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Claim of censorship over Cerner system

The Sydney Morning Herald and ZDNet in Australia report that the University of Sydney removed from its website – temporarily – a negative essay about a Cerner system which had been installed at hospitals in New South Wales.

The author of the essay is a medical IT professor, Jon Patrick, who is reported to have claimed that NSW Health, which is part of the government of New South Wales, put pressure on the university to take down the paper.

If true, it would tie in with what’s been happening in England where mentions of Cerner in a negative context are being officially discouraged.


Cerner is due to be installed at hospitals across London as part of the National Programme for IT [NPfIT] but several trusts that have already gone live – including the Royal Free and Hampstead, Barnet and Chase Farm, and Barts and The London – have run into serious problems, including the losing of patient appointments and patients not being treated.

A showcase Cerner site at Homerton ceased mentioning Cerner in its public board papers after doing a deal with NHS Connecting for Health and the Department of Health. Homerton also rejects FOI requests related to its discussions on Cerner.

Homerton told me: “We are unable to share documents relating to these meetings as ourcontract with Cerner includes a confidentiality clause and as suchdisclosure of the information could give rise to an actionable breachof confidence.”

More recently, another Cerner site, Barts and The London, has refused to answer Computer Weekly’s questions on the role of Cerner in its problems. Several weeks ago we submitted an FOI request to Barts – and have had nothing more than an acknowledgment so far. [Please see “PS” note on Barts at end of this article]

In Australia, the Sydney Morning Herald reports that the University of Sydney removed from its website “an extremely critical essay abouta new multimillion-dollar emergency department IT system after pressure from theNSW Health Department”.

The newspaper reports that “Doctors, nurses and administrators at four area health services heavilycriticised the system – which tracks patients – as posing an ”unacceptably highrisk” to patient safety because it was so slow, cumbersome and inefficient”.

Some hospitals have boycotted Cerner FirstNet and reverted to paper to recordclinical notes because it is too difficult and too time-consuming to retrievecritical patient information from the system, the essay by professor Jon Patrick said.

The essay was published late last month but NSW Health asked that it beremoved, Professor Patrick said on his website. The university then published itagain two weeks later.

“I have been able to establish confidently that NSW Health phoned my head ofdepartment and asked him to remove the article without giving a specificcomplaint,” Professor Patrick wrote on November 5.

Last Wednesday, he wrote: ”The university has affirmed my right to publish mycritical essay and the attempt to censor me has been mitigated.”

The Deputy Director-General of NSW Health, Tim Smyth, told the Sydney Morning Herald that the acting chief information officer contacted the universityabout the essay but did not ask for it to be removed.

”That’s entirely a matter for the university but my personal view havingread the article is that I don’t believe it’s balanced, it’s certainly notaccurate and it certainly misrepresents reality,” Dr Smyth said.Cerner also declined to comment to the newspaper.

ZDNet reported that Patrick had said that open source could be the answer to vendor lock-in, an opinion he has previously expressed in the media, and that in the long term, the government should be spending money on research and development of clinical systems for Australia.

He believed that it wasn’t possible to know all requirements in advance of writing software because of the variety of users with autonomous behaviour which all have a limited view of how others operate.

He thought the system should be flexible in its interface so that hospitals could make it optimal for their needs. “The era of rigidly designed user interfaces that do not allow any variation for user preferences or a capacity to model the user’s needs is long gone,” he said.

NSW Health was offered the opportunity to provide comments to an early version of the essay but declined the offer, according to Patrick.

Comment:

The essay in question is indeed very negative, which makes it hard to understand why NSW Health declined to provide a defence of the system. That said, there’s much material on the internet in Cerner’s favour and Patrick’s paper provides a counterview which could inform open and frank debate.

That open and frank debate isn’t happening in the UK because information about the implementations is being suppressed by officialdom.  That’s bound to increase scepticism about the system – perhaps unfairly. 

**

PS

After the article (above) was published this morning a spokeswoman at Barts and The London called me to say that my criticism of Barts was unfair. I’d said that my FOI request to Barts about the role of Cerner in its problems had elicited nothing more than an acknowledgment so far. The spokeswoman said that my FOI request is being given proper attention and I will receive a response shortly.

I am grateful to Barts for this assurance.

Links:

Minister defensive over Cerner sites – IT Projects blog

Essay on Cerner by Jon Patrick, University of Sydney

When there are NHS IT problems don’t mention Cerner – IT Projects blog

Jon Patrick’s essay – his blog comment

Switch to electronic records getting mixed reviews – The Huffington Post

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Your article captures the situation in NSW very clearly. However it is lamentable that valid criticism of the Firstnet deployment is suppressed by inappropriate confidentiality clauses in the contract, as they can only be there to hide faults and deficiencies. We have seen similar constraints start to be talked about in NSW now that my essay has been broadcast, in that staff have expressed they are fearful there will be recriminations if they are caught either reading or disseminating my essay. It sounds like we are more in a totalitarian state than an open democracy.

