Criminal Matter for the Attorney General of NY? NYC’s $764M Medical Records System Will Lead to ‘Patient Death’: Insiders

Lambert here: I’d be interested to hear if readers have similar experiences with Electronic Health Records — especially readers from the New York area.

By InformaticsMD. Originally published at Health Care Renewal.

I believe the suffering and death of my mother in 2010-2011 due to EHR flaws – including but not limited to lack of essential confirmation dialogs on medication deletion at triage, lack of notification messages informing down-line staff of such action by unqualified personnel (inadequate support of teamwork), and other issues – lends me some moral standing to comment on the following as a horrifying and potentially criminal matter.  (See http://khn.org/news/scot-silverstein-health-information-technology/).

Two back-to-back articles appeared in the New York Post:

NYC’s $764M medical records system will lead to ‘patient death’: insiders
By Michael Gartland
March 15, 2016
http://nypost.com/2016/03/15/nycs-764m-medical-records-system-will-lead-to-patient-death-insiders/

and

Hospital exec [CMIO] quits, compares $764M upgrade to Challenger disaster
By Michael Gartland
March 16, 2016
http://nypost.com/2016/03/16/hospital-exec-quits-compares-764m-upgrade-to-challenger-disaster/ 

It is well-known and indisputable that this technology can and does injure and kill, especially when poorly designed, defective, poorly implemented, or all of the above.  See for instance the ECRI EHR risk Deep Dive study results at http://hcrenewal.blogspot.com/2013/02/peering-underneath-icebergs-water-level.html.

Any official in leadership of health IT who denies this – or sidesteps it – or makes excuses for compromises on health IT safety, especially in view of dire warnings from clinician experts – in 2016 is guilty of conduct of the type below:

http://www.legalmatch.com/law-library/article/criminal-negligence-laws.html

What is Criminal Negligence?

Under some criminal law statutes, criminal negligence is defined as any type of conduct that “grossly deviates” from normal, reasonable standards of an ordinary person.  It generally involves an indifference or disregard for human life or for the safety of people.  Sometimes the definition for criminal negligence also requires a failure to recognize unjustifiable risks associated with the conduct.

Examples of criminally negligent behavior may include knowingly allowing a child to be in very dangerous conditions, or driving in an extremely irresponsible way.  Criminal negligence is less serious than intentional or reckless conduct.  Generally, reckless conduct involves a knowing disregard of risks, while negligence involves an unawareness of the risks.

The two articles reflect a good possibility that the politics of what I’d once termed “cybernetics über alles” has trumped patient safety concerns in NYC.

Here’s details from the first article:

A new $764 million medical records system is launching at the municipal hospital system on April 2 — even though insiders warn it isn’t ready and patients will suffer.

The soft launch of the electronic system Epic is scheduled at Elmhurst and Queens hospitals.

“Sooner or later, it will crash,” said one source involved in the project. “There will be patient harm — patient harm and patient death.”

That sounds like insiders warning of far more problems than mere crashes causing patient harm and death, a brave act considering possible retaliation.

I wonder if the users of this EPIC system are having imposed on them the speech and though controls imposed on users at University of Arizona (see my Oct. 3, 2013 post “Words that Work: Singing Only Positive – And Often Unsubstantiated – EHR Praise As ‘Advised’ At The University Of Arizona Health Network” at http://hcrenewal.blogspot.com/2013/10/words-that-work-singing-only-positive.html).

Sources say Dr. Ramanathan Raju, who runs the municipal network, NYC Health + Hospitals, is under the gun from City Hall to meet the deadline and fears he’ll be fired if he doesn’t.

“Raju has said too many times to count that the Mayor’s Office has told him if April 1st doesn’t happen, then Ram will lose his job,” one source said.

The source added that Raju has threatened to fire top executives if the project doesn’t launch on time.

If this is true, than the “gun” from City Hall is aimed straight at patients, and if patients indeed are mortally affected, the responsible officials might be deemed accessories to murder.

