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Hospital Turns Away Ambulances When Computers Go Down

CmdrTaco posted more than 5 years ago | from the oh-that's-not-good dept.

Medicine 406

CurtMonash writes "The Indianapolis Star reports that Tuesday Morning, Methodist Hospital turned away patients in ambulances, for the first time in its 100-plus history. Why? Because the electronic health records (EHR) system had gone down the prior afternoon — due to a power surge — and the backlog of paperwork was no longer tolerable. If you think about that story, it has a couple of disturbing aspects. Clearly the investment in or design of high availability, surge protection, etc. were sadly lacking. But even leaving that aside — why do problems with paperwork make it necessary to turn away patients? Maybe the latter is OK, since there obviously were other, more smoothly running hospitals to send the patient to. Still, the whole story should be held up as a cautionary tale for hospitals and IT suppliers everywhere."

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Nurse != Secretary (3, Insightful)

casals (885017) | more than 5 years ago | (#28209217)

... in theory, at least.

Re:Nurse != Secretary (4, Interesting)

mcgrew (92797) | more than 5 years ago | (#28209373)

Secretaries are increasingly like computers.

If you find an old, pre-1950 dictionary and look up "computer", you'll find that it defines "computer" as a person who is employed to do maths. Thousands of computers were employed for the military, large corporations, etc doing ballistics calculations, statistical math, and the like.

There are fewer and fewer human secrtaries, as human secretaries are going the way of the human computer. Electronic computers are superceeding human secretaries just as they obsoleted human computers.

Re:Nurse != Secretary (4, Funny)

ConsumerOfMany (942944) | more than 5 years ago | (#28209917)

call me when your computer can wear a tight skirt and make me a cup of coffee...

Re:Nurse != Secretary (3, Funny)

Starayo (989319) | more than 5 years ago | (#28210037)

I'm sure I could jerry-rig an espresso machine to my computer, and a tight skirt would merely be a matter of alteration to fit the dimensions...

Re:Nurse != Secretary (3, Funny)

Anonymous Coward | more than 5 years ago | (#28210113)

But can you get it to bend over and pick up those files you dropped again...

Re:Nurse != Secretary (1)

iYk6 (1425255) | more than 5 years ago | (#28209997)

Secretaries will not be obsoleted any time soon. They do too many things that machines are just no good at. On another note, statisticians, accountants and engineers are still employed, despite mechanical computers being less expensive.

Re:Nurse != Secretary (5, Informative)

AlecC (512609) | more than 5 years ago | (#28210133)

Actually, secretaries are reverting to their original function, except that the job title has changed to Personal Assistant. A secret-ary was an assistant who was entrusted with your secrets (hence Secretary of State, Foreign Secretary). The job title that typists and data-entry staff should have had was "clerk" (if not typist or data-entry clerk). But secretary was more prestigious, and a good job title always helps keeping people satisfied with low pay. The people who were unable to perform their function in this hospital when the computers died were data-entry clerks.

Re:Nurse != Secretary (1)

Divebus (860563) | more than 5 years ago | (#28209415)

What happens when The Big One hits? Time for a stress test on hospitals now.

Re:Nurse != Secretary (3, Insightful)

ShieldW0lf (601553) | more than 5 years ago | (#28209503)

How do you guys feel about the DRM in hospitals when you read about this stuff? The people you entrusted (willingly or not) to wield your political authority for you are determined to see it happen. Calls the validity of the whole system into question, doesn't it?

Re:Nurse != Secretary (1)

commodore64_love (1445365) | more than 5 years ago | (#28209767)

A monopoly, of any kind, is a bad idea. Imagine the DMV or Amtrak running your hospitals - no thanks. I prefer the freedom of choice where if I don't like Country General I can go visit St. Josephs instead. If they are crap I can to to John Hopkins or Mt. Sinai or any other place within driving difference.

Just as we have multiple stores, some of them crap (Walmart), some mediocre (Sears, Penneys), and some of them excellent (Macys), we should have multiple choice in hospitals. Only when you have choice do you have true power as a consumer.

Re:Nurse != Secretary (1)

OeLeWaPpErKe (412765) | more than 5 years ago | (#28209725)

Actually how about eliminating the problem itself ? If the paperwork is overwhelming, with a reasonable minimum workforce present in the hospital, the government (the recipient of said paperwork), needs to accept the fact that there isn't any paperwork, and foot the bill anyway.

Obviously this will present docters with patients without medical records. But better to be treated a bit worse than not at all.

Obviously any sort of national healthcare system will preclude having this common-sense approach, as any system that does not make it the responsibility of the patient to ensure medical bills are paid will ration health care ("total health care resources" are limited. Either you let people pay for them, or you ration them). Rationed health care means "no government approval, no healthcare" both in theory and in practice. Unless congress likes unmarked expense reports ala "Something -> $500.000". And I fear that when they're not coming from congress critters (you know the "oops I forgot to pay my taxes" people) they really dislike them.

Let's not forget the house speaker is a woman that screams (literally) about the need to conserve co2 emissions, but refuses to fly on anything other than a private jet. National healthcare is another way of saying that she's the one deciding whether your cancer gets treated.

Re:Nurse != Secretary (4, Insightful)

unlametheweak (1102159) | more than 5 years ago | (#28209753)

Nurse != Secretary (Score:1)

I think this has more to do with Management not being able to properly bill insurance companies. Because profit is more important than human lives.

Re:Nurse != Secretary (5, Insightful)

wealthychef (584778) | more than 5 years ago | (#28209861)

We don't know that human lives were at stake here. First of all, the situation lasted from 1AM to 3AM on a Wednesday morning, so I doubt if anyone was even turned away. Also, the summary implied that there were other options for the patients. Hospitals now are very complex systems, and losing track of a patient could mean making an error that bodes worse for the patient than not admitting them, like administering the wrong medicine or applying the wrong procedure. We don't know the whole story, but I'm thinking it's not as bad as the sensation-grabbing news reporters might like it to seem.

Re:Nurse != Secretary (2, Interesting)

MrMarket (983874) | more than 5 years ago | (#28210155)

Your statement about Methodists' incompetent management is valid. Every three year's or so they've had some terrible [google.com] safety [google.com] failures. Quality care is just not a priority for them.