I am keen to hear of stories from the UK for a number of reasons. Firstly, One of the strategies used in NSW to silence critics is a "divide an conquer" strategy, where people are told they are the only critics and hence that makes them just sole complainants. It takes a strong sense of conviction not to be daunted by such assertions about your own behaviour.

Secondly, one of my critical points is that the problems with Firstnet and its deployment are systemic, and this can only be shown if the same problems occur in different places.

Thirdly, the more problem stories that are expressed in the open the weaker the obfuscation and dissimulating strategy will become and the more the true voice will be heard through all the artificial white noise being put out.

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It's a pity that staff are "fearful there will be recriminations if they are caught either reading or disseminating my essay".

If NSW is so convinced that your essay is not balanced, it would not mind people reading it, unless it thought people too stupid to judge.

It wouldn't be the first time a bureaucracy considered its critics stupid.

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Re: "We are unable to share documents relating to these meetings as our contract with Cerner includes a confidentiality clause..."

As per my July 22, 2009 letter in the Journal of the American Medical Association "Health Care Information Technology, Hospital Responsibilities, and Joint Commission Standards" ( http://jama.ama-assn.org/cgi/content/extract/302/4/382 ), as well as my much more thorough posting on these issues at http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=koppel_kreda , these EHR confidentiality clauses will end up causing great loss of money in failed systems, and/or harming patients. Those who signed them will then likely be liable, at least in the U.S., as the clauses breach the safety standards of the accrediting agency for hospitals here, the Joint Commission.

In Australia and the U.K., I cannot comment, but good luck to those who signed these clauses.

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The signing of inappropriate confidentiality clauses in IT contracts is certainly frowned on by MPs and the Information Commissioner - and it doesn't follow that the Information Tribunal will agree to keep confidential information secret.

FOI requests that are rejected because of confidentiality clauses should be appealed.

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Interesting paper from the Prof, but “unbalanced” hardly begins to describe it. The only positive comment about the system seems to be introduced solely so it can be knocked down. So I don’t think it’s that surprising that Health NSW and Cerner have not responded – it’s kind of a “have you stopped beating your wife yet…answer yes or no” situation for them. If they do respond they look defensive plus they draw more attention to this bizarre paper, if they don’t they are criticised for not responding.

Also I must say I find the picture of timid clinicians somewhat hard to swallow, as would anyone else who has worked in Australia where they are generally not backward in coming forward.

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Dear Mr Robinson,

The IT industry has invaded healthcare, and then the occupants blame the victims of the occupation for the occupation's failure when the occupees complain about the terms of the occupation. The utter arrogance is beyond astounding.

By Dr Patrick's accounts many physicians are complaining -- internationally -- about ED EHR's, to the point where they express serious concerns about time wasted, distractions, disruptions of cognitive processes, etc. These translate directly into possible patient harm being caused in a highly charged and time critical environment. Yet you dismiss their concerns as "imbalance."

One of the American ED physicians whose comments were noted in the report is well known to me, the head of the ED at the largest provider for an entire state here in the U.S. I worked with this physician for years and personally know him to be extremely savvy in the benefits and risks of IT in that environment, himself having led non-EHR but otherwise exceptionally innovative IT projects in his area.

What qualifies you to call the reports of such a physician "unbalanced?" How many ED's have you run? How many patients have you taken care of?

What makes you an expert in anything other than very unimpressive pro-IT industry political spin?

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Michael Robinson, asserts my essay is "unbalanced" without providing any counter evidence. The article contains ALL of the positive evidence I gleaned from clinicians but only a portion of the negative evidence. It is "unbalanced" in the sense that the situation is worse than I have presented. Given the evidence it also spends a great deal of space interpreting it in a balanced manner.

NSWHealth has answered the essay, by attempting to have it suppressed. Could Mr Robinson tell me why they might act in that way if the article wasn't of concern to them. On the other hand if it is of no concern for them and they can refute assertions in the essay why wouldn't they so. It would give them the moral high ground.

The "picture of timid clinicians" is Mr Robinson's own construction and not part of the contents of the essay, rather the essay clearly identifies highly frustrated and inflammed clinicians who see the behaviours of the implementers as caring little for patient safety and care, and threatening to force them into inefficient and unsafe work practices, where just one example is returning to writing and storing clinical notes on paper after years of typing them into the electronic clinical record.

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The likelihood is high that with the army of UPMC "musclemen" on the Newcastle campus to protect its investments and its product, that silence will be enforced, as they accomplished in Pittsburgh.

There is potent silencing effect of threats of sham peer review to discipline physicians who are declared disruptive and disgruntled by Cerner and the Trust Administration because of complaints about the computerization horlicks.

Jon Patrick weears a badge of courage.

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