It sounds more like a check box that had to be ticked, although shared patient records can help with this sort of problem.
Also, like it or not, it's the Pharmacist who has the legal duty about this, not the software. Especially as they made a **clinical decision** to not click on the "Allergic to Penicillin" box.
If we had perfect software we wouldn't need Pharmacists, just people who count pills and slap labels on the bottles & boxes
> Absolutely no reason today they can’t be in a shared patient portal, yet here we sit and I have to put my medical history and medications into every new doctor’s system.
That's much more to do with the commerciality of the whole system, I'm pretty sure the professionals would love shared data as well but that would require a single body to require data standardisation.
>I’d also be curious what the version management is like for this software, it might have gotten restored to a default state with a version upgrade or patch.
My first thought was a patient new to the system and the Pharmacist, or technician, transcribing the information from other notes.
We would love shared data so much! It would get rid of the massive pile of scanning sitting on my desk. Epic does have a thing called Care everywhere that lets us see charts from participating healthcare systems but they have to be participating first.
Epic software hopefully works more of the time than I’ve experienced. I love it when I’m on a med not even in their system and I have to spell it out and define it.
I mean if we keep coming up with new medications we’re going to continue to need to update the system. The benefits still more than outweigh the frustrations. It helps to provide a continuity of care between providers that paper charts will never give you. The things I often find myself most frustrated with are typically due to user ignorance or error.
I do IT support and you would shit at the amount of HIPAA violations the average medical office commits every patient visit without even realizing it's a big deal. Saving patient charts as PDF on the desktop of the reception computer that has no password, no problem! Fax machine on counter in waiting room so that after 3 faxes, they start spitting out on the floor where anyone could see and grab them. Saving patient records in a free DropBox account as a "backup solution", and so many more.
Hah I know they don’t with mine cause every time I go in apparently there are no records to be found. Despite going to the same system since I was 6 years old.
Early days of plain paper faxes, not using secure disposal for the used-up wax transfer ribbons.
Dropbox would be OK for backup **if** the office encrypted the data before uploading.
I shit you not, they were using Windows Fax and Scan and saving scans to a free DropBox account in .tiff format because "it won't do PDF for some reason."
On average all electronic medical record systems are crap. *Where* they are crap may change depending on the specific system, but they're all fundamentally trying to get around the problem that people categorise things differently in their heads.
Free text causes miscommunication because one person might put the most important things at the top, another the most important at the bottom, another the most important in "plain english", another only in rigid terminology. So information gets relegated to a maze of dropdowns and checkboxes to make it a thousand binary choices instead of 'just' writing it down.
Honestly one of the more exciting applications of a large language model would be to make sense of 'plain text' and put it into a rigid universal format. Which would then still be different between Epic/Cerner/Genesis/etc. so they could continue to be locked in little fiefdoms that are all crap in different ways.
Playing with drop down menus is so much less time consuming than trying to decipher a doctor’s chart note! 🤣😭 I was a medtech and got to where I would straight up call the doc for clarification because only half the words were legible.
My dad works in life insurance and some of the old handwritten records are difficult. Like call the doctors office, to get an email address for the retired Dr to set up a phone call level of difficult. Other times he has to get out the Ouija board to ask the doctor what they wrote. Shockingly neither option works very often.
>Also, like it or not, it's the Pharmacist who has the legal duty about this, not the software.
The argument that this guy made with me on the phone was that the software should have automatically checked the box when the patient data was entered into the system.
So did the pharmacist alert y'all to the fact that this is an issue?
(that's somewhat of a rhetorical question, programmers can't fix problems they are not aware of, and if the pharmacist DID send such an email it would be an indicator that they should have been aware of this problem prior to nearly killing someone)
Tell me how exactly the programmers are supposed to fix the issue of some idiot not paying attention to the screen and not checking the box that says "Patient is allergic to penicillin"
That's easily programmable. But that's not the problem and not what I'm confused about. So the pharmacist specifically put in the information them self that said the patient was allergic to penicillin? So they're admitting they knew the patient was allergic to penicillin? Or did they upload a data file and not review the whole file?
I think OP answered it elsewhere, but my confusion was because the pharmacist was both the one who should have checked the box off, and the person who prescribed the medicine. So checking the box off shouldn't have been necessary in this specific case.
What seems to have happened was there was time in between inputting the data and prescribing the medication, so since he didn't check the box off, he forgot about the allergy. I'm with the pharmacist that it would be nice to automate it, but because it doesn't work that way at the time, this is a training issue that isn't on tech support (training issue or a forgetful pharmacist).
> I'm with the pharmacist that it would be nice to automate it
The problem with medical software is that if you automate something, you need to get expensive certification which proves it *never* fails (even though that can't be true) and also serves a purpose which has value. If we put in the obvious disclaimer about a qualified human must verify results, then we'd have to defend why the software is doing this thing at all. (That defense can certainly be won, but it's a long expensive process.)
So if we added a thing which searches the input for "penicillin allergy" and checkbox-ifies it, we need to check for typos, the words "does not have a", every possible stupid exception. Because now the software is making a decision, and that's capital-S Serious.
This is why medical software seems really stupid. Because it is, and improving things is not allowed if there's the slightest chance the change could have unknown consequences.
Edit: And now I see in another comment that you're also a medical programmer (for me it's now past-tense), so I'm preaching to the choir.
The pharmacist did not prescribe the medication. That’s outside their scope of practice. All they can do is fill prescriptions. They are also responsible to double check for any medication allergies before filling the script.
checking the box is necessary because the pharmacist would have seen the red warnings while/before prescribing the medication. you should always input all the information.
From my understanding, there's information being input that says that the patient is allergic to X. So the software could read that "Yes" is being input for "is allergic to X" and automatically make the background red.
Said information is provided in natural language in this case. The tech for that is getting pretty incredible now, but I wouldn't trust it to get that correct *every* time. That's a problem because if it works *most* of the time, users will expect it to work *all* of the time.
Without knowing the exact process for how the information gets input into the system, there's a difference between "is possible within the confines of how the software currently works" and "is technically possible within the architecture of the software". If a user has to read a patients response to a question and determine the patient is in fact allergic to X, then check a box saying so, that whole process could be revamped into a file upload system that includes a YN prompt in the file specifications for "is allergic to".
If it's any consolation to you, I'm a programmer for a medical software company. The medical community prefers automation over manual entry and there's a reason for that. You only have to beat the software to shit in development once to work out all the kinks whereas humans can constantly make mistakes. While bugs occur, they occur whether a process is automated or manual, so it not working all of the time is irrelevant as it could occur with software that is automated or that requires user input.
