A Case of Murder and EHRs
By Peter J. Groen and Jaime Nasuti
Published with the co-authors' permission
In the United States, even though President Bush has mandated the use of electronic health record (EHR) systems nationwide by 2014 and many politicians support this stance, progress is painfully slow. A recent Health Industry Insights national survey shows most Americans are unaware of the U.S. government's initiative to make EHRs available to citizens within 8 years.
To date, only 9 percent of physician offices and approximately 25 percent of hospitals have implemented comprehensive EHR systems. Less than 1 percent of the population is using computerized personal health records systems.
It is our contention that progress would improve significantly if the popular media were to bring the issue before people's eyes in the form of a movie drama, TV show and entertaining short stories.
The following short story -- in which all characters are purely fictional -- is one such initial attempt. ADVANCE presents the first chapter below, and will post the story's remaining 10 chapters in this blog on the next 10 consecutive business days.
CHAPTER ONE
"Presidential hopeful Congressman Stan Martin has dedicated his political career to trying to prevent similar instances as what the U.S. saw in the aftermath of Hurricane Katrina. With no national health care in place and major resistance from the American Medical Association and the pharmaceutical and insurance industries, Congressman Martin has focused his presidential campaign on national health care, with an emphasis on the nationwide implementation of electronic health records."
-- Reuters News Article
Stan could never forget the circumstances surrounding his wife's death. The constant stream of news articles brought the memories. Surely one of the most reputable hospitals in the nation should have been able to handle her situation, even if there was a hurricane raging. She shouldn't have died. The memory was still painful, even after all this time.
They had spent most of their married life in New Orleans, just outside the French Quarter. Even with the imminent threat of Hurricane Katrina looming over the area, Stan never considered relocating the family inland. After all, they had lived through the threat of other hurricanes over the years and had successfully weathered those storms.
The decision to stay was also based on his wife's medical condition. She had to stay on track with her chemotherapy if they expected to beat it this time. After being reassured by the physicians at the medical center that they would be able to continue her treatments uninterrupted, Stan had made the fateful decision not to evacuate, but to remain in their home and brave the storm.
Hurricane Katrina hit New Orleans with tremendous force. Windows were blown out and flying glass and debris filled their Victorian house. With no storm cellar or basement in which to seek refuge, Stan, Kitty and their kids huddled in the antique cast-iron tub in the guest bathroom in the center of their home. It was at the height of the storm that a branch from the kids' favorite climbing tree came crashing through the roof. As the bathroom wall began to crumble, it was too late to move. Kitty took the brunt of the impact as she shielded the kids from the wall's debris.
The winds began to die down, but cries from the children filled the destroyed room. Blood began to make a small pool in the tub, which caused the kids to panic and start screaming for help. From under the debris, Stan struggled to move the remains of the bathroom wall covering them in the tub. But a large tree branch weighed down debris from the wall, slowing his progress. He finally managed to shift the tree branch, lift a section of the wall and clamber out of the tub. The kids' panic heightened when there was a loud crackling and they heard their mother yell out in pain. Stan began working like a madman in the dying rain, applying all his strength to move the tree branch and debris from the fallen wall. Kitty's pain-filled yells reverberated off the walls and drove him onward.
Stan finally managed to make a hole big enough for the kids to climb to safety. As they grabbed hold of his neck and climbed out of the opening, blood smeared all over Stan's clothes. He checked them over quickly to see if they were okay, making sure none of the blood was coming from them. Aside from a few scrapes and bruises, they seemed fine, so Stan immediately turned his attention back to his wife. She had not cried out in pain during the last few minutes and Stan hoped she was quietly waiting for him to rescue her.
Kitty was a petite woman, and four months of chemotherapy had caused her to lose quite a bit of weight. It should have been easy for Stan to drag her through the hole in the wall. But as he stuck his head through the opening he had made to determine her condition, he could see she was bleeding badly and he didn't know where it was coming from. He tried to get her to tell him where she was hurt, but she had passed out from the pain. Stan gently placed his hands under her armpits to pull her out and could feel that her left arm was in bad shape. As he pulled her up and dragged her body through the hole, she made a whimpering sound, which gave him hope. He knew she was going to be okay, but he had to get her to a hospital. He carried his wife out to the car, which had miraculously survived the storm. The kids sat quietly in the back of the car as Stan carefully drove through the wreckage caused by the storm.
Hurricane Katrina had hit with devastating force. The local hospital was damaged beyond recognition. Stan knew Kitty was in desperate need of medical care; besides her arm, he was certain she had suffered other injuries he had overlooked. The hospital had no electrical power. The emergency power from backup diesel generators was being used to provide lighting and power to the emergency rooms, surgical suite and selected medical equipment. Ceiling tiles, glass and other debris littered the once spotless patient waiting rooms and halls. The skeleton crew of physicians, nurses and technicians struggled not to be overwhelmed by the disastrous situation they faced.
When the medical staff finally turned their attention to Kitty, they tried to do their best. Her physical condition related to her cancer treatment complicated the picture. Her chemotherapy for a rare form of cancer involved the use of some very powerful drugs.
Unfortunately, her medical records were not available to the clinical staff. Her entire medical record -- along with those of almost all other residents of New Orleans -- had been destroyed during the storm. The medical record rooms, containing paper charts on hundreds of thousands of patients, were located in the basement of the hospital. Initial flood damage to those rooms by the storm was further compounded when the city's levees broke. At that point, virtually all the medical records in hospitals, clinics, and doctor's offices across New Orleans were totally obliterated.
Given the crush of patients, the need for immediate treatment and the lack of information about the patient's medical history, the doctors proceeded to treat Kitty's external wounds. As the nurse administered a pain medication through an IV, Kitty began to shake uncontrollable. The doctors tried desperately to resuscitate her when she stopped breathing, even as the nurses forcefully dragged Stan back to the waiting room to wait with his kids.
A short while later a doctor came out to give Stan the devastating news of her death. The doctor, accompanied by a nurse, tried to console Stan and the kids, but Stan rushed into the emergency room not wanting to believe it. But she was already gone. They never got a chance to say good-bye.
All Stan could think about was, "How could this have happened?"