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Designing for Privacy & Security : All your base are belong to us

Living in the HealthCare IT Bubble

Reality is a harsh mistress.  With the advances in Electronic Health Records, patient portals and records transport ala Direct X.509, my peers and I see a very bright future for healthcare in the U.S. and talk about all the great things we have accomplished.

Then a friend gets sick and enters the U.S. medical system and the bubble bursts.  The following happened over the last two weeks.   They have an issue and go to the ER of an Atlanta hospital.  Afterwards they are sent to their primary care physician and get a blood workup.  And sent for a CT scan at the imaging center.   The physician, hospital and imaging center are part of the same healthcare delivery system and all have the same EHR from a company in Tampa Florida.

First I contacted the medical records department at the hospital to get the CCD for the ER visit through their patient portal.  After being directed to four different people, they had no idea what a patient portal was.

The blood panel came back from the lab and since the physician had no patient portal, they sent a fax of the results.  The physician got the CT scan and was concerned (if you guessed the imaging center didn't have a patient portal, you would be correct).

My friend was sent to a surgeon on a referral.  During his examination he prescribed a simple medical procedure to correct what he saw.  He too was part of the network, but never got the CT scan or physicians report and we did not have copies.  Fortunately it was brought to his attention before he left, he ordered a rush on the reports and he scheduled surgery.

In the hospital the mishaps continued.  During prep for surgery the anesthesiologist went over the check list and stated the patient weighed 110 kilograms.  She was corrected and told 110 pounds.  The surgical nurse said not to worry, it happens all the time with the EHR but they always catch it in the operating room.

After the surgery and a few days on the med-surgical ward, the physician specifically prescribed a non-opiate pain medication.  Well, the pharmacy couldn't deliver it in 6 hours so she was given an opiate and had a severe reaction to it. 

6 hours later she was given the correct drug, to be repeated in 6 hours.  3 hours later the nurse came in to deliver the next dose.  She hadn't looked carefully at the chart.  When questioned, she said it was no big deal because the system would have caught it.

In discussions with the physicians and staff, it turns out they do have an patient portal.  It just doesn't work.

And this is one of the best hospital systems in Atlanta.  I'm sure they collect their MU1 and MU2 payments.  And the CEO makes over $1.5M a year.

added: Overall, the staff and the physicians are excellent.  Poor UX design, implementation and training resulted in these issues, and that's on us.  Depending on a system to catch your medication errors is like waiting to change the oil in your car when the check engine light comes on.  And that's a training issue all the way up to the CEO!

We have a lot of work to do.



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