Contemporary Issues in Medical Informatics: Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties
From the Spartanburg, South Carolina

From the Spartanburg, South Carolina
Herald Journal, March 22, 2000:


Several Spartanburg Regional Medical Center staff members say malfunctions
in the hospital computer system that stores patients' medical records are
jeopardizing patient care.

They say the breakdowns are occurring in a $2.7 million system nurses use
for clinical reports, the computer program that keeps electronic medical
records and a database used by doctors to track patients' clinical progress.

A hospital report obtained by the Herald-Journal lists more than 600
operational problems with patient medical records systems since mid-July.
The problems include difficulties retrieving medical histories, frequent
error messages and failure of the system to post lab and pathology reports
in patients' files, according to hospital documents.

Officials have also expressed concerns about delinquent records that cannot
be completed because doctors have problems retrieving medical histories.

In a portion of a letter obtained by the Herald-Journal, Lynn Henderson,
Regional's director of medical records, wrote that the hospital will have a
problem in July, when it must report its number of delinquent records to
the Joint Commission on Hospital Accreditation. The letter was part of a
greater correspondence with the software maker to explain problems
Spartanburg doctors were having with the system.

"The system is not perfect, but we've made a lot of progress since
October," Henderson said.

Officials put the medical records system online in April 1999, with
software purchased from California-based McKesson/HBOC, according to
hospital spokesman Hunter Kome.

"The Pathways Image Manager system has a normal level of downtime for a
complex system," Kome said in a prepared statement. "Downtimes for routine
maintenance and upgrades are carefully planned to have a minimal impact on
the users of the system."

Kome could not discuss the specific number of errors that have occurred
with the system because the hospital's contract with McKesson/HBOC forbids
those disclosures.

Cardiologist James Story said putting patients' records on computer was a
visionary idea, but it has not worked well at Regional.

"Corporate medical records are clearly a problem," Story said. "I've seen
very little progress (in solving the problems) since the system'sinception."

Story said the problems with the medical records have created low morale
among most members of Regional's nursing staff.

"They're logging into a computer when they'd like to be at a patient's
bedside," Story said.

Kome acknowledged there are occasional input mistakes, but said electronic
medical records are the way hospitals must go for quality care and error
reduction. He said electronic records are also more secure.

"The use of an electronic medical record is the future of patient care,"
Kome said. "We are already experiencing its advantages, including faster
access, greater security and the ability of more than one medical
professional to view the record simultaneously."

But Henderson wrote in her letter that "The Medical Staff is extremely
displeased with the functionality of the software - related to both error
messages and speed. The physicians have expressed displeasure with the fact
that the system is 'wasting' their valuable time and resulting in lost
revenue for their practice."

Many of the hospital's nurses will speak only on condition of anonymity
regarding the hospital's computer problems because they are afraid of
losing their jobs.

One nurse said dealing with the problems is causing more stress than she's
felt throughout a career with the hospital that's lasted more than 10years.
"I, and many of my colleagues, feel guilty when we leave at the end of our
shift because of how little time we've had to spend with the sick people
who need us," the nurse said.

Dr. Steven Garrell, a Spartanburg kidney specialist, said SRMC's patient
record system is not time efficient.

Garrell and Story said it takes them twice as long to make hospital rounds
as it did before the system was installed.

"It's still easier to flip through a chart instead of having to go through
several computer screens," Garrell said. "There was no clear plan for (the
system) to work when they set it up. The doctors were not asked how (the
computer system) would impact them."

Garrell said doctors are expected to retrieve and print patient records
from a computer database when they arrive on the floor to visit patients.
"I'm not going to be a secretary," Garrell said. "I want the data waiting,
so I have more time to spend seeing my patients and their families. Some
things can't be computerized."

The system was installed without a gradual phase-in testing period.
Hospital officials started tracking downtime and malfunctions in July,
after receiving a rash of complaints from doctors and nurses about the
system's poor performance.

Regional began purchasing software programs about 1995 from McKesson/HBOC,
a pharmaceuticals distributor and information technology company.

Records show that hospital administrators agreed last year to increase
their purchases from the California company by contracting to purchase at
least 85 percent of Regional's pharmaceutical and medical/surgical supplies
from McKesson over the next five years.

The contract totaled $50 million, and included additional computer software
and equipment used for distribution of pharmaceuticals throughout the hospital.
"Pathways Image Manager is the leading electronic medical record system on
the market," Kome said. "McKesson/HBOC is the leading healthcare
information systems company in the world. We have an excellent relationship
with the company and have every confidence in their ability to continuously
develop and refine their products."