August 29, 2013
Technology Failed Again. That reminds me to remind you about the need for redundancy, when it comes to HIT stuff.
When thinking about EMR<>EHR<>HIT stuff and designing better HIT systems ... remember this.
Wall street went down on (Thursday, August 22, 2013)
http://dealbook.nytimes.com/
but, nothing happened. A few guys made less money? There was a delay in trading ... so what? Who cares? If I were one of those trader guys, I would have hiked out of the office, grabbed a cup of coffee, walked down to the river, felt the sunshine and watched the water run by. "Call me when things are back up and running." But, in my business, I can't do that.
There are few things in life during which time is critical. In fact, time is usually irrelevant. But, in the spectrum of life, health, healthcare and death, the natural history of injuries and diseases dictate some of the critical moments in life. So, chill when you can ... drink the coffee and smell the roses. And, recognize those things that require immediate attention ... true emergencies.
In other words, there are certain illnesses and injuries during which minutes ... even seconds of delay in proper diagnosis and definitive treatment may result in permanent cell damage, organ damage, loss of limb, or loss of life. The diagnosis and treatment of these conditions is CRITICAL CARE ... That's my day job. In this business, there is no excuse or time for "systems down". In other words, we have to be ready to take care of these sorts of problems 24 x 7 with or without technology. That is the simple truth. Veritas!
During Katrina, ALL SYSTEMS WERE DOWN within a few hours and they stayed down for days to weeks. In the immediate aftermath of Katrina, we had NO RECORDS on many patients, some of whom were critically ill. Direct care Patient<>Physician<>Provider prevented many disasters in our hands.
Intermittently, every electronic record and system I have used has failed.
Intermittently, every piece of technology I have ever used has failed.
Conclusion: There is no such thing as failsafe. But, we can build redundancy into EMR<>EHR<>HIT Systems that will generate smart cards and "hard copy" intermittently, at a frequency to be dictated by the "situation" the patient happens to be in at the moment. If "the patient" is in the hospital, or the Intensive Care Unit, hard copy of the EMR/flow sheet should be printed out at least every 8 - 12 hours. At the push of a button, the "system" should generate a smart card and paper summary for each patient. In critical situations, attach that summary and smart card with all essential data, at least a problem list, to name tag that hangs on the patient's neck. That way, the patients and the folks on the front lines with the patients who are responsible for their care will have a little something to help them get some background information. And, the folks who receive them will also have something to go on. Add this capacity to the design of any robust EMR<>EHR<>HIT System. Just my opinion.
And, HIT guys ... don't look at me as if I have two heads when I tell you these things. Fix it!
Dr. Mike
Michael F. Mascia, MD, MPH
