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Hospital Turns Away Ambulances When Computers Go Down
CurtMonash writes "The Indianapolis Star reports that Tuesday Morning, Methodist Hospital turned away patients in ambulances, for the first time in its 100-plus history. Why? Because the electronic health records (EHR) system had gone down the prior afternoon — due to a power surge — and the backlog of paperwork was no longer tolerable.
If you think about that story, it has a couple of disturbing aspects. Clearly the investment in or design of high availability, surge protection, etc. were sadly lacking. But even leaving that aside — why do problems with paperwork make it necessary to turn away patients?
Maybe the latter is OK, since there obviously were other, more smoothly running hospitals to send the patient to. Still, the whole story should be held up as a cautionary tale for hospitals and IT suppliers everywhere."
... in theory, at least.
AT &F1DT0,T0800665544 - Real men, real help desk support.
please bring your own toilet paper.
But seriously... this is one of the biggest problems with the "paperless" society. Yes, it's nice to have electronic copies of things, but magnetically-stored data (or even optically-stored data) degrades far faster than a paper copy.
We can try and try to hope otherwise, but at the end of the day I worry we're dooming ourselves with our "modernized" recordkeeping. Sure, we have "tidbits" of things from 1000,2000,3000,4000 years ago... but 1000 years from now, most of our own records - much like the oral histories of certain societies that didn't get heavily into good recordkeeping on more solid forms - may well be completely gone.
"But even leaving that aside - why do problems with paperwork make it necessary to turn away patients?"
Lawyers.
"The average reporter we talk to is 27 years old......They literally know nothing." - Ben Rhodes
In an ER, "paperwork" includes information on whether they'll kill you if they give you a certain drug or transfusion. Stuff like that.
Finally modding someone offtopic when they rant about what "Begging the Question" means: priceless.
Problems with paper work don't make it necessary to turn away patients. But the paperwork is what brings the money to the hospital. Backlog of paperwork means backlog of income and meanwhile bills and wages have to be paid.
"It's such a fine line between stupid and clever" -- David St. Hubbins, Spinal Tap
It may not be necessary, but it is a cautious move. Information is important when treating patients. Their history is important. When making decisions on what treatments to provide the doctors consider the patient's history. If you do not have their history and a nearby hospital does then it seems like an easy choice to send the patient elsewhere.
Only in my state...
Most of our records would be worthless in a hundred years. Actually, most of them are nearly worthless in a year. Would it really matter to somebody in the future that I spend $15.19 on June 1st at Lulu.com, for example? Because record keeping is so cheap compared to historical examples, we keep a bunch of records nobody would have bothered with in the past.
-- Support a free market in the field of government
That headline makes no sense.
The hospital I work for is implimenting a form cycle that allows forms to be printed and scaned back to the EMR. Such a system woudl allow my hospital to use the old paper system but maintain the records electronicly if there was ever a temporary interuption of the EMR.
Lawyers, patient safety, and actually getting paid. Vast amounts of documentation must be provided to Medicare/Medicaid and Insurance companies in order to get paid for services. Event the smallest amount of missing or inaccurate documentation can be the difference between getting paid $5 and $5000, the difference between getting paid and getting fined and losing your ability to bill Medicare, etc...
Ed R.Zahurak
You know, oblivion keeps looking better every day.
It doesn't surprise me a bit. I know someone who works in a hospital lab. In any large hospital these days the lab equipment automates the reporting of results into "the system". When some part goes down, they can revert to paper for a period of time. At some point, with how short hospitals are running staff, you reach a point that you do not have enough people and free time available to catch back up manually re-entering the data once the failed system comes back up. The time frame varies with the size of the hospital and the patient load.
In today's litigious society, it is perfectly reasonable to believe that a major hospital would close to new admissions to get the paperwork caught up rather than risk being sued because the electronic trail was missing. With a health records system not being available to produce histories on patients I could see shutting down even sooner.
It's certainly something to be concerned about and it's going to get worse as time goes on. Unfortunately, as the electrical load increases outages are likely to be more frequent as well.
I do IT for a small multispeciality group. This story really points out some problems I've seen. We are in a small town, we have surges, brownouts, you name it. I occasionally have problems even though all my racks are behind decent APC UPSes/conditioners. Inevitably though, spring and fall we have storms and people fire up their AC and the power grid is for crap. I've tried to work with the utility company but they *deny everything*. At this point I am thinking of getting management involved and pulling together a group of merchants who are IT heavy and petitioning the utility directly or through the state. I do worry about the repercussions though. As far as EMR goes, we use redundant systems, offsite backup but with imaging we have well over a TB of data. If the system were to go completely fubar, I don't know what would happen. Critical info like allergic reactions, med lists, would be unavailable. We won't even go into billing. For a small four physician group like ours, we could make do I suppose. For a large hospital in a litigious part of the country? I don't know. I suppose the answer is updatable RFIDs in every citizen so that medical info can travel with and be available with the patient, right? Welcome to the future everyone.
They were afraid that without their data system they wouldn't be able to bill for the services to the patients.
This is just another failure of "Engineering".
This is what you get when you get "Engineers" to design things, that should have been designed by real-engineers, who can be held accountable.
The average IT worker is by nowhere near qualified to design systems like this.
