also consider writing the JC senior officers (<a href="http://www.jointcommission.org/about_us/joint_commission_officers.aspx">link to officer's list</a>), whose awareness of HIT issues I can personally attest to via our correspondences.</li></ul><ul><li>Inform the FDA (or similar healthcare regulator if not in the U.S.) via the FDA Medwatch Form 3500 reporting site at <a href="https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm">https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm</a>. An example of such an adverse event report I filed myself (when the involved hospital refused) is <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/Detail.CFM?MDRFOI__ID=1729552">at this link</a> in the FDA MAUDE (Manufacturer and User Facility Device Experience) database.</li></ul><ul><li>Inform the State Medical Society and local Medical Society of your locale.</li></ul><ul><li>Inform the appropriate Board of Health for your locale.</li></ul><ul><li>If applicable (and it often is), inform the Medicare Quality Improvement Organization (QIO) of your state or region. Example: in Pennsylvania, the QIO is "<a href="http://www.qipa.org/Home.aspx">Quality Insights of PA</a>."</li></ul><ul><li>Inform a personal attorney.</li></ul><ul><li>Inform local, state and national representatives such as congressional representatives. Sen. Grassley of Iowa is aware of these issues, for example.</li></ul><ul><li>As clinicians are often forced to use health IT, at their own risk even when "certified" (<a href="http://hcrenewal.blogspot.com/2012/02/hospitals-and-doctors-use-health-it-at.html">link</a>), if a healthcare organization or HIT seller is sluggish or resistant in taking corrective actions, consider taking another risk (perhaps this is for the very daring or those near the end of their clinical career). Present your organization's management with a statement for them to sign to the effect of:</li></ul><blockquote><span style="font-style: italic;">"We, the undersigned, do hereby acknowledge the concerns of [Dr. Jones] about care quality issues at [Mount St. Elsewhere Hospital] regarding EHR difficulties that were reported, namely [event A, event B, event C ... etc.]</span><br /><br style="font-style: italic;" /><span style="font-style: italic;">We hereby indemnify [Dr. Jones] for malpractice liability regarding patient care errors that occur due to EHR issues beyond his/her control, but within the control of hospital management, including but not limited to: [system downtimes, lost orders, missing or erroneous data, etc.] that are known to pose risk to patients.</span> <span style="font-style: italic;">We assume responsibility for any such malpractice.</span><br /><br style="font-style: italic;" /><span style="font-style: italic;">With regard to health IT and its potential negative effects on care, Dr. Jones has provided us with the Joint Commission Sentinel Events Alert on Health IT at </span><a href="http://www.jointcommission.org/assets/1/18/SEA_42.PDF" style="font-style: italic;">http://www.jointcommission.org/assets/1/18/SEA_42.PDF</a><span style="font-style: italic;">, the IOM report on HIT safety at </span><a href="http://www.modernhealthcare.com/Assets/pdf/CH76254118.PDF" style="font-style: italic;">http://www.modernhealthcare.com/Assets/pdf/CH76254118.PDF</a><span style="font-style: italic;">, and the FDA Internal Memorandum on H-IT Safety Issues at </span><a href="http://www.scribd.com/huffpostfund/d/33754943-Internal-FDA-Report-on-Adverse-Events-Involving-Health-Information-Technology" style="font-style: italic;">http://www.scribd.com/huffpostfund/d/33754943-Internal-FDA-Report-on-Adverse-Events-Involving-Health-Information-Technology</a><span style="font-style: italic;">.</span><br /><br style="font-style: italic;" /><span style="font-style: italic;">CMO __________ (date, time)</span><br /><span style="font-style: italic;">CIO ___________ (date, time)</span><br /><span style="font-style: italic;">CMIO _________ (date, time)</span><br /><span style="font-style: italic;">General Counsel ___________ (date, time)</span><br /><span style="font-style: italic;">etc."</span></blockquote><ul><li>If the hospital or organizational management refuses to sign such a waiver (and they likely will!), note the refusal, with date and time of refusal, and file away with your attorney. It could come in handy if EHR-related med mal does occur.</li></ul><ul><li>As EHRs remain experimental, I note that indemnifications such as the above probably belong in medical staff contracts and bylaws when EHR use is coerced.</li></ul><br style="font-weight: bold;" />These measures can help "light a fire" under the decision makers, and "get the lead out" of efforts to improve this technology to the point where it is usable, efficacious and safe.</blockquote><br />More from the article:<br /><br /><blockquote class="tr_bq">Doctors called the time line to install the EHR system too “aggressive” and said there was a “lack of readiness” among the intended users.</blockquote><br />For financial incentive reasons in part, I'm sure.  Computers, after all, seem to have more rights than patients...or than physicians and nurses.<br /><br /><blockquote class="tr_bq">Since receiving the letter, Thaw said Athens Regional has added "specialized staff" to meet daily with physicians to discuss computer system and safety issues.</blockquote><br />Again, the key word is "AFTER."   A good move, considering the hospital will be up to its head in defections, accreditation inspections and hearings, and possible medical malpractice and corporate liability lawsuits otherwise.<br /><br /><blockquote class="tr_bq">"Regardless of what system we are using, <b>our focus on patient safety is unwavering</b>, and we will never put a system ahead of doing what is right for our patients," Thaw said. "Our team is working around the clock to resolve any remaining issues, and we remain dedicated to delivering outstanding patient care every step of the way."</blockquote><br />Feel-good executive boilerplate and an outright lie on its face.  If the focus on safety was unwavering, this problems would not now need emergency remediation.  As I had written many years ago here: <a href="http://cci.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=Cardiology%20story">http://cci.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=Cardiology%20story</a>, this type of shallow executive puffery and rhetoric only makes clinicians angrier.<br /><br />And while events like this go on, the industry pundits suggest all that's needed is a Health IT 'Safety Center' instead of regulation like the rest of the healthcare industry (<b>"Feds Call For Health IT Safety Center"</b>, May 20, 2014,<a href="http://www.govhealthit.com/news/feds-call-hit-safety-center?topic=,26#.U4FVDnYsC"> http://www.govhealthit.com/news/feds-call-hit-safety-center?topic=,26#.U4FVDnYsC</a>).  This is sort of like putting the safety of our country's hospitals in the hands of Consumer Reports.<br /><br />That's not exactly the ticket to a rapid cure to these problems, which are more common than most physicians have the bravery (or career options in the face of retaliation) to admit.<br /><br />At least nurses' unions are taking action, as at<a href="http://hcrenewal.blogspot.com/2013/11/another-survey-on-ehrs-affinity-medical.html"> http://hcrenewal.blogspot.com/2013/11/another-survey-on-ehrs-affinity-medical.html</a> and <a href="http://hcrenewal.blogspot.com/2014/05/a-nurses-union-national-nurses-united.html">http://hcrenewal.blogspot.com/2014/05/a-nurses-union-national-nurses-united.html</a>.<br /><br />Additional thought:  at least the writer of the article did not use the customary euphemism for problems with patient-endangering bad health IT, specifically: "glitches" (<a href="http://hcrenewal.blogspot.com/search/label/glitch">http://hcrenewal.blogspot.com/search/label/glitch</a>). <br /><br />-- SS<br /><br /><b>May 27, 2014 Addendum</b>:<br /><br />The CEO has apparently resigned, see <a href="http://onlineathens.com/local-news/2014-05-23/thaw-resigns-athens-regional-ceo">http://onlineathens.com/local-news/2014-05-23/thaw-resigns-athens-regional-ceo</a>.  <br /><br />I also solicit physicians from the area of this hospital to contact me regarding any patient harms that did occur as a result of this debacle, via my email address located here: <a href="https://www.blogger.com/profile/03994321680366572701">https://www.blogger.com/profile/03994321680366572701</a>.  I will forward any reports through appropriate legal channels to attorneys who can take action, which in 2014 is probably the only language this industry will actually listen to.<br /><br />-- SS<br /><br /><b>May 27, 2014 Addendum 2:</b><br /><br />The reader comments at <a href="http://onlineathens.com/health/2014-05-22/athens-regional-addressing-new-computer-system-problems-encountered-doctors">http://onlineathens.com/health/2014-05-22/athens-regional-addressing-new-computer-system-problems-encountered-doctors</a> are interesting, and distressing.