This is not so much a story about electronic records as much as it is about Methodist keeping up it's infamous safety record.

Welcome to the paperless office (5, Insightful)

Moryath (553296) | more than 5 years ago | (#28209241)

please bring your own toilet paper.

But seriously... this is one of the biggest problems with the "paperless" society. Yes, it's nice to have electronic copies of things, but magnetically-stored data (or even optically-stored data) degrades far faster than a paper copy.

We can try and try to hope otherwise, but at the end of the day I worry we're dooming ourselves with our "modernized" recordkeeping. Sure, we have "tidbits" of things from 1000,2000,3000,4000 years ago... but 1000 years from now, most of our own records - much like the oral histories of certain societies that didn't get heavily into good recordkeeping on more solid forms - may well be completely gone.

Most records are worthless anyway (4, Insightful)

qbzzt (11136) | more than 5 years ago | (#28209335)

Most of our records would be worthless in a hundred years. Actually, most of them are nearly worthless in a year. Would it really matter to somebody in the future that I spend $15.19 on June 1st at Lulu.com, for example? Because record keeping is so cheap compared to historical examples, we keep a bunch of records nobody would have bothered with in the past.

Re:Most records are worthless anyway (1)

ShieldW0lf (601553) | more than 5 years ago | (#28209703)

Most of our records would be worthless in a hundred years. Actually, most of them are nearly worthless in a year. Would it really matter to somebody in the future that I spend $15.19 on June 1st at Lulu.com, for example? Because record keeping is so cheap compared to historical examples, we keep a bunch of records nobody would have bothered with in the past.

Doesn't this make you question the presumption that we're at the pinnacle of human technological achievement? The more technologically advanced we get, the less durable the things we create seem to be... it implies that the more technologically advanced an ancient culture was, the less evidence there will be that they ever existed.

Re:Most records are worthless anyway (4, Insightful)

noundi (1044080) | more than 5 years ago | (#28209765)

it implies that the more technologically advanced an ancient culture was, the less evidence there will be that they ever existed.

Woah easy there cowboy. This "rule" only applies to historical data of the society, not general evidence. If my hard drive crashes or gets wiped, the drive itself, in its sturdy metal casing, will be around for many, many years to come. So no, L. Ron Hubbard remains a douche.

Re:Most records are worthless anyway (3, Insightful)

qbzzt (11136) | more than 5 years ago | (#28209793)

I suspect that's a mirage, caused by only seeing the durable pieces of older cultures. We can see the Roman Colosseum. We cannot see, in most cases, the papyrus business contracts.

Some of our things, such as records, are very ephemeral. Others, such as satellites and nuclear waste, are very durable.

Re:Most records are worthless anyway (2, Informative)

maxume (22995) | more than 5 years ago | (#28209975)

There would be a Hoover dam (or Three Gorges dam), or a Chernobyl, or something, out there.

If you think geologists, biologists and anthropologists have got it completely wrong I guess there is some chance that it all washed away. Absent that, 200,000 years isn't all that long a period of time.

Re:Most records are worthless anyway (2, Insightful)

mcgrew (92797) | more than 5 years ago | (#28209895)

No, they kept them. Most of them are gone because their use has gone (like your bill) or the media has disintegrated. Its far easier to save and retrieve the info now.

There was a huge fire at some St Louis military building a couple of decades ago, and hundreds of thousands of records were lost. It caused a big headache for countless veterans, who needed copies of those records.

That can't happen today; there are multiple backups at multiple locations.

Re:Most records are worthless anyway (1)

qbzzt (11136) | more than 5 years ago | (#28210095)

Some records were started further back. If I buy something today, it's likely to be with a credit card and have a record. Fifty years ago, it would have been in cash, no record.

When my grandfather enlisted in the British Army to fight in WWII, there was a record of that. But was there a written record for every peasant who fought in Agincourt, for example?

Re:Most records are worthless anyway (1)

spottedkangaroo (451692) | more than 5 years ago | (#28209983)

The things that are important will get copied by others and the things that aren't won't necessarily be copied. In actual fact, the preservation of important records will be more automatic than it was in the past. Take important photos for example: http://images.google.com/images?q=eddie+adams [google.com] -- automatically backed up by people that think it's interesting!

Receipts have sure helped with Koine Greek (2, Interesting)

Fished (574624) | more than 5 years ago | (#28210083)

One of the things that drove the revolution in understanding of Koine Greek (as used in the New Testament) over the last 200 years or so was the discovery of a massive cache of routine commercial transactions in Egypt, written on Papyrus. So, your $15.19 @ Lulu.com might be more relevant than you realize.

Re:Most records are worthless anyway (1)

DerekLyons (302214) | more than 5 years ago | (#28210101)

Most of our records would be worthless in a hundred years. Actually, most of them are nearly worthless in a year. Would it really matter to somebody in the future that I spend $15.19 on June 1st at Lulu.com, for example?

Oh hell yes. Detailed information on the daily life is much more valuable to the archeologist, sociologist, and historian than the 417th copy of the proceedings of $GOVERNMENT.

Re:Most records are worthless anyway (1)

geekoid (135745) | more than 5 years ago | (#28210111)

The most valuable pieces of history we find are almost always in a past generations trash.

Don't be presumptuous and think no one ever could not find value in that record.

Re:Welcome to the paperless office (1)

TheRealMindChild (743925) | more than 5 years ago | (#28209385)

Try this. Print it out and file it away. Use the electronic copy, and go to the cabinet if something goes wrong. Problem solved.

Re:Welcome to the paperless office (0)

Anonymous Coward | more than 5 years ago | (#28209513)

paper actually degrades really fast and we don't even have 1% of 1% of 1% of the stuff that was written in some old distant time. Almost everything rots away very rapidly and it's just a vanishingly small minority of papers that survived.

Re:Welcome to the paperless office (3, Interesting)

ljaszcza (741803) | more than 5 years ago | (#28209569)

No, in the modern US medical system, the paperwork amounts to tons of paper. The manpower needed to maintain it; file new info, pull deceased patients is huge, for a large hospital, the space requirements are huge. The possibility of error (misfiling info, patients with similar name, married name changes, etc)is huge. From a legal point of view, you are probably more safe shutting the place down because EMR is down rather than trying to deal with a backup paper system. It's not best for the patients, but the medical/legal/government system has cared increasingly little about the individual human being for a while now. I say this as an employed experienced MD.