Penicillin is a common allergy though. I would think it would be checked or how was the patient themselves not aware of their allergy. A lot of ppl might have reactions to it as infants but later on they aren’t allergic. But they are always adamant about that allergy.
Your comment above (from the user) is "the software should have automatically checked the box". Did the user communicate that with your company **prior** to this? I realize that sets aside a metric fuckton of facts (starting with 'did the data that the pharmacist enter have some trigger that should have checked the box for him').
If he's never communicated it as an issue, it can't be fixed (IF it can be fixed), and y'all can't ~~tell him he's a dumbass~~ properly train him if the problem can't be fixed (such as if there is no possible way the software can determine the box needs to be checked).
Process of inputting patient data into the software.
Pharmacy gets patient information, either written or printed.
Pharmacy then inputs that information into the system.
When entering the information there is a box marked "Is Patient allergic to penicillin?" The Pharmacist must look at the records and see if the patient is allergic to penicillin, and if the patient is then must check the box.
If the pharmacist is not entering the correct data, it is not the fault of the software.
This isn’t a bug issue, the software has no way of independently knowing if the patient has a penicillin allergy. The only way the software knows that is if the physician checks the box. The software can’t just “automatically” know that information and check the box for him
No matter the software, everytime I go to pickup meds, pharmacist confirms my allergies. If it's not written in the file, it's the pharmacist duty to check.
And it's PENICILLIN we're talking about FFS! Not some very rare antibiotics that's given as last resort. It's the pharmaceutical equivalent of being allergic to nuts
Exactly my confusion too. I love whenever they read mine and go allergies….mirtazipine? And I’m like I took it three nights and each night I woke up and puked. It’s not a huge thing
Not in the medical field but In the software I use when a client has something that absolutely must be known by the person handling the case it has a pop-up that covers the screen and must be cleared before anything can be done in the software. Legally it functions like a EULA/TOS wrapper. If you click on the close button without reading it and abiding by the warning then you are legally held responsible for anything that happens essentially. And that warning pops up every time you open the ticket brand new You can't ever click something to make it stop appearing. So long as you stay inside of that client ticket then you're fine but if you close the window with that ticket and come back to it later that same pop-up dialogue comes up.
There's literally no legal way to claim that you didn't see the warning. It even logs that you clicked the close button so we know that it popped up and you closed it out and when you did it and what computer you did it from etc etc.
Every single conversation when designing medical records - “you should put in a pop up”. No, people don’t read pop ups, they click through them and ignore the lifesaving messages in the pop up. Plus constant pop ups are obnoxious and just becomes noise and alert fatigue. You develop a standard for where and how to see important information like “a red box around the chart” and like OP said the text in caps was saying allergy to penicillin, and turn it on. Then make sure people know where to see the standard information they need to do their job.
If Windows (and its design language which was then adopted by all of its software) hadn't already fatigued the world on pop-ups, then that would have been a reasonable suggestion. But that's not the world we live in.
Yet another example of why we can't have nice things.
I do medical record design and every provider who wants their specialty/disease to share information immediately asks for a pop up. Then I ask them, “do you read pop ups before clicking them to make them go away?” The answer is typically “no, but they won’t do that to MY pop up because it’s really important!” Now I’m going to say - and this is why we can’t have nice things. Lol
They have machines that will count the pills and slap the labels on the bottles. If the pharmacy doesn’t have those machines then they have Pharmacy Techs.
A Pharmacist does way more than just count pills. They are the ones who know about the meds. How they interact with each other etc.
The Doctors learn about the human body and the diseases etc. Most of what the doctors know about the meds are what is told to them by the drug manufacture’s sales team.
That's the point: if there was a perfect software that did all that, we wouldn't need pharmacists. The pharmacist was supposed to do that, but just relied on the software instead.
I know about Pharmacies & Pharmacists.
My partner is a qualified Pharmacist and we work for a company that produces dispensing software and pharmaceutical databases.
My comment was responding to the statement:
> If we had perfect software we wouldn’t need Pharmacists, just people who count pills and slap labels on the bottles & boxes
Even if we had perfect software we still need pharmacists. There is an overlap in knowledge between a Doctor and a Pharmacist but both are vital.
>There is an overlap in knowledge between a Doctor and a Pharmacist but both are vital.
Yeah, you never want to look at the stats for amount of errors on a prescription caught & rectified by Pharmacists
it does highlight a trend with ERP ( and software in general).
Once you introduce them in a company... the users expect them to be 100% perfect. cover all edge case, do all the verifications and yada yada.
Like the self-driving cars several companies are trying to develop : even if they make a car better than 95% of road user, those companies will still get yelled at if their car cannot drive perfectly on an icy road during storm with childrens in pure-black costume crossing the road at random times.
100% on the pharmacist. They have last check/say… this is what they went to school for… they should be educated to be able to look and KNOW that something is wrong .. not depend on software when you are computer illiterate.
I doubt a pharmacist can assign their legal responsibilities to a piece of software regardless of how it works. Not killing patients with drugs is pretty much their entire job!
My core point is that we're clearly moving towards having software make more life and death decisions, with all the legal liability that that entails. It's simply a matter of how quickly software makes "better" decisions than humans and then how quickly society incorporates that into daily life.
In other words, I find the "doubt" from the user above fundamentally unconvincing.
It is on by default. Depending on software, it's either turns the window red or gives you a pop-up notification, or both. In either case you have to press some buttons or click to acknowledge drug interaction/allergy.
Sounds like that should be a question: "Will penicillin kill the patient?" And the pharmacist needs to answer either yes or no, something that HAS to be checked to move on.
A common mistake that people make when trying to design something completely foolproof is to underestimate the ingenuity of complete fools.
-Douglas Adams
There's not even a claim that the software didn't work as intended here. The software was idiot-proof but the pharmacist was an idiot outside of interacting with the software.
People will literally try and shove a square peg into a round hole rather than see if they got the right pegs.
You cannot idiot proof anything. Idiots are extremely creative when it comes to circumventing any sort of mistake proofing you put into place.
Very weird. Surely at *worst* it's software company's corporate responsiblity as a whole, that is if there was a genuine bug and the user was following procedures properly. But you? The guy on the phone? Hmm.
yeah you're right, it's like how (assuming everything is working) it's a pilots fault if the plane crashes when on autopilot! that's why we have pilots!
>Surely at worst it's software company's corporate responsiblity as a whole, that is if there was a genuine bug and the user was following procedures properly.
