Tuesday, April 08, 2014

Again We Seem To Be Seeing Implementation Issues In A Major Hospital System. It Just Seems To Keep Happening.

This appeared a few days ago.

Hospital in chaos over new booking system

Date April 1, 2014

Julia Medew

Health Editor

EXCLUSIVE
Staff at one of Melbourne's largest hospital networks say a new computerised booking system has wreaked havoc over the past year, causing untold distress for vulnerable people and putting lives at risk.
Senior Austin Health employees have told Fairfax Media that the new Patient Choice Booking service at the Austin Hospital and Olivia Newton-John Cancer and Wellness Centre has caused scores of patients to miss crucial appointments with specialists responsible for their care.
This included seriously ill patients, such as organ transplant recipients, cancer patients and those with infectious diseases such as TB and HIV who needed to be seen at particular times to receive continuing tests, medications and other treatment.
When the system was introduced last May, hospital management cancelled about 49,000 future patient bookings with specialist doctors and sent these patients letters advising them of the cancellations and a new booking system.
Under the new regime, patients would receive a letter offering them an appointment around the time that they were previously due to come in.
When they received this letter of offer, they were told to call the hospital if they wanted to negotiate a different time. The letter, which was allegedly only written in English, said patients who needed an interpreter should call to organise one.
Unlike the old system where patients could make bookings up to two years in advance, the new system was meant to provide patients with greater flexibility and reduce the number of patients cancelling, rescheduling or not showing up.
But according to angry staff, the system has been a ''complete disaster'', with many patients either not receiving their letters or not understanding them. This has allegedly caused scores of patients to not attend their appointments or show up at the wrong time.
 Lots more detail here:
This was followed up the next day with the personal view.

Austin Hospital booking system brings grief to cancer sufferer

Date April 2, 2014

Julia Medew

Health Editor

Until May last year, Kevin Biaggini had no reason to doubt his care at the Austin Hospital. In November 2012, the Ivanhoe father was treated there for liver cancer and thought the medical and administrative staff were excellent.
But when the hospital introduced its new ''Patient Choice'' booking system in May last year, Mr Biaggini said things started to deteriorate. After having a routine MRI scan on May 15 to check his liver was clear of cancer, he received an unexpected phone call 10 days later. The nurse wanted to know why he had not attended an appointment that week.
''Straight away I knew what was in the wind,'' he said.
The nurse went on to tell him the MRI had found more cancer and that he had been scheduled for treatment that week.
''They called me on the assumption I had already been informed, but no letter had been generated, there was no text message, no email - nothing. I said to her, 'This is the first I've heard of it, I'm really shocked,' and she said, 'Oh, maybe it's something to do with the new system.'''
Mr Biaggini, 64, said after having treatment that month, he had a follow-up scan last July, followed by the same experience.
Again a nurse called to ask about a follow-up appointment on the assumption Mr Biaggini knew his most recent scan had found more cancer.
''I just shook my head and thought, 'This is unbelievable,''' he said.
Mr Biaggini, who is now well after receiving a liver transplant in December, said he believed the new booking system had caused the ''appalling cock-ups'' and was letting hospital staff down.
More here:
This has all the hallmarks of a failure of the technical, managerial and project management staff failing to design a ‘fool proof’ migration approach and then testing the plans against the needs of all the different stakeholders.
This is by no means  an unusual story with migration from  the from the old to the newly installed systems being sufficiently tricky project to make many systems last a great deal longer than perhaps they should as many users and managers are wary of the associated risks and disruption.
This has meant for example that I know of laboratory and PMI/ATS systems that have been in place for over 20 years and which are only replaced when the software or hardware vendor goes out of business.
I hope there will be a report in due course that properly analyses what happened and suggests how to avoid such migration issues for others.
David.

2 comments:

Juanita Fernando said...

These types of unintended errors characterise theoretical points the Australian Privacy Foundation has been trying to make for years and years. However we could not provide evidence of damage to patient care outcomes. A transparent and public review of the process and associated errors would provide useful information to others trying to implement eHealth systems and universal PCR's overall.

Enrico Coiera said...

"However we could not provide evidence of damage to patient care outcomes."

There is actually a significant and growing evidence base of harms associated with health IT.

The first analyses of IT related patient incident reports from Australia, the US FDA and the UK came from our own group:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3243129/

http://jamia.bmjjournals.com/content/19/1/45.abstract

http://jamia.bmjjournals.com/content/17/6/663.abstract

Our classification has now been used repeatedly in the US - a recent ECRI 'deep dive' as well as two reports from the Pennsylvania Patient safety Authority focus on many hundreds of IT related safety events:

https://www.ecri.org/EmailResources/PSRQ/ECRI_Institute_PSO_Deep%20Dive_HIT_TOC.pdf

http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2012/Dec;9(4)/Pages/home.aspx

http://www.patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2013/Jun%3B10(2)/Pages/55.aspx

some other recent related work that folks might find interesting - focussing on automated detection of IT incidents, is here

http://171.67.114.118/content/20/3/506.abstract

http://171.67.114.118/content/20/5/980.abstract

http://www.sciencedirect.com/science/article/pii/S1386505612002389