26 ms·

Yeah I'm a bit skeptical to this. What exactly about a computer system prevents them from admitting a person? Just pick up a piece of paper and write down wha

Yeah I'm a bit skeptical to this. What exactly about a computer system prevents them from admitting a person? Just pick up a piece of paper and write down whatever you'd write down later in the computer once it's back up. It's not that hard. I could understand if a particular machine that goes ping couldn't be used because of the computer system being down. But that's a very specific issue.

StreamBright 6y ago
Have you worked in an ICU a lot?
- INTPenis 6y ago
  No but one of my clients is a major health care provider with over 35000 employees. I don't manage their MT systems but I know about them and I hear about them from co-workers. And just going on common sense I don't see how a computer could prevent a hospital from admitting a patient. We're talking about admission, not any special treatment. So it's an honest question to the community, not trying to be dogmatic here. I'm honestly asking, what in a computer system could prevent a patient from being admitted for care? As far as I can reason, no drugs are being held hostage by a computer. Doctors can still use their training without a computer. Humans have been treating ailments for thousands of years without the aide of computers. It would be really sad if this woman died because hospital staff felt hopeless without computers. Edit: Going beyond just the human dependence on computers, it would be a good exercise in society readiness to be able to treat patients during a blackout for example.
  - unionpivo 6y ago
    Its not that they cant be admitted for care, its that they can't provide care, if devices that they need to provide the care don't work. A lot of devices in hospitals work on vendor provided machines that are not up to date. If anything happens on either end, you can't use device. I am talking about CT, MRI, endoscopy, and other devices. If you have integrated single sign on with access cards, and AD dies, you can't login, and if you can't login you cant use the device. The reason I am pointing AD out, is because I am working in integrating such device in our software as we speak. more here: https://news.ycombinator.com/item?id=24514441 https://news.ycombinator.com/item?id=24514441
  - afarrell 6y ago
    > just going on common sense I don't see how a computer could prevent a hospital from admitting a patient. Common sense is knowledge gained by experience. Thats' why kids "don't have any". > I'm honestly asking, what in a computer system could prevent a patient from being admitted for care? This is a good question for us to have more detailed understanding of.
    - Funes- 6y ago
      >Common sense is knowledge gained by experience. Thats' why kids "don't have any". I'd say it has more to do with sound logical reasoning, and not only with accrued information.
      - withinboredom 6y ago
        If you don't know what a DAG is, it won't be common sense to use one when you should. It's a mix.
        Funes- 6y ago
        >It's a mix. That's exactly why I said "not only" instead of "not".
        afarrell 6y ago
        You are right about the general definition. In our specific case when someone says > I don't see how X Then what's often lacking is an experience or knowledge that would allow them to imagine X.
  - StreamBright 6y ago
    > Humans have been treating ailments for thousands of years without the aide of computers. And now computers are in many cases deciding about life and death. Very trivial example: Boeing 737 MAX. Not able to turn off automation can cause death. > Going beyond just the human dependence on computers, it would be a good exercise in society readiness to be able to treat patients during a blackout for example. I agree but this does not mean that we are ready for that.
    - INTPenis 6y ago
      The Boeing was a major scandal though. We didn't blame the pilot or the software developers. We blame Boeing and the Air regulation authorities for not doing the necessary QA. >I agree but this does not mean that we are ready for that. Yes, well then this issue is even more important. Because the german police are treating this as a type of homicide. So they seem to be going after the hackers as the cause of death here. Then it becomes even more important to clarify why the woman was turned away. Others have pointed this out but it could be as simple as general policy, or a manager not willing to risk treating her without the proper tools. Either way, european countries have been talking about society readiness lately and this is key for society preparedness. Therefore I'm not sure we should be pointing fingers at the hackers here, seems like an easy scapegoat for a deeper issue. Even if they have to manually operate a ventilator for 4 hours in shifts, they are still a hospital. The most qualified place to save a life, and they turned it away.