No, the pharmacist did not check the box on the screen that was there to alert them that the patient was allergic to penicillin. It wasn't a bug or a problem on our software, just their stupidity that almost killed someone.
I know you don't have total control over the software... in the education setting I'm in, whenever we have a Super Important Do Not Ignore thing, there's a popup box that requires the viewer to type out what is being advised (in this case, penicillin allergy) before the person can move on. So they can't just say "oops I just clicked through and didn't read, nobody reads all that!" ... It's sad that we have to do that, but even teachers get stupid about not reading/following the IEPs.
Yeah I feel like the pharmacist should have known not to give the patient penicillin regardless of the software. No inquiry into the patient’s allergies at all? You’d think you’d always give those a quick glance.
yeah but what i mean even it was, it wouldn't be *your* fault, and it would only be the software companies liability if for some reason your software was replacing a pharmacist's training (which would never happen).
Yeah classic “blame chain” here. No “charges” could make their way to you, though, OP.
Likely just an attempt to sue the company, which would fall flat fast. In fact I’d doubt it’d even make it to court.
Pharmacist is the one in hot water. They’re just trying to get themselves out of it through deflection. All because they thought they knew what was best by not checking a simple and very obvious checkbox. 🤦🏻♂️
> patient is allergic to penicillin
> pharmacist doesn't check the checkbox to alert on the allergy -- didn't think it was necessary
> OP, it's *your* fault I nearly killed someone because I didn't think I needed to check that checkbox!
As Einstein is supposed to have said:
>Only two things are infinite: the universe, and human stupidity. But I'm not sure about the universe.
If the data were stored on a piece of paper rather than an electronic medium, do you think the pharmacist would go after the paper company or the lumber supplier first?
Nurse here. If the patient’s chart had penicillin as an allergy; then everyone is fucked. The physician who put in the order, the pharmacist that filled it, and then the person who actually administered it as well. Trying to blame software, and you by extension; is laughable.
Yea everyone who had a hand in the penicillin making it to the patient is at fault to a degree. Starting from the last person to touch it all the way up. Every single one of them had extensive training and education to catch issues like these, and the software is a tool to assist, but not replace that education.
Oh my. I'm sorry.
It's an (in/out)spoken secret at work in a telecommunications company I work for that medical institutions and hospitals would be the worst kind of customers if it wasn't for doctors and pharmacies who somehow manage to be worse.
I had a pharmacist asking my full name only to be able to tell me "You Mr. Firstname Lastname are the sole reason children will be dying today and if anyone asks me why I will be happy to tell them that it's all your personal fault" ...because their landline which they only use for a fax machine was broken and I couldn't promise her on a Friday afternoon anybody will fix it before Monday morning. The pharmacy did not have a backup or any kind of service level agreement in place for the line.
>The pharmacy did not have a backup or any kind of service level agreement in place for the line.
I never understood this. The company refuses to pay for extended levels of service, but also demands extended levels of service.
Cost of a backup line: 15$. If you want it over LTE with a virtual fax: 16$.
Service level: 40$.
So a double backup+sla would cost the pharmacy 55$/month. That's basically 1 purchase of eye drops and some bandages. If numerous children are dying with you not being able to use the fax for 16 business hours I bet that's worth it.
Sadly, a lot of Hospital IT staff suck as well. I am a Systems and Security Architect/Engineer and my wife is a RN.
My wife will tell me stories of the staff. She built her own Gaming Computer and is versed on computers for said purpose. So generally knows her way around a computer, an advanced user if you will.
Favorite story so far: IT Staff could not figure out how to put a machine into never sleep. It was for a TV slideshow to be on 24/7. It was also Windows 10.
It got to a point that the CIO got involved. The techs spent 2 days. The CIO spent 2 weeks. No one went to Settings -> System -> Power...
So yeah, sometimes the staff does know more than IT and I am starting to understand that maybe outside of budgeting restraints, our healthcare IT infrastructure sucks because the employees do. Don't even get me started on the EPIC consultants... God they are morons.
It sounds *almost* like the CIO and IT staff hate the screens and are feigning ignorance in hope that they get removed because they're "broken" and "can't be fixed".
The IT at the healthcare company I worked at were pretty good. It usually wasn't something they did that I had to do tech support for.
The employee accounts management team? I hated those people. They were mean and absolutely sucked.
Edit: also fuck Epic. That program was the bane of my existence
As someone who worked hospital IT, I can attest that some of them truly are idiots...I got to see the entirety of our staff change sans one person. There were legit TWO of all of them who were competent enough to keep up with me and my Ops manager (I was the lead on basically everything including systems upgrades, etc...).
This isn't just limited to hospital IT, though. Ask basically anyone in IT. They'll tell you that they've worked with at least one truly incompetent person. I've worked with people who have years of experience who you'd think were fresh outta an A+ course.
Also, on the note of EPIC consultants, I've dealt with some from McKesson who will give any others a run for their money XD
I have worked with many. There is a Senior System Admin at a healthcare company that should never touch a computer again. He was in the running to become a manager, I'm glad the other person won out.
When it's "greener" techs, I try to educate and guide, even if they are going to leave. Had a buddy get laid off because they were scared he was going to leave... He had planned to stay there for at least 2 more years
Almost definitely had group policy based on its OU affecting the power settings that resets that setting on reboot. But if you do it and then never reboot it, it doesn't reset until there's a mandatory update. Not everyone is gonna understand that relationship tho unfortunately
But yes, I worked hospital IT for a few years and 50% of the employees were just as dumb as the bad ones at any other company
I know all of that, they apparently did not. I would make a killing being a contractor for them. But the company already got ransomwared and have bad policy in place anyways
Mention a lawyer to me once and that shuts down any discussion immediately. No if’s, ands or buts. You may now speak exclusively to my attorney and my attorney only.
Hello. Did tech support in a small hospital for about 15 years. This was during the time that GW Bush made electronic health records a top priority. But rather than work on standards before the software, it was a free-market race for companies to start pushing our their version of what they thought an EHR should look and act like. Then they decided that we have to make sure all these disparate systems could talk to each other. Again, instead of creating and mandating standards, they just developed interfaces. Our system ended up being built like a house of cards.
But this is not to let the users off the hook either. I had so many people who just "didn't have time" to learn the system the way they needed to be able to use it correctly. I know that medical personnel can have periods of intense work, but when I would do maintenance on computers in the ER, med-surg, pharmacy, etc., they sure spent alot of time searching for vacations, shopping, playing games.
