Warung Bebas

Rabu, 08 Agustus 2012

ONC and Misdirection Regarding Mass Healthcare IT Failure

In my keynote address to the Health Informatics Society of Australia in Sydney recently, I cautioned attendees including those in government to be wary of healthcare IT hyper-enthusiast misdirection and logical fallacy (a.k.a. public relations).

In the LA Times story "Patient data outage exposes risks of electronic medical records" on the Cerner EHR outage I wrote of in my post "Massive Health IT Outage: But, Of Course, Patient Safety Was Not Compromised" (the title, of course, being satirical), Jacob Reider, acting chief medical officer at the federal Office of the National Coordinator for Health Information Technology is quoted.  He said:

"These types of outages are quite rare and there's no way to completely eliminate human error."

This is precisely the type of political spin and hyper-enthusiast misdirection I cautioned the Australian health authorities to evaluate critically.

As comedian Scott Adams humorously noted regarding irrelevancy, a hundred dollars is a good price for a toaster, compared to buying a Ferrari.

Further, when you're the patient harmed or killed, or the victim is a family member, you really don't care how "rare" the outages are.

Airline crashes are "rare", too.   So, shall they just be tolerated as a "cost of doing business" and spun away?

(As I once wrote, the asteroid colliding with Earth that caused the extinction of the dinosaurs was a truly "rare" event.)

It seems absurd for me to have to point out that paper, unless there is a mass outbreak of use of disappearing ink, or locally hosted clinical IT, do not go blank en masse across multiple states and countries for any length of time, raising risk across multiple hospitals greatly, acutely and simultaneously.   Yet, I have to point out this obvious fact in the face of misdirection.

Locally hosted health IT, of course, can only cause "local" chart disappearances.  "Local" is a relative term, however, depending on HC organization size, as in the example of a Dec. 2011 regional University of Pittsburgh Medical Center (UPMC) 14-hour outage affecting thousands here.

Further, EHR's and other clinical IT, whether hosted locally or afar, had better offer truly major advantages, without major risks and disadvantages, over older medical records technologies before exposing large numbers of patients to an invasive IT industry and the largest unconsented human subjects experiment in history.

Unfortunately, those basic criteria are not yet apparent with today's systems (see for instance this reading list).

EHR's and other clinical IT, forming in reality an enterprise clinical resource management and clinician workflow control apparatus, have introduced new risk modes including mass chart theft (sometimes tens of thousands in the blink of an eye); also, mass chart disappearances as in this case - all not possible with paper.

At the very least, if hospitals want enterprise clinical resource management and clinician workflow control systems, these should not be relegated to a distant third party.  Patients are not guinea pigs upon whom to test the ASP software model ("software as a service") that, upon failure for any reason, threatens their lives.

Finally, these complications are a further example why this industry cannot go on without meaningful oversight.  The unprecedented special medical device regulatory accommodations must end.

-- SS

Joint Commission Should Be Named As Defendant If Patients Harmed by EHR "Outages"

At my recent post "Massive Health IT Outage: But, Of Course, Patient Safety Was Not Compromised" over a massive, outrageous Cerner outage to hospitals contracting their clinical IT via an ASP model (that is, 'software as a service'), I observed:

... The Joint Commission, for example, likely issued its stamp of approval for the affected hospitals, hospitals who had outsourced their crucial medical records functions to an outside party that sometimes went mute.  If someone was injured or died due to this outage, they would not care very much about the supposed advantages.

From the JC's page "About the Joint Commission":

An independent, not-for-profit organization, The Joint Commission accredits and certifies more than 19,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

It's time to up the ante regarding this accreditation body, fully aware of health IT risks (e.g., the Dec 2008 Sentinel Events Alert on Health IT) but to date having done little about them.  Through my legal work and my speaking to Plaintiff's attorneys, I am becoming increasingly aware of medical malpractice cases that  involve an EHR or related clinical IT systems at JC-accredited organizations.

In effect, the JC has accredited hospitals whose entire clinical command-and-control structure (the term EHR is an anachronism; these systems are in reality enterprise clinical resource management and clinician workflow control devices) can disappear in the blink of an eye, without warning, raising risk to patients greatly.

If I discover that a patient was harmed or killed as a result of, or related to, this massive recent outage of outsourced medical records/workflow control  infrastructure, I will be recommending that the Joint Commission, including its leadership, which likely certified the hospital(s) involved for safe operations in areas such as Information Management, be named as defendants.

I have informed the JC leadership by email.
 
-- SS

Updates and status

Hello Reader!,
                       It's been awhile since we've talked. Things here at G-C have been pretty busy, the legal sector at least appears to be in a full recovery (knock on wood). While I haven't had time to write up a full blog post on some of the new things we've found over the summer, I did want to take the time to show you how our NTFS $logfile parser is coming. For those of you who attended my CEIC session on 'anti-anti forensics' or who downloaded the labs I posted afterwords you know that we had a rough parser and tests to recover the names of wiped files before.

I'm happy to say we've come a long way since then. The initial proof of concept parser was shown to validate the artifact and divide up the pieces into something we could then further understand. We now have a parser, that is still in development, that can go even further creating CSVs of human readable data extracted from those $logfile segments.