The summary is a bit sensationalist. Being a resident of Indianapolis, I know for a fact that there are a ton of hospitals around this area. Chances are St. Vincent's got a lot of those patients. I'm certain that Methodist would not have turned away any patients that they were not absolutely certain would receive adequate aid at another hospital, or if they thought that the patient in question was in no condition to be re-routed.
As for paper vs. electronic records, hospitals keep both. The point is that paper records take a lot longer to manage, and if they can safely do so, it's in everyone's best interest for them to send patients to other hospitals in order to get caught up on paperwork. If their paperwork keeps piling up, the chances of losing important data increase by a large margin, and that's bad for all parties involved.
No, I say that Methodist made the right call here.
"You will pay for your lack of vision..." - Emperor Palpatine to Ray Charles
Hospital Turns Away Ambulances
Computers Go Down
Go Boom
As someone who works in healthcare, I've discovered that providing good care is entirely about information. If we don't know someone's drug allergies, medical history, and can't effectively communicate between departments, patient safety is impacted. Turning away patients may actually save lives if a hospital is unable to provide communication and medical background for a patient.
When I'm unable to get to the network for some reason, I feel extra stupid as a developer. I can't search for code examples on Google, migrate code to staging servers, and so on. Healthcare is similar, with providers not being as effective as if they had their full EMR at their fingertips.
Turning away patients results in loss of income, so they're basically losing money in order to improve the safety of their patients.
It sounds like they were not accepting patients that couldn't make it to another hospital. Since they were accepting walk-ins, it's very likely an ambulance with a critical patient would have been accepted. If that was true, no one was being denied healthcare. Here in Phoenix, it's hard to go 5 miles without seeing another hospital. I was recently in a motorcycle crash and was not taken to the closest hospital because of the type of injury I had and the reputation the hospital had to handle orthopedic type injuries. I was not in a life threatening situation, just a simple fracture of my fibula, and didn't even go into surgery for 24 hours. I could have ridden several hours to another hospital and still have been just fine.
Hospitals are businesses and have to make money. If they don't get accurate records, they can't bill the insurance companies. While this is an indication of issues with a specific hospital's computer and backup systems and a possible risk with other hospitals, I see no cause for alarm.
I recently had to go to emergency for severe stomach pains and ended up having my gall bladder taken out. I had to wait 5 hours for a room because they were 'code purple'. All beds in hospital and emergency were full. I hope they were turning away non-critical patients also. I wouldn't be surprised if this happens far more often than what the news story reported.
I rarely read replies, it's my opinion and if you thought about your opinion a little more, I'm OK with that.
In a completely computer-oriented hospital system (as more and more hospitals are doing, due to the tax benefits and lack of penalties), it's important that it's up and functional always.
Take for example: you don't want to give a patient food that they're allergic to, or medicine that they're allergic to for that matter. All of that is tracked by computers.
When there's actual paperwork involved with a computerized medical establishment, it gets very hairy. A patient may have notified someone of an important condition, only for it to be noted down and slipped into a stack (in this case, a growing stack) of paper. Such things can lead to lawsuits of malpractice and various other thing, including damaging the reputation of the hospital.
Furthermore, even when things are going -right-, you don't want paperwork at all in a computerized record system. Paperwork means that something hasn't been processed yet, and it may be days (or weeks) when that paperwork is found or processed. In the meantime, people are getting the (wrong) treatment.
I remember reading a story about a chronic asthma case where only a specific medication worked. He notified the same clinic 4 times, and the same hospital endlessly, of this, and it nearly led to his death. He lived because after a week (!) of being in the hospital, someone finally got around to the paperwork, and he was given the appropriate prescription.
Computerization of the medical establishment sounds like progress, but enforced computerization is -not- a step in the right direction. Proper computer management (especially in clinics and such) is important, and it's exactly those people who don't know how to make backups and such.
Washington, if the system works, don't break it, please!
There are no perfect answers, only the right questions. More questions at http://foresightandhindsight.blogspot.com/
I've been waiting for this news for years. Computers that perform fellatio? YES!
Imagine a beowulf cluster of those...
We need socialized medicine so the reliable Government can run the industry! Oh wait...
"Hospital Turns Away Ambulances Computers Go Down"
I guess they meant "The computers in the Away Ambulances for Turns Hospital stopped working".
Or maybe, "The Computers went down when the Hospital started Turning Ambulances Away." - some sort of sympathy strike action, I suppose; or maybe the hospital uses some computer repair technicians that call themselves PC medics, or PC Doctors and they ride around in "ambulances" that are full of tools and replacement parts. They arrived to do some maintenance and someone turned them away, resulting in the computers crashing.
Or perhaps the article title needs some clarifying punctuation.
When our name is on the back of your car, we're behind you all the way!
Years ago, probably in the early 1980's, a friend of the family had to be checked into a hospital. She was on dialisys (kidney disease) and obese and had other troubles associated with the combination of those two conditions. Things went wrong for her pretty frequently.
The hospital food cart kept bringer her food that would flat out kill her: no kidneys means no ability to deal with floods of certain chemicals -- potassium, for example. She used to joke about committing "bananacide". She could just eat a few bananas and sit down to wait for the inevitable.
Day after day, meal after meal, the food cart would bring her food she couldn't eat. She was going hungry when she was sick. She would plead with the staff, but they didn't change anything.
