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I used to work in healthcare IT. Running a code is not always only CPR. Different medications may be pushed (injected into the patient) to help stabilize them.

I used to work in healthcare IT. Running a code is not always only CPR. Different medications may be pushed (injected into the patient) to help stabilize them. These medications are recorded via a bar code and added to the patients chart in Epic. Epic is the source of truth for the current state of the patient. So if that is suddenly unavailable that is a big problem.

dwatson92 2y ago
Makes sense, thank you for the explanation.
627467 2y ago
Okay,not having historical data avaliable to make decision on what to put into a patient is understandable - but maybe also print critical stuff per patient once a day? - but not being able to log an action in realtime should not be a critical problem.
- pas 2y ago
  maybe non-volatile e-paper, which can be updated easily if things are up, and if the system is down it still works as well as the printouts
  - anonymous8888 2y ago
    updatable e-paper is going to be very expensive
    - rbanffy 2y ago
      A small printer connected to the scanner should do.
    - pas 2y ago
      Compared to managing thousands of printers? And then the resulting printouts? Buying ink, changing the cartridges? Technologically it seems doable. Big enough order brings down the costs. https://soldered.com/product/soldered-inkplate-5-5-2%e2%80%b3-e-paper-board/ https://soldered.com/product/soldered-inkplate-5-5-2%e2%80%b... Of course the real backup plan should be designed based on the actual needs, perhaps the whole system needs an "offline mode" switch. I assume they already run things locally, in case the big cable seeker machine arrives in the neighborhood.
- jacurtis 2y ago
  I don't think it is historical data required to make a decision, it is required to store the action for historical purposes in the future. This is ultimately to bill you and to track that a doctor isn't stealing medication, improperly treating the patient, and to track it for legal purposes. Some hospitals require you to input this in order to even get physical access to the medications. Although a crash cart would normally have common things necessary to save someone in an emergency, so I would think that if someone was truly dying they could get them what they needed. But of course there are going to be exceptions and a system being down will only make the process harder.
- adolph 2y ago
  > maybe also print critical stuff per patient once a day? Yep, the business continuity boxes are basically minimally connected PDF archives of patient records "printed" multiple times a day.
- efitz 2y ago
  This. Anyone involved in designing and/or deploying a system where an application outage threatens life safety, should be charged with criminal negligence. A receipt printer in every patient room seems like a reasonable investment.
  - jmcgough 2y ago
    I don't think you understand the scale of this problem. Computers were not up to print from. Our Epic cluster was down for placing and receiving orders. Our lab was down and unable to process bloodwork - should we bring out the mortar and pestle and start doing medicine the old fashioned way? Should we be charged with "criminal negligence" for not having a jar of leeches on hand for when all else fails?
    - efitz 2y ago
      I was advocating for a paper fall back. That means that WHILE the computers are running, you must create a paper record, eg “medication x administered at time y”, etc., hence the receipt printers, which are cheap and low-dependency. The grandparent indicated that the problem was that when all tow computers went down, they couldn’t look up what had already been done for the patient. I suggested a simple solution for that - receipt printers. After the computers fail you tape the receipt to the wall and fall pack to pen and paper until the computers come back up. I completely understand the scale of the outage today. I am saying that it was a stupid decision and possibly criminally negligent to make a life critical process dependent on the availability of a distributed IT application not specifically designed for life critical availability. I strongly stand by that POV.
