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Medicine IT

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."
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Hospital Turns Away Ambulances When Computers Go Down

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  • by FunkSoulBrother ( 140893 ) on Thursday June 04, 2009 @10:28AM (#28209361)

    That headline makes no sense.

  • More-words answer. (Score:5, Informative)

    by TrebleJunkie ( 208060 ) <ezahurak AT atlanticbb DOT net> on Thursday June 04, 2009 @10:31AM (#28209411) Homepage Journal

    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...

  • Not a huge deal (Score:5, Informative)

    by Mayhem178 ( 920970 ) on Thursday June 04, 2009 @10:35AM (#28209479)
    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.
  • Re:they don't (Score:5, Informative)

    by TheMeuge ( 645043 ) on Thursday June 04, 2009 @10:38AM (#28209523)

    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.

  • Re:A one word answer (Score:5, Informative)

    by TinBromide ( 921574 ) on Thursday June 04, 2009 @10:44AM (#28209623)
    The prevailing attitude in the medical industry is that unless patients are telling you where it hurts, they're lying. Doctors will tell you that patients are "forgetful" or possibly "confused about their past conditions and may not understand what was wrong with them". Their lawyers tell them that patients are drug addicts looking for the next narcotic hit or looking to sue them for a big fat malpractice settlement. If I say I'm allergic to iodine, but forget about an allergic reaction I had to antibiotics when I was 3, and they administer antibiotics, they're still on the hook if I decide to sue. "Look at my file! It says I'm allergic ot antibiotics! I said I was allergic, but he wasn't listening!"
  • by vantar ( 1123257 ) on Thursday June 04, 2009 @10:53AM (#28209757)
    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.
  • by davmoo ( 63521 ) on Thursday June 04, 2009 @10:56AM (#28209791)

    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.

  • by Tyrun ( 944761 ) on Thursday June 04, 2009 @10:58AM (#28209835)
    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
  • by maxume ( 22995 ) on Thursday June 04, 2009 @11:11AM (#28209975)

    There would be a Hoover dam (or Three Gorges dam), or a Chernobyl, or something, out there.

    If you think geologists, biologists and anthropologists have got it completely wrong I guess there is some chance that it all washed away. Absent that, 200,000 years isn't all that long a period of time.

  • by AlecC ( 512609 ) <> on Thursday June 04, 2009 @11:21AM (#28210133)

    Actually, secretaries are reverting to their original function, except that the job title has changed to Personal Assistant. A secret-ary was an assistant who was entrusted with your secrets (hence Secretary of State, Foreign Secretary). The job title that typists and data-entry staff should have had was "clerk" (if not typist or data-entry clerk). But secretary was more prestigious, and a good job title always helps keeping people satisfied with low pay. The people who were unable to perform their function in this hospital when the computers died were data-entry clerks.

  • by aukset ( 889860 ) on Thursday June 04, 2009 @11:32AM (#28210293) Journal

    "Turning away ambulances" is not how it really happens. Let me describe it for you:

    The hospital determines it is nearing its capacity to handle emergent cases. The hospital contacts the regional EMS dispatch to let them know. In my area, this is the county Fire Control. When an ambulance calls in that they have arrived on scene, the dispatcher will say, in this case, "Methodist Hospital is the only closed facility." The crew will let the patient know that they can't take them to that hospital. Also, when the crew calls dispatch for a clearance to transport the patient, if the hospital they are going to is closed, dispatch will tell them so (in NY, a patient can demand to be transported to even a closed hospital, but we do our best to convince them to go somewhere else). A hospital ED cannot turn away patients at the door, even if they come by ambulance.

    So what if its a truly life threatening situation that can't be stabilized in the field? Say, full cardiac arrest, or uncontrollable arterial bleed? The ambulance will go to the closest facility, even if that is the closed facility, and will not be turned away. The ambulance will contact the receiving hospital directly and give a report on route, giving the hospital time to clear an appropriate room and mobilize the necessary staff to receive the patient.

