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In modern hospitals, inability to access the EHR will prevent you from doing _anything_! CTs, MRIs, EKGs, automated drug distributing machines, you name it... w

by rscho 6y ago

In modern hospitals, inability to access the EHR will prevent you from doing _anything_! CTs, MRIs, EKGs, automated drug distributing machines, you name it... will simply refuse to work if the patient is not admitted. And no, vendors don't provide you with a "special key" to bypass that. Any problem? Call the company tech and he'll be here real soon... in 12 hours. People call for more automation but they forget the downsides in resource constrained places such as the public hospital system. This thread is full of people who don't know what they're talking about.

NanoCoaster 6y ago
Could you point to any resources for reading / learning about this? Even articles, blog posts? I'm not doubting you (I've worked with the manufacturing industry before, sounds eerily similar), it just seems very, uh, precarious, to say the least and I'm interested to learn more about it.
- rscho 6y ago
  Not really, sorry. This is from personal experience, and all I have is anectodes from the trenches of the OR and ER. I guess you might find some articles on MEDLINE/Pubmed, but I suspect that it's not a well-studied problem because it doesn't make/lose enough money for the right people. However, even if emergency escape hatches exist for the particular task at hand I'd bet on the staff on site to not be aware of those anyways. Technology brought complexities to healthcare that healthcare workers are not educated to handle. For instance, try asking to undock a surgical robot for anesthesia to gain access to the patient in an emergency. On DaVinci robots, there's a procedure for doing that in 30 seconds. Last time we tried it in our OR, it took >10 minutes.
hh2222 6y ago
Modern hospitals have tested manual downtime processes in place.
- rscho 6y ago
  You can ventilate or have light in manual downtime. You don't have immediate access to any advanced stuff. And that's for very specific catastrophic situations. In grey zones where things half work and emergency protocols have not been activated, the hospital is almost completely stalled.
- joshgel 6y ago
  This. The EMR does go down from time to time. We still have paper order pads around so that things can get done. Its annoying AF. You have to fax things to radiology to get a scan. You have to walk to pharmacy to get meds. But, the system worked before computers (which wasn't that long ago in many hospitals) and it works without them today. That said , the first time I had to use paper I felt like I had no idea what I was doing, because a lot of the EMR defaults aren't there to prompt you. So you have to specify a 'start time' for a medication, but in the EMR now is the default, so I didn't think about it as anything mandatory.
  - rscho 6y ago
    And you can transition immediately? When things like that happen over here, adjustments are far from immediate, and my center is not in the middle of nowhere. Of course the papers are there, but radiology is pretty much out of service for a few hours. And then you have advanced/special testing that pretty much does not run at all.
- cordite 6y ago
  Downtime procedures are definitely a thing in the US. Known downtime is certainly the best time to prepare and practice, this happens when an EMR goes through an upgrade and migrations are run. This can be 6-24 hours. There are bundled minor upgrades (think service packs) that have short (10-60 minute) downtimes, blocking migrations run in that time but are kept to a minimum. If it is at all possible, migrations will be async (even on major upgrades) and run in the background after the new version goes live. During downtime, bloodwork and the like involve pre-allocated barcode labels. Either the results will be accessible on the instrument afterwards in its memory, or the results will be printed out and it is up to the lab tech to transcribe the results. I can't speak in depth for radiology, but I expect that they have file share servers involved for the raw results. Likely less local memory (in number of results that can be stored) than clinical lab instruments.

by rscho 6y ago

NanoCoaster 6y ago

Could you point to any resources for reading / learning about this? Even articles, blog posts? I'm not doubting you (I've worked with the manufacturing industry before, sounds eerily similar), it just seems very, uh, precarious, to say the least and I'm interested to learn more about it.

rscho 6y ago
Not really, sorry. This is from personal experience, and all I have is anectodes from the trenches of the OR and ER. I guess you might find some articles on MEDLINE/Pubmed, but I suspect that it's not a well-studied problem because it doesn't make/lose enough money for the right people. However, even if emergency escape hatches exist for the particular task at hand I'd bet on the staff on site to not be aware of those anyways. Technology brought complexities to healthcare that healthcare workers are not educated to handle. For instance, try asking to undock a surgical robot for anesthesia to gain access to the patient in an emergency. On DaVinci robots, there's a procedure for doing that in 30 seconds. Last time we tried it in our OR, it took >10 minutes.

hh2222 6y ago

Modern hospitals have tested manual downtime processes in place.

rscho 6y ago
You can ventilate or have light in manual downtime. You don't have immediate access to any advanced stuff. And that's for very specific catastrophic situations. In grey zones where things half work and emergency protocols have not been activated, the hospital is almost completely stalled.
joshgel 6y ago
This. The EMR does go down from time to time. We still have paper order pads around so that things can get done. Its annoying AF. You have to fax things to radiology to get a scan. You have to walk to pharmacy to get meds. But, the system worked before computers (which wasn't that long ago in many hospitals) and it works without them today. That said , the first time I had to use paper I felt like I had no idea what I was doing, because a lot of the EMR defaults aren't there to prompt you. So you have to specify a 'start time' for a medication, but in the EMR now is the default, so I didn't think about it as anything mandatory.
- rscho 6y ago
  And you can transition immediately? When things like that happen over here, adjustments are far from immediate, and my center is not in the middle of nowhere. Of course the papers are there, but radiology is pretty much out of service for a few hours. And then you have advanced/special testing that pretty much does not run at all.
cordite 6y ago
Downtime procedures are definitely a thing in the US. Known downtime is certainly the best time to prepare and practice, this happens when an EMR goes through an upgrade and migrations are run. This can be 6-24 hours. There are bundled minor upgrades (think service packs) that have short (10-60 minute) downtimes, blocking migrations run in that time but are kept to a minimum. If it is at all possible, migrations will be async (even on major upgrades) and run in the background after the new version goes live. During downtime, bloodwork and the like involve pre-allocated barcode labels. Either the results will be accessible on the instrument afterwards in its memory, or the results will be printed out and it is up to the lab tech to transcribe the results. I can't speak in depth for radiology, but I expect that they have file share servers involved for the raw results. Likely less local memory (in number of results that can be stored) than clinical lab instruments.