      - jmcgough 2y ago
        This would be a disaster from a HIPAA perspective, and an unimaginable amount of paperwork.
      - galangalalgol 2y ago
        This approach is also what popped in my head. I've seen people use white boards for this already so it must be ok from a hipaa standpoint.
- anonymous8888 2y ago
  in this case, it's the entire operating system going down on all computers, so I don't think the printers are working either
  - gtvwill 2y ago
    Most printers in these facilities run standalone on an embedded Linux variant.They actually can host whole folders of.data for reproduction "offline". Actually all scan/print/fax multi function machines can generally do that these days. If the IT onsite is good though the usb ports an storage on devices should be locked down.
- CydeWeys 2y ago
  It is a critical problem if your entire record of life-saving drugs you've given them in the past 24 hours suddenly goes down. You have to start relying on people's memories, and it's made worse by shift turn-overs so the relevant information may not even be reachable once the previous shift has gone home. There are plenty of drugs that can only be given in certain quantities over a certain period of time, and if you go beyond that, it makes the patient worse not better. Similarly there are plenty of bad drug interactions where whether you take a given course of action now is directly dependent on which drugs that patient has already been given. And of course you need to monitor the patient's progress over time to know if the treatments have been working and how to adjust them, so if you suddenly lose the record of all dosages given and all records of their vital signs, you've lost all the information you need to treat them well. Imagine being dropped off in the middle of nowhere, randomly, without a GPS.
  - czl 2y ago
    > It is a critical problem if your entire record of life-saving drugs you've given them in the past 24 hours suddenly goes down. Will outages like this motivate a backup paper process? The automated process should save enough information on paper so a switch over to paper process at any time is feasible. Similar to elections.
    - dogmatism 2y ago
      no money for that there are backup paper processes, but they start fresh when the systems go down If it was printing paper in case of downtime 24/7, it would be massive wasteage for the 99% of time system is up
      - grugagag 2y ago
        A good system is resilient. Paper process could take over when system is down. Form my understanding healthcare systems undergo recurrent outages for various reasons.
    - dopylitty 2y ago
      Maybe if all the profit seeking entities were removed from healthcare that money could instead go to the development of useful offline systems. Maybe a handheld device for scanning in drugs or entering procedure information that stores the data locally which can then be synced with a larger device with more storage somewhere that is also 100% local and immutable which then can sync to online systems if that is needed.
- rbanffy 2y ago
  Looks like a small scanner + printer running a small minimalistic RTOS would be a good solution.
  - ta988 2y ago
    Ok now you have a park of 200 of those devices to handle. And now you move a patient across a service or to another hospital and then.... Reality is complex.
    - rbanffy 2y ago
      Oh yes. This would be a contingency measure, just to keep the record in a human readable form while requiring little manual labor. Printed codes could be scanned later into Epic and, if you need to transfer the patient, tear the paper and send it with them.