I add that this type of situation represents fundamental and severe mismanagement, as I’d been writing about since the late 1990’s at my academic site “Contemporary Issues in Medical Informatics: Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties” at http://cci.drexel.edu/faculty/ssilverstein/cases/.

The hospital system is already on City Hall’s watch list, having required a $337 million bailout in January to stay afloat. 

Money for EHR’s grows on trees.

Note other hospitals where EHR implementations led to financial disaster (e.g., http://hcrenewal.blogspot.com/2014/06/in-fixing-those-9553-ehr-issues.html, http://hcrenewal.blogspot.com/2013/05/clouded-visionary-leadership-wake.html, http://hcrenewal.blogspot.com/2013/06/want-to-help-hospital-go-bankrupt-get.html, http://hcrenewal.blogspot.com/2014/06/100-million-epic-install-dampens.html as examples).

Insiders contend that the only safe way to roll out Epic is to take more time — about three months — to address several key issues.

One is planning for a crash, which some consider almost inevitable because the new setup hasn’t been configured to work with systems at other hospitals or with some of its own internal billing and tracking software.

Existing patient data also has to be transferred from the old system — a process that would normally take six months, but which was shoehorned into less than one.

Going “live” with a half-baked EHR under such circumstances for political reasons, if these facts are true, would be, in my professional opinion, an act worthy of prison time if harm results.

“There are supposed to be all these dry runs,” a source said. “They haven’t been done.”

Again, if true, this reflects expediency at the expense of patient well-being, by rows of political hacks, fools and incompetents calling the shots in an area in which they have no business being involved.

City officials contend Epic remains “on-time and within budget.”

I have a feeling this will be revisited at some time in the future – in court.

A mayoral spokeswoman said there would be a round-the-clock effort to ensure there are no glitches. 

“No glitches?” 

That is a hollow promise that cannot be kept even under the best of circumstances.  Under the hellish circumstances described, such a statement is outright frightening. The Mayor truly has no clue about EHR “glitches”, but I offer the many posts at query link http://hcrenewal.blogspot.com/search/label/glitch for his education.

Mr. Mayor, here’s an example of EPIC and other EHR implementations under the best of circumstances.  These systems are so immensely complex, trying to be pressure-fit into a vastly complex, varying and changing environment, that to not heed CMIO and other expert warnings is the height of recklessness:

Of course, we are reassured that the crack team assigned the implementation duties will produce stellar results:

“NYC Health + Hospitals and its Epic implementation experts are prepared to implement the new system in Queens facilities beginning April 2, and have assembled a team of about 900 technicians and Epic experts who will work around-the-clock that week both in Queens and at remote data centers to ensure the transition to the new system goes as smoothly as possible,” said spokeswoman Ishanee Parikh.

EPIC experts like these?  From this link at the “Histalk” site on staffing of health IT projects, Aug. 16, 2010. Emphases mine:

Epic Staffing Guide 

A reader sent over a copy of the staffing guide that Epic provides to its customers. I thought it was interesting, first and foremost in that Epic is so specific in its implementation plan that it sends customers an 18-page document on how staff their part of the project. 

Epic emphasizes that many hospitals can staff their projects internally, choosing people who know the organization. However, they emphasize choosing the best and brightest, not those with time to spare. Epic advocates the same approach it takes in its own hiring: don’t worry about relevant experience, choose people with the right traits, qualities, and skills, they say. 

The guide suggests hiring recent college graduates for analyst roles. Ability is more important than experience, it says. That includes reviewing a candidate’s college GPA and standardized test scores

I bet many readers were taught by their HR departments to do behavioral interviewing, i.e. “Tell me about a time when you …” Epic says that’s crap, suggesting instead that candidates be given scenarios and asked how they would respond. They also say that interviews are not predictive of work quality since some people just interview well. 

Don’t just hire the agreeable candidate, the guide says, since it may take someone annoying to push a project along or to ask the hard but important questions that all the suck-ups will avoid. 

Epic likes giving candidates tests, particularly those of the logic variety.

The part about “not worrying about relevant experience” and about “hiring recent college graduates as HIT project analysts” is bizarre if true, and downright frightening.