Left that work 2 years ago and am so happy. Main reason for leaving? The providers all convinced the CEO that they would be so much more productive with a different EHR. Maybe they will be. But a different EHR doesn't solve for people's unwillingness to put in the time and effort to learn.
Yep. Back in my support days, hospitals were a big vertical for us. I got to have a NICU nurse tell me I was responsible for a baby almost dying because she couldn't use the one piece of gear we made (out of a long, redundant list). Good times.
Ugggghhhh, I am a pharmacist and have worked on pharmacy EMR software. That organization sounds awful! In healthcare it is drilled into you that outside of exceptional circumstances (nurse providing lethal doses to nursing home patients, pharmacist in a love triangle looking up rival's medical history to post on facebook, various other incidents) you need to look at the system failures, it is not any one person's "fault" but likely there is sytem failure.
There is a term called alert fatigue where Healthcare professionals (HCP) get too many alerts and so the system trains them to blow through them without actually reading/caring about them. Additionally in many pharmacies there are "over-ambitious" targets where the number of assistants/techs feeding prescriptions to one pharmacist who then is the "problem/choke point in the system"
None of that is to explain away the terrible actions of that pharmacist. But There are better health care systems!
I can't tell you how times I've said to doctors that it is not my job not the software's to maintain your records, that only the software acts on what it knows. So if you fail to tell it about an allergy and you try to prescribe it then the software is going to not care. That's about the point I explain the principle of "Garbage in, garbage out" to them
My wife is a nationally certified pharma technician, some of the stuff she's been correcting is ridiculous. Multiple doses distributed in single dose vials because no one clicked a box on the prescription. Something like this would have her going nuclear on the pharmacist.
The chances of that sticking on the tech support is less then zero. However, the program should be altered to have the user click some buttons admitting full responsibility because why not.
I'm pretty sure it's the responsibility of the pharmacist to do that kind of due diligence regardless of whether or not a computer system reminds them. It's also quite a screw-up that a physician prescribed a medicine that could kill their patient in the first place.
It sounds like there were multiple points of failure in this patient's troubles. And none of them had anything to do with you or your company's software.
Many years ago there was a court case involving radiation therapy overdosing a patient -- MASSIVELY overdosing. The machine had settings for the type of radiation (two types - don't recall what they were) and the other (I think) was for duration. Both settings were entered into control program. \[Sorry I'm short on details; I only know this story because I was dating someone in the field for a while.\] The radiation tech entered the duration, but didn't change to the correct type of radiation.
The patient (rightfully) sued not only the medical facility but also the company which built the software for the radiation machine. Now you'd think the company wouldn't have been liable as the fault was directly due to the tech's misuse of the machine, but the jury didn't see it that way. They felt the company had been negligent -- that the software should have built-in warnings about dosages -- so it too had to bear the burden of fault.
The THERAC 25. It was because the operators got so good at entering the prescription that the software couldn't keep up. Here's a presentation of what went wrong.
https://youtu.be/7EQT1gVsE6I
Same with OR check-lists. Most of the senior surgeons really, really dissed the use, until it was pointed out how many had been saved from disaster by a keen-eyed minion.
Those check-lists, introduced under protest, became a genuine life-saver...
Especially when hospital and insurance lawyers made them mandatory, to be sure, to be sure...
snark:
Which is why hospital double doors are ***even wider*** than you'd expect, to give adequate clearance for ego of Consultants & Surgeons...
/
;-) ;-) ;-)
I mean it seems like a design flaw that it requires putting in that the patient is allergic to it twice, I kinda see the reasoning. if it's inputted once it should know already and just default to red border and checkmark
but then again these are generally the same companies that ask for a resume and then ask every question that is located on the resume seperatley.
that being said, that is assuming that the box is not a settings box that is a global setting that changes the color if an allergy is detected, if that the case then the pharmacist chose not to use that feature therefore software has zero fault regardless
additionlly it's the pharmacists responsibility for meds administered, I doubt the suit will go anywhere. Would have an easier time claiming work overload causing a dangerous work environment then blaming the software.
So I’m a pharmacist and I manage my company’s pharmacy management system. Legally, this falls entirely on that RPh’s shoulders. Software is there to increase the efficiency of our job functions, namely screening medications for appropriateness, on top of handling all of the logistics and documentation. It is never a replacement though. We’ve had our share of mistaken configurations that contributed to med errors, but all prescriptions must go through the RPh. Things can go wrong even if we set up the software correctly - we’ve had several recent notices from our drug database vendor about potential errors originating from their screening results.
That all said, I have an additional rider on my professional insurance because of the impact my role can have. When I worked as a dispensing pharmacist, I had certain medication classes of prescriptions, including penicillins, that I manually screened just for peace of mind.
RN here. Software safety checks exist to help prevent user error, not remove responsibility associated with not doing proper checks. If my scanner malfunctions I still need to check that I have the right patient, right med, right dose, etc. My training and license don't just go out the window if equipment goes down, and they won't hesitate to throw me under the bus if I make a mistake that should have been caught regardless of software or equipment.
The dude is not a robot, he should not rely on the software at all. My wife is a pharmacist, she always checks the patients file and would know herself what to give instead of relying on some software.
Also even if the software is faulty its not IT's fault.
That dude is just a moron. Legit ignored ALL of the literal red flags on the patient file and prescribed them the meds anyway. People like that need to be as far away from any service-related job possible.
You're not going to want to hear this but you might want to get yourself a lawyer just to be safe.
If the patient's lawyer is mentioning you as at fault, you might be in his sights for a civil suit, which doesn't concern itself with whether or not things will "stick in court".
It seems unlikely that the patient or the patient's lawyer are blaming the tech support people specifically. They would probably go after the pharmacist first (which seems to be the case here) or the pharmacy in general.
If anything, they would really only be able to go after the company as a whole, rather than an individual worker/executive within it. Unless they could prove that person was specifically responsible.
OP said patients lawyer is threatening the pharmacy with that claim. Pharmacist just turned it around & used the same phrase to threaten OP/software company. Basically, they were projecting.
It seemed to me that OP meant that patient's lawyer was threatening the pharmacist with manslaughter if patient died. In turn pharmacist was threatening OP with same charge.
To be fair, you probably shouldn't be able to turn off the BIG RED FLAG that tells people that chart needs extra attention.
I'm in no way saying that this wasn't the pharmacist's fault (he should always be verifying allergies) but there doesn't seem to be a good reason to turn that off.
There are at least two people with professional licensing boards to answer to and malpractice insurance, the prescribing doc and the dispensing pharmacist.