My father went to visit her and she begged him to help her. She was getting weaker every day. He talked to the staff and pursued the problem until he got to one of the people actually choosing the meals.
The nutritionists were doing the right thing. They were picking the right foods for someone who was obese and had other problems. They were NOT considering the fact that her kidneys didn't work. Why? Because the screen they saw only had room for a few conditions. The last one on the list -- Kidney failure -- wasn't showing. There were a fixed number of lines.
Someone had to shuffle the order of the values so that the various nutritionists, with their hundreds of patients a day, could keep track of what to feed her from then on.
She died a few days later.
Was it because she'd been underfed for days? Would feeding her have helped? I don't know.
But the story illustrates how a reasonable assumption made by someone in the chain that you'd need, let's say "four" lines in that field there, could kill someone.
Surge suppression seems like a no brainer, but the people making the decisions are not always the people who should be.
Since the article is making such a big deal about the rerouting of patients I would like to point out that the the nearest other hospital was Wishard Memorial Hospital, 1.5 miles away as the car drives.(Source:Google Maps) Its not like patients were being denied treatment because of this problem.
It doesn't matter that the headline is worded funny, because the majority of you responding so far obviously did not RTFA. But then why should I be surprised, this being Slashdot and all.
If you had read the article, you would know that the hospital only requested that ambulances *in route to the hospital* reroute to other area hospitals (and Indianapolis has no shortage of hospitals). Patients who were already there were not turned away, and patients who showed up using methods other than ambulances were not turned away.
I want a new quote. One that won't spill. One that don't cost too much. Or come in a pill.
The title! They fixed it! Bastards!
RIP David Carradine. As for you, smidge, you're like Zippy the Pinhead on PCP, keep it up. I thank you and the dearly departed Kung Fu master for your many lulz.
Turning away patients isn't all that surprising. Hospitals do it all the time whenever they reach capacity. It's called overflow and it's quite common. In this instance their capacity was diminished because their system was in the gutter. Just my $.02
The problem is mostly legal: if nothing is documented, the other guy's story wins, and one large lawsuit could take down the hospital. If you cannot organize your records, you're going to lose one, and if you lose one for the guy who claims he slipped, broke his back, and now can't work for life, your hospital goes bye-bye.
Our society has adapted to computers. We require them to move things along at the usual speed. Going back to paper isn't an option. Remote backup and redundant power supplies are a good idea, as that hospital found, but they did the right thing in shutting down instead of taking a huge legal risk.
Futurist Traditionalism
The problem is not so much access to historical records in these situations as it is workflow. After all, a patient sent to another hospital will not have the benefit of medical history records created at another hospital or clinic.
Workflow is where there is trouble. If you're reading this you probably use a GPS or Google maps to get around, probably both. Do you still have any paper roadmaps? I don't. Your process for getting to a new place depends on the technology. Same with hospitals. They increasingly depend on automated workflows for scheduling, for dispensing drugs, for managing lab and x-ray orders and results, and so on.
Hospitals have switched to these systems because they require fewer staff. They have largely dismantled the paper+clipboard+courier systems that preceded them. These older systems were complex and cannot be resurrected quickly. There aren't enough people to implement them. The institutional memory on how to use them is lost.
I would guess that, in this particular case, they've gone back to paper prescriptions, signed by doctors, and taken by courier to the pharmacy, with a paper label on the dispensed drugs. That must be scary, because all the safeguards in the automated system -- checks for allergies, interactions, appropriate dosage for patient weight, not to mention barcode scans at multiple points to guard against mistakes -- are gone. Who will do the manual crosschecking? Have they been trained?
As Isaac Asimov once wrote, ""I do not fear computers. I fear the lack of them."
My research seems to indicate that Clarian uses Cerner as their EMR, which is disappointing, because I was looking for a reason to finally make this joke:
Epic fail.
If a hospital can only process paperwork for X patients per hour, then it can only accept X patients per hour without getting a backlog.
If the paperwork is messed up or not available it can lead to medical errors, including fatal ones.
If computers turn X into 10X or 20X, then great, paperwork is no longer the limiting factor on capacity. Well, not until the computers crash.
Knowledge is how to play a game, intelligence is how to win, wisdom is knowing what game to play.
for this hospital. any competent facility with an electronic system such as this obviously has a competent IT staff dedicated to a recovery procedure of some sort. redundant systems, generator backed servers, and perhaps even colocation while new for healthcare IT should be considered.
if its like every other IT shop, the "budget" was cut and IT got the short end of the stick again.
Good people go to bed earlier.
Holy crap, I thought you were trolling. Well, it's offtopic but damn...
David Carradine Dies. No wonder "Wild West Tech" wasn't on History Channel last Sunday morning.
Damn. They didn't mention Long Riders, a historically accurate portrayal of the James Gang, with the Carridine brothers playing the Youngers and the Keaches playing the James. That's one of my favorite westerns.
In other offtopic obituary news, blues great Koko Taylor has died also. Sad day for blues fans.
Free Martian Whores!