    Hospitals can close for a lot of reasons. Sometimes, a few staff members call in sick and they can't find coverage, so the capacity of the system is reduced. Sometimes a lot of patients come in all at once. Sometimes the hospital's support systems like EMR fail, but it could even be their admissions and billing system that decides to fail and causes the hospital to divert patients. It happens, but the system is designed to handle it.

  • by Judinous ( 1093945 ) on Thursday June 04, 2009 @11:33AM (#28210295)
    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.
  • by lionchild ( 581331 ) on Thursday June 04, 2009 @11:49AM (#28210531) Journal

    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.

  • by SanityInAnarchy ( 655584 ) <> on Thursday June 04, 2009 @11:54AM (#28210609) Journal

    Well, first of all, I'm not sure my medical records need to last a thousand years...

    But more importantly, this is completely irrelevant:

    magnetically-stored data (or even optically-stored data) degrades far faster than a paper copy.

    I assume you're either making some completely uninformed, Luddite claim, or you're talking about the physical media -- in which case, you're ignoring RAID, offsite backup, checksumming (and digital signatures), and other things that are very difficult/costly or even impossible to do with paper, and which make a properly managed digital copy much, much more durable than a paper copy.

    Now, on the other hand, it seems far easier for people to screw this up than with paper. Everyone understands paper, to a reasonable extent -- though as mcgrew points out, most of us probably forget that paper will degrade in 50 years or so. But when I say things like RAID, most people either have no idea what I'm talking about, or assume it has something to do with WoW or cockroaches.

    But this is more a sociological problem than a technical problem -- do it right, and there's no reason a digital copy can't outlast a print copy, and every reason a print copy can't outlast a digital one.

  • by _KiTA_ ( 241027 ) on Thursday June 04, 2009 @12:10PM (#28210865) Homepage

    call me when your computer can wear a tight skirt and make me a cup of coffee...

    Ok, what's your number? []

  • by Gilmoure ( 18428 ) on Thursday June 04, 2009 @12:16PM (#28210955) Journal

    I was an EMT and LPN in the Air Force, back in late 80's and worked 2 years in military and VA hospitals. While there were computerized records, the actual treatment notes stayed on a clipboard that was on the end of the patient's bed. Any pre-existing issues were also noted there.

    The dangers of treatment without prior records sounds pretty tenuous. I wonder if this has more to do with the dangers of not being able to bill 'accurately'? Nicest thing about working in a socialized medical system (military medicine is set up as such) was not having to worry about every nickel and dime. Doctors I spoke with liked it, even though they were paid a lot less than they would be in civilian practice. They didn't have to worry about office expenses, insurance, etc. and didn't have HMO's second guessing their work and suggesting cost-saving measures.

  • by tepples ( 727027 ) <{tepples} {at} {}> on Thursday June 04, 2009 @12:18PM (#28210981) Homepage Journal

    call me when your computer can wear a tight skirt


    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.

  • As a former EMT (Score:5, Informative)

    by drachenfyre ( 550754 ) on Thursday June 04, 2009 @12:53PM (#28211497) Homepage
    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.
  • by kenp2002 ( 545495 ) on Thursday June 04, 2009 @01:07PM (#28211703) Homepage Journal

    If a patient is immediate harm and in need of triage they take the paitient regardless. They don't even get to trying to pull meidcal records till they are in the door.

    I've worked and grew up in hospitals all my life with an RN for a mother, aunt, with brother in central services, maintinance, even a dental assistant. I grew up litterally at Saint Joseph's hospital in Saint Paul (Back when the nuns ran it).

    The majority of turn aways I have seen in my life (I still paint part time at hospitals and clinics), computer or otherwise, which many people do not understand, is transfer paitents.

    If a hospital has 40 beds lets say and they need to try and keep 5 beds open for intake at 39 paitients it may be necessary to transfer patients based on needs but are prefectly stable and not in immediate danger. For rural hospitals this is a must (some as few at 10 beds). If the system is down, they cannot process the transfer and pull the records. It is in the paitent's best interests to be returned to the original hospital. Without the transfer of information, no one at the new hospital would even know what is wrong with their new patient.