Medical environments and clinical affairs are not playgrounds for novices, no matter how “smart” their grades and test scores show them to be. These practices as described, in my view, represent faulty and dangerous advice on first principles.  The advice also is at odds with the taxonomy of skills published by the Office of the National Coordinator I outlined at the post “ONC Defines a Taxonomy of Robust Healthcare IT Leadership.”

The second NY Post article cited above is even more dire:

A senior official was so worried a new $764 million medical records system for the municipal hospital system was launching too early that he resigned, comparing it to the disastrous space shuttle Challenger launch in 1986.

In a “resignation and thank-you” email last week, Dr. Charles Perry urged colleagues at NYC Health + Hospitals — formerly the Health and Hospitals Corp. — to sound the alarm and press for an “external review” to stop the system from going live next month.

Perry was chief medical information officer of Queens and Elmhurst Hospital Centers, the first scheduled to get the new electronic medical data system.

When a CMIO – a role I held in the mid 1990s –  resigns under such circumstances, a project should be halted in its tracks and external examination begun.  Instead, it appears we have spin control.

In his email, Perry offered a comparison to the launch of the Challenger — aboard which seven crew members died when it exploded 73 seconds after liftoff on Jan. 28, 1986 — and cited a presidential panel’s report examining how the disaster occurred.

That is as dire and direct a warning as they come.  Unqualified individuals who second guess such a warning should be held legally accountable for adverse outcomes.

(Such a warning letter about EHRs now sits as “Exhibit A” in the lawsuit complaint regarding my dead mother.  It had not been heeded.)

“For a successful technology, ­reality must take precedence over public relations, for nature cannot be fooled,” Perry wrote in his ­email, quoting from the report.

But fools in leadership roles in health IT think they can fool Mother Nature.

Perry went on to urge a short delay despite “vehement entreaties to make the April 1st date by officials and consultants with jobs and paydays on the line.”

This is exactly how patients end up maimed and dead.

Agency president Dr. Ramanathan Raju has repeatedly told colleagues his job is on the line if the deadline isn’t met, sources said.

Perry, a medical doctor with an MBA, declined to comment.

Maybe Raju should quit, too.  He should know that Discovery over such matters would not be very pleasant, especially if I am assisting attorneys in such matters – which could very well occur.

“He [Perry] took a stand,” said one insider. “He wasn’t going to take part in something that was going to compromise patient safety.”

It’s good to know someone in Medical Informatics still has balls.

The idea that we’d jeopardize patients to meet a deadline is simply wrong,” said Karen Hinton, Mayor Bill de Blasio’s spokeswoman.

“If a patient safety issue is identified, the project will stop until it is addressed.

“NYC Health + Hospitals and its Epic implementation experts have assembled a team of about 900 technicians and Epic experts who will work around the clock through the week surrounding the transition in both Queens and at remote data centers to ensure we shift to the new system as smoothly as possible.”

It’s been said that one expert who truly know what they’re doing will always outperform 1,000 (or 900) generalists following the finest of “process” who are in over their heads (to wit, 900 generic musicians could never exceed the work of Beethoven or Brahms).

In this matter, I take the CMIO’s word over the 900 techies and “experts”, once having voiced such concerns myself.

— SS

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About Lambert Strether

Lambert Strether has been blogging, managing online communities, and doing system administration 24/7 since 2003, in Drupal and WordPress. Besides political economy and the political scene, he blogs about rhetoric, software engineering, permaculture, history, literature, local politics, international travel, food, and fixing stuff around the house. The nom de plume “Lambert Strether” comes from Henry James’s The Ambassadors: “Live all you can. It’s a mistake not to.” You can follow him on Twitter at @lambertstrether. http://www.correntewire.com

31 comments

  1. Juneau

    Epic has been in use for some time at certain other hospitals in NYC. The VA has been on EHR for 2 decades with a different system….wonder what their crash rate is on the taxpayer dime. I have seen that EHR generates more paper than a paper chart. No question. It is the only way to deal with the possibility of a crash-print out the chart. Every shift print out a part of it for nursing report, physician rounds, etc…hopefully sensible administrators will allow hard copy backups during the transition.