<br /><br />-- SS<br /><br /><b>May 29, 2014 Addendum:</b><br /><br />More here:  <a href="http://flagpole.com/news/in-the-loop/james-thaw-out-as-armc-ceo">http://flagpole.com/news/in-the-loop/james-thaw-out-as-armc-ceo</a><b> </b><br /><br />If I were that's hospital's new leadership, I'd immediately go back to whatever system (whether paper or not) was in place before this implementation, and <b>take the time to implement new health IT properly, safely and carefully.</b><br /><br />For at this point, if patient injury or death occurs as a result of a system flaw (whether in design or implementation), I believe charges of criminal negligence against the organization and its leaders would be justified.<br /><br />The following is an example of one state's statute defining criminal negligence:<br /><br /><blockquote>''A person acts with 'criminal negligence' with respect to a result or to a circumstance described by a statute defining an offense when he fails to perceive a substantial and unjustifiable risk that such result will occur or that such circumstance exists. The risk must be of such nature and degree <b>that the failure to perceive it constitutes a gross deviation from the standard of care that a reasonable person would observe in the situation.</b>''</blockquote><br />I believe other states' statutes are similar.<br /><br />-- SS<br /><br /><b>June 13, 2013 Addendum:</b><br /><br />My post on Athens Regional Medical Center's physician revolt was accessed today by someone at Cerner; note the referring link:  <a href="http://cerner.vertabase.com/project/document/index.cfm?&0.12455576848">http://cerner.vertabase.com/project/document/index.cfm?&0.12455576848</a><br /><br />Vertabase (<a href="http://www.vertabase.com/">http://www.vertabase.com/</a>) makes project management software.<br /><br />Cerner.vertabase.com/project/document is some sort of password-protected document resource.<br /><br />I find that interesting - perhaps it's for internal communications and they are learning something from me. <br /><span style="font-family: inherit;"></span><b><br /><br /><span class="HOEnZb"></span></b><br /><table border="0" cellpadding="1" cellspacing="1" style="width: 450px;"><tbody><tr bgcolor="#F5F5E2"><td align="right" width="150"><span style="font-family: Arial;">Domain Name</span></td><td align="center" width="10"></td><td width="290"><span style="font-family: Arial;"> (Unknown) </span></td></tr><tr><td align="right" valign="top"><b><span style="font-family: Arial;">IP Address</span></b></td><td align="center"></td><td><b><span style="font-family: Arial;">159.140.254.# (Cerner Corporation)</span></b></td></tr><tr bgcolor="#F5F5E2"><td align="right"><span style="font-family: Arial;">ISP</span></td><td align="center"></td><td><span style="font-family: Arial;">Cerner Corporation</span></td></tr><tr><td align="right" valign="top"><span style="font-family: Arial;">Location</span></td><td align="center"></td><td><table cellpadding="0" cellspacing="0"><tbody><tr><td><span style="font-family: Arial;">Continent</span></td><td> : </td><td><span style="font-family: Arial;">North America</span></td></tr><tr><td valign="top"><span style="font-family: Arial;">Country</span></td><td valign="top"> : </td><td><span style="font-family: Arial;"><a href="http://www.sitemeter.com/?a=stats&s=s20hcrenewal&v=100&country=US&vlr=14&pg=21&r=76" target="_blank">United States</a> <a href="http://www.sitemeter.com/?a=stats&s=s20hcrenewal&v=100&country=US&vlr=14&pg=21&r=77" target="_blank"><img border="0" height="12" src="https://blogger.googleusercontent.com/img/proxy/AVvXsEjqRg30-NBYCTvdB5xbLIeWb8pInOkPdRZk2QQR2-V1aYwwwkKPVx8XWaG3Pc8GRDYGnkcPfOIZBAzBPLDYY7EhDVN0UO6vMyU8u-Zqgv165Xdliu3lU51bGzEAUayvD-YcR61pttguytcd5RQ=s0-d-e1-ft" width="18" /></a> <a href="http://www.sitemeter.com/?a=stats&s=s20hcrenewal&v=100&country=US&vlr=14&pg=21&r=78" target="_blank">(Facts)</a></span></td></tr><tr><td><span style="font-family: Arial;">State</span></td><td> : </td><td><span style="font-family: Arial;">Kansas</span></td></tr><tr><td><span style="font-family: Arial;">City</span></td><td> : </td><td><span style="font-family: Arial;">Kansas City</span></td></tr><tr><td><span style="font-family: Arial;">Lat/Long</span></td><td> : </td><td><span style="font-family: Arial;">39.1111, -94.6904 <a href="http://www.sitemeter.com/?a=stats&s=s20hcrenewal&r=75&pg=21&vlr=14&v=100" target="_blank">(Map)</a></span></td></tr></tbody></table></td></tr><tr bgcolor="#F5F5E2"><td align="right" valign="top"><span style="font-family: Arial;">Language</span></td><td align="center"></td><td><span style="font-family: Arial;">English (U.S.)<br /><small>en-us</small></span></td></tr><tr><td align="right"><span style="font-family: Arial;">Operating System</span></td><td align="center"></td><td><span style="font-family: Arial;">Macintosh MacOSX</span></td></tr><tr bgcolor="#F5F5E2"><td align="right" valign="top"><span style="font-family: Arial;">Browser</span></td><td align="center"></td><td><span style="font-family: Arial;">Safari 1.3<br /><small>Mozilla/5.0 (Macintosh; Intel Mac OS X 10_8_5) AppleWebKit/536.30.1 (KHTML, like Gecko) Version/6.0.5 Safari/536.30.1</small></span></td></tr><tr><td align="right" valign="top"><span style="font-family: Arial;">Javascript</span></td><td align="center"></td><td><span style="font-family: Arial;">version 1.5</span></td></tr><tr bgcolor="#F5F5E2"><td align="right" valign="top"><span style="font-family: Arial;">Monitor</span></td><td align="center"></td><td><span style="font-family: Arial;"><table cellpadding="0" cellspacing="0"><tbody><tr><td><span style="font-family: Arial;">Resolution</span></td><td><span style="font-family: Arial;"> : </span></td><td><span style="font-family: Arial;">1440 x 900</span></td></tr><tr><td><span style="font-family: Arial;">Color Depth</span></td><td><span style="font-family: Arial;"> : </span></td><td><span style="font-family: Arial;">24 bits </span></td></tr></tbody></table></span></td></tr><tr><td align="right"><span style="font-family: Arial;">Time of Visit</span></td><td align="center"></td><td><span style="font-family: Arial;"><span title="Jun 13 2014 11:47:42">Jun 13 2014 11:47:42 am</span></span></td></tr><tr bgcolor="#F5F5E2"><td align="right"><span style="font-family: Arial;">Last Page View</span></td><td align="center"></td><td><span style="font-family: Arial;"><span title="Jun 13 2014 11:47:42">Jun 13 2014 11:47:42 am</span></span></td></tr><tr><td align="right"><span style="font-family: Arial;">Visit Length</span></td><td align="center"></td><td><span style="font-family: Arial;">0 seconds</span></td></tr><tr bgcolor="#F5F5E2"><td align="right"><span style="font-family: Arial;">Page Views</span></td><td align="center"></td><td><span style="font-family: Arial;">1</span></td></tr><tr><td align="right" valign="top"><b><span style="font-family: Arial;">Referring URL</span></b></td><td align="center"><b><br /></b></td><td><b><span style="font-family: Arial;"><a href="http://cerner.vertabase.com/project/document/index.cfm?&0.12455576848" target="_blank" title="http://cerner.vertabase.com/project/document/index.cfm?&0.12455576848">http://cerner.vertabase.com/<wbr></wbr>project/document/index.cfm?&0.<wbr></wbr>12455576848</a></span></b></td></tr><tr bgcolor="#F5F5E2"><td align="right"><span style="font-family: Arial;">Visit Entry Page</span></td><td align="center"></td><td><span style="font-family: Arial;"><a href="http://hcrenewal.blogspot.com/2014/05/i-could-not-make-this-up-if-i-tried.html" target="_blank" title="http://hcrenewal.blogspot.com/2014/05/i-could-not-make-this-up-if-i-tried.html">http://hcrenewal.blogspot.com/<wbr></wbr>2014/05/i-could-not-make-this-<wbr></wbr>up-if-i-tried.html</a></span></td></tr><tr><td align="right"><span style="font-family: Arial;">Visit Exit Page</span></td><td align="center"></td><td><span style="font-family: Arial;"><a href="http://hcrenewal.blogspot.com/2014/05/i-could-not-make-this-up-if-i-tried.html" target="_blank" title="http://hcrenewal.blogspot.com/2014/05/i-could-not-make-this-up-if-i-tried.html">http://hcrenewal.blogspot.com/<wbr></wbr>2014/05/i-could-not-make-this-<wbr></wbr>up-if-i-tried.html</a></span></td></tr><tr bgcolor="#F5F5E2"><td align="right"><span style="font-family: Arial;">Out Click</span></td><td align="center"></td><td></td></tr><tr><td align="right" valign="top"><span style="font-family: Arial;">Time Zone</span></td><td align="center"></td><td><span style="font-family: Arial;"><a href="http://www.sitemeter.com/?a=stats&&s=s20hcrenewal&v=100&vlr=14&pg=21&r=31" target="_blank">UTC-6:00</a></span></td></tr><tr bgcolor="#F5F5E2"><td align="right" valign="top"><span style="font-family: Arial;">Visitor's Time</span></td><td align="center"></td><td><span style="font-family: Arial;"><span title="Jun 13 2014 10:47:42">Jun 13 2014 10:47:42 am</span></span></td></tr><tr><td align="right"><span style="font-family: Arial;">Visit Number</span></td><td align="center"></td><td align="left"><span style="font-family: Arial;">1,342,222</span></td></tr></tbody></table><br /> -- SS<br /><br />Note: also see my June 16, 2014 followup post at <a href="http://hcrenewal.blogspot.com/2014/06/masters-of-obvious-aat-athens-regional.html">http://hcrenewal.blogspot.com/2014/06/masters-of-obvious-aat-athens-regional.html</a>

