Hospital Turns Away Ambulances When Computers Go Down 406
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."
Nurse != Secretary (Score:3, Insightful)
Welcome to the paperless office (Score:5, Insightful)
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.
A one word answer (Score:5, Insightful)
"But even leaving that aside - why do problems with paperwork make it necessary to turn away patients?"
Lawyers.
It's Not Just Any Beaurocracy (Score:5, Insightful)
In an ER, "paperwork" includes information on whether they'll kill you if they give you a certain drug or transfusion. Stuff like that.
Treating patients in a vacuum (Score:5, Insightful)
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 records are worthless anyway (Score:5, Insightful)
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.
Two Word Answer: Patient Safety (Score:5, Insightful)
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.
Re:Nurse != Secretary (Score:3, Insightful)
Nothing to see here ... move along.... (Score:4, Insightful)
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.
Re:It's Not Just Any Beaurocracy (Score:5, Insightful)
Re:Welcome to the paperless office (Score:5, Insightful)
They've been talking about the "paperless office" for over twenty years now, but it hasn't happened yet. There is far more paper in my office than there was 20 years ago, in fact.
However, IINM the Japanese have paperless toilets that wash your butt with a water spray and dry it with hot air.
The thing about electronic records is that they can be instantly duplicated and sent anywhere instantly. They're easy to back up, without the errors and degredation of past, analog copying methods.
I'm healthy and don't go to the doctor very often. My old family doctor retired about fifteen or so years ago, and when I went to have butthole surgery (hemmoroids, too much sitting on my ass like any nerd) I discovered that I had no medical records!
Unless it's acid-free paper, a book will last maybe fifty years before it starts deteriorating. I have old paperback books I bought when I was young that are nearly unreadable now. Paper is far more nebulous than electronics.
The thing that will kill today's literature (and many other records) for future humanity isn't the supposed fragility of electronic records, but the insane lengths of copyright. If you don't allow electronic copies of your work, it's unlikely to last much longer than a single human generation.
Re:A one word answer (Score:3, Insightful)
I think castigating an entire group of professionals is short-sighted. Perhaps if ours was a less-litigious society, lawyers wouldn't be so powerful. After all, many patients employ lawyers in frivolous lawsuits against hospitals (not all, of course) which may make such detailed health records necessary (even to begin services). Lawyers are just functionaries. Blaming them is like blaming the hammer for hitting your thumb instead of the nail.
I agree with the sentiment above that we place too much faith in our sprawling infrastructure rather than designing proper failover systems in every new project.
Re:Welcome to the paperless office (Score:3, Insightful)
probably not in this case. I means 3 years of McCains records were 1500 pages, for a healthy person. A hospital that treats a 1000 sick people a day, your talking moving millions of pieces of paper a day. So then your talking the need for a library, and librarians, fire suppression...
So while I agree old books, when unused, last longer. When used daily, for instance cash in constant circulation, lasts about 3 months.
Re:Post comments on article moderation goes down (Score:3, Insightful)
Aye. I was going to vote it down, but there's no "Piss Poor Grammar/Spelling/Punctuation" option. Shame.
Let me see.... (Score:3, Insightful)
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.
Re:Nurse != Secretary (Score:4, Insightful)
Nurse != Secretary (Score:1)
I think this has more to do with Management not being able to properly bill insurance companies. Because profit is more important than human lives.
Re:Most records are worthless anyway (Score:5, Insightful)
it implies that the more technologically advanced an ancient culture was, the less evidence there will be that they ever existed.
Woah easy there cowboy. This "rule" only applies to historical data of the society, not general evidence. If my hard drive crashes or gets wiped, the drive itself, in its sturdy metal casing, will be around for many, many years to come. So no, L. Ron Hubbard remains a douche.
Re:Most records are worthless anyway (Score:4, Insightful)
I suspect that's a mirage, caused by only seeing the durable pieces of older cultures. We can see the Roman Colosseum. We cannot see, in most cases, the papyrus business contracts.
Some of our things, such as records, are very ephemeral. Others, such as satellites and nuclear waste, are very durable.
Re:It's Not Just Any Beaurocracy (Score:3, Insightful)
On some level, then, their operating practices and capacity (ER beds, staff, etc.) have been optimized to provide the service levels enabled by (relatively) low-friction electronic records access. One they fall back to paper records, apparently that becomes the friction point in their processes and their service delivery falls back to levels comparable to pre-EMR days. To a hospital administrator, that means wasted capacity (fewer patients seen, more idle ER facilities). To the staff, that means frustration because the switch-down from primary to backup records-keeping didn't come with an automatic switch-down from EMR-enabled service levels to paper-based service levels. During that ramp-down, the staff must have struggled to try to meet EMR-enabled service levels, because it sucks that paperwork is the only obstacle to seeing everyone. (Of course, if you give a rat's ass, it would suck to have to divert inbound cases because you ran out of any resource, but running short on administrative resources must really bite.)