    1. run75441

      Or they can “pilot run it. Or phase it in one department at a time to minimize risk. The VA is on Vista.

  2. DakotabornKansan

    Suffering and death due to EHR flaws …

    Yes, there is something very wrong with this.

    I recall my own idealistic notions of how health care should be practiced when I first began my career.

    Much later I knew a technophile physician who prided himself on never having to spend more than 90 seconds at the bedside because he was an enthusiast of the superiority of electronic data and information systems. He had been seduced by the idea that medicine is nothing but reading data. His time was spent on a keyboard doing mouse clicks rather than interacting with his patients and their nurses.

    Nurses used to spend most of their time directly interacting with patients at the bedside. It has been my observation that EHRs have become a highly intrusive burden on hospital nurses delivering patient care. More and more of their time is also spent on keyboards doing mouse clicks rather than interacting with their patients, negatively impacting communications between nurses and patients and their physicians.

    My late wife’s and son’s catastrophic illnesses were the beginnings of our own journey through our health care system and it was indeed a learning experience for us. It drove home the importance of respect and dignity, empathy and compassion. People will forget what you said, what you did, but they will never forget how you made them feel. Wherever there is a human being, there is an opportunity for kindness. All too often we encountered health care’s bad habit of dehumanizing patients.

    So have EHRs actually resulted in better patient care? IMHO heath care has been converted from a healing occupation into a corporate, industrialized process run by technicians, de-professionalizing physicians and nurses and far worse, depersonalizing patients. The Fat Man [the irreverent, yet wise and compassionate resident in Samuel Shem’s The House of God] loses to this technologically driven world of modern health care.

  3. diptherio

    So the librul mayor and his spokescreature claim that they are better able to assess the risks of making this switch than one of the medical doctors in charge of implementing the program?

    Records aren’t cross-compatible, tests haven’t been run. People have been vocal about the problems but the Mayor claims to have never heard of them, or that the problems are fabricated. What other explanation is there? The Mayor’s office is calling Perry a liar.

    Meanwhile Ram goes around saying he’s fired if this doesn’t happen now, so it has to happen…Iron law of institutions on full display. “I don’t care if every patient in this city dies, I’m not losing my job!!!” I hope for his sake that he’s investing in a personal security detail…

  4. diptherio

    So I guess, on a practical note, this means that everyone should probably keep a hard copy of their medical records on their person at all times, just to be safe :-/

    1. Procopius

      … keep a hard copy …

      You can’t. You’re not authorized access to the records. Unauthorized copying of the data is a felony and will be prosecuted.

  5. ke

    All complex problems are symptoms of simple problems ignored. You simply are not going to beat natural birth, breastfeeding, and free associative playing with c sections, formula and organized play for synaptic response, and no simulated intelligence program for equal rights is going to change that, but the apes will sell. What choice do they have?

  6. Jack Heape

    In my own personal experience the VA EHR system has worked fine. I have never experienced lost records, or any sort of misdiagnosis or Rx falling through the cracks, etc. You can access your records online and print out (or save as a pdf) all of your records. There is even a secure messaging system which I use to routinely contact my Doctors and staff. Right now the VA is under the gun to upgrade their system to be compatible with the DOD. That was supposed to happen this year and will likely not happen until 2018. So far they have spent over a billion dollars trying to make this happen. But remember, it isn’t just health IT that has huge problems. The IRS can’t get their system updated. Ditto for the FAA flight traffic system. How about the Healthcare.gov website which has been discussed at length here? One of the big problems with IT Systems in the US, particularly in regard to the government, is there has never been any over riding authority to bring or keep the systems into line so that they operate with the same structure. The federal government spent $76 billion on IT projects in 2014 and three quarters of that went towards maintaining archaic and outdated systems. Besides the “lowest bidder” mentality, you have the turf wars and competing interests of all the different departments and officials. Never mind the political considerations.

    1. run75441

      Same here on the VA.

      “there has never been any over riding authority to bring or keep the systems into line so that they operate with the same structure.”

