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)
Re:Nurse != Secretary (Score:5, Interesting)
Secretaries are increasingly like computers.
If you find an old, pre-1950 dictionary and look up "computer", you'll find that it defines "computer" as a person who is employed to do maths. Thousands of computers were employed for the military, large corporations, etc doing ballistics calculations, statistical math, and the like.
There are fewer and fewer human secrtaries, as human secretaries are going the way of the human computer. Electronic computers are superceeding human secretaries just as they obsoleted human computers.
Re:Nurse != Secretary (Score:5, Funny)
Re:Nurse != Secretary (Score:4, Funny)
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But can you get it to bend over and pick up those files you dropped again...
Re:Nurse != Secretary (Score:5, Funny)
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call me when your computer can wear a tight skirt and make me a cup of coffee...
Ok, what's your number? [cyberpunkreview.com]
Coffee vending machines (Score:3, Informative)
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.
Re:Nurse != Secretary (Score:5, Funny)
Slashdot, Slashdot, home to so many misogynists :(
Really? I never saw him mention women once in that post. Which raises a far more disturbing thought...
Re:Nurse != Secretary (Score:5, Informative)
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.
Re:Nurse != Secretary (Score:5, Interesting)
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I work as IT support in the health care industry, for what it's worth.
Most of our nurses are competent, dedicated people who are very good at their jobs: caring for patients, following medical orders, and keeping records about visits. They are awesome people.
They are not, however, able to use a computer by and large. And that's a real shame, because the computer is one of the most vital and prevalent tools that they are called upon to use every day. They've just built their skills up elsewhere, and compu
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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
Re:Nurse != Secretary (Score:5, Insightful)
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The computer asks "Cancel or Allow?"
So, what you're saying is that a Mac isn't a computer?
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What happens when The Big One hits? Time for a stress test on hospitals now.
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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.
Just as we have multiple stores, some of them crap (Walmart), some mediocre (Sears, Penneys), and some of them excellent (Macys), we should have multiple choice in hospitals. Only when you have choice
Re:Nurse != Secretary (Score:5, Informative)
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.
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- 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
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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: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.
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...the government (the recipient of said paperwork)...
Really? My first thought was about the insurance companies and billing. Then I read the article (silly me!) and have come to the shaky conclusion (there's not much info in the article) that it's really just a matter of not having enough staff to manually write things down when the database goes down. Something everyone here should at least peripherally understand.
Sorry to step on your rant. BTW, how could you come to the conclusion that it's just the government and not the insurers that want access to
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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.
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Re:Nurse != Secretary (Score:5, Informative)
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.
Re:Nurse != Secretary (Score:5, Interesting)
My grandmother recently had her gallbladder removed and amusingly enough, the only 'electronic records' issues she had were the nurses who refused to provide things like IV's when they couldn't figure out how to scan the bar code off the bag so it could be tracked (and charged). They held up getting her one by about thirty minutes as they dithered around trying to pull their heads out of their asses and manually entered it into the system.
I absolutely guarantee you that a good portion of the 'paperwork overflow' weren't actual patient care records and were actually inventory control issues where the hospital was worried that an aspirin here or there might go unbilled.
Doctors and nurses know how to operate without electronic records. They know how to keep paper charts, while EHR's have the potential to make them more efficient but they aren't required for the job. Accounting, especially as detailed and 'cost controlled' as a hospital's, is a different story.
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.]
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I'm not sure how people get from "government provides health care" to "government prohibits the purchase of health care by private entities."
People get there because of restrictions in Canada and England that do effectively prohibit purchase of health care by private entities.
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http://www.guardian.co.uk/politics/2008/nov/05/alan-johnson-nhs-nice-reforms
And here is where it took a court case in Canada to change things.
http://pn.psychiatryonline.org/cgi/content/full/40/15/2
The government prohibited private purchases in both cases because it would be "unfair" for someone with the means to pay out of pocket to "jump the line" ahead of others and/or that letting physicians work outside the system would increase backlo
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:Nurse != Secretary (Score:5, Insightful)
As a former EMT (Score:5, Informative)
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Your statement about Methodists' incompetent management is valid. Every three year's or so they've had some terrible [google.com] safety [google.com] failures. Quality care is just not a priority for them.
This is not so much a story about electronic records as much as it is about Methodist keeping up it's infamous safety record.
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.
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.
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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.
Receipts have sure helped with Koine Greek (Score:3, Interesting)
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.
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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.
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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:Welcome to the paperless office (Score:5, Interesting)
"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."
Your old paperbacks are not good examples, as they were =intended= to have short-term durability and be more or less disposable -- similar to today's CDRs. A better comparison from a backup standpoint would be good quality hardbacks.
