California Nurses Association, Aug. 27, 2013 – A controversial electronic health records system on which Sutter corporation has said it is spending $1 billion went completely dark Monday at Sutter hospitals in Northern California exposing patients to additional risk beyond problems reported with the system in July, registered nurses reported yesterday.
For several months RNs have cited multiple problems with the new system, known as Epic, with safe care delivery that the California Nurses Association (CNA) says is increasingly troublesome. In July, CNA cited over 100 reports submitted by RNs at Alta Bates Summit Medical Center facilities in Berkeley and Oakland, documenting a variety of problems with Epic.
According to CNA, Sutter management has ignored the nurses concerns. These health information systems are not simply computerized versions of medical charts, but a complex system for maximizing revenue and profits and routinizing care that limits nurses’ ability to meet individual patient needs.
Friday night, Epic was down for a planned “upgrade” for up to eight hours, during which nurses and other users could read medication orders and patient histories, but not enter new data which was kept on paper records then re-entered into the computers later.
Monday morning around 8 a.m. at various Sutter hospitals, Epic suffered a meltdown, going completely dark, requiring nurses and doctors to effectively work blind without any access to patient information, including what medications patients were on or needed, patient history information that informs treatment options, and all other information required for safe patient care delivery.
Facilities affected by the Epic collapse included Alta Bates Summit Medical Center facilities in Berkeley and Oakland, Eden Medical Center facilities in Castro Valley, Mills Peninsula in Burlingame, Sutter Delta in Antioch, and Sutter Tracy and Sutter Modesto, as well as Sutter-affiliated doctor’s offices and clinics. Epic computers remained dark until late afternoon or early evening.
“This incident is especially worrisome. It is a reminder of the false promise of information technology in medical care. No access to medication orders, patient allergies and other information puts patients at serious risk,” says CNA legislative director Bonnie Castillo, RN. “These systems should never be relied upon for protecting patients or assuring the delivery of the safest care.
Reports from RNs throughout Sutter found little or no backup planning by hospital management, inadequate training, and little support during the emergency.
“All information such as medication administration records, and patient histories was outdated by two to three days,” during which a lot can change with the extremely fragile hospital patients, notes Alta Bates Summit RN Mike Hill.
“There were no orders that could be seen of any kind through the day, so nurses called for what they needed.” All that prevented greater chaos, said Hill, was the expertise of the RNs who “knew what to do from experience, not from any direction from management, as management was running around not knowing what to do, according to the nurses. There was no training for this kind of downtime, as it was unplanned. Nurses followed previous downtime training, but this was different because there was no ability to see any info on the patient.”
At the Alta Bates Berkeley facility, nurses reported surgery delays in labor and delivery and widespread problems with lack of vital information in labor and delivery and medical-surgical units.
“Nurses did not have access to vital information during the entire day, including medication orders, patient profiles and previous meds given,” said Esperanza Velasco, an Antepartum RN.
“We did not have information on the history of our patients. Nurses could not determine or administer proper meds when the system failed and the pharmacy backup system failed. If it were not for the nurses going above and beyond, it could have been disastrous,” said labor and delivery RN Beth Sherry.
“I have been a RN since 2001 and have worked with many different electronic documentation systems. I have never experienced a system crashing like what I heard happened at Eden yesterday,” said Kevin Sweat, an ER RN at Eden.
At Sutter Delta, said RN Paulina Zaragoza, the shutdown started after 8 a.m., “no one, including case managers, could log in on Epic. We called the IT help desk and it wouldn’t ring, only get a busy signal. There seemed to be minimal support from management/education/administration. The few times they did show up, the attitude of ‘why don’t you know downtime procedures’ was given. We were told before go-live to be familiar in what to do but never were formally trained.”
Sutter Delta RNs threatened
What the system seems most useful for is billing and assuring it captures all charges that can be passed on to insurers, government payers, and individual patients, says Castillo.
In late July, Sutter Delta management threatened to discipline RNs for not entering all charges into the system. “We had an obstetrical patient with medical surgical evaluations on our floor this week. Care we provided along with her use of the facility was provided for free” because of not entering all data, staff was warned in a memo from Women’s Health department manager Joan Fosenburg. “We can’t afford to operate like this … We have missed $6,332 in charges over the past week. This department will not survive if we continue to operate this way. If you do something that is chargeable, charge for it!”
In another memo, dated July 29, Fosenburg complained of “missed placing charges totaling $11,313.25,” including “frequently not charging for OB checks, missing charges for the hours a patient is in labor” and “missing surgery charges for the time the surgical procedure takes.”
In a separate memo announcing EPIC review classes, Sutter Delta staff is warned, “We have been on EPIC for five months now and we can no longer have incorrect orders, missing information or incorrect or missing charges. Starting on Sept. 1, errors made in any of the above will result in progressive discipline.”
CNA filed charges with the National Labor Relations Board earlier this year charging Sutter’s East Bay region in particular has violated the RN contract by failing to bargain over the implementation of Epic. The discipline threat will now be added to the charge, CNA said today.