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

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

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A Nurse's Union, National Nurses United, Takes On Bad Health IT

National Nurses United (<a href="http://www.nationalnursesunited.org/">http://www.nationalnursesunited.org/</a>), a nurse's union, takes on bad health IT with both satire and seriousness:<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/AVvXsEiprlRmvgYeCeaqg0b0eMZaZW0WhnmaZfgnqn_j_OomQKEPdpVwk4ocZbdHMFms5H7G1sfoxiJW6t-Eu_s7FVF_IfLsopQ6KH3J6WhshWpBNFydN06dQlyQE1Dna3YqEEZiWDWdfw2eJnyC/s1600/hey+dude.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="179" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiprlRmvgYeCeaqg0b0eMZaZW0WhnmaZfgnqn_j_OomQKEPdpVwk4ocZbdHMFms5H7G1sfoxiJW6t-Eu_s7FVF_IfLsopQ6KH3J6WhshWpBNFydN06dQlyQE1Dna3YqEEZiWDWdfw2eJnyC/s1600/hey+dude.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Hey dude!  I'm your highly-cost effective computer technician Steve.  Tell me what's hurtin' and I'll program it into Frank, our computerized doctor and nurse replacement. (YouTube video at <a href="https://www.youtube.com/watch?feature=player_embedded&v=YthF86QDOXY">https://www.youtube.com/watch?feature=player_embedded&v=YthF86QDOXY</a>.)</td></tr></tbody></table><br />See their page at <a href="http://www.nationalnursesunited.org/site/entry/insist-on-an-rn">http://www.nationalnursesunited.org/site/entry/insist-on-an-rn</a><br /><br />I note that nature abhors a vacuum, and since medicine's watchdogs (e.g., FDA), physicians and their organizations, the Medical Informatics community and others who know better have left a deep vacuum over health IT problems, I'm glad unionized nurses have stepped up to the plate.<br /><br />-- SS