I work for an ePCR company that was developed and started by Critical Care Flight Nurses/Paramedics. Our company's main product is the Providers (First Responders) portion of the patient tracking. When they put in a trip, the hospital gets it immediately. Further, we have a program that regions use that changes a hospitals status from open to divert when the hospital has issues or is overly crowded. This happens more than most know. Divert status warns the EMS Providers ahead of time so that they dont waste minutes hauling a patient to a closed ER. As one poster stated, this is actually saving the patient's life in many cases. Our company does not handle medical records of any hospital though.
One of the things that drove the revolution in understanding of Koine Greek (as used in the New Testament) over the last 200 years or so was the discovery of a massive cache of routine commercial transactions in Egypt, written on Papyrus. So, your $15.19 @ Lulu.com might be more relevant than you realize.
"He who would learn astronomy, and other recondite arts, let him go elsewhere. " -- John Calvin, commenting on Genesis 1
They could certainly use standard word processor documents to keep track of patient information. Or copy off some of the old paper forms. How hard is that?
The only reason I can see for not treating patients is that they couldn't validate insurance coverage. Prescriptions can still be written on paper, treatment notes made on paper charts. For a majority of doctors offices, just ePrescribing is a huge technology step. The medical field is never far from their paper roots, so I'd have to vote that this was a financial decision. Delaying treatment because your computers are down? Come on.
That's our life, the big wheel of shit. - The Fat Man, Blue Tango Salvage
If just one of those ambulances turned away had a patient die, the law suits could easily exceed the cost of patient care for all ambulance runs. And for patients taken in, they could have kept them around long enough to get all necessary info. They could have called in temps to help keep up, and catch up.
Of course, if the patients had gotten in, it sounds like the hospital would have left them laying around while they did the paperwork.
They are just insensitive jerks.
wake up and hold your nose
Of course, you have to remember that all of this over-engineering costs money. The more money a hospital spends on bulletproofing EHR, the more they have to charge patients or cut corners elsewhere in order to remain profitable. At some point for any system, be it EHR or any other, this process becomes unsustainable as no one could afford the services of the hospital.
Some may see this as a reason why for profit hospitals are bad and why the government should run things. It really wouldn't change. The government is currently effectively bankrupt. We borrow billions from other countries and the Federal Reserve prints up the shortfall causing currency inflation. When our debt becomes so large that our credit rating falters, other countries will be less and less inclined to finance our debts which will bring more inflation as the Fed continues to print the shortfall. Why do people think that the government's budget is any different from a household budget? How long can you keep spending more than you earn and stave off bankruptcy?
The fact of the matter is that a for profit organization has the most incentive to build the most effective and efficient system for dealing with their core business. Of course, governmentrules and regulations and the organizations' leadership (if inept) can stymie this process.
A closed mouth gathers no foot.
From what my EMT friends have told me, many hospitals are nearly permanently on "divert" status. Whenever a hospital is nearly full of patients (and many, particularly in large cities, almost always are) or their ability to accept and treat people is negatively impacted in some way (such as in this case), they go into divert status. This doesn't mean that they turn away people who come in for treatment, as anyone who comes in the door is still accepted. All it means that when an EMT picks up a patient and they see that one hospital is 12 minutes away, while another is 10 minutes away but on divert status, they may choose to go to the first hospital. If the patient is in critical condition and every minute matters, however, they will still go to the second for treatment. It's a logical measure that helps to ensure that everyone is treated in the most efficient manner.
The article says that two hospitals were unable to access patient records. Who knows what the "power surge" actually affected, but it's clear it happened at a shared datacenter.
Their paperwork increased because they couldn't access the applications hosted by the shared datacenter, which is probably some type of retarded Windows Terminal Service setup, and they also couldn't just run the applications locally. So they would have had to start recording data twice, once on paper and another time on their (remote) records system. After a while, staff would not be able to keep up with the data entry and start diverting people.
And basically this would not have happened if anyone even slightly competent had designed their electronic records system not to be dependent on a real-time data link to remote application servers.
"I assumed blithely that there were no elves out there in the darkness"
Because orders for (and, where applicable, results from) lab tests, diagnostic imaging, medications, etc. are all "paperwork", and all rather essential parts of patient care, and are particularly time sensitive in the case of emergency care. If you can't process "paperwork" (with or without paper) accurately and timely, you can't properly treat patients.
Which is why an EHR system shouldn't be purchased without reliability (uptime, etc.) guarantees.
I guess their administrative METHOD IS Too inflexible.
The computers go down, but the nurses don't.
I've abandoned my search for truth; now I'm just looking for some useful delusions.
On my one and only ambulance ride, instead of going to the closet hospital, I was routed to one that was slightly farther away. The paramedics radioed to dispatch and gave them a synopsis of my conditiona nd outlook, and were told where to go.
I have no idea what factors played into this decision - probably, availability at the two conditions coupled with the perceived seriousness of my condition. I had a ~5 minute longer ambulance ride and received treatment at a good hospital.
This is like load balancing. This is simply a sign that ambulance dispatching works WELL - they automatically adjust to compensate for problems that would delay service at a particular hospital.
This is the biggest reason I can point out for a patient to be an ACTIVE participant in knowing what their treatment is in a hospital or other medical facility with electronic record systems. You need to know what you're supposed to be getting and when. If you don't, you should be asking questions until you get satisfactory answers.
Awk! Pieces of eight. Pieces of eight. Pieces of seven... ERROR: General Protection Fault. [Paroty Error.]