    - akkawwakka 6y ago
      Automation can also go very far in saving lives. We hear about fatal plane crashes in the news, but don’t really hear about the times that automation and computer systems catch or report a pilot overspending the aircraft, making an unsafe maneuver, deviating from standard operating procedures, or touching down too hard. The Boeing situation is an interesting. With the Max, Boeing broke a core tenant of aircraft design that’s been a major factor in making airliners so safe. The MCAS system’s inputs (from angle of attack sensors) were not redundant. They should have been at least doubly-redundant given that the ultimate design of MCAS could pitch the aircraft down to such a degree that the pilot could not overcome it using their own control inputs. While Boeing probably should have redesigned its airframe instead of adding MCAS, it wasn’t a fundamentally bad idea to employ automation. The system behavior changed, but the company failed to re-assess the safety implications. All Airbus products are fly-by-wire and there’s always some level of automation in play. It degrades to employ less protections when system faults occur. There’s a lesson there for Boeing!
afarrell 6y ago
Okay, so you write down that info on that piece of paper. You put the paper down somewhere. A nurse gives someone medication that they told you they are allergic to.
conistonwater 6y ago
I agree with you mostly because doctors were evidently capable of running their departments way back when on paper and pencil alone. But I also think it's possible that there's a well-intentioned regulation somewhere that says that a hospital is legally required to turn away patients when their systems are down. E.g., it could be a regulation for establishing a minimum standard of care and having the systems up and running is defined to be part of that minimum standard. I don't know anything about this case though.
- afarrell 6y ago
  Doctors trained in a 1940s environment with 1950s communication habits and 1950s information-management systems were capable of doing that. I'm not sure a nonmilitary a doctor today could spin one of those info-management systems up in a single day though. I don't see how that is relevant
lordnacho 6y ago
The world has moved on a bit since everything was done on paper. The new process is not necessarily backwards compatible. Everyone is trained on using a computer interface for their work, there's a reliance on the computers to move the data to wherever it needs to be. I reckon even a restaurant with a modern POS system would be problematic to switch to paper, ad-hoc.
- INTPenis 6y ago
  Sure I can accept that we have a very hard dependence on computer systems. In that case there is work to do because imho a hosptial should keep working during a war or a blackout. This is essential for society readiness.
  - unishark 6y ago
    I'm sure they have generators for handling blackouts. Even my local grocery can keep operating in a blackout. Some people can't survive without machines after all. They occasionally get caught by rarer situations like a blackout combined with a flood which takes out the generators.
    - sideshowb 6y ago
      I've more than once been turned away from a supermarket because the POS system is down. My local shop on the other hand would have no issues. Strictly cash only, or a verbal credit agreement if you don't have enough on you. The proprietor refuses to get a card machine, says the risk is too great for a business with such low margins.
- leetcrew 6y ago
  > I reckon even a restaurant with a modern POS system would be problematic to switch to paper, ad-hoc. it would be slower and a couple more orders might get messed up, but it's not that big of a problem. a lot of restaurant POS systems are just a calculator with a touchscreen that prints two tickets per order (one for the kitchen, and one for the servers) and tells you how much to charge the customer. then the kitchen spikes their copy when they finish the order, and the server spikes theirs after they bring it to the table. on fancier ones, the tickets are just shown on a screen and you "spike" them by pressing the done button. anybody who understands how to do their job in the first place can emulate the digital system on pen-and-paper. in fact, the POS went down more than once when I worked in restaurants, and this is exactly what we did.