Re:Welcome to the paperless office (4, Insightful)

mcgrew (92797) | more than 5 years ago | (#28209567)

They've been talking about the "paperless office" for over twenty years now, but it hasn't happened yet. There is far more paper in my office than there was 20 years ago, in fact.

However, IINM the Japanese have paperless toilets that wash your butt with a water spray and dry it with hot air.

The thing about electronic records is that they can be instantly duplicated and sent anywhere instantly. They're easy to back up, without the errors and degredation of past, analog copying methods.

I'm healthy and don't go to the doctor very often. My old family doctor retired about fifteen or so years ago, and when I went to have butthole surgery (hemmoroids, too much sitting on my ass like any nerd) I discovered that I had no medical records!

Unless it's acid-free paper, a book will last maybe fifty years before it starts deteriorating. I have old paperback books I bought when I was young that are nearly unreadable now. Paper is far more nebulous than electronics.

The thing that will kill today's literature (and many other records) for future humanity isn't the supposed fragility of electronic records, but the insane lengths of copyright. If you don't allow electronic copies of your work, it's unlikely to last much longer than a single human generation.

Re:Welcome to the paperless office (-1, Offtopic)

Anonymous Coward | more than 5 years ago | (#28209923)

The japanese may have their fancy toilets, but the geek compound has Jeff "Hemos" Bates. He's a toilet slave. "slave" is the wrong word, since he does it volountarily. Either way, he drinks your piss, eats your shit, and gives you a rimjob too. No paper needed.

Re:Welcome to the paperless office (1)

jbacon (1327727) | more than 5 years ago | (#28209577)

Change in technology breeds change in record keeping, and the trend has shifted away from durability since the dawn of time. Electronic storage is less durable than paper is less durable than chiseled rocks.

Of course, losing records in today's world could mean complete societal meltdown (in the worst case)

Re:Welcome to the paperless office (2, Insightful)

Dare nMc (468959) | more than 5 years ago | (#28209629)

probably not in this case. I means 3 years of McCains records were 1500 pages, for a healthy person. A hospital that treats a 1000 sick people a day, your talking moving millions of pieces of paper a day. So then your talking the need for a library, and librarians, fire suppression...
So while I agree old books, when unused, last longer. When used daily, for instance cash in constant circulation, lasts about 3 months.

Re:Welcome to the paperless office (1)

the_humeister (922869) | more than 5 years ago | (#28209747)

Someone mod parent up. The way the medical-legal system has evolved now it's no longer practical to have a paper chart as the sole medical record.

Re:Welcome to the paperless office (1)

maxume (22995) | more than 5 years ago | (#28210079)

I've had 3 or 4 dental cleanings in the last 3 years. That's the sum of my medical care. All of it.

McCain isn't a healthy person. He might be a relatively healthy old man, but not person in general.

Re:Welcome to the paperless office (1)

stinerman (812158) | more than 5 years ago | (#28210149)

Who gave you the idea that McCain was heathy? He had melanoma. AFAIK, he has recovered and is in good health now (and will probably live to be in his 90s given his mother's longevity), but he was by no means healthy.

Re:Welcome to the paperless office (1)

sznupi (719324) | more than 5 years ago | (#28210151)

If civilization 1000 years from now will be a continuity of our own, they will have probably most of the records we and people in between wished to preserve, plus a lot of junk. While not absolutely everything, it'll still tell quite a lot, even compared to the "good'ol analogue past".

If there will be no continuity...well, with our current development that would probably mean a catastrophe that makes middle ages look like vacations on tropical beach. Not only digital records would fall victim to this en masse.

A one word answer (5, Insightful)

Vinegar Joe (998110) | more than 5 years ago | (#28209267)

"But even leaving that aside - why do problems with paperwork make it necessary to turn away patients?"

Lawyers.

More-words answer. (5, Informative)

TrebleJunkie (208060) | more than 5 years ago | (#28209411)

Lawyers, patient safety, and actually getting paid. Vast amounts of documentation must be provided to Medicare/Medicaid and Insurance companies in order to get paid for services. Event the smallest amount of missing or inaccurate documentation can be the difference between getting paid $5 and $5000, the difference between getting paid and getting fined and losing your ability to bill Medicare, etc...

Re:More-words answer. (1, Interesting)

Anonymous Coward | more than 5 years ago | (#28209795)

But someone could die if they're too anal about it. I say stick to safe procedures, and let the hospital eat a loss while the system is down. When a toll plaza is down, they let people cross it for free, they don't block the highway.

Re:More-words answer. (1)

commodore64_love (1445365) | more than 5 years ago | (#28209897)

>>>Vast amounts of documentation must be provided to Medicare/Medicaid and Insurance companies in order to get paid

Just imagine how much easier it would be if we simply paid cash, you know like our ancestors did prior to World War 2. Walk in; get your service; and hand-over the cash, check, or credit card. That's what I do today. I even get a 10% discount from my doctor since he says my approach makes his life much simpler.

Re:A one word answer (4, Interesting)

lorenlal (164133) | more than 5 years ago | (#28209467)

Funny aside. I happen to know a few physicians pretty well outside their professions. I heard a lovely story involving a surgeon in an office that didn't use paper records. Everything was done through an EMR system.

The "computers were down" as the story was relayed. The surgeon called the family physician asking him about the medical history of the patient. The family doc (primary) asked what was wrong. The surgeon replied that the patient was in the waiting room, but since the EMR system was down, he didn't know anything about the patient. The primary responded with, "By any chance... Did you ask them?" to which the surgeon responded, "What?" The surgeon had a perfectly compus mentus patient, and didn't even bother to ask them a question because the EMR system was down.

Sometimes the lawyers don't even have to be involved for epic failure.

Re:A one word answer (5, Informative)

TinBromide (921574) | more than 5 years ago | (#28209623)

The prevailing attitude in the medical industry is that unless patients are telling you where it hurts, they're lying. Doctors will tell you that patients are "forgetful" or possibly "confused about their past conditions and may not understand what was wrong with them". Their lawyers tell them that patients are drug addicts looking for the next narcotic hit or looking to sue them for a big fat malpractice settlement. If I say I'm allergic to iodine, but forget about an allergic reaction I had to antibiotics when I was 3, and they administer antibiotics, they're still on the hook if I decide to sue. "Look at my file! It says I'm allergic ot antibiotics! I said I was allergic, but he wasn't listening!"

