healthy4u: reckless endangerment

The First State's Deadest (Deadliest?) Duck - Is This ED EHR Harming or Killing Anyone in NSW?

Nobody seems to be asking this simple question: Is This ED EHR harming or killing anyone in NSW? It cannot be "<a href="http://hcrenewal.blogspot.com/2012/01/another-our-crappy-computers-screwed-up.html">not compromising patient care</a>" on first principles. This type of practical and ethical question seems to never get asked, while what appears to be a tit-for-tat political kerfuffle goes on. This is due in part to the baffling special accommodations afforded worldwide towards an extremely profitable but potentially extremely dangerous medical device, as well as due to the issues I described in my post about reckless technophilia and the accompanying disregard for rights of others <a href="http://hcrenewal.blogspot.com/2012/02/health-it-ddulites-and-disregard-for.html">here</a>. <h2 style="font-weight: normal;"></h2><blockquote><h2 style="font-weight: bold;">The Register</h2><h2 style="font-weight: bold;"><a href="http://www.theregister.co.uk/2012/02/12/firstnet_flops_again/">NSW government accused of dodgy software cover-up</a></h2> FirstNet: the First State's deadest duck [or "deadliest duck?" - ed.] By <a title="Send email to the author" href="http://forms.theregister.co.uk/mail_author/?story_url=/2012/02/12/firstnet_flops_again/">Richard Chirgwin</a> Posted in <a href="http://www.blogger.com/business/">Business</a>, <a title="More stories published on this date" href="http://www.blogger.com/2012/02/12/">12th February 2012 22:00 GMT</a> <div id="body"> The buggy FirstNet emergency department software has become the subject of a political argument in NSW. [What about a clinical and ethical argument? - ed.] In one of those paradoxes of democracy, an opposition which, in government, was responsible for a now-despised implementation is now using the IT project as a stick to beat a government which was in opposition when the system was chosen. Last week, the Sydney Morning Herald obtained a report into the system by Deloitte, under a freedom of information request. It <a href="http://www.smh.com.au/it-pro/government-it/hospital-computer-system-found-lacking-20120210-1so7j.html">says</a> [1] the Deloitte report criticises FirstNet because it is: - Is chronically under-funded; - Produces inadequate records; - Was unreliable in delivering messages, and did not provide alerts when messages failed to reach their destination; and - Demanded excessive amounts of screen time from clinicians. [But is it harming or killing anyone? Are those statistics being collected robustly and scientifically, or are self-serving statements by hospital executives that "care was never compromised, and nobody was injured" simply being taken at face value? Further, the obvious increased risk of harm due to deficient IT currently in operation is being cavalierly ignored. This is alien to medicine, and could cause career termination or land people in jail in fields such as aviation if planes with known potentially-dangerous avionics software or other defects are kept flying - ed.]In spite of its inadequacies, the Deloitte report seen by the SMH said the $AU100-plus million Cerner FirstNet system is too entrenched to abandon. [I'm quite sure dead or injured patents would not appreciate that explanation - ed.] Over the weekend, opposition health spokesperson Dr Andrew McDonald issued a statement accusing NSW health minister Jillian Skinner of covering up the report since August 2011. However, other published studies into FirstNet, such as a detailed investigation by Sydney University e-health expert Professor Jon Patrick <a href="http://sydney.edu.au/engineering/it/%7Ehitru/index.php?option=com_content&task=view&id=91&Itemid=146">here</a> [2], identify problems similar to those apparently cited by Deloitte. This study was undertaken to investigate issues with FirstNet outlined in November 2008 in a special commission of review, conducted by Peter Garling, While noting that FirstNet represented an improvement on some aspects of its predecessor, Garling said the system attracted complaints that it was unfriendly to users, that the vendor and Health Department did not respond to complaints about the software, and that emergency department patients were being held in triage for excessive times, while clinical staff fought with the software. [What sane patient would want such a system used in their care? - ed.] Deloitte, on the other hand, was far less critical of FirstNet in 2008, when in a <a href="http://www.health.nsw.gov.au/resources/news/pdf/triage-bench-rev.pdf">review</a> [3] of triage benchmarks it managed to turn up a downtime issue, difficulty in uploading triage data to the Health Department, and the identification of the wrong doctor or nurse with a patient’s records. </div> <div id="pf-links"> <h3>Links</h3> <ol><li><a href="http://www.smh.com.au/it-pro/government-it/hospital-computer-system-found-lacking-20120210-1so7j.html">http://www.smh.com.au/it-pro/government-it/hospital-computer-system-found-lacking-20120210-1so7j.html</a></li><li><a href="http://sydney.edu.au/engineering/it/%7Ehitru/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></li><li><a href="http://www.health.nsw.gov.au/resources/news/pdf/triage-bench-rev.pdf">http://www.health.nsw.gov.au/resources/news/pdf/triage-bench-rev.pdf</a></li></ol></div></blockquote> Stunning. On the argument that "the older system was worse", or the corollary argument that "paper harms and kills too", I suggest anyone who proffers that argument should realize <a href="http://en.wikipedia.org/wiki/Rofecoxib">VIOXX (refoxicib)</a> helped far more people than it harmed in reducing pain while sparing them from GI side effects compared to "older" drugs. <a href="http://www.npr.org/templates/story/story.php?storyId=4054991">Over 84 million people</a> were prescribed rofecoxib at some time and only mere thousands, or tens of thousands, are presumed to have been injured or died. Therefore, following their own illogic and ethical (dis)orientation, they should put all their family members on the drug - especially the elderly with cardiovascular disease - to benefit from pain relief and VIOXX's other miraculous effect, <a href="http://www.sciencedaily.com/releases/2006/08/060830215121.htm">suppression of colonic polyps</a>. Surely those benefits outweigh the risks, and therefore it is ethical to do so, no? Of course not. Health IT, as I've written in many posts on this blog, has a magnitude of harms that is admittedly unknown. Health IT needs significant further study and improvement, certainly before national rollouts, and before decisions are made that particular systems are "too entrenched to abandon." -- SS