    In over 30 years I've never heard of a patient dying as a result of a down system. I HAVE see several cases where someone died as a result of not getting transferred to a specialist but not as the result of a computer failure.

    Specifically I remember a story of a patient that needed to be transfered to Rochester. (This may or may not have been Saint Joseph's, I got it from a Cardio doc when I was young) Due to his condition (I was not privvy to that mind you) he had to be air lifted. The problem was, weather. They waited 10 minutes to see if it was going to clear up. It only got worse and with hail they couldn't drive him there either. His family had to sit there with the staff and basically watch him die. They simply didn't have the equipment nor the surgeon needed apparently.

    Medical care is not a simple system and there are far more factors that no one can control. The creed "Do no harm" may mean sending patients back or not accepting them at all.

    At a level 1 Trauma center (say Region's Hospital) may have a requirement of having X number of beds open. They would likely transfer to Saint Joe's or Saint Johns. If Saint Johns filled while the patient was enroute then the ambluance might get bumped the the Woodbury hospital or bounced to St. Joes. They may also get bounced to HCMC. It all depends on the condition of the patient. Hug your HUC (Hospital Unit Corrdinator) and intake nurse and staff.

    Region's also has a better burn unit for recovery so it may be that a burn victim at St. John's might need to be transferred to Regions if they developed complications as they may be better equipped to handle the recovery.

    Patients can get moved around, showing up in an ambulance doesn't imply you are an fresh intake suffering from trauma.

  • by Ironica ( 124657 ) <> on Thursday June 04, 2009 @01:24PM (#28211899) Journal

    A monopoly, of any kind, is a bad idea. Imagine the DMV or Amtrak running your hospitals - no thanks. I prefer the freedom of choice where if I don't like Country General I can go visit St. Josephs instead. If they are crap I can to to John Hopkins or Mt. Sinai or any other place within driving difference.

    Unless the pain in your abdomen is so intense, you ARE GOING to the closest hospital no matter who runs them, because you don't know what's going on and whether you have time to go to the next one.

    We were in that situation about a year and a half ago. There's a Catholic Healthcare West hospital just a mile from our house. CHW played a large role in my cousin's death, and given all the lawsuits pending against them for their billing practices, I had vowed never to darken their door. But when my husband had a kidney stone (and we had no idea what was going on), and the next hospital was several more miles away, I took him to the closest ER anyway.

    That's why healthcare is a market failure. There is not perfect access, or anything even approaching it. You cannot make informed decisions based on quality of service and cost and all that when you think you might be dying. You'll go wherever's closest, no matter HOW badly they do their job, if you think that they're at least basically competent WRT lifesaving.

    BTW, JC Penney has much better quality than Macy's. You might try "Nordstrom" in that last slot.

  • by flablader ( 1258472 ) on Thursday June 04, 2009 @03:06PM (#28213401)
    If you had no idea what's going on, you call an ambulance; you do NOT drive someone to the hospital yourself. Here's why:
    - You don't know if whatever is happening is going to get worse and if it does, you don't have the equipment on hand to deal with it.
    - Not all hospitals are equal. The closest hospital may not be equipped to handle your emergency. My wife used to work in one such hospital and people have died because someone drove them in instead of calling an ambulance. Hospitals are rated by what kind of emergencies they can handle; some don't have a <insert specialist here> on call 24 hours a day...
    - You don't know the current wait time at the hospital, the EMTs in the ambulance do.
    - You can't communicate with the hospital to let them know what's coming, the EMTs in the ambulance can.
  • Re:they don't (Score:5, Informative)

    by TheMeuge ( 645043 ) on Thursday June 04, 2009 @03:43PM (#28213959)

    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.


    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.


    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. completely insensitive...

    Insensitive? The only thing I am insensitive to, is your own ignorance.

  • Re:they don't (Score:4, Informative)

    by TheMeuge ( 645043 ) on Thursday June 04, 2009 @05:25PM (#28215203)

    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.

What is algebra, exactly? Is it one of those three-cornered things? -- J.M. Barrie