A Nurse's Union, National Nurses United, Takes On Bad Health IT

National Nurses United (http://www.nationalnursesunited.org/), a nurse's union, takes on bad health IT with both satire and seriousness:Hey dude!  I'm your highly-cost effective computer technician St…

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EHR Story for Mother's Day 2014: Even The Formerly Simple Act Of Giving IV Fluids in ICU's Can Kill Babies. But's Let's Be Objective and Happy!

<div style="text-align: center;"><span style="font-size: x-small;">[Note to the humorless:  this post is satirical and sardonic to make a very serious point about the perversity of downplaying/ignoring health IT risks, issues too often ignored by those who know better.  If you don't like satire, don't read it.]</span> </div><br />I've been critiqued for posting in too gloomy a manner for some's taste, even those who like me are in the Medical Informatics field.  For example, in the Feb. 2013 Kaiser Health News article "<b>Health Technology’s ‘Essential Critic’ Warns Of Medical Mistakes</b>" at <a href="http://www.kaiserhealthnews.org/stories/2013/february/18/scot-silverstein-health-information-technology.aspx">http://www.kaiserhealthnews.org/stories/2013/february/18/scot-silverstein-health-information-technology.aspx</a>:<br /><br /><blockquote class="tr_bq">... <u>Many say he comes on too strong</u>. Even admirers cringed when he began blogging about the 2011 death of his mother, which he blames in a lawsuit on a computer error that allegedly caused Abington Memorial Hospital to overlook a key medication. (Both he and the hospital said they couldn’t comment on a pending suit.) Personalizing his campaign, some thought, made him seem <u>less objective</u>.</blockquote><br />Of course, if a close relative of these unnamed "many" were killed by, say, a drunk driver (something this unobjective group of mothers takes seriously:  <a href="http://www.madd.org/">http://www.madd.org/</a>), or if their child were abducted and decapitated (<a href="http://en.wikipedia.org/wiki/Murder_of_Adam_Walsh">http://en.wikipedia.org/wiki/Murder_of_Adam_Walsh</a>), or if something like this event (<a href="https://www.youtube.com/watch?v=55XJivhjB4U">https://www.youtube.com/watch?v=55XJivhjB4U</a>) happened, their response would surely be "oh well, stuff happens, let's all be 'objective', not 'personalize' things, not advocate with our personal stories, and above all, <b>be happy!   </b><br /><br /><div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgz2Sc_Ep0eHVvzgNTK2PPqnYAKho1OUX3pg4Y8MMphHPtZ3nKt71CbjXSeq3PvKwzIPeU6vw8CW5WskPOtYVfQe2bYtIbV9DW-T1KShF-n_EMiMdFwTzT_HR-m58p4oHUhj1JuMVtKbhpg/s1600/smiley.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgz2Sc_Ep0eHVvzgNTK2PPqnYAKho1OUX3pg4Y8MMphHPtZ3nKt71CbjXSeq3PvKwzIPeU6vw8CW5WskPOtYVfQe2bYtIbV9DW-T1KShF-n_EMiMdFwTzT_HR-m58p4oHUhj1JuMVtKbhpg/s1600/smiley.jpg" /></a></div><br />I really do admire the unnamed "many" for their ability to detach, so am presenting the following story of "anecdotal" patient harm to a child in a pediatric ICU in the spirit of happiness, joy, and Mother's Day love!<br /><br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1nVbtntosQYTim-y3sdm6vTMvInD2jgP1ZlsrcxGevCVfigNMgPvzd8HUqh4qznVDYUP4YCPDpMpgcXg4RaT3XCIO4RjdDTdAPL_aExrCYK3A5ePMQZwv8cEk2lGgbZspCOR74YLbtkRd/s1600/vintage_housewife_cook.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1nVbtntosQYTim-y3sdm6vTMvInD2jgP1ZlsrcxGevCVfigNMgPvzd8HUqh4qznVDYUP4YCPDpMpgcXg4RaT3XCIO4RjdDTdAPL_aExrCYK3A5ePMQZwv8cEk2lGgbZspCOR74YLbtkRd/s1600/vintage_housewife_cook.jpg" width="175" /></a></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBVdvcXC2vRHlGd1UhzTgr2F7Ut7bWo3S_ppYkE1Ji-F5AMjm1uHvJx2apITS82nBcYMZDHEVDUwW7IUVMpLLc22Y-7Q318dPGia2NwyjsGojNmzNO4Hpsovvd2f9c42UgYEeaEuEq755A/s1600/smiley1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><br /></a></div><br />Here's the event we should all be happy about, reported via FDA - I note the FDA's said these devices are not "sufficiently risky" to warrant a high level of their attention even though they secretly admitted in an internal memo that there's no way to really know te true level of risk and harm (<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>), so clearly they're all a <b>really jolly bunch:</b><br /><br /><blockquote class="tr_bq"><a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/medsun/medsun_details.cfm?id=117690">http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/medsun/medsun_details.cfm?id=117690</a><br /><br /><b>FDA MedSun report</b><br /><br />Type of device: medical device data system<br />Device brand name: PowerChart<br />Device manufacturer's name: Cerner Corporation<br />Date of this report: (mm/dd/yyyy) 03/04/2014<br /><br />Describe the event or problem:     <br /><b><br />Medication Error. </b>This event was related to Health Information Technology. Specifically, the manner in which the system processed an order for free water replacement. Order was intended to be 20ml/hr for 6 hours for a total of 120ml. It was a 1000 ml bag so first they put 20ml/hr which would have defaulted the infuse over time to 50 hrs.<b> They tried to change the infuse over to 6 hours which then changes the ml/hr rate to 167 ml/hr. </b>They did not notice this had changed. </blockquote><br />Well, that's WONDERFUL!!  :-)  that the computer recalculates the flow rate for them when they change the infusion time, by paternalistically assuming that's what they wanted to do - <b>change the</b> <b>RATE</b> of infusion - when what they actually did is manually <b>change the TIME</b> (duration) of infusion.  <br /><br />How LOVELY of some programmer to have given them this FANTASTIC convenience!!<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/AVvXsEi8yEnZHeor2UZZlhUf4qKrE_4fxFfxrQna0eHhEQagUgU-_a9j1wpRZEfLCAMhkhyphenhyphenOsXIplxq3wLZU4cE3m0rrvjUniE-RugNfZbwUtYsoZXALSsI9k4Grh7jfb78Uc0hHnW_Eh6NGrjDg/s1600/behappy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8yEnZHeor2UZZlhUf4qKrE_4fxFfxrQna0eHhEQagUgU-_a9j1wpRZEfLCAMhkhyphenhyphenOsXIplxq3wLZU4cE3m0rrvjUniE-RugNfZbwUtYsoZXALSsI9k4Grh7jfb78Uc0hHnW_Eh6NGrjDg/s1600/behappy.jpg" width="200" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Aren't computers wonderful!!!