The First State's Deadest (Deadliest?) Duck - Is This ED EHR Harming or Killing Anyone in NSW?

Nobody seems to be asking this simple question:Is This ED EHR harming or killing anyone in NSW?It cannot be "not compromising patient care" on first principles.This type of practical and ethical quest…

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20 Feb 2012

Health IT Ddulites and Disregard for the Rights of Others

At my Feb. 8, 2012 post "<a href="http://hcrenewal.blogspot.com/2012/02/health-it-ddulites-and-irrational.html">Health IT: Ddulites and Irrational Exuberance</a> " I defined a "Ddulite" (Luddite with the first four characters reversed) as the opposite of a Luddite, specifically: <blockquote>Hyper-enthusiastic technophiles who either deliberately ignore or are blinded to technology's downsides, ethical issues, and repeated local and mass failures. </blockquote> An astute reader points out that "opposite" may be an incomplete description, as the <a href="http://en.wikipedia.org/wiki/Luddite">Luddites</a>: <blockquote>"were a social movement of 19th-century English textile artisans who protested – often by destroying mechanized looms – against the changes produced by the Industrial Revolution, which they felt were leaving them without work and changing their way of life. The movement was named after General Ned Ludd or King Ludd, a mythical figure who, like Robin Hood, was reputed to live in Sherwood Forest."</blockquote> In other words, they were merely trying to save their jobs, and their actions did not cause life-threatening adverse events, such as death by freezing due to lack of warm garments. Ddulites, on the other hand, ignore the downsides (patient harms) of health IT. This is despite being already aware of, or informed of patient harms, even by reputable sources such as <a href="http://hcrenewal.blogspot.com/2010/08/smoking-gun-internal-fda-memorandum-of.html">FDA</a> (Internal FDA memo on H-IT risks), <a href="http://hcrenewal.blogspot.com/2008/12/joint-commission-sentinel-events-alert.html">The Joint Commission</a> (Sentinel Events Alert on health IT), the <a href="http://www.isb.nhs.uk/documents/isb-0160/dscn-18-2009/0160182009specification.pdf">NHS</a> (Examples of potential harm presented by health software - Annex A starting at p. 38), and the <a href="http://hcrenewal.blogspot.com/2010/12/ecri-healthcare-it-in-top-ten-health.html">ECRI Institute</a> (Top ten healthcare technology risks), to name just a <a href="http://hcrenewal.blogspot.com/2011/02/updated-reading-list-on-health-it.html">few</a>. In fact, the hyper-enthusiastic health IT technophiles will go out of their way to incorrectly dismiss risk management-valuable case reports as "anecdotes" not worthy of consideration (see "Anecdotes and medicine" essay <a href="http://hcrenewal.blogspot.com/2011/08/from-senior-clinician-down-under.html">at this link</a>). They will also make unsubstantiated, often hysterical-sounding claims that health IT systems are necessary to, or simply will "transform" (into what, exactly, is usually left a mystery) or even "revolutionize" medicine (whatever that means). This is despite the fact that many of this mindset are medical and/or Medical Informatics professionals who know better. They also ignore the draining waste of resources of failed or ineffectual IT ("<a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/" target="_blank">bad health IT</a>"), potentially depriving patients of the best healthcare possible. Thus, as the reader pointed out, there could be an element of <a href="http://en.wikipedia.org/wiki/Psychopathy">psychopathy</a> or, at best,<a href="http://definitions.uslegal.com/c/conduct-in-reckless-disregard/"></a> reckless disregard for rights of others in their thinking. <blockquote><a href="http://law.yourdictionary.com/reckless-disregard">Reckless disregard</a>: An act of proceeding to do something with a conscious awareness of danger, while ignoring any potential consequences of so doing. Reckless disregard, while not necessarily suggesting an intent to cause harm, is a harsher condition than ordinary negligence.</blockquote> In my opinion, at a time of mass funding and pressure for rapid rollout of health IT in its present state of experimental development, this is not an observation that should be casually dismissed. -- SS