While all these things are certainly true, and diverting inbounds because of any other resource shortage is no less necessary and no less likely, the phrase keeps going through my head: "The patient isn't getting better stuck on the ambulance in cross-town traffic."
In a real emergency they could still have treated patients
"Turning away ambulances" (used both in TFA and its source article) tells me they were diverting even truly emergent cases. Perhaps not. Hard to tell, without knowing the operation policies regarding their declaration of "diversion". But if they were truly overcommitment with their current caseload, I'd bet their policy would lean heavily towards "Even critical cases are better off diverted". (Correspondingly, reducing the risk of act-of-commision liability in really sub-optimal circumstances.)
ObDisclaimer: I am not a lawyer, so I'm talking out my ass about liability. I am not a hospital administrator, medical professional, or health system IT guy, so I'm just speculating about how things really happen behind the desks in the Emergency Department. I live nowhere near Indianapolis, so I don't even know the local rumors. I am not an operational analyst, and even if I were there's not enough detail here to make an informed analysis of the environment and the event.
Re:Nurse != Secretary (Score:5, Insightful)
Re:Most records are worthless anyway (Score:3, Insightful)
No, they kept them. Most of them are gone because their use has gone (like your bill) or the media has disintegrated. Its far easier to save and retrieve the info now.
There was a huge fire at some St Louis military building a couple of decades ago, and hundreds of thousands of records were lost. It caused a big headache for countless veterans, who needed copies of those records.
That can't happen today; there are multiple backups at multiple locations.
Re:It's Not Just Any Beaurocracy (Score:3, Insightful)
If you have an issue that could create serious problems if you were given the wrong drugs, etc., you should get a medic-alert bracelet or similar with the information.
Do you have a blood type other than AB positive, and if so, do you have this information on a medic-alert bracelet? There's information that you expect to have in advance (you're right, it doesn't amount to much), information you gather and have to make note of (I give him drug X, so don't give him drug Y, it won't mix, and by the way, he says he's diabetic), information that has to get to and from other parts of the hospital (uh yeah, his potassium was high when he came in, you might want to take him off that banana bag). We don't know what was happening in that ER, what challenges they worked their way through for a day, how many people they turned away exactly between 1 A.M. and 3 A.M., or how badly they needed to be seen (I've had two ambulance rides and zero life-threatening medical emergencies myself). The same guy who blogged that this was "more about billing than patient care" without backing up that assertion in any way links to his own earlier post where he talks about what "an obvious slam dunk" Electronic Health Records are, because it will result in "tens of thousands of lives saved annually in the US alone". My point is that people (I don't mean people like yourself who make sensible points, swillden) who don't know the story - and you still don't when you RTFA - shouldn't be going "OMG! You turn amboolance away 2 catch up on teh paperwork? Me know wuld hav dun that!" should remember the old adage "Nothing's impossible for the man who doesn't have to do it himself."
Workflow (Score:4, Insightful)
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."
Re:IT Kills When In Hospitals (Score:3, Insightful)
"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.
Comment removed (Score:3, Insightful)
Re:Nurse != Secretary (Score:3, Insightful)
Obviously this will present docters with patients without medical records. But better to be treated a bit worse than not at all.
Ya, until you go back to the hosipital and the next doctor on staff doesn't know the dosage of medication you were put on, and gives you something that shouldn't be combined with the previous medication.
Paperwork (Score:3, Insightful)
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.
Re:Nurse != Secretary (Score:2, Insightful)
Until you find out your medical records are locked in county generals drm formatand in order tottansfer them you have to wait until Tuesday,when they will be printed and sent by secure carrier to siad hosiptal because of hippa.
Of course thedoctors at theorher end will have to start over anyways however they can't tell you that.
Re:Nurse != Secretary (Score:1, Insightful)
The necessity of record keeping for safe patient care was probably the biggest issue for these guys. Without a smoothly operating record keeping system in place it is extremely easy to over or under dose a patient and kill them. Note the word smoothly. They obviously failed over to another non-electronic system and used it for several hours, but if it was unable to handle the load then there would be potential for serious errors to start occurring.
Also note that there are legal requirements for medical record keeping. If they were getting overwhelmed and information was being lost then they would not only be breaking ethical guidelines but legal ones as well.
Still, it is disturbing that their backup plan failed. Hospitals are usually very good about testing and drilling on these procedures.
Re:Nurse != Secretary (Score:3, Insightful)
Re:Welcome to the paperless office (Score:2, Insightful)
Re:More-words answer. (Score:5, Insightful)
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.
Re:Nurse != Secretary (Score:5, Insightful)
Re:they don't (Score:4, Insightful)
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.