</td></tr></tbody></table><br />Even the following should not be cause for ardent technophiles to wipe the smile from their downside-ignoring faces!! <br /><br /><blockquote class="tr_bq">... They did not realize that they <b>needed to go into details tab</b> to show the time frame so the patient got 167ml/hr instead of 20ml/hr for 6 hours. </blockquote><br />How obvious!!!  Every doctor, nurse, medical student and janitor knows from time immemorial knows you have to <b>go into the detail tab to show the time frame!</b>  (Smile)<br /><br /><blockquote class="tr_bq">... Order was verified by pharmacy and administered at that rate via peripheral IV. After approximately 1L of fluid had infused, patient showed seizure activity.  PICU (pediatric ICU) team called to bedside. <b>Treatment provided for seizures and critical sodium and potassium. </b></blockquote><br />Awww ...  some seizures and critical sodium and potassium levels in the PICU.  Awww.....too bad!!!  We should be happy anyway!  For if this child died...the sacrifice would have been WORTH IT for the betterment of electronic medical records worldwide, and the parents no doubt would be flattered and joyous about their contribution to computing science.  After all, how better to figure out how to make this technology work??<br /><br />After all, it takes a few broken eggs to make an omelette, and a few bumps in the road (like grave mounds) should be of little concern.<br /><br />Because, remember ... w.e. c.a.r.e! <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/AVvXsEiyOy_d372Rp11w3A5pCQBf6qnkp-yS-f-doYNL_pYtAkTMY8Rzj24CbQOHIUMcYdrEvM8d38R1Y1DKCwpakFqeoc3ZHv67S5PpRuDwz-sq_fpE3DstFh_OLkzQGej3MaZbuWAuHH8BQPTe/s1600/words+that+work.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyOy_d372Rp11w3A5pCQBf6qnkp-yS-f-doYNL_pYtAkTMY8Rzj24CbQOHIUMcYdrEvM8d38R1Y1DKCwpakFqeoc3ZHv67S5PpRuDwz-sq_fpE3DstFh_OLkzQGej3MaZbuWAuHH8BQPTe/s1600/words+that+work.jpg" width="155" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><b>i c.a.r.e!!!!</b>  As at U. Arizona Healthcare System, let's only use Happy Words with our patients about these systems! (click to enlarge, 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> )</td></tr></tbody></table><br />Further, we should use<b> </b>only <b>Words That Work </b>to describe the wonders of these systems in their current state!!!<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/AVvXsEjgAtZ_SQ0RVtQt8McdXxf2OEPLie5Sk706vuqci5i-jIWHJpJS0iZa7s09yVFO41Bbwq4GvWWpzRRMw9AxeldgzFHxb18eCHSaTtZn73KyFqrypUR2XyQHFf_UhSsRPXw0U5t4WQSm3fFv/s1600/flowers.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgAtZ_SQ0RVtQt8McdXxf2OEPLie5Sk706vuqci5i-jIWHJpJS0iZa7s09yVFO41Bbwq4GvWWpzRRMw9AxeldgzFHxb18eCHSaTtZn73KyFqrypUR2XyQHFf_UhSsRPXw0U5t4WQSm3fFv/s1600/flowers.jpg" width="200" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Some flowers from Cerner CEO Patterson to momma to make up for her little baby having seizures and critically deranged potassium and sodium levels from those big, bad doctors' EHR mistake!</td></tr></tbody></table><br /><blockquote class="tr_bq">... The Cerner powerchart software system has functionality for continuous medications/fluid ordering that does not prevent <b>"user error." </b></blockquote><br />Ut oh ... Looks like I'm going to have to be a sourpuss for just a moment and re-introduce the nasty, ill-tempered, non-objective idea of what the dastardly National Institute of Technology and Standards (NIST) calls "use error" (as opposed to "user error", A.K.A. "Blame the User",  <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>):<br /><br /><blockquote class="tr_bq">... The EUP (EHR usability protocol) emphasis should be on ensuring that <b>necessary and sufficient usability validation and remediation</b> has been conducted so that <b>use error</b> [3] is minimized.<br /><br />[3] <span style="font-weight: bold;">“Use error”</span> is a term used very specifically to refer to user interface designs that will engender users to make errors of commission or omission. <b>It is true that users do make errors, but many errors are due not to user error per se but due to designs that are flawed</b>, e.g., poorly written messaging <span style="color: red; font-style: italic; font-weight: bold;">[or lack of messaging, e.g., no warnings of potentially dangerous actions - ed.]</span>, <u><b>misuse of color-coding conventions</b></u> [see below], omission of information, etc. <span style="font-style: italic; font-weight: bold;"><span style="color: red;"></span></span><br /><span style="font-style: italic; font-weight: bold;"><span style="color: red;"></span></span></blockquote><br />Awwwwww....aren't I just mean and non-objective?<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/AVvXsEh8h7Y65reXdJO632szxyY2e3UhlY3P8xr5VhF4vPIz_8cTZXCU_8L4DKIks0v0LLVJwWrKKd9BzQKa7OJpJv5NXGJkqpvjMd7xKU1mjfEaUD6F7MkhesXaq0Gw_4wHcv1DTduyxsr3atPO/s1600/frown.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="165" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8h7Y65reXdJO632szxyY2e3UhlY3P8xr5VhF4vPIz_8cTZXCU_8L4DKIks0v0LLVJwWrKKd9BzQKa7OJpJv5NXGJkqpvjMd7xKU1mjfEaUD6F7MkhesXaq0Gw_4wHcv1DTduyxsr3atPO/s1600/frown.jpg" width="200" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><br /></td></tr></tbody></table><br />That mean doctor Silverstein's just not happy and objective!!  Bad, bad, bad man!<br /><br /><blockquote class="tr_bq">... When the provider orders the fluid, example is D5W, the screen opens to a "continuous details" ordering window. Within the screen, the ordering provider is presented with a preselected bag volume and type of fluid with a brownish background. They have the ability to modify bag volume <b>but it was made this color to discourage that change by Cerner. </b></blockquote><br />Golly gee!  There's something to be happy about once again!  <b><u>Brown, the universally-understood color</u>, in any language, means "Warning, do not change this value, it could kill someone!!!"</b> See how GOOD this technology really is!!!  Why use alerts and confirmation dialogs when a mere COLOR like brown suffices!!<br /><blockquote class="tr_bq"><br />... The rate and "infuse over" fields <b>are a yellow color to show that they need to be completed. </b>The intent <span style="color: #cc0000;"><b><i>[of the programmer, clearly an expert in human-computer interaction and communication by color and smoke signals - ed.]</i></b></span> is for an ongoing continuous fluid and not to limit the time. <i></i></blockquote><br />Golly Gee Times Two!  Yellow, the absolutely universal color for <b>"Warning, you need to complete this to prevent killing someone!"  </b><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/AVvXsEiB07i36jmKHcewYx3Gz9u_Dn1b_sU77r5meRSlFySibvF182tqSVyjtTqOuue6t6pDz1RWP6W580szZKrms1eEmRSb_RIpzZGgVfKNduKoAx7uHGW2dKivEC1nq0UCSXHoKm4H1Q_gHPfw/s1600/yellow-light.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiB07i36jmKHcewYx3Gz9u_Dn1b_sU77r5meRSlFySibvF182tqSVyjtTqOuue6t6pDz1RWP6W580szZKrms1eEmRSb_RIpzZGgVfKNduKoAx7uHGW2dKivEC1nq0UCSXHoKm4H1Q_gHPfw/s1600/yellow-light.jpeg" width="200" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Yellow!  Don't you just think every time you see this color that "warning, you need to complete data entry to avoid killing someone?  Who needs WORDS?</td></tr></tbody></table><br />It's all so CLEAR!!!! <br /><br /><blockquote class="tr_bq">... Providers can misinterpret this field to mean the length of time they want the order to infuse over, <b>when the <u>system intent for that field is to be the system-calculated length of time until the next bag supply will need to be sent</u> to maintain the continuous infusion.  </b></blockquote><br />See how simple!!!!   Isn't it OBVIOUS!!!!<br /><blockquote class="tr_bq"><br />The completed fields turn white. <b>Cerner <u>does not have an intermittent fluid administration order</u> <span style="color: red;"><i>[who the hell needs that, says Cerner and the hospital executives who bought this package for the PICU!! Never a need for that in ICU's!! - ed] </i></span>so providers are <u>expected</u> to go to a second tab, the "details" tab, where they have the options for identifying the duration of the infusion in terms of # doses or time. </b>If the provider does not have awareness of this intent and modifies the "infuse over" field from the "continuous details" tab, <b>they may inadvertently order a higher rate than intended.</b></blockquote><br /><br />Ha ha!  Those silly doctors can't even figure out a simple thing like that!!  What stooges they are!!<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/AVvXsEhT3rcoW8Gw85QLLLUqEtmVvyIqCGPmTDBoLqWmwLa5zC0a-4ORhr7iLkFrSZBeA02TCfVLzn5pqH7WxtywG0kyZt54ExddyyuDE_UjALynE545TJIgb5SaosZIC6vFUiC9jt6yhyphenhyphenPpqf5i/s1600/three-stooges.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="156" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhT3rcoW8Gw85QLLLUqEtmVvyIqCGPmTDBoLqWmwLa5zC0a-4ORhr7iLkFrSZBeA02TCfVLzn5pqH7WxtywG0kyZt54ExddyyuDE_UjALynE545TJIgb5SaosZIC6vFUiC9jt6yhyphenhyphenPpqf5i/s1600/three-stooges.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">NYUK NYUK NYUK ... Hey Moe!!  Those silly doctors and nurses cannot understand the simple fact that <b>Cerner does not have an intermittent fluid administration order so providers are expected to go to a second tab, the "details" tab, where they have the options for identifying the duration of the infusion in terms of # doses or time. </b>If the provider does not have awareness of this intent and modifies the "infuse over" field from the "continuous details" tab, <b>they may inadvertently order a higher rate than intended.</b>  </td></tr></tbody></table><br />See how much FUN health IT problems can be?  After all, in this ANECDOTAL case, all that happened was: <br /><br /><blockquote class="tr_bq">The device(s) may have caused or contributed to: Potential for patient harm, Serious Injury </blockquote><br />But nobody died of this particular problem (that we know of), so this technology is SAFE!!!!<br /><br /><br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNHrlprFiMwMg8w-uhH23RA1KLiJ7O5qDqdj547Mc40zYY4nDhmNEqZ_d5163YRafaQ34simadB6lLrldXAktiWpOZNGbn2kctTetmpIBNH6FhjjBEO7ZIqwQm9Lgo68p7sjlS1Z5FofgT/s1600/Happy-Mothers-Day.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="268" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNHrlprFiMwMg8w-uhH23RA1KLiJ7O5qDqdj547Mc40zYY4nDhmNEqZ_d5163YRafaQ34simadB6lLrldXAktiWpOZNGbn2kctTetmpIBNH6FhjjBEO7ZIqwQm9Lgo68p7sjlS1Z5FofgT/s1600/Happy-Mothers-Day.png" width="320" /></a></div><br /><br />Happy mother's day!!!<br /><br />--------------------<br /><br />Additional not-so-funny thought:  depending on brown, yellow etc. instead of clear, written alerts/warnings, plus the fact that the system likely "knew" the weight of the child and should have alerted that the infusion of a liter was a very dangerous thing, reflect <b>Bad Health IT </b>on its face:<br /><br /><blockquote class="tr_bq"><span style="font-family: inherit;"><span style="font-size: small;"><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 hypervigilance (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></span></span></blockquote><br />Had I been a pre-marketing tester of this system working for FDA, those fluid-ordering characteristics would have been changed before the system would have been released to market.<br /><br />Oh, wait ... there is no premarketing testing process for health IT, and FDA, via advice from the FDASIA committees as in the linked FDA-related post above, writes that none is really needed.<br /><br />And who wants to damage TRUE INNOVATIONS like this - turning something that takes 5 seconds for a clinician to write, "<b>D5W, 20 ml/hr x 6 hrs</b>" (meaning dextrose 5% in water, 20 milliliters per hour for 6 hours) into a <i>cryptic and muddled exercise</i> with tabs, colors and numerous caveats - via regulation? <br /><br />-- SS<br /><br />