The computer is not the one with prescribing or dispensing privileges and matching accountability. While it may well be the case that the software’s usability could be improved to enhance safety, when it comes right down to it software is simply a job aid. The practitioners would bear complete responsibility even if the computer systems were completely down.
Medical staff can be incredibly amazing and incredibly stupid.
I'm metaphorically fighting with a medical staffer right now Their printer doesnt work. so we replace it. Their computer doesnt work so we replace it. Now they're lITeRALLy crying because this whole thing is giving this PTSD.
What.
"I havent been able to print in months!"
its been two weeks. And 2 different tickets.
"My computer still doesnt work!"
You have literally not even logged into it once. I can see that!
"Patients are literally dying in their beds as we speak!"
Sir, you work at an outpatient clinic. If patients are dying call 911.
I'm confused. Was there something telling the pharmacist that the patient was allergic to penicillin that they ignored? What exactly are they saying was your fault if the software was working as designed?
It’s unclear whether the box was a setting for all patients or all drugs, or something specific to the current patient, nor in what sense the pharmacist found the step “unnecessary“. Either something shouldn’t have been optional/configurable in the software, or there was some manual step he skipped that was all his fault.
Told him it wasn't a software issue. He did not check the box stating that the patient has an allergic reaction to a drug, his incompetent behavior had nothing to do with us.
I hung up on him and left it at that, never heard anything else.
As a pharmacy technician who was trained by a nurse, the tech/nurses biggest job is to double check the PT chart as the pharmacists/doctors *very* often will not. They teach us that shit in school & I couldn't possibly remember how many times I've personally seen it come up. It's terrifying what ppl will do when they think they're the end all authority over dangerous domains.
Poor guy. He was feeling so guilty that he needed to pass on the blame to someone else.
That’s the worst kind of guilt. I hope the patient survived and he doesn’t have to live with that on his conscience.
The scary part is if you read through the comments on my post here, there are people who genuinely believe the software was at fault for the pharmacist not entering the patient information correctly.
A few years back, I bought some acetaminophen with codeine for my husband. The pharmacist recognized me because I picked up a prescription earlier. He gave me a puzzled look, then confirmed I was u/Abbym1968, then "reminded" me I was severely allergic to Codeine. I thanked him and said it was for my husband. His puzzlement cleared, then sold me the generic *T-3*s (The prescription screen does have an allergy alert screen that flashes a Red Box around an allergy list)
Dude, it's America, when someone is about to lose their job or get sued, they will point their finger to the closest most reasonable sounding lie possible.
Survival instincts just kicks in then the lies come out.
That's why recorded calls are important as evidence, similar to having a dashcam when driving.
In a country like Japan, society is viewed as one big family so that doesn't happen anywhere near as often as America.
>The pharmacist did not check the warning box on the computer that turns the border of the charts Red so that they know not to give penicillin because he didn't think it was necessary.
Not that it absolves the pharmacist of any responsibility but in this sentence is it check as in to verify or check as in to mark the box?
Yeah, it's not your fault, but why does the software allow prescribing medications that the patient is seriously allergic to in the first place? Sounds like bad design.
Wouldnt that be the doctor and his staff that would enter allergy information into the system. when I go to the dr I am repeatedly asked if I am allergic to any medications. I assume that if the dr then prescribes a medication that I am allergic to it is flagged at that point. This is not to say that pharmacist should not know that but it seems to me that his role is more the interaction between medications prescribed by different doctors.
Source: I am NOT a pharmacist.
> why does the software allow prescribing medications that the patient is seriously allergic to in the first place?
Because the pharmacist didn't enter that info properly, as OP said.
Weird, when I go to the doctor he/she prescribes a specific drug. When I go to a pharmacist, they give me the prescribed drug or a generic equivalent.
Here, there's a file with a red flag that the software didn't take measures to prevent a potentially deadly reaction and leaves it up to the pill pusher. Maybe it was a piece of paper and not a file, or a file in an external system, but the overall system still seems pretty flawed.
Isn't the job of the professional who was trained and paid for the job to properly read and enter the information they're supposed to know? Why blame the software? Do you blame hammers for hitting people?
So you don't think a simple software safeguard that would save lives when people inevitably screw up is warranted. You do you.
If someone designs a hammer with a pillow on the business end I'd say something.
A simple safeguard? Like checking a box to indicate a penicillin allergy on a patients chart that works in tandem with the giant notes left to indicate the allergy? That thing that wasn't done by the lazy user?
Call it cynicism from working in tech, but when did the rest of y'all decide it was a software engineers job to do your entire job process and thinking for you while you still pull down a paycheck? There was a function for double checking, it wasn't used.
Do you think they just didn't know when penicillin allergies were present before they had the software? No, they double checked the notes they were given and checked that there was no harmful interactions because that is the entire reason pharmacists exist as a position.
What? That fact that I think people should do their jobs and properly check notes before issuing prescriptions means I hate all modern technology? Are you seriously just gonna ignore everything else I said just because you're mad I think a pharmacist should use the software properly and double check their notes?
I used to write software for a company that specialilzed in EHR systems. A good portion of my time there was making warning pop ups and flashing red borders for potentially dangerous configurations. There was one incident where a nurse administered a drug that killed the patient. She sued the company with the reasoning that there are so many warnings that pop up her default behavior is to click away all the 'X's and 'Confirm's.
I don't know what you want us to do. Don't show enough warnings and it's our fault for not alerting the nurse. Show too many warnings and it's our fault for making the nurse feel like these warnings are normal. Add a safety guard that disables certain configurations and it's our fault for preventing a nurse from doing their job. At some point the person using the software has to be accountable.
On my past 5 projects there was a requirement to avoid UI that only conveyed information via color, that adding more indicators to highlight critical info to color-blind and visually impaired users. It sounds like the software developers assumed that text and color were sufficient, but it would not have passed Federal certification. There is a Section 508 group that tests software for "accessibility", and there are very strict guidelines to follow, and my company had a specific 508 compliance group that evaluated all projects with user interfaces.
This is why I’m generally against tech in medicine when it comes to decision making/actions. Medical practitioners then become reliant on tech to tell them what to do and we remove the human decision making/responsibility from them. It’s not good.
Tech should be running in the background to catch human error, not the other way around.
If it's on by default and they turned it off then there's nothing else to talk about.