Health IT Ddulites and Disregard for the Rights of Others

At my Feb. 8, 2012 post "Health IT: Ddulites and Irrational Exuberance " I defined a "Ddulite" (Luddite with the first four characters reversed) as the opposite of a Luddite, specifically:Hyper-enthu…

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19 Feb 2012

How Academic and Government "Anecdotes Are Not Data" Ideologues Kill People

I'm already receiving comments that, regarding Prof. Jon Patrick's <a href="http://sydney.edu.au/engineering/it/%7Ehitru/index.php?option=com_content&task=view&id=120&Itemid=116">detailed exposé of the dangers of ill-suited-for-purpose ED EHR's</a>, Patrick's observations are: <blockquote style="font-family:arial;">... not really valid because they're not peer reviewed; they're just anecdotal. </blockquote> Only an egghead could pen such words. <div style="font-family: arial; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnm-VeDoSTOA0VFdXBJX1y4Hq8pyCu-Tdm0vp3ZLcnb9DtRWE04U4A6roR74FqyefhpAs64e6m1Y1Ocu48BU5nS9CfQ6F-yD9M_OLUguFELqMVXZDWL5mUM2Y4mz-owegR86ENRfQJEsN1/s1600/egghead.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5586993306053914498" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnm-VeDoSTOA0VFdXBJX1y4Hq8pyCu-Tdm0vp3ZLcnb9DtRWE04U4A6roR74FqyefhpAs64e6m1Y1Ocu48BU5nS9CfQ6F-yD9M_OLUguFELqMVXZDWL5mUM2Y4mz-owegR86ENRfQJEsN1/s320/egghead.jpg" style="display: block; margin: 0px auto 10px; width: 134px; cursor: pointer; height: 121px; text-align: center;" /></a>I always get hives immediately after eating strawberries. But without a scientifically controlled experiment with all the right peer review, it's not reliable data. So I continue to eat strawberries every day, since I can't tell if they cause hives. </div> I'd already written about anecdotalist refrains at my Mar. 7, 2011 post "<a style="font-family: arial;" href="http://hcrenewal.blogspot.com/2011/03/australian-ed-ehr-study-putting-lie-to.html">Australian ED EHR Study: Putting the Lie to the Line "Your Evidence Is Anecdotal, Thus Worthless" Used by Eggheads, Fools and Gonifs.</a>" In that essay I cite Dr. Patrick himself on "anecdotal evidence", regarding which he hit the ball out of the Southern Hemisphere in an editorial in "<a style="font-family: arial;" href="http://aci.schattauer.de/en/contents/archive/issue/1124/manuscript/15463/show.html">Applied Clinical Informatics</a>" entitled "The Validity of Personal Experiences in Evaluating HIT." Aside from the fact that eggheads also don't seem to care about the issues of faulty peer review, especially in profitable biomedical sectors, such as at "<a href="http://hcrenewal.blogspot.com/2010/12/lancet-emphasizes-threats-to-academic.html">The Lancet Emphasizes the Threats to the Academic Medical Mission</a>" with its embedded links, and "<a href="http://hcrenewal.blogspot.com/2009/08/has-ghostwriting-infected-experts-with.html">Has Ghostwriting Infected The Experts With Tainted Knowledge, Creating Vectors for Further Spread and Mutation of the Scientific Knowledge Base?</a>", there's this simple fact: <blockquote>Public health catastrophe warnings from responsible sources don't need peer review, they need investigation.</blockquote> Yes, there were those pesky, off-narrative journalistic reports that the Japanese nuclear reactors were not entirely safe, that Bernie Madoff was a fraud, that mortgages for everyone was not a good idea, that the O-rings couldn't stand sub-freezing temperatures, that the the foam that broke off the Columbia launch tank caused a danger, and that the Titanic didn't have enough lifeboats, but they weren't peer reviewed...so we ignored them. Saved us a lot of money, too. <div style="text-align: center; font-family: arial;"></div> -- SS Addendum: At my post "<a style="font-family: arial;" href="http://hcrenewal.blogspot.com/2011/03/real-medical-informatics-what-does.html">Real" Medical Informatics: What Does a Problem List of Typical Health IT Look Like, Part 2</a>", I opined: <blockquote style="font-family:arial;">If the purpose of Medical Informatics is the improvement of healthcare (as opposed to career advancement of a small number of academics through publishing obscure articles about HIT benefits while ignoring downsides in rarified, echo-chamber peer reviewed journals), then: <ul><li>Who are the "real" medical informatics specialists, and; </li></ul><ul><li>Who are the poseurs?