It is valuable in the aggregate, with representative examples. It is not valuable to keep all the details.
-- Support a free market in the field of government
You can't be seriously telling me that critical systems in a hospital that takes in emergency patients are so weak that a single power surge can take them all down? What happened to redundancy?
We do backups, but if we never do a restore, we don't really know that the restore procedure will work. If you REALLY want to make your downtime minimal, you occasionally test your restore procedure.
I'd like to suggest that any life critical application like this be forced, at least one day a month, to run without computers.
If it causes them to hire another employee, good--we need more employment. It should also help them gauge how many extra people they will need to handle a situation where the computer services are unavailable.
Computers are nice, the internet is nice, email is nice, NONE of these should be required for the normal functioning of a country--it's too big a vulnerability. We already know the effects of an EMP, do we really want a single attack to be able to shut down all the hospitals in a state?
When I'm unable to get to the network for some reason, I feel extra stupid as a developer.
Odd. Just the opposite for me. When I'm able to get to the network, I usually have a slashdot window open, and I feel my IQ drop.
I just like to note here that I started in the early 90s with a company that didn't care to invest too much in infrastructure. Now I'm working at a University and they care about their data, but also don't want to spend money on keeping it safe. This makes my job easier, but I don't sleep as well at night knowing that I don't have the best backup scheme or the best surge protection, simply because I can't afford it. Not having the experience of keeping truly critical data safe, my heart palpitates thinking about working in IT for a hospital where not just your job but people's lives are on the line if you screw up.
I stress enough about kicking Eudora to the curb, never mind trying to make 100s of TB of data highly available in case a doctor needs a patients allergy history pulled in a blink or we're all dead, Scotty.
Same thing happened, but it didn't shut down the Hospital(s). Data ceter they have in Addison, that is WAY to big for the power and data lines they have, blew a breaker. Not just ANY breaker, but the 800amp main breaker that comes in. The backup was fine, but this baby not only blew itself in a nice fiery mess, it took the UPS with it, requiring all the electronic guts to be removed. Thing was that they had on UPS and two power circuits. So when even that one blew, the UPS shut down and EVERYTHING shut down. Billing, CAT scans SAN's and all of the intranet and internet. God, I was one of the vendors, but I could see people burning money in there. Cisco eng was there, IBM, Sun, HP, Dell. EVEY vendor for all their software. They had many EMC techs there. All of us were standing around, a good 15 feet away mind you, as the UPS guys were rebuilding the damn thing. Was there for 8 hours of over time. Luckly this was all at night, but really, who the heck do you blame for a faulty main?
call me when your computer can wear a tight skirt
Pr0n.
and make me a cup of coffee...
There are already computers in drip coffee makers, even if only a microcontroller that acts as an alarm clock to turn on the coffee maker. Coffee vending machines have computers in them as well.
But even leaving that aside â" why do problems with paperwork make it necessary to turn away patients?
Because paperwork is how a hospital communicates. Without it it is very difficult to effectively treat anything except the simplest problems. Missing paperwork also prevents billing for services, causes serious legal and standard of care issues, and reduces the number of cases a hospital can effectively manage.
In any case the hospital did not "turn away" patients, it diverted patients arriving by ambulance to other hospitals. This is standard practice in every hospital outside of times of crisis. Sometimes hospitals get more patients than they can handle and so they divert patients to nearby hospitals to handle the overflow. Happens to smaller Emergency Departments all the time. Hospitals aren't designed to handle unlimited numbers of cases. Lack of access to medial records reduces the number of cases a hospital can effectively manage and so diversion becomes the responsible course of action. They did the right thing.
One of the reasons electronic records have been slow in coming is that actual paper paperwork has a nearly unbeatable advantage in reliability which is obviously important when lives are on the line. There are good reasons for electronic medical records but using them always will carry the risk of paralysis when the electrons aren't flowing correctly. There are manual fallback procedures but they are necessarily less efficient. Had there been a catastrophe (think terrorist attack or natural disaster) the hospital would have accepted the patients if needed. Every hospital has contingency plans for circumstances like this.
In other words, nothing to see here - move along.
for the first time in its 100-plus history
100 years, months, days, hours, patients, ambulance drop-offs...some details would be nice.
I do not support "The Man". I also do not support your irrational stupidity
there obviously were other, more smoothly running hospitals to send the patient to
Yes, though all of those other hospitals are run by Clarian, the same company that manages Methodist. God help us if we ever have a more centralized problem.
The problem is that all that the manual paper work for each patient is enormous, because it covers all blood tests, all doctors and nurses observations, and little things like patient supplies. All this paper work has to be entered into the computer when it comes back up so that the billing cycle can run. Even a couple of hours of downtime can slow patient care down, and you need the a lot of staff to enter all the manual paperwork when the computer comes back up. When you think that a simple blood test may have 20+ values you see that this may be a problem.
to replace manual systems with computers to such an extent that business can't be done during a power failure. Remember back in the day when we were taught how to make change in school and had a real world demonstration of that task every time we went shopping? It is so stupid for a store not to sell stuff just because its record keeping system is down.
