After a hot summer in the Texas sun spent working as a camp counselor, the last thing a teenage boy would want is to be stuck in the student housing for another day. But, this is exactly what happened to my son due to a major outage on the Southwestern Airlines system. Over two days, more than 1,100 flights were cancelled and hundreds more were delayed because of issues with their computer system.
Just this week, Delta suffered a similar outage that was described at a “System Outage Nationwide”. Fortunately, flights that were en route continued to operate normally, but this was no consolation for the thousands of people who were struggling to get where they were going. To add insult to injury, flight status systems in the airports continued to show flights as on time.
Just like with these massive flight systems, electronic anesthesia charting systems sometimes suffer outages. This can even occur during the middle of an anesthetic. An almost too polite error message informs you that the system has malfunctioned and will be shutting down.
It is at this very moment where the promise of the electronic medical record faces its toughest test. All of the convenience of automatic data recording is suddenly negated. Vital signs like blood pressure and heart rate no longer get tabulated. Ventilator settings and anesthetic concentrations no longer flow over automatically to the chart. As the system goes into limbo during an unexpected reboot, it is customary to invoke incantations to banish whatever disturbed the delicate balance between hardware, software, and server.
Ultimately, the solution is a “down-time” form – aka a paper anesthetic record.
As an increasing amount of medical work is done on computerized systems, we certainly gain efficiencies. However, we also run the risk of becoming overly dependent on these same systems. Losing the ability to document in the electronic record is much less problematic than other problems that can – and sometimes do – arise at the worst times.
I have been in an elevator that stopped working between floors (I seem to recall a Grey’s Anatomy episode about this). I have been unable to open the medicine cabinet’s electronically locked drawers. At times, laboratory data has failed to automatically populate in the electronic system causing a delay in diagnosis and treatment. On a couple occasions, my ID badge failed to open doors to critical areas like the OR or ICU. In a world when seconds can mean the difference between good and bad outcomes, any of these issues are potentially life-threatening.
As clinicians, we are increasingly expected to be on the lookout for these electronic pitfalls that endanger our patients’ safety. When an airline cancels flights, the impact it is generally limited to financial concerns. However, delays and cancellations in healthcare can have consequences to our patients’ mortality.
Join the discussion about Electronic Medical Records on Twitter during our monthly #PeriopTalk Twitter chat on September 6, 2016, at 6pm CT. I will post a few questions about electronic medical records and encourage participation by anyone who works in or is interested in patient care in the perioperative setting.
For more information or to view previous chats search #PeriopTalk or visit https://twitter.com/perioptalk.
Bracken S. Kolle, M.D. ⚕ 
Another great post. Thanks
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Reblogged this on patientsafe.
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That’s a great perspective – my only comment is to not compare the “electronics-working” scenario with “electronics-not working” scenario. That’s not the issue. What you need to compare is the digitised process with the alternative : a poorly functioning paper-based system that is continually corrupted leading to patient harm.
There will never be a perfect system, though efforts will inevitably continue to improve them. But don’t throw the baby out with the bathwater.
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Todd – The issue I had hoped to highlight wasn’t that the non-electronic system is superior. The pro/con discussion of EMR is certainly an ongoing debate, but I am generally a supporter of new technology. Even with the mentioned issues, the efficiencies and interoperabilities are worth the headaches of data entry.
However, as was the case for the many airline passengers during recent outages, when the electronic system goes down, risks that did not exist on the non-electronic system can be induced into the system. As we adopt new technologies, we often develop new paradigms. Charting in a new system can take away steps and create totally new workflows. This is the beauty of the EMR revolution. However, we should be vigilant to the limitations of the electronic system and be able to default to another system that maintains patient safety.
This may be as simple as “reverting to the old system” until the system comes back online. But, as the airlines have shown us, sometimes that is not possible. A simple example, it is possible that a situation would occur in which a hospital has stored all their patients’ data (laboratory, pharmacy, study reports, notes, etc) in a cloud system that suddenly becomes unreachable. I do not know if hospitals have a cache of local data and the ability to create paper copies or whether this could leave a provider “flying blind” until the system comes back online.
I encourage discussion about this issue and hope to stir interest around the concept in my #PeriopTalk Twitter chat on Sept 6th. I hope you can join!!
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