      I might add everyone tries to design the system differently so there is no commonality and connecting one to another is difficult. Seen it enough times at multi-billion dollar corporations.

    2. Lambert Strether Post author

      The VA system works because they haven’t rewritten their MUMPS code to use, say, node.js. A lot of the systems that are running are old, but that’s also because they were actually engineered.

  7. Norb

    The problem with US health care is citizens have been successfully conditioned to see themselves as consumers first and foremost. Anecdotal evidence abounds illustrating customers/patients cannot see past the hotel like atmosphere that is currently being implemented throughout the healthcare system. The stress is on customer satisfaction- the demand of hospital employees to adopt the “customer is always right” attitude and to focus on hospital “experience” instead of demanding quality healthcare treatment for patients. The updated technology in most of its forms has little to do with improving patient care. It is implemented to increase profits.

    Until people demand to be seen as patients and not customers, the downhill slide will continue. It will be a tall order because when asked, most people still think the US has exceptional healthcare. They don’t see or understand the rot that is festering below the shiny surface of our healthcare system.

    Many people are feeling the economic pain firsthand of our distorted system. They will soon discover how the system is being hollowed out of caring and competent health professionals- the professionals who put patient care first are the ones targeted for removal from the system, and that is the greatest tragedy.

    1. Procopius

      … citizens have been successfully conditioned to see themselves as consumers first and foremost.

      I disagree. It’s not the citizens who have been conned this way, it’s the people who have authority to direct the money. Sometimes it’s not even about stealing the money, although it usually is. In the last seven and a half years the main strategy of the Republican Party was to prevent the Democrats, and especially the President, from accomplishing anything. If they couldn’t prevent it from being accomplished then the fallback was to make sure it was damaged so it couldn’t work as intended. Most of the time you don’t have any choice about what hospital you go to. Who cares if it’s “hotel-like” or not? That diversion of money to the pockets of scam “designers” is done by the administrators because it makes them look good to the wealthy donors who will be hiring them in the future.

  8. Wade Riddick

    Shifting software from a product to a service decades ago definitely helped companies selling software with their liability but it hasn’t really helped product quality, has it? Users are stuck with North Korean gangs hacking their email and Chinese conmen in Philippine casinos pilfering Bangladeshi central bank accounts.

    All of this would be much easier to handle if you penalized the people actually responsible for security design and stability. It’s a basic issue of moral hazard run amuck in a responsibility-free zone. Users are in the least advantageous position for managing these risks and yet it’s been dropped in our laps.

    In many ways, this is the same economic problem you see with medicine itself. There is no Edwards Demming-style quality control, either in most software design or in actual medical care. Toyota has a good auditing system for catching manufacturing flaws. You don’t really see that in medicine itself. The same guy guiding treatment is often the same one who made the diagnosis. Imagine if a bank made their chief loan officer the chief auditor too (and called it “synergy”).

    There’s no auditing on diagnosis. There’s no data gathering on treatment efficacy – especially *cost*-efficiency. We do permit marketers to gather data from pharmacies, but that’s purely for corporate profit margins. I wonder who’s blocking the same data gathering from being applied to find out if their drugs are unnecessary?

    Given that rent-seeking is rife in big medicine, I wouldn’t be surprised if software contracts/purchasing had more to do with accounting gimmickry than actual functionality of the product.

  9. Bubba_Gump

    EPIC is used by all of the hospitals in my area and by some of the healthcare providers I’ve used over the past ten or so years: Inova, Virginia Hospital Center, Johns Hopkins, Sentara, Kaiser Permanente. They are the de facto standard. As a patient I’ve not observed any issues related to this system, and it seems to work well from what I’ve experienced in an unfortunately large number of hospital encounters.

    I’m not defending the significant downsides of EHR and I’m not in favor of them being used primarily as mechanisms for billing over care, but from a safety standpoint I don’t think there’s a fundamental safety issue with EPIC as long as the implementation is done properly.

    1. Yves Smith

      The plural of anecdote is not data.

      I suggest you read Health Care Renewal’s extensive work on this topic.

