What to do (and what not to do) when your $1B system-wide EHR fails
The 24-hospital Sutter Health system in Northern California was the talk of the town late August after a software glitch rendered its $1 billion Epic electronic health record system inaccessible to nurses and clinical staff throughout all Sutter locations.
On Aug. 26 at approximately 8 a.m., nurses, physicians and hospital staff had no access to patient information, including patient medications and all vital patient history data, according to reports from the California Nurses Association, part of National Nurses United, the largest nurses' union in the U.S.
"Many of the families became concerned because they noticed the patients were not getting their medications throughout the day,” explained Mike Hill, RN at Sutter’s Alta Bates Summit Medical Center and CNA representative for the hospital. "Meds were not given for the entire day for many of the patients."
Officials at Sutter Health confirmed the outages. On the morning of Aug. 26, "we experienced an issue with the software that manages user access to the EHR," wrote Sutter Health spokesperson Bill Gleeson, in an emailed statement to Healthcare IT News. "This caused intermittent access challenges in some locations."
By some reports, the issue was caused by a Citrix glitch, but Sutter officials wouldn’t confirm the vendor. The Sutter Health IT team applied a software patch later that night to resolve the issue and restore access. "We regret any inconvenience this may have caused patients," said Gleeson, who added that throughout the glitch, the "EHR was live," despite users being unable to access it.
Hill said it caused more than inconvenience, as "everything went down including the backup." Even when nurses attempted to use the health system’s Pyxis medication management system to print out patient information, the data was outdated by two to three days. "The nurses basically were operating blind that day," Hill added.
[See also: Setback for Sutter after $1B EHR crashes.]
"Everything went down including the backup."
Other readers argue that Sutter responded swiftly and efficiently. Reader Anish Arora, founder and president of healthcare IT consulting firm Afyatech and has worked with Sutter before, said, "No time was lost, no stone left unturned to fix the problem as quickly as possible."
Days earlier, the EHR system was also down for eight hours due to a planned upgrade; nurses could still read medication orders and patient histories but had to record new data on paper to then be re-entered into the system later.
Some Healthcare IT News readers were shocked over this amount of downtime. "The IT department should not even be taking down the EHR for eight hours for a planned upgrade anyway. They need to find a better way to manage upgrades," said Martalli, in a comment posted on the Healthcare IT News web site.
What to do differently
So what could Sutter Health officials have done differently? Three things, Hill says.
First, better training on backup systems. Sutter has a paper backup system, but it’s typically used for outages lasting one to two hours, and nurses haven’t been thoroughly trained on it, said Hill. So, when an outage occurs for more than eight hours, and nurses have been poorly trained on the paper systems, issues are going to come up, he explained, and that's just not good for patient care.
Secondly, good communication is critical, said Hill. "There really wasn’t any support from management on what was going on. They seemed to be lost and weren’t really providing any guidance to the nurses."
And third comes down to involving the nurses in the EHR design process so the system is optimized for both the nurses and patients. Hill explained that although the Sutter EHR system has an Epic Systems base, it’s been mostly modified and built by Sutter Health IT programmers who aren’t as familiar with the system as the actual Epic Systems IT programmers, which has ultimately led to poor designs, he opines.
He cited several examples. "You can sign on with your badge, and someone else’s name pops up. You can try to give blood and it pops up as a different type of blood than you’re giving and you can’t get it into the system," he said. And when the nurses go back to the IT staff, many times these requests aren't fulfilled in a timely manner, as the team already has a lot on their plates. Added Hill, "This system really wasn't ready to come out."
Gleeson, however, pointed out that Sutter physicians and nurses are very much involved in the EHR implementation and design process. "EHR configurations are designed by our physicians and nurses, configured by Information Services and then validated by our physicians and nurses," he explained.
"This system really wasn't ready to come out."
However, Gleeson said it really comes down to CNA opposition to the use of health information technology and ultimately misrepresented the situation. "It comes as no surprise given the fact that we are in a protracted labor dispute with CNA," he said. Gleeson also cited the uptime percentage for these systems as being 99.4 percent.
Hill was quick to clarify: "CNA has never been opposed to technology because technology is part of what is going on." What some 5,000 Sutter nurses represented by CNA do have an issue with is the lack of inclusion in the design process, which is why they include a technology section as part of their contract. "Much of the language here says the hospital needs to involve the nurses from the very beginning because this technology involves what we do every day as nurses, so it needs to be nurse friendly, and it needs to be patient friendly," Hill said.