Re:A one word answer (1)

L4t3r4lu5 (1216702) | more than 5 years ago | (#28209825)

Check out the lyrics to this song *NSFW* [moron.nl] for why asking the patient is not a good idea. It's humour, but poignant.

Re:A one word answer (1)

L4t3r4lu5 (1216702) | more than 5 years ago | (#28209851)

Crap, sorry... It's to the tune of "Any Dream Will Do" if you want to sing along in your own head.

Two Word Answer: Patient Safety (4, Insightful)

PIPBoy3000 (619296) | more than 5 years ago | (#28209501)

As someone who works in healthcare, I've discovered that providing good care is entirely about information. If we don't know someone's drug allergies, medical history, and can't effectively communicate between departments, patient safety is impacted. Turning away patients may actually save lives if a hospital is unable to provide communication and medical background for a patient.

When I'm unable to get to the network for some reason, I feel extra stupid as a developer. I can't search for code examples on Google, migrate code to staging servers, and so on. Healthcare is similar, with providers not being as effective as if they had their full EMR at their fingertips.

Turning away patients results in loss of income, so they're basically losing money in order to improve the safety of their patients.

Re:A one word answer (2, Interesting)

ILongForDarkness (1134931) | more than 5 years ago | (#28209525)

Patient safety is another one. If you can't keep up with the paperwork then the next doctor that sees the patient has no idea what drugs were given, etc. Without all the facts available, diagnosis and treatment go out the window.

Re:A one word answer (1)

DerekLyons (302214) | more than 5 years ago | (#28209545)

Not just lawyers - doctors.

Without paperwork, they don't know who is in the ER, who is being treated for what, who is allergic to what, who is waiting on what treatment, etc... etc...

There's a lot of data flowing around an ER, and the quality of the data (is the paperwork up to date) may mean the difference between life and death.

Re:A one word answer (2, Insightful)

MollyB (162595) | more than 5 years ago | (#28209591)

I think castigating an entire group of professionals is short-sighted. Perhaps if ours was a less-litigious society, lawyers wouldn't be so powerful. After all, many patients employ lawyers in frivolous lawsuits against hospitals (not all, of course) which may make such detailed health records necessary (even to begin services). Lawyers are just functionaries. Blaming them is like blaming the hammer for hitting your thumb instead of the nail.

I agree with the sentiment above that we place too much faith in our sprawling infrastructure rather than designing proper failover systems in every new project.

Re:A one word answer (1)

rakkasan (444517) | more than 5 years ago | (#28209927)

Liability, yep..give a patient a contra indicated med..and the hospital will get sued big time. Which is more likely without the afore mentioned records.

Re:A one word answer (1)

geekoid (135745) | more than 5 years ago | (#28210141)

If they were life and death, thye would have treated them. Not all ambulance are life and death.

It's Not Just Any Beaurocracy (5, Insightful)

4e617474 (945414) | more than 5 years ago | (#28209291)

Why do problems with paperwork make it necessary to turn away patients?

In an ER, "paperwork" includes information on whether they'll kill you if they give you a certain drug or transfusion. Stuff like that.

Re:It's Not Just Any Beaurocracy (1)

DarrenBaker (322210) | more than 5 years ago | (#28209429)

Certainly... But turning away ambulances? They don't even know if it's just a bone that needs setting, a cut that needs stitching, or a similar condition. Triage, people!

Re:It's Not Just Any Beaurocracy (5, Insightful)

tomhath (637240) | more than 5 years ago | (#28209521)

They sent word to out the ambulances to divert to another hospital. It's not like they turned them away at the door. Basically they couldn't keep up with the number of patients without compromising patient safety or having incomplete records. In a real emergency they could still have treated patients, but in a lawsuit happy country like the USA they don't dare skip record keeping in a non-emergency situation.

Re:It's Not Just Any Beaurocracy (2, Insightful)

idontgno (624372) | more than 5 years ago | (#28209819)

On some level, then, their operating practices and capacity (ER beds, staff, etc.) have been optimized to provide the service levels enabled by (relatively) low-friction electronic records access. One they fall back to paper records, apparently that becomes the friction point in their processes and their service delivery falls back to levels comparable to pre-EMR days. To a hospital administrator, that means wasted capacity (fewer patients seen, more idle ER facilities). To the staff, that means frustration because the switch-down from primary to backup records-keeping didn't come with an automatic switch-down from EMR-enabled service levels to paper-based service levels. During that ramp-down, the staff must have struggled to try to meet EMR-enabled service levels, because it sucks that paperwork is the only obstacle to seeing everyone. (Of course, if you give a rat's ass, it would suck to have to divert inbound cases because you ran out of any resource, but running short on administrative resources must really bite.)

While all these things are certainly true, and diverting inbounds because of any other resource shortage is no less necessary and no less likely, the phrase keeps going through my head: "The patient isn't getting better stuck on the ambulance in cross-town traffic."

In a real emergency they could still have treated patients

"Turning away ambulances" (used both in TFA and its source article) tells me they were diverting even truly emergent cases. Perhaps not. Hard to tell, without knowing the operation policies regarding their declaration of "diversion". But if they were truly overcommitment with their current caseload, I'd bet their policy would lean heavily towards "Even critical cases are better off diverted". (Correspondingly, reducing the risk of act-of-commision liability in really sub-optimal circumstances.)

ObDisclaimer: I am not a lawyer, so I'm talking out my ass about liability. I am not a hospital administrator, medical professional, or health system IT guy, so I'm just speculating about how things really happen behind the desks in the Emergency Department. I live nowhere near Indianapolis, so I don't even know the local rumors. I am not an operational analyst, and even if I were there's not enough detail here to make an informed analysis of the environment and the event.

Re:It's Not Just Any Beaurocracy (1)

Hijacked Public (999535) | more than 5 years ago | (#28209691)

I assume they mean Methodist's main campus, since the lump IU in there as well.

If so, there are a couple other hospitals within a few minutes drive by ambulance. It was probably faster for the patient to just go there.

Re:It's Not Just Any Beaurocracy (1)

swillden (191260) | more than 5 years ago | (#28209439)

Why do problems with paperwork make it necessary to turn away patients?