      EHRs are designed with billing as their top and arguably only concern, not patient care.

      A post at NC:

      Health Care Information Technology: A Danger to Physicians and to Your Health. Key section:

      ECRI did an earlier deep dive on the health care information technology issue in 2012,. †he results were not pretty. The Institute found 171 technology-induced problems were reported in 9 weeks by 36 “facilities,” which were mainly hospitals. Eight of the incidents resulted in harm to the patient and three may have contributed to deaths.

      Health Care Renewal gave a back-of-the-envelope calculation as to how to extrapolate these results to the US as a whole:

      I note that’s 36 of 5,724 hospital in the U.S. per data from the American Hospital Association (link), or appx. 0.6 %. A very crude correction factor in extrapolation would be about x 159 on the hospital count issue alone, not including the effects of the voluntary nature of the study, of non-hospital EHR users, etc. Extrapolating from 9 week to a year, the figure becomes about x 1000. Accounting for the voluntary nature of the reporting (5% of cases per Koppel), the corrective figure approaches x20,000. Extrapolation of course would be less crude if # total beds, degree of participant EHR implementation/use, and numerous other factors were known, but the present reported numbers are a cause for concern

      From a search of the Health Care Renewal posts cross-posted at NC:

      Electronic Health Record Vendors Use Gag Clauses to Hide Lethal Bugs in the IT Systems They Sell

      There was a survey that Health Care Renewal featured that I am unable to find that listed EHRs as among the very top risks to patient ssafety at hospitals.

      And see this comment later in the thread from a doctor on his experience with EHRs. Key statement:

      It is often impossible to grasp what a clinician was actually thinking when they evaluated a sick person seeking care.

    2. m

      EPIC and Cerner are the two big players, sadly they are trying to get the VA to use their overpriced, clunky systems. Here are a few things I have seen during roll outs:
      The people that are there to assist staff (from the EHR companies) during the roll out really don’t know what they are doing, many times questions had to been sent to the programmers and were not addressed in a timely manner. Remember time is valuable in healthcare.
      The programs are difficult to use, so hospitals often take on extra staff during roll outs, so actual patient care is done. And yes, hospitals push happy, happy so as a patient you will never see the frustration.
      Take lab draws-a patient/lab sticker will print out with bar code, many times the two systems do not work well together, stickers print at wrong time, print once so if a repeat print is needed the order must be resubmitted. Wasted time.
      The charting is difficult as free text which is quick is not allowed, people are forced to use check boxes. It takes time to locate the correct box.
      Electronic scripts which are send and systems not compatible, huge problem. Some pharmacies were refusing E scripts till glitches were fixed. Huge problem especially in pedi/chemo where numbers really matter. Don’t worry though cause major chains are adopting these over priced programs.
      Then of course the crashes, then back to paper back up. System comes back up and all that data must be put in.
      Roll outs are hectic. Try not to be a patient till long after.

  10. Anonymous

    It would be very to prosecute or blame anyone in the healthcare IT field because it’s a fragmented, byzantine world of various vendors and local regulations operating on a very fragile interoperability. I implement alot of custom programming and logic on behalf of my clients’ various wishes and requests. Any changes I make can possibly break an IT system downstream. I also make alot of adjustments and modifications when an upstream change somewhere “breaks” our client’s implementation.

    And speaking as someone who implements new software features (such as the “essential confirmation dialogs” mentioned in this article) because our customers want as to, I’d rather say “no” most of the time. I am still forced to because the client will then go up the chain or to sales (who is trying to sell them a new product) and threaten to cancel their business otherwise. My company usually isn’t paid more for a new feature because the original contract was signed a long time ago. Yet, we may end up taking on liability if that feature fails.

    1. S Silverstein

      Even a ten year old can grasp why a confirmation dialog about medication deletion might be essential in medicine. Bad health IT is common.