Here's a 5.25" floppy. It's less than 15 years old. I'd warrant not 1% of the people reading this post have the equipment required to read this once-common format -- assuming, of course, that the data on the disk is still readable, which is highly doubtful.
Conversely, I have here a book published in 1848. It's still perfectly readable to anyone with eyes, no other equipment required.
The problem really is how often one must upgrade the storage media, and how durable it is in the face of failure. Books can burn, but meanwhile they can be copied by anyone with pen and ink. Digital media requires matching hardware just to read it, another set of hardware to print it out, and rigidly regular backups to newer media forms as old ones age out and ultimately become unavailable.
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.
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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.
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Someone mod parent up. The way the medical-legal system has evolved now it's no longer practical to have a paper chart as the sole medical record.
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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 pa
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.
More-words answer. (Score:5, Informative)
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...
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>>>Vast amounts of documentation must be provided to Medicare/Medicaid and Insurance companies in order to get paid
Just imagine how much easier it would be if we simply paid cash, you know like our ancestors did prior to World War 2. Walk in; get your service; and hand-over the cash, check, or credit card. That's what I do today. I even get a 10% discount from my doctor since he says my approach makes his life much simpler.
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.
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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
Re:A one word answer (Score:5, Interesting)
The "computers were down" as the story was relayed. The surgeon called the family physician asking him about the medical history of the patient. The family doc (primary) asked what was wrong. The surgeon replied that the patient was in the waiting room, but since the EMR system was down, he didn't know anything about the patient. The primary responded with, "By any chance... Did you ask them?" to which the surgeon responded, "What?" The surgeon had a perfectly compus mentus patient, and didn't even bother to ask them a question because the EMR system was down.
Sometimes the lawyers don't even have to be involved for epic failure.
Re:A one word answer (Score:5, Informative)
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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
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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:Two Word Answer: Patient Safety (Score:5, Informative)
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.
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Not just lawyers - doctors.
Without paperwork, they don't know who is in the ER, who is being treated for what, who is allergic to what, who is waiting on what treatment, etc... etc...
There's a lot of data flowing around an ER, and the quality of the data (is the paperwork up to date) may mean the difference between life and death.
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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 o
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.
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Certainly... But turning away ambulances? They don't even know if it's just a bone that needs setting, a cut that needs stitching, or a similar condition. Triage, people!
Re:It's Not Just Any Beaurocracy (Score:5, Insightful)
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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
Re:It's Not Just Any Beaurocracy (Score:5, Informative)
"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.
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I assume they mean Methodist's main campus, since the lump IU in there as well.
If so, there are a couple other hospitals within a few minutes drive by ambulance. It was probably faster for the patient to just go there.
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In an ER, "paperwork" includes information on whether they'll kill you if they give you a certain drug or transfusion. Stuff like that.
In some cases that's true, but not usually. It's only true if they already have records for the patient, and if they have identified the patient, and if they have bothered to look it up. The first is often not true and in urgent care situations the second and third are not usually done. Not until the emergency situation is stabilized, anyway. 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 informat
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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 t
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Yeah cause they killed all kinds of people before 1990 when all they had was paper.
Yes, and they still do [medicalnewstoday.com]. And that's not despite a sweeping adoption of IT, it's partly due to a lack of one.
they don't (Score:2)
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.
Re:they don't (Score:5, Informative)
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: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:they don't (Score:5, Informative)
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.
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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 m
Re:they don't (Score:4, Informative)
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.
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.
Post comments on article moderation goes down (Score:4, Informative)
That headline makes no sense.
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Aye. I was going to vote it down, but there's no "Piss Poor Grammar/Spelling/Punctuation" option. Shame.
In need of a form cycle system (Score:5, Interesting)
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.
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The problem I see with that is how do you search for stuff exactly? Our system does that too for ER notes, but it can be difficult with how poorly people's handwriting can be.
the real reason (Score:2)
Not a huge deal (Score:5, Informative)
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.
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.
This will only get worse. (Score:2)
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 import
It's here! (Score:3, Funny)
I've been waiting for this news for years. Computers that perform fellatio? YES!
Imagine a beowulf cluster of those...
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.
IT Kills When In Hospitals (Score:2, Interesting)
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
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"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 hav
Patients turned away? (Score:4, Informative)
So what if the headline is worded funny (Score:4, Informative)
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.
Overflow in hospitals is actually quite common (Score:3, Informative)
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."
Comment removed (Score:3, Insightful)
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.
Patient Participation.. (Score:4, Informative)
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.