Emergency rooms can triage so that the obvious cases do get treated there. It doesn't take long to write or dictate removed splinter from left middle finger and then the name and phone number. Everything else can be input later. If the kid is diabetic or something, the parent will probably mention it, especially if reminded. Maybe this was done, the article didn't say all patents were turned away, did it?
stores are even easier. it's not life or death to the customer, he will just go to another stay while the cashiers stand around. But, barcodes can be scanned (wireless scanner, and if store is smart, the database will have the price, too) and recorded to be uploaded later, and the transaction takes place manually, The entire stores entire table of sku's and prices can fit on a laptop, as well as a rudimentary cash register program.
The only time power outage should cause a problem is if doctor/nurse/clerk needs to access information on that particular customer from a previous encounter. For nobrainers, if a skinned knee can be called a nobrainer, just get the name, phone number, and insurance ID and deal with it later.
If you must moderate, please moderate as irrelevent, not something bad, because I'm sure someone will find this interest
enron, lehman brothers, etc.
The hospital going on divert simply means "If you can take a patient somewhere else without threatening their well being, please do so". It doesn't mean that if I rolled up with someone in cardiac arrest that they'd refuse my patient and send me elsewhere. Hospitals go on divert hundreds of times a day in this country. This isn't news. Move along.
why do problems with paperwork make it necessary to turn away patients?
You can thank the legal system, multi-million dollar lawsuit awards, and greedy lawyers and "patients" for that one. As a doctor I am appalled at the amount of paperwork involved - and I don't even practice in the US. The volume paperwork has NOTHING to do with medicine, and EVERYTHING to do with physicians and staff protecting ourselves from potential litigation.
It's sad to think that the decision not to treat should take precedence over the patient's comfort, but frankly why should a hospital or staff expose themselves to potential litigation? It's much safer legally to inform the ambulance services that the hospital is no longer accepting patients. This is the world "we" (ie the courts, the lawyers and the patients) have built. And even now you find flaws in their logic, and someone is probably thinking of suing (or trying to sue) the hospital over this. In medicine you are always damned if you do, and damned if you don't.
Ideally paperwork would be the bare minimum to inform my colleagues of what my diagnosis is, why, and what my plan is. I can do that in a couple sentences per patient. Everything else is just legalese. Remember that the medical file is, in a way, a method of getting a physician to waive his protections from self-incrimination. There is no "5th" amendment for physicians. If it's not in the file, it doesn't exist or it never happened. And if it's in the file, it had better be 100% right, all the time.
Seven puppies were harmed during the making of this post.
" ... Because the electronic health records (EHR) system had gone down the prior afternoon -- due to a power surge -- and the backlog of paperwork was no longer tolerable. ..."
The key phrase here is "backlog of paperwork". In about a day, the amount of paper records required to meet the data needs of the EHR system overwhelmed the staff.
It's not about the EHR system going down, or an inability to admit and care for patients via paper forms, because there were paper-based forms to fall back on.
It was an inability to cope with the sheer volume of information the system demanded. This is a cautionary tale illustrating the vast quantity of data we now collect. The EHR system enables the hospital to collect much, much more data than a paper-based system would have deemed necessary 20 years ago.
The easy proof is those paper-based systems worked just fine at the time, while collecting the data the EHR wants on paper forms, a system in place for just such an eventuality, is quickly overwhelming.
Anyone designing systems for hospitals, the failure of which would interfere with the hospital's ability to provide care, especially emergency care, to patients (whether the failure of a records and billing system _should_ interfere is a separate debate, but if the hospital considers it so, then it counts here) that doesn't ensure that something as simple as a *power surge* can't cause it to fail, is utterly incompetent to be remotely involved in the designing of systems for hospitals.
That would include building anything on any Microsoft platform, as well as not having 100% fault tolerant isolated power systems.
Is it me or is this a step towards the 1984 novel where the world has no more real historical data?
It's good to be able to take advantage of technology, but you should always be prepared to do the work without it. This is especially important in hospitals. The only thing is that hospitals are least likely to think of this as a problem because they usually have their power on a separate grid.
It was a 2 hour ambulance bypass.
That's nothing. Seriously.
They weren't turning away people at the door, just sending ambulances elsewhere.
Look at when it happened, 1am.
They would have what, one, maybe two if they're lucky, people working at the admit desk at that time.
Yeah, it might back up a bit., but it shouldn't.
This was a failure of hospital policy more than an IT system failure.
disclaimer: I work at a HIMSS level 6 rated hospital.
(I've even had the experience of being an inpatient recently. Knowing the system, I still said "Wow! This is how things need to be run".)
Almost everything is computerized.
Everything is backed-up and redundant, and if the whole thing went down, you wouldn't be coming to us because there'd be a huge hole in the ground.
legally they cant take patients in if they cant do an adequate job treating them. i wouldnt be surprised if some of their regular staff was busy fixing the medical records. therefore they were probably short on workers and also unable to keep adequate medical records for patients. this is a big no-no in the health care industry. bottom line is that a hospital may send patients elsewhere if they cannot adequately treat them (ie. overcrowded, don't specialize in the needed area, etc.). They must, however, be sure not to send patients away simply based on that patient's ability to pay - so long as the hospital is eligible for federal funding of any sort (ie. medicaid, medicare). I don't see this as a situation where they are "dumping" patients. Therefore, it's both legal and smart. Failure to correctly treat patients could lead to huge malpractice suits. no one wants that.