      Bad Health IT is ill-suited to purpose, hard to use, unreliable, loses data or provides incorrect data, is difficult and/or prohibitively expensive to customize to the needs of different medical specialists and subspecialists, causes cognitive overload, slows rather than facilitates users, lacks appropriate alerts, creates the need for hypervigilance (i.e., towards avoiding IT-related mishaps) that increases stress, is lacking in security, lacks evidentiary soundness, compromises patient privacy or otherwise demonstrates suboptimal design and/or implementation. (Silverstein/Patrick)

  11. Ronbert

    EPIC is used by all the hospitals in my area. What I most like about it is the online availability of medical records and patient data to the patient.

  12. sd

    Not exactly related…but perhaps close enough. At one point I had to undergo repeated MRI tests at a good sized hospital for my head. It’s unpleasant. A helmet with a brace is secured around your head so that it is held perfectly still. And then you are strapped down with blocks onto the bed that then slides into the machine, head first.

    I’m claustrophobic when it comes to undergoing these tests so I take a specific dose of a sedative 45 minutes prior.

    I hadn’t had to undergo an MRI in a couple of years. When I scheduled my appointment, I specifically included the information about the sedative (it’s not that uncommon) so that my appointment included the 45 minute wait for the sedative to kick in. When I got to the facility, they had installed a new records system since my last MRI and couldn’t access my medical records so they could not get to the information about dose and medication.

    Eventually, the med tech was able to access my records but she said it was in a very strange way and that what she eventually go to sounded like a photo of a paper record for billing that showed the dose/medication. It was not actually my medical records.

    The thing is, this was just one very small minor piece of information. It wasn’t life threatening. But this little piece of information was not available when it should have been.

  13. mdh

    I’m 67 y.o. and in a solo paper records “retirement ” practice. I’ve live through many introductions and fixes of EHRs (each worse and more expensive than the last) over the rears and knew some of the early clinician innovators for sane, pragmatic EHR designs (good ones). EHR is routinely a top down imposition on patient-oriented nurse/physician clinical culture. Aside from anything else, medical records now have a schizoid, shattered, unreadable/interpretable quality, disorganized and confusing, plagued by a kind of anti-prose. It is often impossible to grasp what a clinician was actually thinking when they evaluated a sick person seeking care.
    I believe this is happening to all professional/technical subcultures that rely on the human element as primary. I also don’t see how these “disruptions” can be made good even with reforms–long -developed social/human techniques and cultural standards as aides to clear thought, clear communication and humane, rational action simply don’t recover overnight after years of being torn apart. Like all other cultures, the scientific/medical culture was an acummulation of struggles towards improvement, now being parasitized and turning into a caricature of its former self.

  14. Synoia

    Same old story. Roll it out (complete with bugs) get the progress payment and fix it later.

    I made good money in the fix it later mode.

    The only time I was in control of the do it now mode we have a good plan, months early, and the users were totally surprised when they asked about possible outages during open enrollment and were told the migration was already complete.

  15. Left in Wisconsin

    Some background on Epic, the company: So in my town of government and university, Epic has become THE local employer of note. Our county is by far the fastest growing in the state and Epic is responsible for something like 25% of all new hires in the county. It has become difficult and expensive to fly in and out of the local airport because Epic consultants are on the road all the time and make up some staggering percentage of all airport users. Even though the Epic campus in 10 miles out of town, Epic has almost single-handed stimulated a huge boom in downtown living here, because they hire lots of young people and pay well.

    Epic hires several hundred new people every month. Virtually all are recent college grads with good quantitative and/or computer skills. (Local word of mouth is that a large number are Mormons, though I know several people who work there and none are.) Their MO is to weed non-compatible new hires out during the training period (3-6 months) and, after that, the typical career at Epic is on the order of 2-3 years, not because people get fired but because they quit, even though the jobs are by far the best paying around for kids of that age. It’s one of those work-all-day-and-all-night kind of places.

    Epic is one of the 2 or 3 big players in EHR but the industry is not standardized. Epic’s EHR system is renown for NOT being compatible with other systems. Many people who work at Epic are computer coders but the vast majority are client hand-holders/problem solvers, which is why they are on the road all the time. Not only that, but Epic has spawned a spin-off world of consulting companies, many started and staffed by former Epic employees, who do contract consulting on Epic EHR systems. Several of these are also located here in Madison.

