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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.
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.
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
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.
Aye. I was going to vote it down, but there's no "Piss Poor Grammar/Spelling/Punctuation" option. Shame.
"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!
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."
"She would plead with the staff, but they didn't change anything."
That hospital had a much bigger problem than a bad computer system. Mistakes--even life-threatening ones--will happen, but your friend noticed the mistake and no one would fix it or even investigate?
In the hospitals my family has stayed at, when there's a problem (like getting soup when you're on a low-water diet), you tell the nurse and the nurse goes and gets a different meal.
Could the computer system be improved? Sure! Line #4 could have said "And More" (don't even have to change the look of the screen, then). But there's no point fixing the computer system when the problem is that people are completely abrogating their responsibility to a machine and no longer doing their jobs--they'll just find some other way to kill people.
In short: the tool is there to help, not do the job. Just because it is a shitty hammer doesn't mean it's okay to build a shitty house.
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.
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.
In other words, getting paid is more important than human lives.
This seems to contradict the mission statement of the hospital industry as it was conceived, but I think is a good indicator of where insurance-driven (which is to say, privately socialized) medicine is headed.
~REZ~ #43301. Who'd fake being me anyway?
Ok.
I'm sorry your child has autism. It must be harder than I can imagine. And I know that you're looking to blame an external force for this condition. But you're looking in the wrong place.
Vaccines didn't give your child autism, and they're not going to make him worse. YOU gave your child autism... or the other parent did... or probably both.
This terrible condition has NOTHING to do with vaccines, as has been shown DOZENS of times now, to the tune of countless millions of dollars that could've been spent trying to actually fix the problem, as opposed to trying to prove something that was already known to the people who won't believe the studies anyway.
By denying basic healthcare to your child, you're in no way protecting him, but rather endangering him, as well as the other children he comes in contact with. That is both selfish, and stupid.
And if you think the entire medical and scientific community is trying to force you to do something, and is concealing "the truth (tm)" from you, then why seek any professional medical care at all. After all, I am sure you can find a site on the internet that will tell you that antibiotics cause autism. Think about that, next time you're dealing with pneumonia.
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.
GP mentioned patient safety but didn't elaborate, so I will take the opportunity. Nurses are responsible for actually delivering most of the patient care in a hospital (nearly everything outside of the operating room). A good portion of a nurse's work is paperwork. Therefore, if nurses are swamped in paperwork, this has bad implications for the quality of patient care. The likelihood of a life-threatening medical mistake goes up.
Put another way, a backlog of paperwork overloads the hospital staff and reduces the number of patients they can competently treat.
So I think turning non-critical patients away from a hospital that is backed up with paperwork could be a positively useful step toward protecting patient safety, if done for that reast. Obviously you would want to still admit someone who's in cardiac arrest. Something less serious like a broken leg could be safely rerouted to another hospital that's not overloaded. The patient might grumble but in fact he may very well get treatment sooner by taking a road trip to the next town.
[Sir Garlon] is the marvellest knight that is now living, for he destroyeth many good knights, for he goeth invisible.
It's a recent phenomenon that many people with Asperger's Syndrome are becoming reasonably successful, especially in technical fields. Where someone might have been "that weird guy who sweeps the stables and barely talks" ninety years ago, he could be a successful programmer or electrical engineer now. That plays a big part in whether you can find someone actually willing to settle down and have kids with you.
And no, Asperger's is not the same as autism, but genetic proponents seem to be suggesting that maybe it's just a matter of degree.