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The Ebola Patient Was Sent Home Because of Bad Software
- cosmic_shame 12y ago*bad software configuration
- pestaa 12y ago*users of fine software not understanding how information flows within the system
- gress 12y agoEven if this story were true (which it appears not to be), if the users don't understand the system, it is the design of the system that is at fault. To paraphrase Jony Ive: When we eat bad food, we don't blame ourselves. Why do we blame ourselves when we use bad software?
- chippy 12y agoSo it's not the code in the software but the software project as a whole that may be faulty.
- twistedpair 12y agoWhen I eat that five week old pizza in the fridge or go to that shady Chinese buffet on the edge of town, and then feel ill, I do blame myself. Come on Jony.
- gress 12y agoJony assumes you have taste.
- timr 12y agoThe hospital has subsequently altered its story. The doctors knew about the patient's travel, and didn't act: "Friday evening, the hospital effectively retracted that portion of its statement, saying that “there was no flaw” in its electronic health records system. The hospital said “the patient’s travel history was documented and available to the full care team in the electronic health record (E.H.R.), including within the physician’s workflow." http://www.nytimes.com/2014/10/04/us/containing-ebola-cdc-troops-west-africa.html http://www.nytimes.com/2014/10/04/us/containing-ebola-cdc-tr...
- Kerlix 12y agoYeah, that's what I suspected: just another arrogant piece of shit doctor who thinks s/he's too important to be bothered learning anything about his/her patients. This patient neglect by way of physician arrogance is endemic and far more dangerous to the health of all the individuals in this country than most of the ailments for which patients initially seek treatment.
- maxharris 12y agoarrogant piece of shit doctor Please, be civil.
- tiatia 12y agoThey are more common than you think.
- pyre 12y agoThere is a bar for passing to become a doctor. You have no way of knowing if your doctor just barely passed or was top of the class.
- btown 12y agoOn top of this, grades are an imperfect indicator for whether a doctor is detail-oriented when dealing with patients. Just because they ace all the tests doesn't make them a great doctor.
- ghshephard 12y agoFrom: http://www.nytimes.com/2014/10/04/us/containing-ebola-cdc-troops-west-africa.html http://www.nytimes.com/2014/10/04/us/containing-ebola-cdc-tr... "But on Friday evening, the hospital effectively retracted that portion of its statement, saying that “there was no flaw” in its electronic health records system. The hospital said “the patient’s travel history was documented and available to the full care team in the electronic health record (E.H.R.), including within the physician’s workflow.”"
- jonstokes 12y agoFYI the Dallas hospital has now "walked back" this part of the story. They're no longer blaming it on the software: http://www.latimes.com/nation/nationnow/la-na-dallas-ebola-hospital-20141004-story.html http://www.latimes.com/nation/nationnow/la-na-dallas-ebola-h...
- ams6110 12y agoDallas hospital's debacle highlights the atrociousness of many electronic health records. Yeah OK health records software mostly sucks. But let's think about it... how often does a patient present at the ER with "fever and abdominal pain" I am guessing dozens of times a day at a busy hospital. Is it really unexpected that the staff would triage this as anything other than a low-priority case to try to "treat and street" so they can deal with the serious immediately life-threatening trauma, heart attacks, strokes, etc. that are also constantly coming in. He mentioned he had recently been in Africa yes, and yes in hindsight that was not given due attention. Maybe the software could have presented this better, but maybe everyone's mind was already on the next ten more urgent cases. If he instead said "I have had contact with Ebola patients" that would have been another kettle of fish, why didn't he say that? I don't think we can blame the hospital too much here.
- anigbrowl 12y agoI don't agree. He said he'd come from Liberia, and the CDC has issued numerous advisories about the epidemic risk, plus it's been near the top of the news for months. You'd have to be living under a rock not to know about the Ebola outbreak. Being up to speed and prepared for this sort of thing is why hospital administrators and clinicians are paid the big bucks.