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EHR Story for Mother's Day 2014: Even The Formerly Simple Act Of Giving IV Fluids in ICU's Can Kill Babies. But's Let's Be Objective and Happy!

[Note to the humorless:  this post is satirical and sardonic to make a very serious point about the perversity of downplaying/ignoring health IT risks, issues too often ignored by those who know bet…

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Physician whose mother had heart surgery reflects on sane EHR use

The following from a physician I know, an ED physician, on the care their mother received at a major academic medical center's teaching hospital using EHR.<br /><br />Emphases mine:<br /><span class="HOEnZb"></span><br /><blockquote class="tr_bq">Mom just had aortic valve at hospital [name redacted] associated with [redacted] Medical School.  EHR used was [major EHR vendor name redacted] but it clearly had been pushed into the background......<br /><br />1) Every ICU patient also had a <b>printed chart in a notebook (paper) medical record book </b>kept at the nursing station.  Just like the old days. <b>It was the most commonly used source of info to the residents and staff.</b><br /><br />2) <b>Not once did I see an EHR physically come between a patient and a staff member</b> (as opposed to <b>nearly every encounter</b> where I work).<br /><br />3) Mom's (and every ICU patients) plan for the day was outlined in magic marker directly on the glass doors and windows and updated during rounds...<b>.available for immediate reference, not buried in an EHR.</b><br /><br />4) Her clinical info was accurate....... it was <b>dictated and not fabricated from pick lists</b> or dot phrases.<br /><br />5) <b>Clerks put in the data and Dr's orders</b>......apparently they long ago figured out the nonsense called CPOE and let the clerks do it.<br /><br />I suspect many major University hospitals h<b>ave worked around the workflow barriers and most egregious documentation sins.</b>  The doctors there (at least in that Cardiothoracic ICU) have enough clout that they can just say HELL NO.  Those of us working for less astute/ non cutting edge community hospitals run by "also ran" healthcare corps are left to bear the crosses ONCHIT and the EHR industry have dumped upon us.<br /><br />I am grateful to the folks at [hospital] for an excellent job on my mom and demonstrating <b>that efficient healthcare pushes the EHR (as currently sold and configured) to the back burner.</b><br /><br />Oh, [EHR name redacted] still is loaded with those prefilled templates and copy/ paste pull forward geared for upcoding.....but these "top of the food chain" docs just didn't waste their time with them.</blockquote><br />Having had to gut and remediate really, really terrible health IT for invasive cardiology and cardiac surgery years ago (<a href="http://cci.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=Cardiology%20story">http://cci.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=Cardiology%20story</a>), and revise workflows to relieve busy clinicians with critically-ill patients from the stupidity and time-sink of fiddling with balky computers with poorly-designed software, I identify with this physician's observations and beliefs.<br /><br />As I've stated in previous posts, most clinicians need to be relieved of clerical tasks associated with computers, especially data entry and ordering, not just surgeons.<br /><br />If the data is really that valuable, hiring clericals to do clerical work should remain a true bargain, with massive return on investment.<br /><br />If that is not the case, then the data is really not that valuable.<br /><br />-- SS<br /><br />

Physician whose mother had heart surgery reflects on sane EHR use

The following from a physician I know, an ED physician, on the care their mother received at a major academic medical center's teaching hospital using EHR.Emphases mine:Mom just had aortic valve at ho…

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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 caused or contributed to the following tragedy? http://www.cnn.com/2013/12…

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Yet Another "Anecdote" - Inpatient Results of Electronic Prescribing "Disappointing"