In an ER, "paperwork" includes information on whether they'll kill you if they give you a certain drug or transfusion. Stuff like that.

In some cases that's true, but not usually. It's only true if they already have records for the patient, and if they have identified the patient, and if they have bothered to look it up. The first is often not true and in urgent care situations the second and third are not usually done. Not until the emergency situation is stabilized, anyway. If you have an issue that could create serious problems if you were given the wrong drugs, etc., you should get a medic-alert bracelet or similar with the information. Otherwise, there's a very good chance the ER doctors will have no idea, even if you're at your local hospital.

Re:It's Not Just Any Beaurocracy (2, Insightful)

4e617474 (945414) | more than 5 years ago | (#28209907)

If you have an issue that could create serious problems if you were given the wrong drugs, etc., you should get a medic-alert bracelet or similar with the information.

Do you have a blood type other than AB positive, and if so, do you have this information on a medic-alert bracelet? There's information that you expect to have in advance (you're right, it doesn't amount to much), information you gather and have to make note of (I give him drug X, so don't give him drug Y, it won't mix, and by the way, he says he's diabetic), information that has to get to and from other parts of the hospital (uh yeah, his potassium was high when he came in, you might want to take him off that banana bag). We don't know what was happening in that ER, what challenges they worked their way through for a day, how many people they turned away exactly between 1 A.M. and 3 A.M., or how badly they needed to be seen (I've had two ambulance rides and zero life-threatening medical emergencies myself). The same guy who blogged that this was "more about billing than patient care" without backing up that assertion in any way links to his own earlier post where he talks about what "an obvious slam dunk" Electronic Health Records are, because it will result in "tens of thousands of lives saved annually in the US alone". My point is that people (I don't mean people like yourself who make sensible points, swillden) who don't know the story - and you still don't when you RTFA - shouldn't be going "OMG! You turn amboolance away 2 catch up on teh paperwork? Me know wuld hav dun that!" should remember the old adage "Nothing's impossible for the man who doesn't have to do it himself."

Re:It's Not Just Any Beaurocracy (1)

MasseKid (1294554) | more than 5 years ago | (#28209457)

Yeah cause they killed all kinds of people before 1990 when all they had was paper.

Re:It's Not Just Any Beaurocracy (1)

4e617474 (945414) | more than 5 years ago | (#28209963)

Yeah cause they killed all kinds of people before 1990 when all they had was paper.

Yes, and they still do [medicalnewstoday.com] . And that's not despite a sweeping adoption of IT, it's partly due to a lack of one.

David Carradine Has Died, He Was Delicious (-1, Offtopic)

Smidge207 (1278042) | more than 5 years ago | (#28209301)

Words cannot describe how sad this is. Carradine's acting was top-notch for the hey-day of 60's Kung-fu pop culture. His purple colour (a colour option picked up from an earlier version) clashes with the grey of any other window, that can be changed though. The black of acting in Kill Bill (Vol. 1 & 2) is overbearing and doesnt meld with his earlier works. His *cough* apparent suicide *cough* stands out like a sore thumb. I somehow feel like his death resembles the chrome looks like a webpage, rather than someone who won an award in 2005 for lifetime acting achievements and for browsing web pages. I cannot believe someone who created the Firefox icon could create something so hideous and inappropriate, especially when David Carradine's marketshare is bad enough already. I could not bear to look at this all day, every day, it would drive me mad.

A suicidal has-been Kung-fu actor should be transparent, a thin veneer between me and the web page. Not a clown honking his horn in my face. I went into preferences and changed to the Mac "native" theme and no particular colour, mildly improved, but still the black is overpowering, the new-tab button is the wrong colour, and the side pane has a tinge of blue that doesnt work well with the OS X grey. The tab touching the title bar also just looks poor and conflicting. This is the same bullshit I had to put up with when Dana Plato finally offed herself. It's goudy, non-native, clashes with the websites you view, and generally gets in the way, the toolkit underneath still rears it's ugly head in how the app works, and the general layout of the widgets. Apparently Carradine was eaten by wolves on the Connecticut turn-pike. All reports say he was delicious. The dialogues throughout the app crap all over the spacing guides in the HIG. Every inch of this app is annoying and grates on me. I'm not an interface elitist or an apple fanboy, but I can't use software that gets on my nerves and Opera and Vista occupy the top two slots for that. The browser is eclectic, with too many preferences, too complicated preferences, too many customisation options. Features not everybody needs, or wants.

=Smidge=

Re:David Carradine Has Died, He Was Delicious (0)

Anonymous Coward | more than 5 years ago | (#28209827)

RIP David Carradine. [wikipedia.org] As for you, smidge, you're like Zippy the Pinhead on PCP, keep it up. I thank you and the dearly departed Kung Fu master for your many lulz.

they don't (1)

dunkelfalke (91624) | more than 5 years ago | (#28209311)

Problems with paper work don't make it necessary to turn away patients. But the paperwork is what brings the money to the hospital. Backlog of paperwork means backlog of income and meanwhile bills and wages have to be paid.

Re:they don't (4, Informative)

TheMeuge (645043) | more than 5 years ago | (#28209523)

It's a reply that WILL get you karma from "fight-the-machine", "vaccines-cause-autism", and "they're-hiding-cures" crowd... but one that has no bearing at all on reality, and only reflects your ignorant disdain for the healthcare system.

The reason why they can't operate without the electronic system likely has to do with the mountains of required documentation that needs to be filled out for every patient, and the fear that without the electronic system they may miss a counter-indication and kill a patient, whose family will then proceed to sue the hospital, the software company, and the universe for three thousand gazillion dollars. If the patient is stable and there is another hospital nearby, why risk it?

P.S. If you think that a hospital would have trouble billing people without the electronic records, and that they'd turn away the ($1000 minimum) ER patients because of that, you're delusional.

Re:they don't (0, Offtopic)

dunkelfalke (91624) | more than 5 years ago | (#28210051)

You are using the wrong strawman here, buddy, all four times. I know why vaccinations are important and wish they were compulsory everywhere.

You cannot know it, but my mother is a medical doctor working at an actual hospital. Paperwork is the evidence of treatment so unless you pay cash the insuranse won't pay anything unless all the papers are filled.

