The Politics of Health Care : Patient Safety

Patient Safety: Getting the Name Wrong May be Fatal

Frank Irving — Thu, 13 Aug 2009 14:48:00 GMT

Guest commentary by Dr. Bruce Lambert, University of Illinois at Chicago professor, Department of Pharmacy Administration, and president, Pharm I. R., Inc.; and Dr. Leonard A Shaefer, IBM chief scientist, Global Name Recognition After taking Flomax, used...(read more)

E-prescribers Pass 100,000 Milestone

Frank Irving — Fri, 24 Apr 2009 17:46:00 GMT

Surecripts, operator of the nation's largest electronic prescribing network, reported on April 22 that more than 100,000 prescribers are now routing prescriptions electronically in the United States. Surescripts made the announcement in conjunction with...(read more)

A Case of Murder and EHRs -- Final Chapter

Frank Irving — Tue, 06 Nov 2007 12:40:00 GMT

A Case of Murder and EHRs

Published with permission of the co-authors.

Editor's note: This is the final chapter in this series of blog posts, completing the co-authors' short story. If you don't want to spoil the ending, please be sure to scroll back and read the progression of chapters from the beginning. We'd love to hear your reaction to this series.

CHAPTER ELEVEN

"Welcome back to this special coverage of the presidential election results. If you have not heard, Democratic Congressman Stan Martin has beaten his opponent in a landslide victory."

"Some might say Congressman Martin, or I should say President-elect Martin, was helped by the recent harrowing events that took place at the Martinsburg VA Medical Center. An attempted assassination plot was foiled by the computer security measures embedded in the VA's electronic health record system, designed to both protect patients and their confidential medical information. Even as the hospital computer system was used to foil the murder attempt, President-elect Martin's doctor used the same system to discover a life-threatening brain tumor. Physicians successfully removed it within days after the assassination attempt."

"When questioned about his experience at the VA Medical Center, President-elect Martin had this to say":

"I have always stood behind the VA and its use of an electronic medical record. Ever since the tragedy of my wife's death, I have seen the need for a better health care system within our country. My opponents used patient privacy and computer security concerns as a way to discredit my call for a national health care solution and the use of electronic medical records systems similar to that used by the VA. I have seen not only the workings of the electronic medical record, but also the extensive security measures put in place to protect that record. I have also learned first-hand how such a system could actually save my life, and the lives of my fellow Americans."

*** This story and all characters are purely fictional. ***

About the authors

Peter J. Groen is on the faculty of the Computer & Information Science Department at Shepherd University in West Virginia. He is one of the founders of the Shepherd University Research Corporation.

Jaime Nasuti is a graduate of Shepherd University, a former English teacher and an aspiring author. She currently works for a national health care provider organization on the development of training programs and materials for EHR and other health IT systems.

A Case of Murder and EHRs -- Chapter Ten

Frank Irving — Mon, 05 Nov 2007 14:59:00 GMT

A Case of Murder and EHRs

Published with permission of the co-authors.

CHAPTER TEN

As Dr. Douglas was recovering from the unbelievable events that had unfolded just days before, he made a final detailed pass through Congressman Martin's electronic medical record as he prepared to discharge him. He wanted to make sure only his orders had been entered in the electronic chart, that everything was clearly documented, and that no mistakes had been made.

He carefully looked through the clinical images from the CT scan and other radiology tests he had ordered. The radiologist had read this scan in record time, he remembered. Apparently having a high-priority presidential candidate makes everyone move a bit faster. Congressman Martin had presented with basic symptoms of a heart attack, but that was ruled out due to his normal EKG. An anxiety attack was the final diagnosis, which was no wonder considering the pressures of running for office. But the slightly slurred speech and extreme headache had forced Dr. Douglas to order the CT scan of Martin's head. Was it possible something was missed?

As he double-checked the images, Dr. Douglas noticed a slight irregularity in the scan that caused him to jump up from his chair and run down the hall.

They had missed something!

A Case of Murder and EHRs -- Chapter Nine

Frank Irving — Fri, 02 Nov 2007 13:56:00 GMT

A Case of Murder and EHRs

Published with permission of the co-authors.

CHAPTER NINE

The Secret Service agents suddenly had their hands full. Dr. Rose immediately denied any wrongdoing and went on the offensive when confronted about his unauthorized access to a patient’s medical record.