What does that mean? Well it means:
1. We can recover the names of deleted files and their metadata, even if its been purged out of the MFT. This includes the metadata associated with the file (directory, creation, modification and acess times).
2. We can recover the complete rename operation showing cleanly which file became which file. Including parsing out the directory, creation, modification and access times before and after the operation. This essentially will allow you to undo what a wiper has done (except for recover the contents of the file itself).
3. We can determine if files were written to other drives, and an approximation of how many. (This is not in the current version of the parsers and will require ist own blog post).
4. We can recover the original metadata of a file when it was created
5. We should be able to recover timestamps that have been altered

It's all written in perl (woo!) and we are going to release the source and documentation as soon as its ready (tm). In the mean time check out this awesome screenshot showing the parser recovering the metadata from 22 files that were wiped with eraser:




If you are need of this tool for a case immediately drop me a line and I'll see what we can do to help you out!

Dead Links

Just a quick note as I've received a few email alerts about this.  A little while back I began a little revamping of the website, nothing major, but wanted to update the Welcome Brochure and Who is CarbSane pages.  Well, I forgot to save the originals so can't re-instate them while the updates are under construction.  I'll try and get them finished and back up ASAP, but this isn't really high on the priority list right now.  Feel free to email me or ask in comments if you have any questions in the meantime.  Thanks for your patience.  

Biophysical Electrochemistry and Human Metabolism

Oxidation is a word that gets tossed around a LOT in discussions of nutrition and metabolism.  And for good reason -- it is integral to how our bodies "burn" fuels for energy and how that energy is harnessed to drive all manner of chemical reactions.    I spent my graduate years studying oxidation -- in metals -- but in many ways the principles are the same.  A little while ago I came across the following paper:  The Pecking Order of Free Radicals and AntiOxidants: Lipid Peroxidation, α-Tocopherol and Ascorbate.  In it we find the following chart:
Read more »

Wales and the Water by Robert James

Robert James is Chief Executive of Swim Wales and a Board Member of British Swimming.
Here he talks through Welsh performances in the Olympic pool and his hopes for the future.

Once again, the Olympic swimming has produced one of the toughest competitions of the Games. We have seen a mix of established stars, and some remarkable young talent, pick up medals and it is clear that swimming is at a standard above what we have seen in the past.
Make no mistake, this British Swimming squad was strong and it was a battle for our five Welsh swimmers to win a place to swim in London.
And I was encouraged by the performances we have seen.
Jemma Lowe finished sixth in the 200m butterfly final - an event in which she finished ninth in Beijing in 2008. Jemma is a gutsy performer who is proving consistent on the World stage.
Georgia Davies produced a personal best morning swim and qualified sixth fastest overall in the heats in the 100m backstroke. In the semi-final, after putting so much effort into the heats, she was unable to replicate the time and make the final. It was Georgia’s first Olympics and she will benefit greatly from the experience. Her heat time showed the improvements she is making as she looks towards future meets.
Ieuan Lloyd, just 19 and also at his first Olympics, swam the fastest leg for the British 4x200m relay team when they finished their final in sixth place.
Marco Loughran is another who has got valuable Games experience as we look at how we can improve on our four medals won in Delhi when the Commonwealth Game comes to Glasgow in 2014.
And finally David Davies. David is one of Wales’ greatest ever Olympians and has been mixing with the World’s best distance swimmers throughout his career.  A third Olympic medal was just a bridge too far, but we all appreciate the work and dedication he has put in and it was an honour to watch him swim at a home Games in London.
Now the major focus for us at Swim Wales is preparing and planning for Glasgow in two years’ time. In Delhi we were Team Wales’ most decorated sport and we want to win medals again. Everyone is back at the beginning of September and we’re straight into the hard work again.
The swimmers mentioned above will have big hopes after their London 2012 experience.
There are also swimmers like Jazz Carlin, a double medallist in Delhi, who has fought hard with illness recently and just missed out on a place in London, who will be looking to peak again in Scotland.
We have some great young talent coming through.
At the Commonwealth Youth Games last year we won nine swimming medals, including a big haul for Ieuan Lloyd that highlighted his growing potential. We also have a strong young men’s relay squad who took gold.
Fifteen year-old Chloe Tutton recently won two medals at the European Junior Championships in Belgium.

The structure for identifying talent is growing all the time. We recently had 4,000 entries for our Summer Nationals – our highest ever.
Away from the elite level, we are working hard on all other aspects of swimming in Wales.
We know that positive experiences at an early age through school swimming or at a local swimming pool will encourage young people to want to swim more.
With our partners we are working hard on new resources, technology and marketing to make swimming and learn-to-swim a consistent model across Wales.
Currently around 63% of children in Wales can swim by the age of 11, just under 11,000 swimmers are a member of a swimming club and just under 4 million social participation swims take place in the country each year.
But we want every child to be a swimmer by 2020, 100,000 aquatic members by 2020, and 6.5 million social participation swims by 2014.
It’s all about trying to engage better and make swimming as fun and appealing as possible. As a governing body we have to use things like technology and keep up with social and cultural trends. A new online tool for young people and families to chart their learn-to-swim progress is one thing on the horizon.
Currently there are around 80 swimming clubs in Wales with 65 being development clubs for competition, and other forms aquatics such as water polo, while for the more gifted swimmers Swim Wales has 10 performance clubs working to maximise potential at Commonwealth or Olympic level.
It’s our job to make sure that those opportunities are available to all young people in Wales. We want clubs to work together with local authorities and private providers so that those different stages are available for young swimmers to move along.
I’m looking forward to seeing how our Paralympic swimmers perform in just a few weeks’ time. They have won medals in the past and we now have a chance to cement our reputation in disability swimming. We will talk more about disability swimming developments in the coming weeks.
See the new Swim Wales website www.swimwales.org

 

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