Re:they don't (1)

TheMeuge (645043) | more than 5 years ago | (#28210129)

And electronic records going down are important here why? Did the hospitals not bill their ER visits 5 years ago?

Treating patients in a vacuum (5, Insightful)

capt.Hij (318203) | more than 5 years ago | (#28209321)

why do problems with paperwork make it necessary to turn away patients?

It may not be necessary, but it is a cautious move. Information is important when treating patients. Their history is important. When making decisions on what treatments to provide the doctors consider the patient's history. If you do not have their history and a nearby hospital does then it seems like an easy choice to send the patient elsewhere.

Indiana rocks! (1)

coolate (1173457) | more than 5 years ago | (#28209331)

Only in my state...

Re:Indiana rocks! (1)

NES HQ (1558029) | more than 5 years ago | (#28209563)

Hey, you could live in South Carolina!

Post comments on article moderation goes down (3, Informative)

FunkSoulBrother (140893) | more than 5 years ago | (#28209361)

That headline makes no sense.

Re:Post comments on article moderation goes down (2, Insightful)

Psiren (6145) | more than 5 years ago | (#28209635)

Aye. I was going to vote it down, but there's no "Piss Poor Grammar/Spelling/Punctuation" option. Shame.

In need of a form cycle system (4, Interesting)

modmans2ndcoming (929661) | more than 5 years ago | (#28209367)

The hospital I work for is implimenting a form cycle that allows forms to be printed and scaned back to the EMR. Such a system woudl allow my hospital to use the old paper system but maintain the records electronicly if there was ever a temporary interuption of the EMR.

Re:In need of a form cycle system (1)

lorenlal (164133) | more than 5 years ago | (#28209499)

It also provides a verifiable paper record. Something our voting system could use too.

Re:In need of a form cycle system (1)

the_humeister (922869) | more than 5 years ago | (#28209809)

The problem I see with that is how do you search for stuff exactly? Our system does that too for ER notes, but it can be difficult with how poorly people's handwriting can be.

The paperless hospital (1)

hierofalcon (1233282) | more than 5 years ago | (#28209425)

It doesn't surprise me a bit. I know someone who works in a hospital lab. In any large hospital these days the lab equipment automates the reporting of results into "the system". When some part goes down, they can revert to paper for a period of time. At some point, with how short hospitals are running staff, you reach a point that you do not have enough people and free time available to catch back up manually re-entering the data once the failed system comes back up. The time frame varies with the size of the hospital and the patient load.

In today's litigious society, it is perfectly reasonable to believe that a major hospital would close to new admissions to get the paperwork caught up rather than risk being sued because the electronic trail was missing. With a health records system not being available to produce histories on patients I could see shutting down even sooner.

It's certainly something to be concerned about and it's going to get worse as time goes on. Unfortunately, as the electrical load increases outages are likely to be more frequent as well.

EMR (1)

ljaszcza (741803) | more than 5 years ago | (#28209435)

I do IT for a small multispeciality group. This story really points out some problems I've seen. We are in a small town, we have surges, brownouts, you name it. I occasionally have problems even though all my racks are behind decent APC UPSes/conditioners. Inevitably though, spring and fall we have storms and people fire up their AC and the power grid is for crap. I've tried to work with the utility company but they *deny everything*. At this point I am thinking of getting management involved and pulling together a group of merchants who are IT heavy and petitioning the utility directly or through the state. I do worry about the repercussions though. As far as EMR goes, we use redundant systems, offsite backup but with imaging we have well over a TB of data. If the system were to go completely fubar, I don't know what would happen. Critical info like allergic reactions, med lists, would be unavailable. We won't even go into billing. For a small four physician group like ours, we could make do I suppose. For a large hospital in a litigious part of the country? I don't know. I suppose the answer is updatable RFIDs in every citizen so that medical info can travel with and be available with the patient, right? Welcome to the future everyone.

David Carradine Has Died, He Was Delicious (-1, Offtopic)

Anonymous Coward | more than 5 years ago | (#28209443)

Words cannot describe how sad this is. Carradine's acting was top-notch for the hey-day of 60's Kung-fu pop culture. His purple colour (a colour option picked up from an earlier version) clashes with the grey of any other window, that can be changed though. The black style of his acting in Kill Bill (Vol. 1 & 2) is overbearing and doesn't meld with his earlier works. His *cough* apparent suicide *cough* stands out like a sore thumb. I somehow feel like his death resembles the chrome looks like a web page, rather than someone who won an award in 2005 for lifetime acting achievements and for browsing web pages. I cannot believe someone who created the Firefox icon could create something so hideous and inappropriate, especially when David Carradine's market share is bad enough already. I could not bear to look at this all day, every day, it would drive me mad.

A suicidal has-been Kung-fu actor should be transparent, a thin veneer between me and the web page. Not a clown honking his horn in my face. I went into preferences and changed to the Mac "native" theme and no particular colour, mildly improved, but still the black is overpowering, the new-tab button is the wrong colour, and the side pane has a tinge of blue that doesnt work well with the OS X grey. The tab touching the title bar also just looks poor and conflicting. This is the same bullshit I had to put up with when Dana Plato finally offed herself. It's goudy, non-native, clashes with the websites you view, and generally gets in the way, the toolkit underneath still rears it's ugly head in how the app works, and the general layout of the widgets. Apparently Carradine was eaten by wolves on the Connecticut turn-pike. All reports say he was delicious. The dialogues throughout the app crap all over the spacing guides in the HIG. Every inch of this app is annoying and grates on me. I'm not an interface elitist or an apple fanboy, but I can't use software that gets on my nerves and Opera and Vista occupy the top two slots for that. The browser is eclectic, with too many preferences, too complicated preferences, too many customisation options. Features not everybody needs, or wants.

Re:David Carradine Has Died, He Was Delicious (0, Offtopic)

mcgrew (92797) | more than 5 years ago | (#28210031)

Holy crap, I thought you were trolling. Well, it's offtopic but damn...

David Carradine Dies [nytimes.com] . No wonder "Wild West Tech" wasn't on History Channel last Sunday morning.

Damn. They didn't mention Long Riders, a historically accurate portrayal of the James Gang, with the Carridine brothers playing the Youngers and the Keaches playing the James. That's one of my favorite westerns.

