It has been very difficult to acquire information about problems with the Epic EHR software that is installed in a many hospitals, particularly large ones. I have blogged before on what I, and others, have called the Epic contract gag clause (see: Some of the Details Behind the Maine Medical Center/Epic EHR Meltdown). I do not know for sure that this exists. However, another way for Epic to suppress unfavorable information would be to insert a clause into hospital contracts stipulating that it could be broken if hospital personnel release proprietary information about the company or its products. In effect, then, the gag order is imposed by the hospitals on their own personnel for fear of having the Epic contract cancelled.
All of this is interesting and relevant to a recent news article about an Epic system-wide, EHR crash at Sutter Health in California (see: Setback for Sutter after $1B EHR crashes). Below is an excerpt from it:
The nearly $1 billion electronic health record system at Sutter Health in Northern California crashed...[recently], leaving nurses and clinical staff unable to access any patient information for a full day. On Aug. 26 at approximately 8 a.m., the Epic EHR system crashed, at which time nurses, physicians and hospital staff had no access to patient information, including what medications patients were taking or required to take 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. 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. [See also: Nursing Union Demand Delay of Hospital EHR Go-LIve in Massilon, Ohio; Concern Over Epic EMR Go-Live in Contra Costa, California] The Epic EHR went dark at several Sutter Health locations, including Alta Bates Summit Medical Center, Eden Medical Center, Mills-Peninsula Hospital, Sutter Delta, Sutter Tracy, Sutter Modesto and numerous affiliated clinics.....
"This incident is especially worrisome," said Bonnie Castilla, RN, CNA legislative director, in a news release. "No access to medication orders, patient allergies and other information puts patients at serious risk. These systems should never be relied upon for protecting patients or assuring the delivery of the safest care." "All information such as medication administration records and patient histories was outdated by two to three days," said Mike Hill, Alta Bates Summit RN, of the incident. "There were no orders that could be seen of any kind through the day so nurses called for what they needed." Officials at Sutter Health confirmed the outages....Recently, nurses at Sutter Health have come under fire for failing to enter all the billing charges into the EHR system, which has resulted in the hospital reporting a loss of more than $6,000 in charges in a single week, according to a July memo sent to staff....Starting on September 1st, errors made in any of the above will result in progressive discipline," according to another hospital memo sent to staff.
I believe that an embargo on public discussion about problems with the Epic EHR (or any other EHR for that matter) is a threat to patient safety (see: Judith Faulkner, EMR Interoperability, and Washington IT Politics). I need to insert here a contrasting opinion at a prestigious hospital like UCSF that the Epic software enhances patient safety (see: UCSF Takes Giant Leap Toward Improved Patient Safety, Care With Electronic Health Records). You can make up your own mind on this matter and both sides may be correct.
It's now clear that a crack in the preexisting embargo on public discussion about Epic EHR problems can now be chalked up to the nursing unions, particularly in California. They often have an adversarial relationship with hospital management and may not feel duty bound by hospital contracts. Some of the hospitals deploying the Epic software are struggling with financial problems, sometimes leading to CIO dismissals (see: Some of the Details Behind the Maine Medical Center/Epic EHR Meltdown). Some of these financial problems have also been attributed to the failure of nurses to enter patient billing charges into the EHR.
I suspect that hospital/nurse relations vis-a-vis Epic EHR issues is only going to get worse with nurses possibly being disciplined for failure to log patient charges. Some logical comebacks on the part of the nurses and their unions would be that they have not been adequately trained for this task, the Epic workflow and user interfaces are poorly designed, or that they are too busy with patient care tasks to operate as billing clerks. The net result of all of this is that the news embargo on problems with the Epic EHRs may be rapidly coming to an end. Whoever wrote the Sutter computer crash article certainly knew how to gain the reader's attention by quoting the price of the Sutter EHR system at $1B. Multi-billion dollar computer systems are perceived, at least by the general public, to be totally reliable.