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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
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.
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
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.
It's a reply that WILL get you karma from "fight-the-machine", "vaccines-cause-autism", and "they're-hiding-cures" crowd... but one that has no bearing at all on reality, and only reflects your ignorant disdain for the healthcare system.
The reason why they can't operate without the electronic system likely has to do with the mountains of required documentation that needs to be filled out for every patient, and the fear that without the electronic system they may miss a counter-indication and kill a patient, whose family will then proceed to sue the hospital, the software company, and the universe for three thousand gazillion dollars. If the patient is stable and there is another hospital nearby, why risk it?
P.S. If you think that a hospital would have trouble billing people without the electronic records, and that they'd turn away the ($1000 minimum) ER patients because of that, you're delusional.
I've been waiting for this news for years. Computers that perform fellatio? YES!
Imagine a beowulf cluster of those...
"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.
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 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."
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.
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
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.
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.
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.]
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.
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.
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.
Because this hasn't had an impact on your life, you have had no motivation to get educated.
I happen to hold multiple degrees in biology.
In fact, please stop speaking about autism at all. You lack standing, and are failing to educate yourself.
You keep using that word. I don't think it means what you think it means. It certainly does not mean reading blogs on the internet.
I prefer properly controlled, peer-reviewed studies. Here's a review of such:
Vaccines and autism: evidence does not support a causal association.
Clin Pharmacol Ther. 2007 Dec;82(6):756-9. Epub 2007 Oct
If the traits exist genetically, and are passed from generation to generation, why did this condition rapidly advance in the past few decades?
The only conclusion that supports the rapid increase in the number of diagnosable cases of autism is that 'something new' is causing it. Something changed and now we're seeing more of it.
I am not sure it has advanced. It's quite likely that it has become diagnosed more often due to a better understanding of diagnostic criteria and the accompanying campaign of educating physicians.
Unless you fiddle with the data, this is absolutely the conclusion that needs to be drawn first.
Actually, you yourself said what kind of a conclusion can be drawn given the current data:
There is no known cause for autism.
Period.
Again, there is no known cause for autism.
I assume, though, that you're going to say the diagnosis rates aren't real because the diagnosis is over-used. Next you'll say my son isn't autistic - he's just a brat.
You're defensive because you're clinging to a comfortable idea. I'll let you reply to you:
Again, this doesn't withstand logical scrutiny.
Exactly.
SOMETHING changed, sir. And until you're ready to accept, at minimum, the possibility please do the world a favor and shut the hell up.
This is a perfect example of the kind of attitude that has become so prevalent recently (hey, maybe that's what the vaccines cause). I feel no obligation to accept the possibility of something that has been repeatedly shown to be false.
Insensitive? The only thing I am insensitive to, is your own ignorance.
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.
Speaking with you, sir, is akin to addressing a wall.
1. The cause of autism is unknown.
2. We do, however, know that vaccines ARE NOT the cause.
The two concepts are only contradictory in your mind.
That's pretty much as far as I am willing to go in conversing with you. As R. A. Heinlein wrote:
Never try to teach a pig to sing; it wastes your time and it annoys the pig.