Hospital sounds alarm after 3-day struggle

BOSTON - The healthcare industry is sitting up and taking notice after one of Massachusetts' best-known hospitals suffered network slowdowns and interruptions for more than three days earlier this month.

The incident at Beth Israel Deaconess Medical Center  prompted its CIO to go public with the network problems, in the hope of educating other healthcare IT executives that might have similarly vulnerable networks.

Dr. John Halamka is CIO of CareGroup Healthcare System  and an advocate of healthcare computing. Beth Israel Deaconess is the keystone asset of the CareGroup healthcare network, which consists of five Massachusetts hospitals and more than 1,800 physicians. The IT infrastructure at Beth Israel Deaconess has been singled out among healthcare corporate networks for its cutting-edge use of Web-enabled and wireless applications.

Last week Halamka told the story of his network woes at a meeting of healthcare CIOs held at Massachusetts Health Data Consortium, a nonprofit corporation aimed at developing and disseminating healthcare information. He detailed the cause, effects and resolution of the hospital's network problems.

The contagion turned out to be compute-intensive analytic software. When a researcher launched it, the software triggered enormous levels of network traffic. The overload slowed systems significantly, causing intermittent problems with e-mail, data entry and Web access to patient records and prescriptions.

The network interruptions occurred every four to six hours, so the hospital decided to revert to paper processes to minimize the disruption caused by having to switch between automated and manual processes every few hours, Halamka says.

Additional details about the cause of the network failure were not available.

Analysts say such incidents might become common in healthcare facilities - which have a history of underinvesting in IT, compared with other industries - as their network systems accumulate and age.

Gartner reports that healthcare companies devoted an average of 2.5% of revenue to IT spending in 2002, compared with 8.9% among telecom companies and 6.6% among banking businesses. Concerns about the business value of IT and the maturity of healthcare solutions are two inhibitors to healthcare IT spending, according to Gartner.

As a result, a network outage might not be much of a problem at many hospitals because most haven't automated critical patient care services, says Ken Kleinberg, vice president and research director at Gartner.

At as many as 90% of healthcare facilities, doctors still carry paper charts during rounds, documents are sent through pneumatic tubes, and patients still work through stacks of forms in triplicate, he says.

"Healthcare is not as automated as a lot of industries, so ironically, when there are problems, healthcare can often work around them," Kleinberg says. Hospitals are least-automated in the areas of patient safety, he says. "But those that are automated in those areas have taken on a greater risk - for the greater reward of providing more advanced patient care," he says.

Beth Israel Deaconess' IT department is ahead of the adoption curve. It has taken broad steps to Web-enable clinical systems. Combined, its systems handle 40 terabytes of information daily.

Systems affected by the network problems included:

  • A Web-based prescription-ordering system.
  • An electronic whiteboard in the emergency room for tracking patient status, which doctors can access over the Web and wireless LAN.
  • Web-enabled clinical information systems that offer online access to clinical records including problem lists, medications, allergies, notes, electrocardiograms, labs and X-rays.
  • PatientSite, which lets patients schedule appointments, renew prescriptions, request a referral and communicate with their caregivers via the Web.

So the hospital reverted to its paper-based systems. Employees printed records and manually monitored prescription doses. Lab tests were done as normal, but results were sent to doctors on paper instead of via computer, Halamka says.

Meanwhile, the IT department called in a team of network specialists from Cisco to help repair the network systems. Through all this, there was no disruption of customer services and patient safety never was jeopardized, Halamka says.

"No changes in clinical care occurred," he says. "Surgeries proceeded as usual, all transfers and admissions were accepted as usual."

The Emergency Department was diverting patients for two hours one day, but, contrary to other press reports, this was unrelated to the network outage, he says.

The incident at Beth Israel Deaconess underscores the importance of back-up systems.

"The benefits of automation are real, but the risks go up. If you're going to automate, you have to also find the money to put the back-up systems in place," Kleinberg says.

"Whatever problems were experienced at Beth Israel, you can be sure this is just a harbinger of what's to come as healthcare more fully automates and starts to rely on these systems for clinical capabilities," he adds.

Halamka's candor with his peers suggests he wants to spread the word about potential risks of automation.

"It is not surprising to those of us who know John that he is willing to share his experiences for the greater good," says Meg Aranow, vice president and CIO at Boston Medical Center.

"He is very committed to improving the discipline of healthcare computing," she adds.

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