However, Dr. Rose had no idea there was enough security in place within the VA’s hospital computer systems to pinpoint the exact time and place of a login, whose record was accessed, by whom, and what actions had been taken -- keystroke by keystroke. He knew nothing of the ISO capability to monitor suspicious activity within the system, or of the automatic flags that went up when access was made without authorization.

The evidence collected by the system’s security software module was damning. The Secret Service arrested Dr. Rose and took him away.

A Case of Murder and EHRs -- Chapter Eight

Frank Irving — Thu, 01 Nov 2007 16:34:00 GMT

A Case of Murder and EHRs

Published with permission of the co-authors.

CHAPTER EIGHT

Dr. Douglas, the cardiologist taking care of Congressman Martin, sat in a stupor in the chief of staff's office. What was going on? Dr. Rose was not his favorite colleague...but to be tampering with his patient's medical record, ordering unauthorized meds, potentially deadly ones...

The chief of staff's phone rang loudly in the deadly silenced room. The chief of staff raised his eyebrows as he listened. The director, who was also in the office, watched him closely. Dr. Douglas noticed the perspiration beginning to bead on the chief of staff's face.

"I think we better call the head of the congressman's Secret Service detail and have them meet with me and the director here in two minutes! You better come too, Dirk, so you can brief them in detail and show them what you found in the computer system."

A Case of Murder and EHRs -- Chapter Seven

Frank Irving — Wed, 31 Oct 2007 14:37:00 GMT

A Case of Murder and EHRs

Published with permission of the co-authors.

CHAPTER SEVEN

The warning message began flashing on Dirk's computer screen, a somewhat rare occurrence. Not too many high-profile public officials tend to be admitted to the VA Medical Center in Martinsburg, West Virginia, for treatment. Especially not a presidential candidate.

"I better check this out right now," he thought.

As the VA's information security officer (ISO) for the Martinsburg VA Medical Center, it was one of Dirk's jobs to keep an eye on suspicious activity within the VA health IT systems. Dirk opened up the warning message from the computer and quickly scanned and evaluated the information the computer had automatically gathered and forwarded to him. He saw that Dr. Douglas had ordered a series of tests for Congressman Martin. He called the chief of staff to confirm that Dr. Douglas was the physician officially assigned to care for the congressman. This was confirmed and Dirk hung up the phone relieved.

Politicians never sat well with Dirk. With the upcoming election looming, Dirk made it a point to watch the numerous debates just so he could speak intelligently about why he hated all the candidates. However, a recent interview had caught his attention when a candidate began talking about the VA's electronic medical record. No one ever seemed to give the VA any recognition for its technological advances in the field of medicine or the high quality of care it provided, as confirmed by the Joint Commission on Hospital Accreditation. But it still didn't matter to Dirk. He still wasn't going to take the time to go down to his local precinct to cast a vote on Election Day.

Just as he hung up, another security alert appeared on his computer screen. Dirk opened the computer-generated warning and noted that another physician, Dr. Rose, had apparently logged on to the hospital's computer system, accessed Congressman Martin's chart, and had placed an inpatient pharmacy order. This was odd, especially since the chief of staff had just told him Dr. Douglas had been assigned as the Congressman's primary treating physician. It was not an unusual occurrence for doctors to open the chart of a patient being treated by someone else, since they often worked in teams or were asked to consult on a case.

However, it was unusual for a doctor to order a prescription for another doctor's patient. The computer was also indicating that the prescription could result in a deadly drug-to-drug interaction. Something definitely seemed out of place.

Dirk immediately called the chief of staff's office again. He gave the secretary a rather curt response as to why he was calling to speak to the chief of staff. She could tell this was an urgent matter and quickly connected him. Once the chief of staff got on the phone Dirk quickly explained what he had discovered. The chief of staff was silent for a moment and then said he needed to get the hospital director involved.

He then said, "Make sure! Double-check the computer's audit trail and let me know everyone who accessed the congressman's record and what they did. I will personally put a hold on anything in Martin's record and verify nothing adverse has been given to him. I hope this turns out to be a non-issue, but you never know."

After he hung up, the chief of staff called his secretary into his office. "Get the director on the phone," he said. "Also, find Dr. Douglas now! Get him in here and be quiet about it."

A Case of Murder and EHRs -- Chapter Six

Frank Irving — Tue, 30 Oct 2007 14:00:00 GMT

A Case of Murder and EHRs

Published with permission of the co-authors.