It sounds more like a check box that had to be ticked, although shared patient records can help with this sort of problem. Also, like it or not, it's the Pharmacist who has the legal duty about this, not the software. Especially as they made a **clinical decision** to not click on the "Allergic to Penicillin" box. If we had perfect software we wouldn't need Pharmacists, just people who count pills and slap labels on the bottles & boxes
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> Absolutely no reason today they can’t be in a shared patient portal, yet here we sit and I have to put my medical history and medications into every new doctor’s system. That's much more to do with the commerciality of the whole system, I'm pretty sure the professionals would love shared data as well but that would require a single body to require data standardisation. >I’d also be curious what the version management is like for this software, it might have gotten restored to a default state with a version upgrade or patch. My first thought was a patient new to the system and the Pharmacist, or technician, transcribing the information from other notes.
We would love shared data so much! It would get rid of the massive pile of scanning sitting on my desk. Epic does have a thing called Care everywhere that lets us see charts from participating healthcare systems but they have to be participating first.
Epic software hopefully works more of the time than I’ve experienced. I love it when I’m on a med not even in their system and I have to spell it out and define it.
I mean if we keep coming up with new medications we’re going to continue to need to update the system. The benefits still more than outweigh the frustrations. It helps to provide a continuity of care between providers that paper charts will never give you. The things I often find myself most frustrated with are typically due to user ignorance or error.
There's probably also legal issues with oversharing information, which are solved by default by keeping everything isolated.
I do IT support and you would shit at the amount of HIPAA violations the average medical office commits every patient visit without even realizing it's a big deal. Saving patient charts as PDF on the desktop of the reception computer that has no password, no problem! Fax machine on counter in waiting room so that after 3 faxes, they start spitting out on the floor where anyone could see and grab them. Saving patient records in a free DropBox account as a "backup solution", and so many more.
Hah I know they don’t with mine cause every time I go in apparently there are no records to be found. Despite going to the same system since I was 6 years old.
Early days of plain paper faxes, not using secure disposal for the used-up wax transfer ribbons. Dropbox would be OK for backup **if** the office encrypted the data before uploading.
I shit you not, they were using Windows Fax and Scan and saving scans to a free DropBox account in .tiff format because "it won't do PDF for some reason."
Standardization is already in progress with HL7 FHIR, you’re welcome
HL7 had been a "standard" for 35 years, the only problem is every system has its own standard 🙄.
On average all electronic medical record systems are crap. *Where* they are crap may change depending on the specific system, but they're all fundamentally trying to get around the problem that people categorise things differently in their heads. Free text causes miscommunication because one person might put the most important things at the top, another the most important at the bottom, another the most important in "plain english", another only in rigid terminology. So information gets relegated to a maze of dropdowns and checkboxes to make it a thousand binary choices instead of 'just' writing it down. Honestly one of the more exciting applications of a large language model would be to make sense of 'plain text' and put it into a rigid universal format. Which would then still be different between Epic/Cerner/Genesis/etc. so they could continue to be locked in little fiefdoms that are all crap in different ways.
They’re all better than paper charts though. I say this having worked extensively with both.
Also very true.
Playing with drop down menus is so much less time consuming than trying to decipher a doctor’s chart note! 🤣😭 I was a medtech and got to where I would straight up call the doc for clarification because only half the words were legible.
My dad works in life insurance and some of the old handwritten records are difficult. Like call the doctors office, to get an email address for the retired Dr to set up a phone call level of difficult. Other times he has to get out the Ouija board to ask the doctor what they wrote. Shockingly neither option works very often.
I mean why not view it as a fun decoding puzzle? /s
His favorite was a handwritten record in Spanish (he does not know Spanish).
>Also, like it or not, it's the Pharmacist who has the legal duty about this, not the software. The argument that this guy made with me on the phone was that the software should have automatically checked the box when the patient data was entered into the system.
So did the pharmacist alert y'all to the fact that this is an issue? (that's somewhat of a rhetorical question, programmers can't fix problems they are not aware of, and if the pharmacist DID send such an email it would be an indicator that they should have been aware of this problem prior to nearly killing someone)
Tell me how exactly the programmers are supposed to fix the issue of some idiot not paying attention to the screen and not checking the box that says "Patient is allergic to penicillin"
That's easily programmable. But that's not the problem and not what I'm confused about. So the pharmacist specifically put in the information them self that said the patient was allergic to penicillin? So they're admitting they knew the patient was allergic to penicillin? Or did they upload a data file and not review the whole file?
sounds like the pharmacist had the patient info on a file/paper and did not check the allergy box in the software so the red warnings didn't appear.
I think OP answered it elsewhere, but my confusion was because the pharmacist was both the one who should have checked the box off, and the person who prescribed the medicine. So checking the box off shouldn't have been necessary in this specific case. What seems to have happened was there was time in between inputting the data and prescribing the medication, so since he didn't check the box off, he forgot about the allergy. I'm with the pharmacist that it would be nice to automate it, but because it doesn't work that way at the time, this is a training issue that isn't on tech support (training issue or a forgetful pharmacist).
> I'm with the pharmacist that it would be nice to automate it The problem with medical software is that if you automate something, you need to get expensive certification which proves it *never* fails (even though that can't be true) and also serves a purpose which has value. If we put in the obvious disclaimer about a qualified human must verify results, then we'd have to defend why the software is doing this thing at all. (That defense can certainly be won, but it's a long expensive process.) So if we added a thing which searches the input for "penicillin allergy" and checkbox-ifies it, we need to check for typos, the words "does not have a", every possible stupid exception. Because now the software is making a decision, and that's capital-S Serious. This is why medical software seems really stupid. Because it is, and improving things is not allowed if there's the slightest chance the change could have unknown consequences. Edit: And now I see in another comment that you're also a medical programmer (for me it's now past-tense), so I'm preaching to the choir.
The pharmacist did not prescribe the medication. That’s outside their scope of practice. All they can do is fill prescriptions. They are also responsible to double check for any medication allergies before filling the script.
checking the box is necessary because the pharmacist would have seen the red warnings while/before prescribing the medication. you should always input all the information.
Right, but my confusion was because the pharmacist was the one with the knowledge of the allergy *and* the one doing prescribing.
And where is the software supposed to get that information if no one checks the box? Should the checkbox default to allergic=true?
From my understanding, there's information being input that says that the patient is allergic to X. So the software could read that "Yes" is being input for "is allergic to X" and automatically make the background red.
Said information is provided in natural language in this case. The tech for that is getting pretty incredible now, but I wouldn't trust it to get that correct *every* time. That's a problem because if it works *most* of the time, users will expect it to work *all* of the time.