"i stand on the edge of destruction" -shai hulud
Because the whole strength of digital media is that you can easily copy/regenerate it. If the data is important, it isn't difficult to keep transferring it to new formats. For that matter, it isn't difficult even if the data isn't important. I have papers I wrote back in high school, well over a decade ago. The original computer on which they were written is long gone to a landfill, but I can transfer the data to new drives as often as I like.
Now can your book be copied? Sure, but only with a good deal of effort. Even if you are using a machine to make the copies it is a hell of a lot more work than copying digital data. If you are doing it by hand, it is a major marathon. So even though the book CAN be copied, it is much less likely for it to actually BE copied.
Digital also has the advantage of not having physical boundaries. You can easily copy digital data to anywhere in the world that is wired. If you need to back something up against an extreme catastrophe, like a city getting burned down or something, this is easy to do. For paper, much harder. You have to truck it to where it needs to go and do so regularly.
So yes, there is lots of digital data out there with very little permanence, but that is because there is lots of digital data out there with very little relevance. The amount of information we generate today as compared to the pre digital age is staggering. It is thus no surprise that we keep much less of it.
However because it is so much easier to back up, we can back up much more data as is needed, and do so in a much more reliable fashion. Paper seems great until you consider the amount that we know has been lost on paper (massive numbers of Mayan codicies for example) and consider that there's even more we are never aware of (because it was lost and no documentation of the loss was made).
If you sniff around on the Internet, you'll find that there are archives of plenty of old data, data that shipped on floppies or punch card or tape and so on. The data has been copied and recopied and is preserved.
In other words, getting paid is more important than human lives.
It isn't more important, and not taking patients because of an IT problem is a massive failure that should be closely examined, but getting paid is important. Hospitals don't run on magic fairydust, they run on human labor and equipment and facilities... all of which cost money. Equipment and facilities might be sunk costs even if there's lapse in cash flow, but staff probably need income to make their lives work. In a sense, money *is* human time, because it represents time necessary to produce a good or service... and so even if we weren't considering the fact that the hospital itself will have to stop operating eventually if it doesn't have funding, getting paid would be important.
This isn't to say that we shouldn't be taking a long hard look at how medical care is paid for in the United States. And any hospital that has to shutdown because of an IT problem quite possibly shouldn't be operating anymore. Just that money isn't necessarily an afterthought.
Tweet, tweet.
this is just one small example, put out there by Republicans to help fight the Dem's health system plans.
its dispicable
"But even leaving that aside -- why do problems with paperwork make it necessary to turn away patients?" Hospitals are in the business of making money, until we have universal health care.
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the health care system today has price floors (union contracted wages), price ceilings (usual and customary rate), the removal of the individual being able to negotiate a better price (hmo legislation from 1970s), and mandated electronic locks on everything (hippa). all i hear is it's broken and when are we gonna fix it? jesus h christ, congress has been 'fixing' it longer than i have been alive! when are you going to wake up?
Big brother may be watching (since I'm in Indianapolis) so this is going up anonymously. Sorry.
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Methodist Hospital is a member of Clarian Health Partners, which also manages Indiana University Hospital and Riley Hospital for Children, located about 2 miles away from Methodist Hospital, also in downtown Indianapolis. Also located in downtown Indy are the Roudebush Veterans Affairs Medical Center (VAMC) and Wishard Memorial Hospital - the county hospital. Wishard Memorial and Methodist are both Level 1 Trauma Centers (Indiana's only two Level 1 Centers). Both are staffed primarily by Indiana University faculty physicians or Indiana University graduates.
Clarian Health Partners uses an implementation of Cerner's Electronic Medical Record system. Cerner Corp., in Kansas City, provides "support" and roll-out assistance. In-house support staff seems capable only of basic help - password resets, how to access lab values, etc. More complex support requests get "sent out" to Cerner. A response may arrive in hours, days, or never. The roll-out of the system, from what I have heard and seen, has been plagued by problems. The roll-out has been phased across the three hospitals... and problems seem to occur on a daily basis. It's like the system wasn't scalable enough to handle the complexity of three major interconnected hospitals in a metropolitan area. Physicians and nurses frequently complain that this brand new, multi-million dollar system is slow, unreliable, crashes, and loses "works in progress" when it fails due to the lack of any type of auto-save feature.
Surprisingly, CPRS (the system used by the VAMC and by all VA hospitals, from what I have heard) is lauded as BETTER than the Cerner system, from the doctors I've heard from who have used both. Many docs in town work at multiple hospitals, so they have experience with all of the systems. Even the proprietary in-house system developed at Wishard (the county hospital), and which has been in continuous use since the mid 1990's, is reportedly better than this new 2008-2009 implemented system. It's unfortunate this happened, but unsurprising.
Hospitals really need to get physicians, nurses, and unit staff involved when developing and choosing an EMR system. Unfortunately, it seems like the people who develop these systems or who decide to purchase them are isolated from the needs of the personnel that will use the system. Something that looks great on a software designer's computer screen may not accommodate the workflow of the staff and physicians when it comes to clinical implementation. Maybe this was done, maybe it wasn't.
It's too late to go back now - the system is so entrenched in the three hospitals that it's unlikely it will be replaced in the next decade or two, despite its numerous shortcomings. The hospitals are at the mercy of Cerner Corporation and their planned "upgrades" in the future.