CHAPTER SIX

Dr. Rose was a relatively new physician on the medical staff of the hospital. Upon hearing of the presidential hopeful's admittance to the hospital, Dr. Rose decided to take a quick look at the medical record of Congressman Martin. It was not that he had any need to look at the record, but he was disturbed by this upstart politician's liberal position on health care and just wanted to know more about this man with whom he strongly disagreed on so many levels.

If he could be the one to keep Stan Martin from continuing on his quest for the presidency, he would be held up as a hero by some of his peers. He might also just get that position he had been dreaming about at the highly prestigious Johns Hopkins medical center. He decided to use the VA's EHR system to learn more about the patient. How ironic, he thought, to use the very type of system Congressman Martin was promoting to bring about his downfall. If the system could be used to harm the congressman, that would prove his plan for a national health care system and the use of EHR systems was wrong and just might just cause him to lose the election.

Dr. Rose reasoned with himself that he was doing this for the betterment of the citizens of this country.

Logging in at a nearby computer console, Dr. Rose pulled up Stan Martin's electronic chart. With adrenaline pumping, he felt a deep urge to do something to keep this candidate off his feet. The longer he was not on the campaign trail, the better it would be for his opponents. Dr. Rose knew that this candidate for president was bad news for health care and private industry.

Seeing no one around, Dr. Rose quickly placed a pharmacy order, logged off the computer, and walked away.

A Case of Murder and EHRs -- Chapter Four

Frank Irving — Fri, 26 Oct 2007 14:49:00 GMT

A Case of Murder and EHRs

Published with permission of the co-authors.

CHAPTER FOUR

As his presidential campaign progressed, Congressman Martin began to feel the mental and physical strain on his body. Recounting stories of the victims of Hurricane Katrina, along with his personal tragedy, Stan tried to keep his detractors at bay. His push for national health care hit roadblocks at every turn from lobbyists of the American Medical Association (AMA) and the pharmaceutical and insurance industries. If he could only convince the American people of the overwhelming benefits of EHRs, he might just win this race.

His conservative opponent was putting up a good fight. They seemed to agree on most political issues except health care, and the Congressman was seeing how the lack of financial backing from the health care industries was hurting his campaign. But Stan believed so much in the need for a better national health care solution and the use of EHRs, he had to persevere.

It was while speaking at an outdoor rally at Shepherd University in Shepherdstown, West Virginia, that Congressman Martin began to feel the ill effects of the summer heat and humidity. He visibly struggled to complete his speech and then quickly headed for his limousine. He felt overheated, like he was having a heart attack. As he climbed into his limo, he told his campaign manager and head of security he needed to get to a hospital. The closest hospital emergency room was at the nearby VA Medical Center in Martinsburg.

Concerned for his charge, the head of his Secret Service security detail called ahead and asked to speak to the director of the VA Medical Center.

A Case of Murder and EHRs -- Chapter Three

Frank Irving — Thu, 25 Oct 2007 14:05:00 GMT

A Case of Murder and EHRs

Published with permission of the co-authors.

CHAPTER THREE

Congressman Stan Martin, sat at ease waiting for the questions to begin once again. In his tailored pinstriped suit that Kitty had bought for his birthday last year, he felt confident and in no doubt of his decision to run for office. He knew the pressure interviews like this would cause in normal circumstances, but he believed whole-heartedly in what he stand for. Shifting ever so slightly to get more comfortable, the interviewer turned to Stan and asked him if he needed anything before they started the next segment.

Stan knew what was coming and was prepared. He shook off the offer for a drink of water and sat patiently for the cameras to start rolling.

"Welcome back to ABC's Nightly News Special Report...Presidential hopeful Congressman Stan Martin from Louisiana speaks out on his controversial platform calling for the creation of a national health care system and electronic health record (EHR) for every citizen. Congressman Martin, thank you again for joining us this evening.

"Now let's get down to this key issue of your campaign. Let's talk about your stance on health care reform. We've been hearing a lot about an electronic health record throughout your campaign. Help me to understand exactly what an EHR is and why it is so pivotal in improving our nation's health care system."

Stan knew he needed to let people know what he believed and try to win them over to his side. But his response was a carefully crafted presentation of facts. He planned to voice his response in such a way that every American would listen and understand that he knew what he was talking about. He didn't want listeners to tune him out because he spouted off too much data.

