November 26, 2007

1. Quaid Twins' Heparin Overdose Sure to Raise Barcoding Questions

Facts and Background

The newborn twins of actor Dennis Quaid and his wife were overdosed with 1,000 times the intended amount of the blood thinning drug heparin at Cedars-Sinai Medical Center in Los Angeles last Sunday. The incident is nearly identical to that of Methodist Hospital in Indianapolis last year, which mis-stocked a drug dispensing machine with concentrated heparin in the hospital's neonatal ICU, causing the deaths of three premature infants. The Quaid babies are said to be recovering.

Opinion

It's hard to believe that Cedars-Sinai made this mistake after the national uproar over the Indianapolis deaths, which were followed by a raft of warnings about heparin packaging and stocking. As always, however, multiple factors were involved. The heparin's manufacturer had recently added precautionary labeling, but the hospital wanted to use up its old  stock first. Cedars is among the 80% of hospitals that do not require bedside barcode checking of medications by nurses.
Musings

  • Cedars had a high-profile CPOE failure a few years back, with massive cost and physician push-back. They should have focused on barcoding first, as they must now realize.
  • Hospitals must redesign medication administration to assume that nurses won't read labels, because they obviously don't sometimes. Many of the most tragic incidents involved the clearly labeled wrong product, not caught by nurses.
  • Today's barcoding systems are often primitive and nurse-unfriendly, with negative impact on workflow. Despite their obvious appeal, major system design problems keep their penetration low. Fatal medication errors have occurred even in hospitals with bedside barcoding in place because nurses formulated elaborate workarounds to avoid its productivity-sapping use.
  • Hospitals seem to forget that loading up a drug dispensing cabinet without adequate controls is no different than giving nurses a key to the pharmacy, except that the drug list is shorter and charge capture is better. Pyxis without profiles or with allowed overrides = really bad idea.
  • Technology exists to double-check dispensing cabinet drug replenishment. Hospitals that don't use it are asking for trouble.
  • Picture yourself as a Cedars executive trying to explain to a belligerent lawsuit attorney that you know barcoding could have prevented somebody's death, but you chose not to buy it. The cost of a barcoding system will look like the world's biggest bargain compared to wrongful death payout and bad PR.
  • After this incident, Cedars reportedly said it was considering using a bar code system.

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2. Survey Says Britain's Big Health IT Project Has Lost Most Physician Support

Facts and Background

The UK's National Programme for IT has lost most of the support of the UK's doctors, according to survey results announced last week. Only 30% of GPs say it is an important priority, down from 70% three years ago. Over two-thirds of doctors rated the project as "poor" or "unacceptable" and only 1% thought progress was good.

Opinion

At least it's not just US docs who don't like technology that slows them down or provides them no immediate value. And, it's not the government's money that's being spent here ($25 billion for NPfIT, by National Accounting Office estimates).

Musings

  • The best that NHS could come up with to rebut the survey were a couple of patient anecdotes about NPfIT's value.
  • NPfIT is a political football, so it's hard to say whether this or any other assessment is impartial.
  • The inevitable opportunity cost questions arise - could $25 billion been better invested in something other than computers?

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3. Ohio Pushes Physician EMR Contract Standards to Reduce Buyer Risk

Facts and Background

The Ohio State Medical Association announced plans last week to include EMR vendors on a Standards of Excellence list if they agree to include an approved list of contract provisions in their sales agreements. A consulting firm put the list of contract terms together, which will be used starting January 1.

Opinion

This brilliant action will do more to encourage EMR use than CCHIT certification. Most doctors work for small practices that can't afford the consulting help they would need to ensure a fair contract. Now, they get that at no cost. Among the terms: payments based on implementation milestones, transferable software licensing, and capped maintenance fee increases.

Musings

  • Too bad hospitals didn't think of this first for their own software purchases. Market pressure works.
  • HIMSS could do this for hospitals as their advocate ... oh, wait, that's right, vendors chip in most of the bottom line of HIMSS.
  • Even though this is an Ohio-only program, doctors in other states could simply review the same list and demand similar terms. The impact is likely to be national.
  • Did I already say this was brilliant? Because it is.

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4. Sunquest Revives Radiology Products

Facts and Background

The new Sunquest Information Systems announced last Tuesday that it will begin marketing the company's radiology information system once again after it was mothballed by former company owners Misys following a December 2006 release. Also back in play is the Sunquest PACS Integration Module that connects PACS products to radiology information systems.

Opinion

When a team gets a new coach and suddenly starts winning, you have to wonder if the previous coach was all that smart. Former coach Misys obviously wasn't, at least when it comes to hospitals. New owners Vista Equity Partners figured out quickly that the radiology product is good, has some high-profile customers, and makes a nice diagnostic systems pairing with Sunquest's lab offerings. Mothballing a perfectly good radiology system because it takes internal focus away from creaky physician EMR products? Now that's a coach that needed firing.

Musings

  • Of the four radiology systems reported in KLAS, the former Misys Radiology is still #3, ahead of Cerner's RadNet.
  • Customers kept buying Misys Radiology even after the maintenance-only announcement, according to the press release. Hello, Misys, is anyone home?

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5. IDN's VP of Information Technology Shot in Parking Lot Robbery

Facts and Background

Tim Belec, the 50-year-old vice president of IT for Wheaton Franciscan Healthcare, was shot in the parking lot of the health system's Glendale, WI headquarters in a robbery last Tuesday. Despite being struck in the chest with two bullets from a .38 pistol, he's out of intensive care at Froedtert Hospital and is expected to recover. A 17-year-old male has been arrested and charged with attempted murder, reckless injury, and armed robbery.

Opinion

A quote from the shooter, who is obviously filled with sorrow (at being caught, anyway): "I didn't mean to do this. I never shot a man before." Maybe he specialized in shooting women until now. Being a juvenile is probably enough to keep him prowling parking lots for many years unless he can be tried as an adult, which is actually not unlikely given the circumstances.


Musings

  • Walking after dark in any hospital parking lot or garage is scary. Because of hodge-podge parking arrangements, security is usually minimal and visibility poor, especially for visitors and staff leaving at odd hours.
  • Doctors should try hard not to look like one when heading for their cars. Junkies (of which crystal meth has created many) love people carrying medical bags.
  • Hospitals are a microcosm of society, which is why armed police officers guard EDs and employees have to break up altercations. Crime in a hospital is nearly as abhorrent as in a church, but much more common. Be careful out there.

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