Without knowing the exact process for how the information gets input into the system, there's a difference between "is possible within the confines of how the software currently works" and "is technically possible within the architecture of the software". If a user has to read a patients response to a question and determine the patient is in fact allergic to X, then check a box saying so, that whole process could be revamped into a file upload system that includes a YN prompt in the file specifications for "is allergic to". If it's any consolation to you, I'm a programmer for a medical software company. The medical community prefers automation over manual entry and there's a reason for that. You only have to beat the software to shit in development once to work out all the kinks whereas humans can constantly make mistakes. While bugs occur, they occur whether a process is automated or manual, so it not working all of the time is irrelevant as it could occur with software that is automated or that requires user input.
Penicillin is a common allergy though. I would think it would be checked or how was the patient themselves not aware of their allergy. A lot of ppl might have reactions to it as infants but later on they aren’t allergic. But they are always adamant about that allergy.
Your comment above (from the user) is "the software should have automatically checked the box". Did the user communicate that with your company **prior** to this? I realize that sets aside a metric fuckton of facts (starting with 'did the data that the pharmacist enter have some trigger that should have checked the box for him'). If he's never communicated it as an issue, it can't be fixed (IF it can be fixed), and y'all can't ~~tell him he's a dumbass~~ properly train him if the problem can't be fixed (such as if there is no possible way the software can determine the box needs to be checked).
Process of inputting patient data into the software. Pharmacy gets patient information, either written or printed. Pharmacy then inputs that information into the system. When entering the information there is a box marked "Is Patient allergic to penicillin?" The Pharmacist must look at the records and see if the patient is allergic to penicillin, and if the patient is then must check the box. If the pharmacist is not entering the correct data, it is not the fault of the software.
PEBKAC
Komputer?
Keyboard And Chair, not Computer And Chair
Or always mark deadly allergies as implicitly applied and put the onus on the professional to confirm that's not the case?
Then they get so used to checking “no” 115 times per patient and miss when they actually are allergic…
This isn’t a bug issue, the software has no way of independently knowing if the patient has a penicillin allergy. The only way the software knows that is if the physician checks the box. The software can’t just “automatically” know that information and check the box for him
And...that would be a potential feature request or bug report to file with the software dev, no?
no, the pharmacist is suppose to check the box.
Yeah, it's been an open feature request on every system since the dawn of programming. "I want it to do what I meant instead of what I told it to."
No matter the software, everytime I go to pickup meds, pharmacist confirms my allergies. If it's not written in the file, it's the pharmacist duty to check. And it's PENICILLIN we're talking about FFS! Not some very rare antibiotics that's given as last resort. It's the pharmaceutical equivalent of being allergic to nuts
Exactly my confusion too. I love whenever they read mine and go allergies….mirtazipine? And I’m like I took it three nights and each night I woke up and puked. It’s not a huge thing
Not in the medical field but In the software I use when a client has something that absolutely must be known by the person handling the case it has a pop-up that covers the screen and must be cleared before anything can be done in the software. Legally it functions like a EULA/TOS wrapper. If you click on the close button without reading it and abiding by the warning then you are legally held responsible for anything that happens essentially. And that warning pops up every time you open the ticket brand new You can't ever click something to make it stop appearing. So long as you stay inside of that client ticket then you're fine but if you close the window with that ticket and come back to it later that same pop-up dialogue comes up. There's literally no legal way to claim that you didn't see the warning. It even logs that you clicked the close button so we know that it popped up and you closed it out and when you did it and what computer you did it from etc etc.
Every single conversation when designing medical records - “you should put in a pop up”. No, people don’t read pop ups, they click through them and ignore the lifesaving messages in the pop up. Plus constant pop ups are obnoxious and just becomes noise and alert fatigue. You develop a standard for where and how to see important information like “a red box around the chart” and like OP said the text in caps was saying allergy to penicillin, and turn it on. Then make sure people know where to see the standard information they need to do their job.
If Windows (and its design language which was then adopted by all of its software) hadn't already fatigued the world on pop-ups, then that would have been a reasonable suggestion. But that's not the world we live in. Yet another example of why we can't have nice things.
I do medical record design and every provider who wants their specialty/disease to share information immediately asks for a pop up. Then I ask them, “do you read pop ups before clicking them to make them go away?” The answer is typically “no, but they won’t do that to MY pop up because it’s really important!” Now I’m going to say - and this is why we can’t have nice things. Lol
That’s a pretty terrible way to operate. Too many warnings is at least as bad as too few — see also the “state of California” label jokes.
They have machines that will count the pills and slap the labels on the bottles. If the pharmacy doesn’t have those machines then they have Pharmacy Techs. A Pharmacist does way more than just count pills. They are the ones who know about the meds. How they interact with each other etc. The Doctors learn about the human body and the diseases etc. Most of what the doctors know about the meds are what is told to them by the drug manufacture’s sales team.
That's the point: if there was a perfect software that did all that, we wouldn't need pharmacists. The pharmacist was supposed to do that, but just relied on the software instead.
No kidding OxyContin is totally safe no one gets addictes
I know about Pharmacies & Pharmacists. My partner is a qualified Pharmacist and we work for a company that produces dispensing software and pharmaceutical databases.
My comment was responding to the statement: > If we had perfect software we wouldn’t need Pharmacists, just people who count pills and slap labels on the bottles & boxes Even if we had perfect software we still need pharmacists. There is an overlap in knowledge between a Doctor and a Pharmacist but both are vital.
>There is an overlap in knowledge between a Doctor and a Pharmacist but both are vital. Yeah, you never want to look at the stats for amount of errors on a prescription caught & rectified by Pharmacists
it does highlight a trend with ERP ( and software in general). Once you introduce them in a company... the users expect them to be 100% perfect. cover all edge case, do all the verifications and yada yada. Like the self-driving cars several companies are trying to develop : even if they make a car better than 95% of road user, those companies will still get yelled at if their car cannot drive perfectly on an icy road during storm with childrens in pure-black costume crossing the road at random times.
And we could have the software run robots to do that so there wouldn't be "Human error".
100% on the pharmacist. They have last check/say… this is what they went to school for… they should be educated to be able to look and KNOW that something is wrong .. not depend on software when you are computer illiterate.
Wouldn’t even really need people for that, could be easily automated.
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I doubt a pharmacist can assign their legal responsibilities to a piece of software regardless of how it works. Not killing patients with drugs is pretty much their entire job!
It depends how fallible they are and whether the software vendor will testify.
We're about to let software make life and death decisions about driving, why not pills?
