I once flagged a bug in Epic, the big EHR system.
The system had somehow mixed up kilograms and pounds.
For example, a normal adult male weight of 150lbs would be ~68kg,
But accidentally save it without converting and get 150kg.
Convert back and it becomes 330lbs.
Suddenly our reasonably slim man becomes grossly obese.
It's not just wrong,
it's extremely dangerous.
In an emergency situations,
where morphine is commonly administered for extreme pain,
the dosage needed to relieve the pain of a 330lb man would kill a 150lb man.
Granted the responder at the patient's side would probably realize something is amiss,
but a pharmacist in another room filling an order wouldn't have the context,
and could make the error.
Every user I’ve heard coming from a Cerner facility has said that Cerner is an unmitigated disaster.
It almost makes sense that the only way to get a customer was to essentially lobby and force your way into a government contract for it, and it’s still an unmitigated disaster.
My heart goes out to those that are going to get fucked over by this piss-poor deployment and be actually, physically harmed by bad EMR decisions and implementation choices.
I'm amazed that city, county, state, and federal tech projects never want to clone best-of-show systems instead of starting from scratch. City needs a web site? Clone the best one you can find amongst the tens of thousands of cities already doing that. County jail needs tracking of inmate transports? Clone the best one you can find amongst the thousands of counties already doing that. State needs a sales tax system? Clone whatever other state system is the best. VA needs a system for hospital records? Don't develop from scratch, start by cloning the best system you can find amongst the thousands of existing hospital networks, and customize from there.
I used to work at Cerner for a couple years. Honestly working at Cerner was a decent experience. Biggest private employer in Kansas City so everyone knew about the company. Huge campuses across Missouri and Kansas. Huge gym in HQ campus.
I was aware of this VA project at the time, although I was no part of it. I knew it was going to take years and we basically had no competition. Shortly before I left the company we got a new CEO from Google (Health?). Now looking back this guy was probably brought specifically for preparing for the Oracle acquisition.
We were a team of 5. After the Oracle acquisition everyone left. That team basically disappeared. Three of my teammates left for another IT company in Kansas. Things must have gotten really tough after the acquisition.
After some 25 years of consulting/professional services in IT and working probably a dozen or more health care industry businesses or hospitals themselves, I can honestly say they are the worst clients and most I will simply refuse now as a rule. I've never met one that wasn't run poorly run, overly political, low paying, high spending, morale/morally deprived... I could go on, but mostly mismanaged applies, and more so this is universal when it comes to their EMR software systems, as every one needs one.
One need only google "Oracle failure" or visit theregister.com to see a list of atrocities committed yearly by Oracle for ERP and Financial system implementation fiascos, buying Cerner for their EMR that was already bad to use could only make it worse. It's like bad and worse got together to make a baby, but what are your alternatives in the space? I never met an ERP that wasn't a mess, or the staff that tend to manage them. Oracle just keeps expanding, because why be a lesser evil?
If you work in the medical IT field, you have my condolences, and my best advice is don't. The only ones that win are the executives above their meat shields and the investors. If you have to visit one in the US, you also have my condolences, as you'll see first hand the product above commentary.
Vanilla is the best flavor. The decision makers at large health systems often waste fortunes customizing EHR configurations based on the mistaken belief that they know better than the vendor. But often it would be better to stick with the software defaults and retrain the users. Of course this is politically difficult when experienced physicians who bring in a lot of revenue threaten to leave if they don't get their way.
I'll tell you how "dangerous errors" work in practice in a hospital
Let's say we design a "dangerous errors" system. What it's going to consist of is some "are you sure you want to do that" style popups, and some sort of error reporting system.
The error reporting system (human entered) is where it gets interesting. The real nasty errors dutifilly get reported, no choice. The nasty and/or embarrassing errors are not reported. You get some of what they call "virtue signalling" errors where a person may report themself and pat themselves on the back for it - small errors. And than finally, about 1-5% of staff, the sorts that don't belong in medicine, will use it as their personal vendetta machine, ham up, falsify, fictionalize stories written against whoever it was that crossed them that day. Every day.
There CAN be on honest fair reporting system in the absolute healthiest of work cultures, with trust i.e. if I disclose I did something wrong I am confident that I won't be in trouble (that also means nobody can character assassinate someone else who crossed them - they won't be in trouble). But medicine, it's the opposite of such a culture, viciously political, unethical interpersonal practices, obsession with preserving ones career, license, and legal exposure over the common sense best interests of the patients.
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[ 2.5 ms ] story [ 34.2 ms ] threadIt's not just wrong, it's extremely dangerous. In an emergency situations, where morphine is commonly administered for extreme pain, the dosage needed to relieve the pain of a 330lb man would kill a 150lb man. Granted the responder at the patient's side would probably realize something is amiss, but a pharmacist in another room filling an order wouldn't have the context, and could make the error.
It almost makes sense that the only way to get a customer was to essentially lobby and force your way into a government contract for it, and it’s still an unmitigated disaster.
My heart goes out to those that are going to get fucked over by this piss-poor deployment and be actually, physically harmed by bad EMR decisions and implementation choices.
> Scrapping the millennium: introduction of a health record in Sweden fails
> The introduction of a new, heavily criticized electronic journal system from Oracle in two Swedish health districts has failed spectacularly.
https://www.heise.de/en/news/Scrapping-the-millennium-introd...
I was aware of this VA project at the time, although I was no part of it. I knew it was going to take years and we basically had no competition. Shortly before I left the company we got a new CEO from Google (Health?). Now looking back this guy was probably brought specifically for preparing for the Oracle acquisition.
We were a team of 5. After the Oracle acquisition everyone left. That team basically disappeared. Three of my teammates left for another IT company in Kansas. Things must have gotten really tough after the acquisition.
Everything has to run as root.
All their scripts are Korn shell hacks from the 90s that have been carrier over.
Their god awful Kickstart scripts were written in stone even if you prove that there were better ways.
Cerner controlled the root password.
Cerner123!
They hard coded passwords with ROT13.
No wonder Oracle bought them.
One need only google "Oracle failure" or visit theregister.com to see a list of atrocities committed yearly by Oracle for ERP and Financial system implementation fiascos, buying Cerner for their EMR that was already bad to use could only make it worse. It's like bad and worse got together to make a baby, but what are your alternatives in the space? I never met an ERP that wasn't a mess, or the staff that tend to manage them. Oracle just keeps expanding, because why be a lesser evil?
If you work in the medical IT field, you have my condolences, and my best advice is don't. The only ones that win are the executives above their meat shields and the investors. If you have to visit one in the US, you also have my condolences, as you'll see first hand the product above commentary.
Let's say we design a "dangerous errors" system. What it's going to consist of is some "are you sure you want to do that" style popups, and some sort of error reporting system.
The error reporting system (human entered) is where it gets interesting. The real nasty errors dutifilly get reported, no choice. The nasty and/or embarrassing errors are not reported. You get some of what they call "virtue signalling" errors where a person may report themself and pat themselves on the back for it - small errors. And than finally, about 1-5% of staff, the sorts that don't belong in medicine, will use it as their personal vendetta machine, ham up, falsify, fictionalize stories written against whoever it was that crossed them that day. Every day.
There CAN be on honest fair reporting system in the absolute healthiest of work cultures, with trust i.e. if I disclose I did something wrong I am confident that I won't be in trouble (that also means nobody can character assassinate someone else who crossed them - they won't be in trouble). But medicine, it's the opposite of such a culture, viciously political, unethical interpersonal practices, obsession with preserving ones career, license, and legal exposure over the common sense best interests of the patients.