StreamBright 6y ago

Have you worked in an ICU a lot?

INTPenis 6y ago
No but one of my clients is a major health care provider with over 35000 employees. I don't manage their MT systems but I know about them and I hear about them from co-workers. And just going on common sense I don't see how a computer could prevent a hospital from admitting a patient. We're talking about admission, not any special treatment. So it's an honest question to the community, not trying to be dogmatic here. I'm honestly asking, what in a computer system could prevent a patient from being admitted for care? As far as I can reason, no drugs are being held hostage by a computer. Doctors can still use their training without a computer. Humans have been treating ailments for thousands of years without the aide of computers. It would be really sad if this woman died because hospital staff felt hopeless without computers. Edit: Going beyond just the human dependence on computers, it would be a good exercise in society readiness to be able to treat patients during a blackout for example.
- unionpivo 6y ago
  Its not that they cant be admitted for care, its that they can't provide care, if devices that they need to provide the care don't work. A lot of devices in hospitals work on vendor provided machines that are not up to date. If anything happens on either end, you can't use device. I am talking about CT, MRI, endoscopy, and other devices. If you have integrated single sign on with access cards, and AD dies, you can't login, and if you can't login you cant use the device. The reason I am pointing AD out, is because I am working in integrating such device in our software as we speak. more here: https://news.ycombinator.com/item?id=24514441 https://news.ycombinator.com/item?id=24514441
- afarrell 6y ago
  > just going on common sense I don't see how a computer could prevent a hospital from admitting a patient. Common sense is knowledge gained by experience. Thats' why kids "don't have any". > I'm honestly asking, what in a computer system could prevent a patient from being admitted for care? This is a good question for us to have more detailed understanding of.
  - Funes- 6y ago
    >Common sense is knowledge gained by experience. Thats' why kids "don't have any". I'd say it has more to do with sound logical reasoning, and not only with accrued information.
    - withinboredom 6y ago
      If you don't know what a DAG is, it won't be common sense to use one when you should. It's a mix.
      - Funes- 6y ago
        >It's a mix. That's exactly why I said "not only" instead of "not".
        afarrell 6y ago
        You are right about the general definition. In our specific case when someone says > I don't see how X Then what's often lacking is an experience or knowledge that would allow them to imagine X.
- StreamBright 6y ago
  > Humans have been treating ailments for thousands of years without the aide of computers. And now computers are in many cases deciding about life and death. Very trivial example: Boeing 737 MAX. Not able to turn off automation can cause death. > Going beyond just the human dependence on computers, it would be a good exercise in society readiness to be able to treat patients during a blackout for example. I agree but this does not mean that we are ready for that.
  - INTPenis 6y ago
    The Boeing was a major scandal though. We didn't blame the pilot or the software developers. We blame Boeing and the Air regulation authorities for not doing the necessary QA. >I agree but this does not mean that we are ready for that. Yes, well then this issue is even more important. Because the german police are treating this as a type of homicide. So they seem to be going after the hackers as the cause of death here. Then it becomes even more important to clarify why the woman was turned away. Others have pointed this out but it could be as simple as general policy, or a manager not willing to risk treating her without the proper tools. Either way, european countries have been talking about society readiness lately and this is key for society preparedness. Therefore I'm not sure we should be pointing fingers at the hackers here, seems like an easy scapegoat for a deeper issue. Even if they have to manually operate a ventilator for 4 hours in shifts, they are still a hospital. The most qualified place to save a life, and they turned it away.
  - akkawwakka 6y ago
    Automation can also go very far in saving lives. We hear about fatal plane crashes in the news, but don’t really hear about the times that automation and computer systems catch or report a pilot overspending the aircraft, making an unsafe maneuver, deviating from standard operating procedures, or touching down too hard. The Boeing situation is an interesting. With the Max, Boeing broke a core tenant of aircraft design that’s been a major factor in making airliners so safe. The MCAS system’s inputs (from angle of attack sensors) were not redundant. They should have been at least doubly-redundant given that the ultimate design of MCAS could pitch the aircraft down to such a degree that the pilot could not overcome it using their own control inputs. While Boeing probably should have redesigned its airframe instead of adding MCAS, it wasn’t a fundamentally bad idea to employ automation. The system behavior changed, but the company failed to re-assess the safety implications. All Airbus products are fly-by-wire and there’s always some level of automation in play. It degrades to employ less protections when system faults occur. There’s a lesson there for Boeing!

afarrell 6y ago

Okay, so you write down that info on that piece of paper. You put the paper down somewhere. A nurse gives someone medication that they told you they are allergic to.

conistonwater 6y ago

I agree with you mostly because doctors were evidently capable of running their departments way back when on paper and pencil alone. But I also think it's possible that there's a well-intentioned regulation somewhere that says that a hospital is legally required to turn away patients when their systems are down. E.g., it could be a regulation for establishing a minimum standard of care and having the systems up and running is defined to be part of that minimum standard. I don't know anything about this case though.

afarrell 6y ago
Doctors trained in a 1940s environment with 1950s communication habits and 1950s information-management systems were capable of doing that. I'm not sure a nonmilitary a doctor today could spin one of those info-management systems up in a single day though. I don't see how that is relevant

lordnacho 6y ago

The world has moved on a bit since everything was done on paper. The new process is not necessarily backwards compatible. Everyone is trained on using a computer interface for their work, there's a reliance on the computers to move the data to wherever it needs to be. I reckon even a restaurant with a modern POS system would be problematic to switch to paper, ad-hoc.

INTPenis 6y ago
Sure I can accept that we have a very hard dependence on computer systems. In that case there is work to do because imho a hosptial should keep working during a war or a blackout. This is essential for society readiness.
- unishark 6y ago
  I'm sure they have generators for handling blackouts. Even my local grocery can keep operating in a blackout. Some people can't survive without machines after all. They occasionally get caught by rarer situations like a blackout combined with a flood which takes out the generators.
  - sideshowb 6y ago
    I've more than once been turned away from a supermarket because the POS system is down. My local shop on the other hand would have no issues. Strictly cash only, or a verbal credit agreement if you don't have enough on you. The proprietor refuses to get a card machine, says the risk is too great for a business with such low margins.
leetcrew 6y ago
> I reckon even a restaurant with a modern POS system would be problematic to switch to paper, ad-hoc. it would be slower and a couple more orders might get messed up, but it's not that big of a problem. a lot of restaurant POS systems are just a calculator with a touchscreen that prints two tickets per order (one for the kitchen, and one for the servers) and tells you how much to charge the customer. then the kitchen spikes their copy when they finish the order, and the server spikes theirs after they bring it to the table. on fancier ones, the tickets are just shown on a screen and you "spike" them by pressing the done button. anybody who understands how to do their job in the first place can emulate the digital system on pen-and-paper. in fact, the POS went down more than once when I worked in restaurants, and this is exactly what we did.