"Nearly killed" by e-records data model

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...

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

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