dwatson92 2y ago

Makes sense, thank you for the explanation.

627467 2y ago

Okay,not having historical data avaliable to make decision on what to put into a patient is understandable - but maybe also print critical stuff per patient once a day? - but not being able to log an action in realtime should not be a critical problem.

pas 2y ago
maybe non-volatile e-paper, which can be updated easily if things are up, and if the system is down it still works as well as the printouts
- anonymous8888 2y ago
  updatable e-paper is going to be very expensive
  - rbanffy 2y ago
    A small printer connected to the scanner should do.
  - pas 2y ago
    Compared to managing thousands of printers? And then the resulting printouts? Buying ink, changing the cartridges? Technologically it seems doable. Big enough order brings down the costs. https://soldered.com/product/soldered-inkplate-5-5-2%e2%80%b3-e-paper-board/ https://soldered.com/product/soldered-inkplate-5-5-2%e2%80%b... Of course the real backup plan should be designed based on the actual needs, perhaps the whole system needs an "offline mode" switch. I assume they already run things locally, in case the big cable seeker machine arrives in the neighborhood.
jacurtis 2y ago
I don't think it is historical data required to make a decision, it is required to store the action for historical purposes in the future. This is ultimately to bill you and to track that a doctor isn't stealing medication, improperly treating the patient, and to track it for legal purposes. Some hospitals require you to input this in order to even get physical access to the medications. Although a crash cart would normally have common things necessary to save someone in an emergency, so I would think that if someone was truly dying they could get them what they needed. But of course there are going to be exceptions and a system being down will only make the process harder.
adolph 2y ago
> maybe also print critical stuff per patient once a day? Yep, the business continuity boxes are basically minimally connected PDF archives of patient records "printed" multiple times a day.
efitz 2y ago
This. Anyone involved in designing and/or deploying a system where an application outage threatens life safety, should be charged with criminal negligence. A receipt printer in every patient room seems like a reasonable investment.
- jmcgough 2y ago
  I don't think you understand the scale of this problem. Computers were not up to print from. Our Epic cluster was down for placing and receiving orders. Our lab was down and unable to process bloodwork - should we bring out the mortar and pestle and start doing medicine the old fashioned way? Should we be charged with "criminal negligence" for not having a jar of leeches on hand for when all else fails?
  - efitz 2y ago
    I was advocating for a paper fall back. That means that WHILE the computers are running, you must create a paper record, eg “medication x administered at time y”, etc., hence the receipt printers, which are cheap and low-dependency. The grandparent indicated that the problem was that when all tow computers went down, they couldn’t look up what had already been done for the patient. I suggested a simple solution for that - receipt printers. After the computers fail you tape the receipt to the wall and fall pack to pen and paper until the computers come back up. I completely understand the scale of the outage today. I am saying that it was a stupid decision and possibly criminally negligent to make a life critical process dependent on the availability of a distributed IT application not specifically designed for life critical availability. I strongly stand by that POV.
    - jmcgough 2y ago
      This would be a disaster from a HIPAA perspective, and an unimaginable amount of paperwork.
    - galangalalgol 2y ago
      This approach is also what popped in my head. I've seen people use white boards for this already so it must be ok from a hipaa standpoint.
anonymous8888 2y ago
in this case, it's the entire operating system going down on all computers, so I don't think the printers are working either
- gtvwill 2y ago
  Most printers in these facilities run standalone on an embedded Linux variant.They actually can host whole folders of.data for reproduction "offline". Actually all scan/print/fax multi function machines can generally do that these days. If the IT onsite is good though the usb ports an storage on devices should be locked down.
CydeWeys 2y ago
It is a critical problem if your entire record of life-saving drugs you've given them in the past 24 hours suddenly goes down. You have to start relying on people's memories, and it's made worse by shift turn-overs so the relevant information may not even be reachable once the previous shift has gone home. There are plenty of drugs that can only be given in certain quantities over a certain period of time, and if you go beyond that, it makes the patient worse not better. Similarly there are plenty of bad drug interactions where whether you take a given course of action now is directly dependent on which drugs that patient has already been given. And of course you need to monitor the patient's progress over time to know if the treatments have been working and how to adjust them, so if you suddenly lose the record of all dosages given and all records of their vital signs, you've lost all the information you need to treat them well. Imagine being dropped off in the middle of nowhere, randomly, without a GPS.
- czl 2y ago
  > It is a critical problem if your entire record of life-saving drugs you've given them in the past 24 hours suddenly goes down. Will outages like this motivate a backup paper process? The automated process should save enough information on paper so a switch over to paper process at any time is feasible. Similar to elections.
  - dogmatism 2y ago
    no money for that there are backup paper processes, but they start fresh when the systems go down If it was printing paper in case of downtime 24/7, it would be massive wasteage for the 99% of time system is up
    - grugagag 2y ago
      A good system is resilient. Paper process could take over when system is down. Form my understanding healthcare systems undergo recurrent outages for various reasons.
  - dopylitty 2y ago
    Maybe if all the profit seeking entities were removed from healthcare that money could instead go to the development of useful offline systems. Maybe a handheld device for scanning in drugs or entering procedure information that stores the data locally which can then be synced with a larger device with more storage somewhere that is also 100% local and immutable which then can sync to online systems if that is needed.
rbanffy 2y ago
Looks like a small scanner + printer running a small minimalistic RTOS would be a good solution.
- ta988 2y ago
  Ok now you have a park of 200 of those devices to handle. And now you move a patient across a service or to another hospital and then.... Reality is complex.
  - rbanffy 2y ago
    Oh yes. This would be a contingency measure, just to keep the record in a human readable form while requiring little manual labor. Printed codes could be scanned later into Epic and, if you need to transfer the patient, tear the paper and send it with them.