In other offtopic obituary news, blues great Koko Taylor has died also. Sad day for blues fans.

the real reason (1)

Jeff1946 (944062) | more than 5 years ago | (#28209453)

They were afraid that without their data system they wouldn't be able to bill for the services to the patients.

Failure of Engineering (0)

Anonymous Coward | more than 5 years ago | (#28209463)

This is just another failure of "Engineering".

This is what you get when you get "Engineers" to design things, that should have been designed by real-engineers, who can be held accountable.

The average IT worker is by nowhere near qualified to design systems like this.

Not a huge deal (4, Informative)

Mayhem178 (920970) | more than 5 years ago | (#28209479)

The summary is a bit sensationalist. Being a resident of Indianapolis, I know for a fact that there are a ton of hospitals around this area. Chances are St. Vincent's got a lot of those patients. I'm certain that Methodist would not have turned away any patients that they were not absolutely certain would receive adequate aid at another hospital, or if they thought that the patient in question was in no condition to be re-routed.

As for paper vs. electronic records, hospitals keep both. The point is that paper records take a lot longer to manage, and if they can safely do so, it's in everyone's best interest for them to send patients to other hospitals in order to get caught up on paperwork. If their paperwork keeps piling up, the chances of losing important data increase by a large margin, and that's bad for all parties involved.

No, I say that Methodist made the right call here.

Re:Not a huge deal (0)

Anonymous Coward | more than 5 years ago | (#28210049)

I agree, methodist is part of a huge medical center and there are a bunch of hospitals are in that area (university, wishard, riley, clarian, the va and methodist).

Missing syllables, not comma (1)

thinker (7404) | more than 5 years ago | (#28209495)

Hospital Turns Away Ambulances
Computers Go Down
Go Boom

Nothing to see here ... move along.... (3, Insightful)

johnlcallaway (165670) | more than 5 years ago | (#28209519)

It sounds like they were not accepting patients that couldn't make it to another hospital. Since they were accepting walk-ins, it's very likely an ambulance with a critical patient would have been accepted. If that was true, no one was being denied healthcare. Here in Phoenix, it's hard to go 5 miles without seeing another hospital. I was recently in a motorcycle crash and was not taken to the closest hospital because of the type of injury I had and the reputation the hospital had to handle orthopedic type injuries. I was not in a life threatening situation, just a simple fracture of my fibula, and didn't even go into surgery for 24 hours. I could have ridden several hours to another hospital and still have been just fine.

Hospitals are businesses and have to make money. If they don't get accurate records, they can't bill the insurance companies. While this is an indication of issues with a specific hospital's computer and backup systems and a possible risk with other hospitals, I see no cause for alarm.

I recently had to go to emergency for severe stomach pains and ended up having my gall bladder taken out. I had to wait 5 hours for a room because they were 'code purple'. All beds in hospital and emergency were full. I hope they were turning away non-critical patients also. I wouldn't be surprised if this happens far more often than what the news story reported.

This will only get worse. (1)

Celeste R (1002377) | more than 5 years ago | (#28209547)

In a completely computer-oriented hospital system (as more and more hospitals are doing, due to the tax benefits and lack of penalties), it's important that it's up and functional always.

Take for example: you don't want to give a patient food that they're allergic to, or medicine that they're allergic to for that matter. All of that is tracked by computers.

When there's actual paperwork involved with a computerized medical establishment, it gets very hairy. A patient may have notified someone of an important condition, only for it to be noted down and slipped into a stack (in this case, a growing stack) of paper. Such things can lead to lawsuits of malpractice and various other thing, including damaging the reputation of the hospital.

Furthermore, even when things are going -right-, you don't want paperwork at all in a computerized record system. Paperwork means that something hasn't been processed yet, and it may be days (or weeks) when that paperwork is found or processed. In the meantime, people are getting the (wrong) treatment.

I remember reading a story about a chronic asthma case where only a specific medication worked. He notified the same clinic 4 times, and the same hospital endlessly, of this, and it nearly led to his death. He lived because after a week (!) of being in the hospital, someone finally got around to the paperwork, and he was given the appropriate prescription.

Computerization of the medical establishment sounds like progress, but enforced computerization is -not- a step in the right direction. Proper computer management (especially in clinics and such) is important, and it's exactly those people who don't know how to make backups and such.

Washington, if the system works, don't break it, please!

It's here! (2, Funny)

DarrenBaker (322210) | more than 5 years ago | (#28209553)

I've been waiting for this news for years. Computers that perform fellatio? YES!

Imagine a beowulf cluster of those...

This is why... (1)

dburkland (1526971) | more than 5 years ago | (#28209571)

We need socialized medicine so the reliable Government can run the industry! Oh wait...

Let me see.... (2, Insightful)

camperdave (969942) | more than 5 years ago | (#28209677)

"Hospital Turns Away Ambulances Computers Go Down"

I guess they meant "The computers in the Away Ambulances for Turns Hospital stopped working".

Or maybe, "The Computers went down when the Hospital started Turning Ambulances Away." - some sort of sympathy strike action, I suppose; or maybe the hospital uses some computer repair technicians that call themselves PC medics, or PC Doctors and they ride around in "ambulances" that are full of tools and replacement parts. They arrived to do some maintenance and someone turned them away, resulting in the computers crashing.

Or perhaps the article title needs some clarifying punctuation.

IT Kills When In Hospitals (2, Interesting)

wonkavader (605434) | more than 5 years ago | (#28209749)

Years ago, probably in the early 1980's, a friend of the family had to be checked into a hospital. She was on dialisys (kidney disease) and obese and had other troubles associated with the combination of those two conditions. Things went wrong for her pretty frequently.

The hospital food cart kept bringer her food that would flat out kill her: no kidneys means no ability to deal with floods of certain chemicals -- potassium, for example. She used to joke about committing "bananacide". She could just eat a few bananas and sit down to wait for the inevitable.

Day after day, meal after meal, the food cart would bring her food she couldn't eat. She was going hungry when she was sick. She would plead with the staff, but they didn't change anything.

My father went to visit her and she begged him to help her. She was getting weaker every day. He talked to the staff and pursued the problem until he got to one of the people actually choosing the meals.