    Epic is privately held and the founder, CEO and controlling shareholder, Judith Faulkner, who is in her 70s, recently put all her stock into a trust so that the company will be able to remain independent and privately held. She has also generated much good will here because she publicly broke with the state chamber of commerce (Wisconsin Manufacturers and Commerce) over their right wing agenda. She is a very private person but has apparently given big to at least some Democrats.

    Perhaps not surprisingly, one thing that one never hears locally is that EHR is anything other than awesome.

  16. Disturbed Voter

    EHR aren’t a panacea. Nothing is. I have been in the business almost 20 years now. Patient records are much more available now, though not perfect. You don’t want to know what patient records were like when they were on paper. Paper patient records were frequently “in transit” rather than lost, but still unavailable to another physician.

    Software is a 1/3rd phenomena. To do it quickly takes one third as much money and time as it does to do it right. So it is almost a universal human practice to get it out there, and fix it later … even with Microsoft Word.

    1. Procopius

      Well, that used to be public perception of Microsoft’s business model. Copy some program that seems to have future sales potential. Don’t do it well, do it fast. The .0 version is to find bugs. The .1 version is to try out the bug fixes. No smart person would buy any MS software until at least the x.3 revision. Then bring out a major upgrade, so users have no choice but to buy the whole damned thing. Same cycle. x.0 version is to have customers find bugs for you. Rinse and repeat. Eventually Office became pretty good. I think about 1995. Since then it’s all been about planned obsolescence.

  17. ginnie nyc

    I wonder if the tremendous urgency of the April 1 deadline for the HHC pilot in Queens is because of a delightful Andrew Cuomo project, DSRIP, or New York State Delivery System Reform Incentive Payment Program.

    I just last week received a notice from the state DOH that I (and everyone else on Medicaid) have been involuntarily enrolled in this marvelous program. All HHC hospitals are participating, two of the largest teaching hospitals (Mt. Sinai/Roosevelt/St. Lukes/Beth Israel system and Columbia Presbyterian/New York Hospital/Weill Cornell system), and one newly-invented group that my cursory research showed to be very dodgy, Advocate Community Providers, Inc.

    To quote the endless missive: “The new program will help you, your doctors and other HC providers work together to better serve your HC needs. …These groups of providers are forming what is….a ‘Performing Provider System (PPS)’….To help the PPS assist you, NYS Medicaid, in compliance with state and federal laws, will share certain information with the PPS about your medical care…medical conditions, prescription drugs and visits to doctors.”

    Naturally, I had a lot of questions about this sca- , excuse me, arrangement. I called the toll-free number three times one afternoon; each time I was auto-transferred to a section of DOH that knew nothing about the implementation of the program in NYC. One question concerned the fact that my primary physician is employed by a hospital system not currently participating in this project. Does this mean it is pointless for me to be in DSRIP? Would I be forced to use only professionals and services who are in DSRIP? What are the special services the DSRIP provides that I currently don’t have?

    I did find out that this is yet another arm of the Obamacare octopus. There is meant to be a managed care aspect here, but it really looks to me that anyone on Medicaid that did not opt for the HMO version is being de facto dragooned into an HMO system.

    There is an opt-out, by phone or paper, which I will probably send in this week, certified, because I have been unable to get answers to my questions. It doesn’t pass the smell test to me. There is clearly a big monetary incentive from the state and feds for the city hospitals and privates participating to link up patient info (for better rent extraction), via the EPIC system. Their failure to meet unrealistic deadlines means beaucoup bucks will be lost.

    As Lambert is wont to say, “Kaching!”

    1. m

      There is a carrot and stick approach. The MDs and hospitals will start getting fined for not using these programs, reduced CMS reimbursement (on top of the other ways their reimbursement has been reduced, thank you Obamacare-30 day readmits & pt satisfaction scores). And the programs that assist in these huge purchases. After seeing data in charts I am reluctant to go to the doc, if I do I am not sure how much I will disclose.

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