Tuesday, December 16, 2014

Computers are efficient. And other lies.

Sometimes stuff gets put into perspective.  With force.

I was recently reminded of a few things which happened several months ago while I was visiting friends in hospitals (this happens more and more as you get old- or they are visiting you).

All events occurred at large, modern facilities- the kind with computers in every patient room plus roving computer carts, and all the patient info readily available to authorized personnel.  Of course, by “all” I mean “all information which has already been entered into the right systems”, which leads to my first observation.

Hanging out with my friend for an afternoon I got to overhear some of his conversations and frustrations with the medical staff.  It was a busy afternoon for him, no sooner had one team of specialists left him than another would wander in.  Each team came in with a handful of patient files, and checked up on him in the computer when they were talking to him.  And he invariably had to fill them in on some test result or comment from other specialists about his challenging situation- it was common enough that he kept a journal to make sure he could pass the latest info on to his caregivers.  Remember, computers everywhere, in rooms, staff stations, and mobile carts.  Oh, and paper files in a binder outside each patient’s room.  And that wasn’t enough to get info shared in a timely manner.  The computer systems were apparently less than efficient, so data input was tedious- thus forcing the reliance on paper, further slowing the timely input of data.  Somewhere the technology became a burden instead of an aid, and that compounded aggravation for the people who relied on the systems to do their jobs.  We’ve all seen poorly implemented technology like this, but seeing it in a hospital where a patient, your buddy, has to keep notes to make sure he bridges failures in communication with medical staff, that’s pretty terrifying.

Just as this was sinking in, one of the aides came in and took his vital signs- and scribbled them down on a scrap of paper to input somewhere else later.  This was not an anomaly, my buddy assured me that happened every time his vitals were taken throughout his stay, expensive machines display numbers, aides scribble them on scraps of paper for later input.  Damn, that’s the way to share important information in a timely manner.  And efficient, too.

doctor at office

That afternoon I wandered down to the waiting room a few times as doctors were examining him.  One time I overhead an interesting conversation, there was a pretty ugly technical problem and the person looking into it was the kind of network admin I want working in healthcare.  I’m sure he thought the waiting room was empty as he used the phone in the hall, so I got to overhear a pretty candid exchange.  He was investigating a connectivity problem with the wireless telemetry system, the system which monitors patients and reports the vitals and more to staff throughout the floor.  Wireless telemetry systems are generally used for patients who need continuous monitoring, but are somewhat mobile, such as post-operative recovery and patients with self-administered pain management.  The telemetry wireless was down and patient data wasn’t filling the screens in the halls and nurses stations, and that threatens patient care.  The admin was polite, and chose his words carefully, but he was obviously livid.  It was clear he was a network guy, not a medical professional, but his primary concern was patient care (as you would hope in a hospital).  It sounded like poorly planned maintenance had caused the outage, and proper procedures weren’t followed, resulting in the outage.  Another pretty scary scenario given the systems affected by the outage.  As appalled as I was that this happened, I was impressed with the admin’s focused outrage.  “Not only can’t this be happening now, it can’t ever have happened, and it can’t ever happen again” was one comment he made over the phone, a line I’m not likely to forget soon.  At the end of the call he explained to whoever was on the other end of the line that the issue would be reported to senior management- not IT management, but senior medical management.  As bad as it was that this problem happened, I was glad to hear that a network admin had a direct path to report issues to appropriate executives directly, even in a huge facility like [redacted].  That’s the way it should be, the head of medicine needs to know about preventable and unusual threats to patient care, regardless of the source.  Imagine what technology could accomplish without insular silos disconnecting technology from consequences- maybe my buddy could put away his notepad.

Another incident happened as I was leaving a different friend’s room at the end of visiting hours in another large, modern facility.  But that’s a story for another day, I’ll leave you to reflect on this little set of horrors until then.