Last week saw another wave of healthcare-related IT malfunctions, problems, and issues being reported. This time, we turn our focus to a controversy currently capturing the attention of the French press: the startling admission by administrators at the university hospital in Rennes that perfectly good drugs and other medical supplies are being trashed as a result of technical issues with its relatively new automated pharmacy system.
What first drew my attention to this story was an English-language story appearing at the International Business Times that claimed the Centre Hospitalier Universitaire de Rennes—better known as CHU—has sent a staggering €10 million worth of medicine and other medical paraphernalia to its incinerator because of a “computer bug” in the pharmacy distribution “robot” that was installed at the hospital in 2010. According to the IBT story—which claimed as its source an investigative story published in The Monthly Rennes—the “bug led to duplication and storage problems, which caused pallet-loads of medication to be destroyed.”
However, the The Monthly Rennes indicates in its story that the hospital workers who came forward and claimed that the medical supplies were being sent to the hospital incinerator said that they were worth more in the hundreds of thousands of euros per year—still an astonishing amount, but one that the hospital administration hotly disputed in a subsequent story. CHU administrators claim that “only” €30,000 in medical supplies had been discarded each year, although they also admit they aren’t exactly confident whether that was indeed the true cost. Why not? The of flaws in the automated pharmacy distribution system make it hard to know for sure.
The hospital workers who first brought the issue to the public's attention are scoffing at the CHU administrators €30,000 estimate, and insist that the true figure is many times that amount.
CHU administrators have tried to get out in front of the growing firestorm by explaining in stories at Le Télégramme and Le Parisien that the hospital annually purchases about €100 million worth of drugs and other types of medical supplies through its central pharmacy. However, about €2 million of those purchases arrive on pallets or in containers that cannot be easily placed into the hospital’s Magmatic automated pharmacy distribution system. Some, for example, don’t meet European size standards. As result, hospital workers are forced to repackage the supplies into containers that CHU’s automated distribution system can use.
The repackaging causes a variety of problems, such as delays in a particular item being shown as in stock by the hospital pharmacy and therefore available for use by the hospital staff. This time lag frequently leads to the "missing" supply to be reordered mistakenly. This not only causes order duplication issues but, exacerbates on-site storage problems. Additionally, CHU administrators admit, sometimes the effort (physical labor as well as the tracking and government-mandated safety paperwork involved) required to repack a supply is not worth it, and so the perfectly good medical item is indeed thrown away. Oddly enough, safety regulations also prohibit the excess stock to be given away to local medical clinics, administrators said. This is all on top of the frequent malfunctions of the Magmatic distribution system that themselves contribute to confusion over the availability of drugs and other medical supplies at the hospital.
Then came the rationalizing. CHU administrators insisted that while it may seem morally outrageous to throw out €30,000 worth of perfectly good drugs and other medical supplies, it really wasn’t that much waste in the overall scheme of things. They assured observers that hospital technicians have been involved in efforts over the past several years to reduce the waste and improve the reliability of its automated pharmacy distributed system. But CHU administrators concede that the Magmatic system was undersized when it was designed and that the constraint is not easily overcome.
CHU also tried another tack to deflect press criticism by claiming that other French hospitals were doing exactly the same thing and probably were throwing out more drugs and medical supplies than it was. This, of course, has merely encouraged the French press to start investigating the total cost of new drugs and medical supplies across France that are making their way to the local hospital incinerator. It stands to reason that they would probe, given the French Minister of Health’s very recent calls for reducing the cost of government-provided healthcare by—you guessed it—reducing unnecessary waste.
Alberta Patients Turned Away Because of Electronic Health Records Glitch
Shifting gears slightly to another health IT problem in the news last week, Alberta’s Medicine Hat News reported that patients were turned away last Monday because of an Alberta-wide failure of the province’s cloud-based TELUS Wolf electronic health record system (pdf). The paper reported that this was the second outage in a year. In addition, over the previous few weeks, doctors reported that the TELUS EHR system had been “extremely slow.” One doctor reported that it had taken him 15 minutes to renew a prescription.
TELUS apologized for the outage, calling it a “technical issue that was hard to find and address.” The company admitted that it was “too slow repairing the system” and promised that it would “get better.” Doctors and patients, however, seem skeptical given similar promises from the company in the wake of an outage last year.
Last week also saw the disclosure by New Zealand’s Southern District Health Board of what took out the IT systems at hospitals in Dunedin and Invercargill for 36 hours in February. A story appearing in the Otago Daily Times stated that a report from the Health Board placed the blame on a mistyped single digit in system maintenance software (shades of the Joyent outage). The Health Board stated that:
“The root cause of the outage event was the incorrect configuration of the monitoring and alerting system on the storage area network equipment. This was due to an incorrect IP address being entered into a configuration field on the alerting software and is most certainly to have been caused by human error. A single digit in a 12-digit address was incorrect.”
As a result, no one was alerted to the fact that there were disk failures occurring and that the corrupted disks needed to be replaced. So, “as disks failed, the storage area network automatically reassigned spare disks to cover these failures.” The SAN kept doing so, until a point was reached where the system ran out of spare disk space, and automatically shut itself down in order to preserve data. However, since there was no indication from the monitoring and alerting software of anything being wrong, it took some time before technicians determined the cause of the surprise outage and fixed it.
The Southern District Health Board said it has taken steps to improve its system maintenance procedures to ensure that this type of problem won’t happen again.
Finally, there was a news report that Vermont's largest hospital, Fletcher Allen Health Care in Burlington, lost its EHR system mid-morning on Friday and that staff have had to resort to manual means to record patient information. There haven't been follow-up news reports indicating that the EHR has come back on-line; if any do appear, I'll update this post.
In Other News…
Robert N. Charette is a Contributing Editor to IEEE Spectrum and an acknowledged international authority on information technology and systems risk management. A self-described “risk ecologist,” he is interested in the intersections of business, political, technological, and societal risks. Charette is an award-winning author of multiple books and numerous articles on the subjects of risk management, project and program management, innovation, and entrepreneurship. A Life Senior Member of the IEEE, Charette was a recipient of the IEEE Computer Society’s Golden Core Award in 2008.