</li></ul> ... researchers like Jon Patrick who address real-world issues of great import to patients on HIT risks, and further go public on the web with their work without the full blessings of some dusty journal (and those like Ross Koppel who also directly address the downsides, and others who make available to the public material such as on blogs like <a href="http://www.emrupdate.com/">this</a> and <a href="http://hcrenewal.blogspot.com/">this</a>, papers <a href="http://www.scribd.com/doc/28747771/Remediating-an-Unintended-Consequence-of-Healthcare-IT-A-Dearth-of-Data-on-Unintended-Consequences-of-Healthcare-IT">like this</a> and sites <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/">like this</a>) are the former. Those who deem only "peer reviewed" articles worthy of daylight, and everything else - especially and particularly reports of downsides - "anecdotal" (the <a href="http://hcrenewal.blogspot.com/2010/09/dangers-of-critical-thinking-in.html">anecdotalists</a>) are the latter.</blockquote> I stand by this assertion. Finally, I ask: at what point does ignoring work such as Prof. Patrick's, if patient harm is caused by the system he reviewed, constitute reckless endangerment and perhaps <a style="font-family: arial;" href="http://en.wikipedia.org/wiki/Criminal_negligence">criminal negligence</a> by hospital and government officials? -- SS Addendum Mar. 23: As if on cue, this story appeared in the WSJ: <blockquote style="font-family: arial;"> March 23, 2011 <a href="http://online.wsj.com/article/SB10001424052748703410604576216481092750122.html">Japan Ignored Warning of Nuclear Vulnerability </a> TOKYO—Japanese regulators discussed in recent months the use of new cooling technologies at nuclear plants that could have lessened or prevented the disaster that struck this month when a tsunami wiped out the electricity at the stricken Fukushima Daiichi power facility. However, they chose to ignore the vulnerability at existing reactors and instead focused on fixing the issue in future ones, government and corporate documents show. There was no serious discussion of retrofitting older plants with the alternative technology</blockquote> I guess the "vulnerability reports" just weren't peer reviewed, therefore meaningless - or not reviewed by the "right" peers. This sounds like our own FDA, ONC office and Institute of Medicine (via the <a style="font-family: arial;" href="http://hcrenewal.blogspot.com/2011/03/committee-on-patient-safety-and-health.html">Committee on Patient Safety and Health Information Technology</a>), "choosing to ignore" health IT "vulnerabilities" (such as the <a style="font-family: arial;" href="http://sydney.edu.au/engineering/it/%7Ehitru/index.php?option=com_content&task=view&id=120&Itemid=116">aforementioned</a>) and focusing on future issues such as comparative effectiveness research, "the common good", etc. instead. I call this attitude "reckless endangerment" and hope plaintiff attorneys are paying close attention. -- SS

How Academic and Government "Anecdotes Are Not Data" Ideologues Kill People

I'm already receiving comments that, regarding Prof. Jon Patrick's detailed exposé of the dangers of ill-suited-for-purpose ED EHR's, Patrick's observations are:... not really valid because they're no…

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22 Mar 2011

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