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
Hospital exec [CMIO] quits, compares $764M upgrade to Challenger disaster
By Michael Gartland
March 16, 2016
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:
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.
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:
- Nov. 2013: “We’ve resolved 6,036 issues and have 3,517 open issues”: Extolling EPIC EHR Virtues at University of Arizona Health System, at http://hcrenewal.blogspot.com/2013/11/weve-resolved-6036-issues-and-have-3517.html
- June 2014: In Fixing Those 9,553 EHR “Issues”, Southern Arizona’s Largest Health Network is $28.5 Million In The Red, http://hcrenewal.blogspot.com/2014/06/in-fixing-those-9553-ehr-issues.html
- Oct. 2010: “Medical center has more than 6000 ‘issues’ with Cerner CPOE system in four months – has patient harm resulted?”, http://hcrenewal.blogspot.com/2010/10/medical-center-has-more-than-6000.html)
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.