A senior analyst at a technology group says that the data model
for an electronic health records system nearly killed him.
As Joseph Bugajski struggled to breathe, doctors in the US asked
him repeatedly for the same information, failed to update his
e-records in time and were unable to access critical information on
paper.
He spent 28 hours in an intensive care unit, attached to
networked monitors which sounded alarms nobody responded to. He
praises a "heroic" nurse in intensive care who spent more than an
hour "searching for previously entered data, correcting errors, and
moving or re-entering data".
She argued with a doctor whose concurrent access to the
hospital's e-records system blocked her access to his information
and "called the hospital's pharmacy repeatedly to get my
medications delivered". He added that she also convinced a doctor
and a pharmacist to come to his room to "resolve data errors in
person".
Bugajski says that even then he did not receive correct
medications during his stay. "My wife snuck one of my inhalers into
my room. After I used it, I finally began to recover."
Now Bugajski, who works for the
Burton Group in Utah, has written to President Obama to warn
him of the complexity of $19bn plans in the US - similar to the
NPfIT scheme in the UK - to produce an integrated health
record.
He says that the idea of a national, interoperable, secure,
private, reliable, accurate, and instantaneous electronic
healthcare data network is delusional and, at worst,
pernicious.
In his case there was a failure by IT system architects to
correctly capture business requirements, says Bugajski. There is
also evidence that "no one ever produced a reliable conceptual data
model".
The case highlights the need for an integrated patient record
system which works well for patients and is liked by clinicians.
But Bugajski's near-death experience shows how difficult it will be
to build an integrated, user-friendly and indispensable e-record
system in a single large health institution, let alone
nationally.
He says that problems with his treatment happened at one of the
best tertiary medical centers in the world, with modern electronic
health information systems. This, he says, illuminates the "chasm
between the President's
NHIN [Nationwide
Health Information Network] vision and its reality".
Bugajski says: "During the last week of January 2009 a faulty
electronic, networked, health information data model nearly killed
me despite its vaunted status as a component of two
state-of-the-art, health information systems at two of the world's
most advanced medical facilities."
The blog of
the Royal Free and University College London Medical School in
London says Bugajski's experiences show that some of those involved
in the early decisions around NPfIT might have been too easily
convinced that American technology would somehow be able to solve
problems that had hitherto been intractable. "In practice the
evidence seems to suggest that different healthcare systems require
different IT systems."
US blogger Mark Frisse says that
Bugajski sought care at very solid institutions but the system
as a whole failed him.
Lessons from Bugajski case - IT Projects Blog
The
data model that nearly killed me - [69 comments so far, many
from experts]
Dear Mr. President, a Data Model for my Electronic Health Records
Nearly Killed Me
Watching the
Americans - University College London comment
Benefits of electronic records