If you wonder why hospitals aren't moving to EMR systems more quickly... this is why. Once one is selected, you're trapped and can't switch without an even larger investment to port the data from one system to the next. From what I've heard, the commercial EMR systems out there are in their infancy. They just don't scale - the programmers have minimal insight or skill - and they're kludged together with add-ons and work-arounds to make them fit the hospital's needs. Someone needs to come out with something that "just works."
Think Apple will be entering the EMR market anytime soon? I hope so.
This probably had more to do with the doctors not being able to get on WebMD.
I'm and ER doc. It is increasingly difficult to care for patients when the electronic system is down. Lab, xray and even such basic things as getting vital signs are all tied into the system.
one node in a distributed system is malfunctioning, requests are re-routed to other nodes. what are you bitching about again? maybe you have a perfect utopia system, why don't you just let it out loud?
The answer to the question "Why?" is always Money
"why do problems with paperwork make it necessary to turn away patients?"
Before posting a rhetorical question try answering it yourself. It may not hold up.
What do you think would happen the first time a patient died or suffered other permanent consequences as a result of improper treatment due to missing or incorrect paperwork describing their condition and medical history? Those ambulances didn't drive into the river. They went to another hospital, one with a working computer that could give doctors in the emergency room the information they need to have the best chance of delivering the proper treatment.
Without the computers, they can't keep track of the 15 specialists that need to bill you a full hour for the 3 minute walk-by interviews just to say that they aren't needed.
My mother is a medical records coder. She needed to pass an exam to get a certificate as a "Registered Health Information Technicians" to able to input the data into the computer from the ER paperwork. What she does is she sits at the computer, reading over the ER paper work, and inputting it into the computer. This information is how the government gets the statistics on how people injure themselves as well. There has been numerous times when the paper work has piled up so that she is quite literally forced into doing overtime and even going in on SATURDAYS to be able to catch up.
So in my humble opinion, it sounds like the hospital just doesn't want to give their medical records techs overtime to catch up on the paperwork that they miss due to the computer systems being down. But I could be wrong. Yes, I am aware it says "access records of patients" but when visiting the ER, they really only just input records and not retrieve them much + if it is recent enough, can always go get the hard copies, they should have hard copies just for the reason the system goes down. The more I think about it, the more I am convinced that the hospital isn't able/doesn't want to pay for overtime to catch up on the work.
Disclaimer: this is for the state California, might not be be so with Indianapolis, and they just skip having medical records coders, and the nurses fill in the reports directly to the mainframe. But still, nothing one or two people won't be able to clear up with a Saturday of overtime.
Hospitals around here go on diversion on a pretty regular basis. We have a system set up to minimize patient risk. Diversion means that the facility is not able to provide timely care to a patient whose condition is not critical, and that patient will receive better, more rapid care at another hospital. Why take an MI to a hospital that is experiencing an IT issue causing orders to be delayed, blood labs to be held up, x-rays to not be delivered in a timely fashion, etc...when we can drive 5 minutes further and the patient will be in the cath lab within 30 minutes? We can still take patients to a hospital on diversion if we don't think they'll make it to the next one OR if that hospital has specialty care that is required (such as a burn unit or hyperbaric chamber).
A hospital being CLOSED is a whole different animal. Here, hospitals have a closed status because they are unable to accept any patients whatsoever. Most recently, we had a hospital closed for 28 hours because a bunch of haz-mat victims left the scene of a hazmat incident and walked into the ED covered in a toxic inhalation chemical.
Why is this story in the science category? It has nothing to do with science.
You're confusing administrative paperwork with that required for patient care.
At the hospital I worked at in the IT department; when the system/network/EMR went down the hospital ran on various backup methods.
The pharmacy (for example), switched to using fax machines to process perscriptions. Then delivery by hand instead of computer controlled robot. With the system down the capacity of the pharmacy to fill and deliver perscriptions dropped.
And of course the EMR system took care to verify dosage, drug interactions, allergies, etc.
Or how about radiology? Normally x-rays are distributed electronically so any provider in the hospital can quickly access patient records. Using a backup system that provides actual film? Takes longer, and is much more work. A doctor wants to consult a specialist across the other side of the hospital? Someone now has to hand-carry the x-ray and get bring back a hand-written summary. Things that used to take seconds or minutes now take minutes to hours.
When the EMR goes down, the resultant loss in hospital productivity cuts down on the number of patients the hospital can treat. The paper backup systems just can't keep up with the electronic versions. Billing can wait, but patient care cannot.
Just lately, Slashdot's preview engine has taken to eating the empty lines in paragraph breaks; they do show up in the final posting, though.
It is annoying, yes.
Until you're allergic to Iodine, like my wife is. She would be in serious trouble had she gotten a skinned knee and someone cleaned it with an iodine-containing compound. It's in her records of course.
with a 4 hour backlog of data, they probably weren't looking for allergy information. I'm afraid it was mostly just a data entry backlog.
But, even if it wasn't, your wife should probably get a medicalert bracelet if her allergy is life threatening. Or, you can make a point of being with her if she loses conscience. If she is conscience, she's probably smart enough to tell the doc about her allergies unless they are extremely complex.
If you must moderate, please moderate as irrelevent, not something bad, because I'm sure someone will find this interest