Re:Nurse != Secretary (Score:5, Insightful)
Actually how about eliminating the problem itself ? If the paperwork is overwhelming, with a reasonable minimum workforce present in the hospital, the government (the recipient of said paperwork),
I work for a non-profit healthcare provider, where 94% of our patients are below 200% of the Federal Poverty Level. Most of *our* paperwork does go to the government... the County as part of the Public-Private Partnership fund, the State as part of OAPP, the Feds as part of our FQHC billing, etc. (Only about 17% of our patients even have Medicaid or Medicare). A lot of that paperwork also goes to our private funders; foundations and corporations that donate to specific programs and then expect us to report on our results.
But for most hospitals and doctor's offices, most of that paperwork is for billing private insurance companies. A fraction is for billing public insurance for those without private. Some is sent straight to the patient. A lot is for accreditation and patient records, too (and The Joint Commission is a private, non-profit entity... they are who is usually accrediting hospitals and ambulatory care).
needs to accept the fact that there isn't any paperwork, and foot the bill anyway.
As mentioned above, they're not generally footing the bill.
Obviously this will present docters with patients without medical records. But better to be treated a bit worse than not at all.
It's not "a bit worse." Incomplete or inaccurate medical records kill thousands of people every year, and many more suffer permanent or temporary injury as a result. Giving me or my son certain common antibiotics via IV can kill me. Medical records are EXTREMELY important, because people are very different from each other.
Obviously any sort of national healthcare system will preclude having this common-sense approach, as any system that does not make it the responsibility of the patient to ensure medical bills are paid will ration health care ("total health care resources" are limited. Either you let people pay for them, or you ration them). Rationed health care means "no government approval, no healthcare" both in theory and in practice.
I really don't know where this keeps coming from. Obviously, just like every private insurance company in creation, a government-run health plan would also decide what was worth the money and what wasn't. This does not currently and could not in the future prevent people from paying out of pocket if they think it's worth it. I'm not sure how people get from "government provides health care" to "government prohibits the purchase of health care by private entities."
It is very true that, when confronted with the incredible costs of certain treatments and medications that are declined for coverage, people find themselves unable or unwilling to pay. It's therefore unlikely that people will just pay out-of-pocket for those services which are not covered. This does not mean they are prevented from doing so by legislation; it simply means that the person footing the bill is likely to weigh the situation differently.
[wtf is up with /. formatting today? I've tried everything to put line breaks in the right places, but it keeps running paragraphs together anyway. Bah.]
Your floppy is not a good example (Score:5, Insightful)
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.
Re:More-words answer. (Score:3, Insightful)
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.
Re:Nurse != Secretary (Score:4, Insightful)
Take that up with your HMO, then. Bureaucrats are running healthcare RIGHT NOW, except with hardly anyone to answer to, and a mandate that runs counter to what their customers (businesses) and suppliers (doctors) actually want.
Speaking as someone who has worked as a provider in for-profit healthcare, I'll take a government bureaucrat over a corporate bureaucrat any day. If it's like the DMV (the canonical example) it would be the choice between someone who doesn't give a crap whether I get what I want, versus someone who has a vested interest in my not getting what I want.
There were as many people in the billing and finance department as there were in the clinical staff. If you count the billing and finance people up the chain, there were far more bureaucrats than healthcare providers involved in my clients' care.
Re:they don't (Score:3, Insightful)
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.
Re:A one word answer (Score:3, Insightful)
yup. You can't depend on a patient to tell you everything in their chart. You are supposed to read their chart. My cousin is an orthopedic surgeon in a trauma center and we've had this conversation. It's not just for liability, it's for the patients own good, the exception being if they are in critical danger and need immediate attention. Without the chart they can inadvertently kill you simply by picking the wrong meds.
It's true they don't want to be sued but the big danger is accidentally killing you.
-Viz
Re:Nurse != Secretary (Score:3, Insightful)
If you can get to an ER in less time then the Ambulance would take to arrive you are ahead of the game anyhow.
That's typically true no matter where you live. Emergency response times suck universally.
If you can safely move the person you call 911 and start driving. The ambulance can meat you halfway if things are that bad.
Re:Nurse != Secretary (Score:3, Insightful)
Just wanted to note that maybe a critical health-care setting is one of those places where "this is diverging from my script -- let's see what happens if I do $THIS" could be a bad bad move. Caution when using any unfamiliar systems seems like a positive characteristic for nurses and doctors -- and we all know that the most dangerous user is the one with the knowledge to truly screw up but without the wisdom not to.
The other thing about computers in medical settings... it increases dependence on computers for basic actions. When I went to college, this was a big issue in the school of pharmacy. Pharmacists learn to depend on the computer to check for drug interactions, contraindications, etc. Full computerization of records actually *increased* medication incidents industry-wide -- the conclusion at the time was the reduced vigilance was the problem. This was likely exacerbated by the increased workload of pharmacists during the late 80s and 90s as well, so it's hard to sort out the primary causes, and I don't know if the industry found a good solution... but I think it's a pretty natural tendency for people to get intellectually lazy when they have a system built to do some of their 'thinking' for them.