"Let me give you a few simple facts about our health care system. Last year, the U.S. spent over $1.8 trillion on health care, which is over 16 percent of our country's Gross National Product. That's a lot of money. Yet the richest country in the world, the United States, ranks at or near the bottom of all industrialized countries in terms of vital health statistics. Of 13 developed countries, the United States ranked 13^th in infant mortality, 13^th for years of potential life lost, and 10^th for age-adjusted mortality.

"Depending on which major studies you read, at least 44,000 people, and perhaps as many as 200,000 people, die as inpatients in hospitals each year as a result of medical errors that could have been prevented. It has also been estimated that there were 199,000 deaths from medical errors in outpatient care. This makes our health care system itself, one of the leading causes of death in the U.S. In addition to the cost in terms of human lives, medical errors have been estimated to result in total costs between $17 and $29 billion per year to hospitals nationwide.

"To put this into perspective, this is the equivalent of a World Trade Center disaster every week for over a year and a half, or the crash of two fully loaded 747 aircraft every day of a year.

"We have to do something now!

"One thing we can do that will make a huge difference is to ensure that all health care providers in this country start using EHR systems as soon as possible. The Department of Health & Human Services estimates that use of health information technology and EHR systems in the U.S. could save approximately $140 billion per year, not to mention saving countless lives."

The interviewer wanted to appear balanced and fair-minded in this interview. With obvious shock in his voice he continued with the questions on the cue cards.

"That sounds like a far-fetched fantasy of a highly critical health care professional. However, your background is in public administration, not health care. Can you explain further how you came to your position on the need for a national health care system and use of electronic health records? Why do you feel the U.S. needs such dramatic health care reform?"

Stan responded with sincerity and passion to the questions.

"We all know of the sufferings of the residents in my home state of Louisiana, and our neighboring state of Mississippi. Hurricane Katrina was a wake-up call to me and to our country. As you know, I have a very personal interest in making sure we are better prepared next time. My wife was one of the many victims who died as a result of the storm. As you may know, she went into shock due to an allergic reaction to one of the medications she was given. Because her medical record was unavailable, the doctors didn't know about her previous allergic reactions. Because the doctors didn't have that one tiny bit of crucial information, their uninformed actions proved fatal. I don't want that to happen again to others. We need to move toward a national health care system and the availability of lifelong electronic health records for everyone."

A Case of Murder and EHRs -- Chapter Two

Frank Irving — Wed, 24 Oct 2007 15:30:00 GMT

A Case of Murder and EHRs

Published with permission of the co-authors.

CHAPTER TWO

In the aftermath of Hurricane Katrina, Congressman Stan Martin listened to a seemingly endless series of horror stories presented at the Congressional hearings. Many of these stories were very similar to his own. Stories of citizens seeking care both in New Orleans and elsewhere across the country. Tens of thousands of evacuees learned first-hand how unprepared the U.S. was to deal with this kind of natural disaster. Even with all the technological advances we have made in health care, it became clear the health care system as a whole was inadequate. The loss of the paper charts of thousands of New Orleans residents seemed to be the cause of most of the medical disasters. It became obvious to Congressman Martin that our country was not fully embracing IT advances -- medical facilities were still running on paper!

However, one surprising story emerged from the hearings -- a success story from a most unlikely place, the veterans' health care system. The congressman found it hard to believe, but the U.S. Department of Veterans Affairs (VA) was the only health care system to continue to provide uninterrupted care to its patients no matter where they showed up after the storm. Because all VA patient records were computerized and backup copies were kept at a remote location hundreds of miles away, no records were lost due to the storm or the flooding that followed. As patients showed up in Baton Rouge, Houston, Washington, D.C., and other VA medical centers across the country, doctors were able to pull up copies of their electronic health records and effectively care for the evacuees.

Congressman Martin was a military veteran, having enlisted right out of high school as a way to see the world and pay for college. When his military service ended, he took advantage of the GI Bill benefits package for veterans. The GI Bill paid for his undergraduate and most of his graduate school expenses. Because he was not wounded during his tour of duty in Vietnam, he had never gone to the VA for medical care. Nonetheless, having seen movies like "Born on the Fourth of July," he had come to believe the stereotypes associated with the VA healthcare system...the care was sub-standard and admission to a VA medical center was to be avoided at all costs.

So how could the VA be the most notable major success story to come out of the Hurricane Katrina disaster? Stan vowed to look closely into the phenomenon.