- ams6110 12y agoYes but this is our view as outsiders. When you see a dozen patients a day with "fever and abdominal pain" it's going to take something out of the ordinary to set off your alarm bells. Ebola has still affected only thousands of people in the world, and it's never been seen "in the wild" in the USA. It is legitimately almost the LAST thing a health care provider would suspect based on initial symptoms. The first few cases are going to be misdiagnosed initially. I think we have to look at this the same way the NTSB looks at airplane crashes. Not to assign blame, but to identify root causes, procedural/training problems, and changes to prevent the same failure from happening again.
- anigbrowl 12y ago
- OoTheNigerian 12y agoSome of my friends while joking about the famed "ignorance of Americans" say that the person that was told he came from Liberia was not alarmed because, after all, it was West Africa that had Ebola. There is absolutely no excuse. And definitely not the computers problem. Liberia should have raised a flag even if it was a janitor in a hospital that heard it Anyway, Ebola can be easily contained if taken seriously. Nigeria (Lagos a city of 20 million and not much larger than the bay area to be precise) contained it in a couple of months and all the cases were from the index case. A Liberian too. Everyone should be on the alert and maintain good hygiene and avoid unnecessary body contact. This is not an excuse to discriminate against Liberians and/or West Africans.
- anigbrowl 12y agoBad software or bad configuration? (EDIT: Hospital has since retracted this claim, presumably because someone on staff was going to expose them as liars.) There are technical problems beyond the software, too: Ebola isn't even considered its own disease under the current medical classification system for diseases, called ICD. Under ICD-9, the current version, Ebola shares a code with "multiple viral diseases." (The virus will have its own code under ICD-10, which rolls out next year.) This needs more context. ICD stands for International Classification of Diseases - these codes are the obtuse numerical codes that appear on your medical bills with little explanation. Under ICD-9 there are ~17,000 codes, under ICD-10, 140,000 (although that includes both procedural and diagnostic codes and many, many obscure sub-categories). ICD-10 has been around for over 20 years, and almost every other developed country uses it because it makes electronic record keeping much easier - for example, different codes distinguish between left and right sides of the body. Under ICD-9 someone who presented with injuries on both hands would have the same code for both, leading to assumptions of duplication, unpaid bills etc. The US is late to the party and the deadline for implementation of this for billing Medicare, Medicaid etc, has been pushed back from 2012 t0 2013 to 2014 to 2015 because hospitals and physicians keep whining about the costs and administrative complexity, and certain politicians would like people to associate those costs and complexity with Obamacare, even though HHS adopted a final rule scheduling the transition to ICD in January 2009, a few days before Obama took office.
- twistedpair 12y agoSo Ebola was first identified 38 years ago as a disease, but not until 2015 (in the US) will ICD-10 recognize it as a unique disease? This, despite having unique codes for the same afflictions to different areas of the body? Perhaps the coding and EMR standards body assumed that African hospitals weren't going to be upgrading soon.
- anigbrowl 12y agoNo, not until 2015 will the US require EMR systems to be using ICD-10. The ICDs are developed and promulgated by the World Health Organization, and I suspect the US has been a bit slow to join in because a) anything coming out of the United Nations is politically toxic to about a quarter of the electorate, and b) US healthcare is a patchwork of private businesses and promulgating any sort of new standard leads to endless complaints about 'government red tape' and so on. Anyone who is already using ICD-10 can code for Ebola, which is A98.4. So if you were a clinician billing the government, they're ready to accept ICD-10 coding, and I imagine most insurance companies are too. But lots of people are still stuck on ICD-9, same way many businesses were stuck on Internet Explorer 6 and windows XP for the longest time.
- sparkzilla 12y agoFor those catching up. Updated Ebola News Timeline http://newslines.org/ebola/ http://newslines.org/ebola/
- phaus 12y agoEven if it was a software problem (which according to timr it apparently wasn't), it would still be 100% the fault of the medical staff. Its absolutely ridiculous that the people caring for a patient don't even fucking talk to one another.