Many of those in the Medical Informatics community, especially the academics in the upper echelons of the American Medical Informatics Association, are not of a risk recognition / risk management mindset.  Typical of academics, they are often also hostile towards dissent from the party line, as you can read about at my post "<b>The Dangers of Critical Thinking in A Politicized, Irrational Culture</b>" at <a href="http://hcrenewal.blogspot.com/2010/09/dangers-of-critical-thinking-in.html">http://hcrenewal.blogspot.com/2010/09/dangers-of-critical-thinking-in.html</a>.<br /><br />The academics, with a few exceptions, have repeatedly conflated <i>scientific anecdote</i>s<i> of supposed positive results</i> from health IT with <i>risk management-relevant incident reports</i> <i>of bad outcomes and 'near misses'</i>, as an Australian colleague wrote about, via me, on August 17, 2011 at "<b>Anecdotes and Medicine, We are Actually Talking About Two Different Things</b>" at <a href="http://hcrenewal.blogspot.com/2011/08/from-senior-clinician-down-under.html">http://hcrenewal.blogspot.com/2011/08/from-senior-clinician-down-under.html</a>).<br /><br />They dismiss the latter incident reports, even when from well-qualified observers, while giving great attention and credence to the former <span style="color: red;"><i><b>[a few years as a safety manager in a large urban transit authority disabused me of that type of behavior - ed.]</b></i></span>, when the former conveniently fit their most cherished beliefs about the beneficence and efficacy of today's health IT.  Further, quality or lack thereof of the former type of evidence is often not considered.  See for instance my post of March 9, 2011 "<b>ONC: The Benefits Of Health Information Technology: A Review Of The Recent Literature Shows Predominantly Positive Results</b>" at <a href="http://hcrenewal.blogspot.com/2011/03/benefits-of-health-information.html">http://hcrenewal.blogspot.com/2011/03/benefits-of-health-information.html</a> for a stunning example of this phenomenon directly from the national leadership of health IT.<br /><br />In my view, this phenomenon has led to a substantial loss of focus on health IT realities needed in order to remediate the industry and realize the true benefits of which the technology is capable.<br /><br />Now there's yet another "anecdote" at <b>Med Page Today.com </b>for the experts to chomp on:<br /><br /><blockquote class="tr_bq"><a href="http://www.medpagetoday.com/MeetingCoverage/ASHP/43400?utm_source=cardio-meetings&utm_medium=email&utm_content=mpt&utm_campaign=DCH">http://www.medpagetoday.com/MeetingCoverage/ASHP/43400?utm_source=cardio-meetings&utm_medium=email&utm_content=mpt&utm_campaign=DCH</a><br /><br /><b>E-Prescribing: Inpatient Results Disappointing</b><br />Published: Dec 12, 2013<br />By Sarah Wickline , Contributing Writer, MedPage Today<br /><br />ORLANDO -- Electronic prescription order entry and medication reconciliation reduced some errors in hospital settings but increased others, and did not meet overall expectations, researchers reported here.<br /><br />After implementation of a computerized prescriber order entry (CPOE) system, one hospital experienced a 29.2% increase in medication dispensation errors (P less than 0.05), Ramadas Balasubramanian, PharmD, PhD, of the Carolinas Medical Center-Pineville in Charlotte, N.C., and colleagues reported at the midyear meeting of the American Society of Health-System Pharmacists.</blockquote><br />It is likely these are qualified observers who in fact might be expected to be biased towards showing good results of this technology.<br /><br /><blockquote class="tr_bq">In a second study, another hospital experienced a 12% improvement in accuracy (P less than 0.001) after implementation of electronic medication reconciliation charts, according to Jill Covyeou, PharmD, of Ferris State University in Big Rapids, Mich., and colleagues.</blockquote><br />For the tens of millions of dollars likely spent to achieve a mere 12% improvement, one wonders if a far less expensive investment in experienced human resources might not have accomplished the same results or even far better.<br /><br /><blockquote class="tr_bq">For their study, Balasubramanian and colleagues looked at the impact of CPOE on medication errors in a community hospital setting.<br /><br />At the end of 2011, when the Carolinas Medical Center-Pineville hospital had only 119 beds, officials there implemented the CPOE-CANOPY system. In early 2012, the hospital nearly doubled in capacity to 210 beds and opened the pharmacy to 24-hour operation. The researchers looked at medical errors from October 2008 through October 2012.<br /><br />The categories of medication errors included: <b>drug omission, administration at the wrong time, unauthorized drug, wrong dose, and wrong form of dose. </b></blockquote><br />Any of which, of course, can harm or kill, I note.<br /><br /><blockquote class="tr_bq">There was a 57% increase in medication doses from prior to the CPOE system to after implementation, but even after volume adjustments, <b>the number of errors per 1,000 dispensed medications still increased by 29.2%</b> (P less than 0.05).</blockquote><br />Bad health IT such as CPOE systems designed for (per Joan Ash) "calm and solitary office environments" would be expected to perform more poorly as caseloads increase and clinicians have less time for computer fritter.<br /><blockquote class="tr_bq"><br />Unauthorized drug dispensation and improper dose of medication decreased post-CPOE, but <b>drug omission and administration at the wrong time were responsible for the increase.</b></blockquote><br />Those seem to match the expressed concerns of another large group of "anecdote-profferers", e.g., the nurses at my Nov. 17, 2013 post <b>"Another 'Survey' on EHRs - Affinity Medical Center (Ohio) Nurses Warn That Serious Patient Complications 'Only a Matter of Time' in Open Letter"</b> at <a href="http://hcrenewal.blogspot.com/2013/11/another-survey-on-ehrs-affinity-medical.html">http://hcrenewal.blogspot.com/2013/11/another-survey-on-ehrs-affinity-medical.html</a>:<br /><br />From those nurses' Open Letter to management on health IT risks:<br /><br /><blockquote class="tr_bq">... Some of the concerns that nurses have brought to the attention of management include:<br /><ul><i></i><li><i><b>Medication errors/scanning issues - perhaps the biggest concern of all RNs</b></i></li><li>RNs unable to access patient records for hours at  a time</li><li>Incorrect descriptors and inaccurate drop-down menus</li><li>Incorrect calculations in the I&O<span style="color: red;"> </span>and MAP<span style="color: red;"><i><b> [mean arterial pressure - ed.]</b></i></span> portions of the chart </li><li><i><b>Inaccurate medication times and the inability of RNs to ensure medications are scheduled correctly</b></i></li><li>Endless loops of computer prompts that are unable to be dismissed by RNs in an emergency</li></ul></blockquote><br />Back to the current Med Page Today.com article:<br /><br /><blockquote class="tr_bq">The use of CPOE software created a<b> time cut-off issue that explained the wrong time of administration increase</b>, the study authors told MedPage Today. If drugs were ordered 5 minutes after the cut-off for the morning medication administration, they <b>would not make it to the patient until the evening rounds unless a special alert was sent to the nurse staff.</b></blockquote><br />That is, a time-eating and fragile (and thus potentially dangerous} workaround.  I note that one does not have to work around something that is not standing in their way.<br /><br /><blockquote class="tr_bq">Balasubramanian and colleagues suggested that the<b> lack of flexibility in the CPOE software </b>was responsible for the drastic increase in medication errors, despite the fact that they thought it would improve error rates across the board.</blockquote><br />In other words, the software is not truly fit for purpose.  See definition of "bad health IT" below.<br /><br /><blockquote class="tr_bq">... The authors suggested that electronic prescribing would be better with electronic medical records. "[E]lectronic prescribing alone<b> may </b>fail to increase medication list accuracy to the extent we would like," Covyeou wrote.</blockquote><br />Replace <b>"may </b>fail<b>"</b> with "in our case,<b> did</b> fail."<br /><br />The point about adding an EHR is certainly in the category of "wishful thinking." <br /><br />If the EHRs are bad health IT, I opine the situation would likely get even worse (<i>cf. </i>Affinity Health, above).<br /><br />From my site at <a href="http://cci.drexel.edu/faculty/ssilverstein/cases">http://cci.drexel.edu/faculty/ssilverstein/cases</a>/:<span style="font-family: inherit;"><span style="color: black;"><b> </b></span></span><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></span></blockquote><br /><span style="font-family: inherit;"><span style="color: black;">In summary, the technology is not a panacea, and can in fact be worse than paper.  Those who blindly ignore that reality and push for mass rollout of this still-experimental technology "no matter what" do not share, in my opinion, the ethics I was taught in Medical School.</span></span><br /><br /><span style="font-family: inherit;"><span style="color: black;">-- SS </span></span>

Yet Another "Anecdote" - Inpatient Results of Electronic Prescribing "Disappointing"

Many of those in the Medical Informatics community, especially the academics in the upper echelons of the American Medical Informatics Association, are not of a risk recognition / risk management mi…

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