Senior analyst "nearly killed" by e-records data model

[This is a longer version of an article on ComputerWeekly.com]

joe bugajski pic.jpgA senior analyst at US technology research and advisory group Burton says the data model for an electronic health records system nearly killed him.

As Joseph Bugajski struggled to breathe, doctors 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 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.

**

These are the IT lessons Bugajski extracts from his near-death experience:

• Incoherent database design isolates patient information from one department to the next and from one organisation to the next. This wastes time and increases errors because medical personnel must enter patient information into a unique view of the system that corresponded to user identity and department – this prevents one medical professional from seeing patient information input by another medical professional.

• Patient information is easily lost inside the electronic records system

• Hard copy patient information becomes dissociated with the electronic record

• A healthcare professional’s work pattern is not reflected in either the system design or data model – people spent considerable time searching and data reentry

• No master data management was in evidence – production of a consistent record of me as a patient required the ICU nurse to copy data from multiple database views into the in-patient record

• Admitted in-patient records are treated differently by the system than out-patient or ER record only patients – no information about my medical history gathered during a prior visit to ER was available to my doctors or nurses.

• Nurses and doctors do not have ready access to listings of pharmaceuticals which wasted much time while they searched for information about my daily medications – lists of medications in the system are limited to those at the hospital pharmacy.

• No support existed for recording allergies differently than to ambient source and foods – Lists of allergies were not in drop down menus although these are well known by allergists and drug companies. 

Links:

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 [Bugajski’s letter]

 

Watching the Americans – University College London “Chime” blog comment

 

President Obama’s $19bn healthcare IT plan – Bloomberg

Benefits of electronic records

 “Nearly killed” by e-records data model – Computer Weekly

 

 

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Nurses will tell you that this is all in a day's work for them. They are used to picking up discrepancies and contradictions in formal orders and less formal plans. Indeed, because they carry out most of the activities of healthcare delivery, they are attuned to situations and sequences that are inconsistent with the clinical goals -- especially those practical sorts of things like "you have to have a working IV in order to give intravenous medication" that so often baffle adminisrtators and computers.

I would also point out to you that there is a level of dedication and purpose from the nurse in this story that no computer or administrator can ever approach. It is not that clinicians take their responsibilities more seriously than others. Rather, their main responsibility is directly to the patient rather than to some larger system or organizational goals.

What is evident in this story is something we see throughout clinical practice. In the old days this was so much a part of medicine that it could be taken entirely for granted. Today, of course, it is being eroded by a variety of mechanisms.

On the whole, I find this story to be very much uplifting and positive. No one with an ounce of sense is surprised that the computerized system failed in a spectacular way. But we are all very glad that there was someone with the training, experience, and willingness to tackle this difficult problem.

Three cheers for the nurse!

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This article has really caught my attention. If this thing could happen to a senator "Joseph Bugajski" then what about regular patients. Electronic Medical Record EMR may seems a step forward for medical institution but if some malfunction happens then the patient might be in some serious problem. In my opinion Hospitals and clinics should have EMR system along with a hard copy of the patient record in case of any malfunction. This incident also shows that medical staff was not trained enough for EMRs.

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