- bleair 12y agoThese EHR systems - programs for managing patient information - are some of the absolute worst in terms of frustrating usability and difficulty. Think of how bad the very worst HR applications you've had to use and then go 10x worse than that. My mother works as an ER nurse and she has to type the same duplicated information into multiple spots. Any single mistake in entry can result in loss of all information or in some cases can't be corrected. Very often the system forced upon the nursing staff are worse and different than the systems used by doctors. That sounds moronic, but doctors have a bit more influence and can push back hard against horrible mandates from IT departments, while the nursing staff have no such advocates. Naturally an IT department that has spent 10-20 million dollars on a contract for such and awful computer system isn't going to willingly admit that the system is awful, reduces patient care, and slows down how many patients the nursing staff can see to.
- robomartin 12y agoNah, not bad software (even though most medical software can be horrifically bad). Nope. Incompetent, indifferent or uninformed people (or all of the above). The number of people in the US who have virtually no clue of what is going on in the world is staggering. They can tell you the latest news about Miley of Bieber. Ask them "What's going on in Liberia" and you are far more likely to get a blank stare than an intelligent response. Ask them "Where is Liberia?" extra credit. So you have a guy with a fever come into the ER saying he just got back from West Africa and, in a huge number of cases, that is likely to be met with "Cool! Got pictures?". Even if the hospital had no computers, informed and knowledgeable providers would immediately escalate the patient based on two simple bits of data: West Africa + Fever. Someone with more information than the latest on Miley's ass-shaking antics might even ask: "How close were you to the ebola-afflicted area?". In this case the answer to that question should have resulted in immediate isolation and further actions. You can't blame computers and software for everything.
- kens 12y agoUnder ICD-9, the current version, Ebola shares a code with "multiple viral diseases." I looked into this, and Ebola is coded as "065.8 Other specified arthropod-borne hemorrhagic fever". The strange thing is that arthropod-borne means spread by insects, etc. It's puzzling to classify Ebola this way when it's not thought to be spread by insects. Disclaimer: I don't know anything about ICD except that ICD-10 is the famous flaming waterskis version.
- vpeters25 12y agoWhen I learned the hospital which sent that ebola patient home was managed by Texas Health Resources I wasn't surprised. I personally witnessed their incompetence when I walked to their Arlington ER 10 years ago with appendicitis symptoms. It took them 6 hrs after drawing blood, an ECO and a freaking MRI but they weren't sure what I had until at around 2am they woke up some doctor and explained the symptoms over the phone. Before the surgery, this doctor told me he pretty much yelled at them "it's appendicitis you morons, get him a bed and schedule surgery first time in the morning!" Needless to say, that was the first and last time I ever voluntarily walk to a Texas Health Resources hospital.
- noonespecial 12y agoI think we should remember that this guy had already been willfully deceptive in order to get to the US with Ebola in the first place. We don't know what or how "slyly" he might have mentioned his "travels in Africa". He probably didn't march in and say "I'm pretty sure I've got Ebola because I hung out with Ebola victims and then lied to airport screeners to get here."
- calinet6 12y agoBad systems. Systems are the responsibility of the people who implement them. They must care about the systems they put in place; and they must care more about the systems the more important the outcome. Emphasis on the whole system is the only way to improve quality; not focus on a particular individual failure case.
- deleted 12y ago[deleted]
- pseale 12y agoHISTalk (a website devoted to healthcare IT) has its take on this article: http://histalk2.com/2014/10/03/monday-morning-update-10614/ http://histalk2.com/2014/10/03/monday-morning-update-10614/ (browse down to the "Other" section) Here's a glimpse of what they have to say about the Atlantic article: > Author credentials are fair game if you’re going to editorialize, so let’s check hers: an intern until 2010, moved down from global editor to staff writer after 10 months in the higher position, wrote about home design and architecture, and listed her most recent accomplishment on LinkedIn as, “Talk about beards on the radio.” Nothing makes me angrier than people who’ve never spent a day working in either IT or healthcare blasting out their entirely unqualified opinions in passing themselves off as authoritative. Anyway, read the HISTalk article for an insider take.