The nutritionists were doing the right thing. They were picking the right foods for someone who was obese and had other problems. They were NOT considering the fact that her kidneys didn't work. Why? Because the screen they saw only had room for a few conditions. The last one on the list -- Kidney failure -- wasn't showing. There were a fixed number of lines.

Someone had to shuffle the order of the values so that the various nutritionists, with their hundreds of patients a day, could keep track of what to feed her from then on.

She died a few days later.

Was it because she'd been underfed for days? Would feeding her have helped? I don't know.

But the story illustrates how a reasonable assumption made by someone in the chain that you'd need, let's say "four" lines in that field there, could kill someone.

Surge suppression seems like a no brainer, but the people making the decisions are not always the people who should be.

Re:IT Kills When In Hospitals (3, Insightful)

Anonymous Coward | more than 5 years ago | (#28210007)

"She would plead with the staff, but they didn't change anything."

That hospital had a much bigger problem than a bad computer system. Mistakes--even life-threatening ones--will happen, but your friend noticed the mistake and no one would fix it or even investigate?

In the hospitals my family has stayed at, when there's a problem (like getting soup when you're on a low-water diet), you tell the nurse and the nurse goes and gets a different meal.

Could the computer system be improved? Sure! Line #4 could have said "And More" (don't even have to change the look of the screen, then). But there's no point fixing the computer system when the problem is that people are completely abrogating their responsibility to a machine and no longer doing their jobs--they'll just find some other way to kill people.

In short: the tool is there to help, not do the job. Just because it is a shitty hammer doesn't mean it's okay to build a shitty house.

Patients turned away? (4, Informative)

vantar (1123257) | more than 5 years ago | (#28209757)

Since the article is making such a big deal about the rerouting of patients I would like to point out that the the nearest other hospital was Wishard Memorial Hospital, 1.5 miles away as the car drives.(Source:Google Maps) Its not like patients were being denied treatment because of this problem.

So what if the headline is worded funny (3, Informative)

davmoo (63521) | more than 5 years ago | (#28209791)

It doesn't matter that the headline is worded funny, because the majority of you responding so far obviously did not RTFA. But then why should I be surprised, this being Slashdot and all.

If you had read the article, you would know that the hospital only requested that ambulances *in route to the hospital* reroute to other area hospitals (and Indianapolis has no shortage of hospitals). Patients who were already there were not turned away, and patients who showed up using methods other than ambulances were not turned away.

Nooooo! (1)

jbacon (1327727) | more than 5 years ago | (#28209801)

The title! They fixed it! Bastards!

Overflow in hospitals is actually quite common (4, Informative)

Tyrun (944761) | more than 5 years ago | (#28209835)

Turning away patients isn't all that surprising. Hospitals do it all the time whenever they reach capacity. It's called overflow and it's quite common. In this instance their capacity was diminished because their system was in the gutter. Just my $.02

The problem with no paperwork (0)

hessian (467078) | more than 5 years ago | (#28209945)

The problem is mostly legal: if nothing is documented, the other guy's story wins, and one large lawsuit could take down the hospital. If you cannot organize your records, you're going to lose one, and if you lose one for the guy who claims he slipped, broke his back, and now can't work for life, your hospital goes bye-bye.

Our society has adapted to computers. We require them to move things along at the usual speed. Going back to paper isn't an option. Remote backup and redundant power supplies are a good idea, as that hospital found, but they did the right thing in shutting down instead of taking a huge legal risk.

Workflow (3, Insightful)

bzzfzz (1542813) | more than 5 years ago | (#28209993)

The problem is not so much access to historical records in these situations as it is workflow. After all, a patient sent to another hospital will not have the benefit of medical history records created at another hospital or clinic.

Workflow is where there is trouble. If you're reading this you probably use a GPS or Google maps to get around, probably both. Do you still have any paper roadmaps? I don't. Your process for getting to a new place depends on the technology. Same with hospitals. They increasingly depend on automated workflows for scheduling, for dispensing drugs, for managing lab and x-ray orders and results, and so on.

Hospitals have switched to these systems because they require fewer staff. They have largely dismantled the paper+clipboard+courier systems that preceded them. These older systems were complex and cannot be resurrected quickly. There aren't enough people to implement them. The institutional memory on how to use them is lost.

I would guess that, in this particular case, they've gone back to paper prescriptions, signed by doctors, and taken by courier to the pharmacy, with a paper label on the dispensed drugs. That must be scary, because all the safeguards in the automated system -- checks for allergies, interactions, appropriate dosage for patient weight, not to mention barcode scans at multiple points to guard against mistakes -- are gone. Who will do the manual crosschecking? Have they been trained?

As Isaac Asimov once wrote, ""I do not fear computers. I fear the lack of them."

I've been waiting! (0)

Anonymous Coward | more than 5 years ago | (#28210005)

My research seems to indicate that Clarian uses Cerner as their EMR, which is disappointing, because I was looking for a reason to finally make this joke:

Epic [epicsystems.com] fail.

Be thankful for computers (1)

davidwr (791652) | more than 5 years ago | (#28210017)

If a hospital can only process paperwork for X patients per hour, then it can only accept X patients per hour without getting a backlog.

If the paperwork is messed up or not available it can lead to medical errors, including fatal ones.

If computers turn X into 10X or 20X, then great, paperwork is no longer the limiting factor on capacity. Well, not until the computers crash.

i have no sympathy or pity (2, Insightful)

nimbius (983462) | more than 5 years ago | (#28210025)

for this hospital. any competent facility with an electronic system such as this obviously has a competent IT staff dedicated to a recovery procedure of some sort. redundant systems, generator backed servers, and perhaps even colocation while new for healthcare IT should be considered.

if its like every other IT shop, the "budget" was cut and IT got the short end of the stick again.

I work in the Electronic Records Industry (0)

Anonymous Coward | more than 5 years ago | (#28210045)

I work for an ePCR company that was developed and started by Critical Care Flight Nurses/Paramedics. Our company's main product is the Providers (First Responders) portion of the patient tracking. When they put in a trip, the hospital gets it immediately. Further, we have a program that regions use that changes a hospitals status from open to divert when the hospital has issues or is overly crowded. This happens more than most know. Divert status warns the EMS Providers ahead of time so that they dont waste minutes hauling a patient to a closed ER. As one poster stated, this is actually saving the patient's life in many cases. Our company does not handle medical records of any hospital though.

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