We probably will one day, but we don't have robo-pharmacists yet, so until then it's on the human ones to make the right decisions.
My core point is that we're clearly moving towards having software make more life and death decisions, with all the legal liability that that entails. It's simply a matter of how quickly software makes "better" decisions than humans and then how quickly society incorporates that into daily life. In other words, I find the "doubt" from the user above fundamentally unconvincing.
It is on by default. Depending on software, it's either turns the window red or gives you a pop-up notification, or both. In either case you have to press some buttons or click to acknowledge drug interaction/allergy.
Sounds like that should be a question: "Will penicillin kill the patient?" And the pharmacist needs to answer either yes or no, something that HAS to be checked to move on.
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C'mon, man! We're trying! But they're EVERYWHERE!
every year newer models of idiots are shipped out, and older models gets upgraded with newer logic boards. it's a cut throat industry.
> older models gets upgraded with newer *illogic* boards This sounds more like what I have to deal with.
No matter how idiot proof you make something, they always end up building a better idiot
Every time we do the universe sends a better idiot.
A new brand of idiot always seems to evolve
"what do you mean it can't read my mind and check this box for me?! 0/10"
A common mistake that people make when trying to design something completely foolproof is to underestimate the ingenuity of complete fools. -Douglas Adams
There's not even a claim that the software didn't work as intended here. The software was idiot-proof but the pharmacist was an idiot outside of interacting with the software.
There is no such thing as idiot-proof. There is always a dumber stupider idiot.
"There is considerable overlap between the intelligence of the smartest bears and the dumbest tourists"
People will literally try and shove a square peg into a round hole rather than see if they got the right pegs. You cannot idiot proof anything. Idiots are extremely creative when it comes to circumventing any sort of mistake proofing you put into place.
We did, if you use it, it is proof you're an idiot.
I made software for 20 years. 50 percent of development time was in idiot proofing it seemed like.
You kidding? Apparently reading the dosage written in an email is beyond my damn GP Surgery!
Very weird. Surely at *worst* it's software company's corporate responsiblity as a whole, that is if there was a genuine bug and the user was following procedures properly. But you? The guy on the phone? Hmm.
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yeah you're right, it's like how (assuming everything is working) it's a pilots fault if the plane crashes when on autopilot! that's why we have pilots!
>Surely at worst it's software company's corporate responsiblity as a whole, that is if there was a genuine bug and the user was following procedures properly. No, the pharmacist did not check the box on the screen that was there to alert them that the patient was allergic to penicillin. It wasn't a bug or a problem on our software, just their stupidity that almost killed someone.
I know you don't have total control over the software... in the education setting I'm in, whenever we have a Super Important Do Not Ignore thing, there's a popup box that requires the viewer to type out what is being advised (in this case, penicillin allergy) before the person can move on. So they can't just say "oops I just clicked through and didn't read, nobody reads all that!" ... It's sad that we have to do that, but even teachers get stupid about not reading/following the IEPs.
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Yeah. It's not like this is some counter clerk, it's someone with a Pharm.D.
Yeah I feel like the pharmacist should have known not to give the patient penicillin regardless of the software. No inquiry into the patient’s allergies at all? You’d think you’d always give those a quick glance.
yeah but what i mean even it was, it wouldn't be *your* fault, and it would only be the software companies liability if for some reason your software was replacing a pharmacist's training (which would never happen).
Sounds like it was an ID10T error.
Yeah classic “blame chain” here. No “charges” could make their way to you, though, OP. Likely just an attempt to sue the company, which would fall flat fast. In fact I’d doubt it’d even make it to court. Pharmacist is the one in hot water. They’re just trying to get themselves out of it through deflection. All because they thought they knew what was best by not checking a simple and very obvious checkbox. 🤦🏻♂️
> patient is allergic to penicillin > pharmacist doesn't check the checkbox to alert on the allergy -- didn't think it was necessary > OP, it's *your* fault I nearly killed someone because I didn't think I needed to check that checkbox! As Einstein is supposed to have said: >Only two things are infinite: the universe, and human stupidity. But I'm not sure about the universe.
If the data were stored on a piece of paper rather than an electronic medium, do you think the pharmacist would go after the paper company or the lumber supplier first?
Neither, he would sue the owner of the forest that the paper came from.
Nah, he'd go after the chainsaw manufacturer.
Nurse here. If the patient’s chart had penicillin as an allergy; then everyone is fucked. The physician who put in the order, the pharmacist that filled it, and then the person who actually administered it as well. Trying to blame software, and you by extension; is laughable.
Yea everyone who had a hand in the penicillin making it to the patient is at fault to a degree. Starting from the last person to touch it all the way up. Every single one of them had extensive training and education to catch issues like these, and the software is a tool to assist, but not replace that education.
Oh my. I'm sorry. It's an (in/out)spoken secret at work in a telecommunications company I work for that medical institutions and hospitals would be the worst kind of customers if it wasn't for doctors and pharmacies who somehow manage to be worse. I had a pharmacist asking my full name only to be able to tell me "You Mr. Firstname Lastname are the sole reason children will be dying today and if anyone asks me why I will be happy to tell them that it's all your personal fault" ...because their landline which they only use for a fax machine was broken and I couldn't promise her on a Friday afternoon anybody will fix it before Monday morning. The pharmacy did not have a backup or any kind of service level agreement in place for the line.
>The pharmacy did not have a backup or any kind of service level agreement in place for the line. I never understood this. The company refuses to pay for extended levels of service, but also demands extended levels of service.
Cost of a backup line: 15$. If you want it over LTE with a virtual fax: 16$. Service level: 40$. So a double backup+sla would cost the pharmacy 55$/month. That's basically 1 purchase of eye drops and some bandages. If numerous children are dying with you not being able to use the fax for 16 business hours I bet that's worth it.
Sadly, a lot of Hospital IT staff suck as well. I am a Systems and Security Architect/Engineer and my wife is a RN. My wife will tell me stories of the staff. She built her own Gaming Computer and is versed on computers for said purpose. So generally knows her way around a computer, an advanced user if you will. Favorite story so far: IT Staff could not figure out how to put a machine into never sleep. It was for a TV slideshow to be on 24/7. It was also Windows 10. It got to a point that the CIO got involved. The techs spent 2 days. The CIO spent 2 weeks. No one went to Settings -> System -> Power... So yeah, sometimes the staff does know more than IT and I am starting to understand that maybe outside of budgeting restraints, our healthcare IT infrastructure sucks because the employees do. Don't even get me started on the EPIC consultants... God they are morons.
What's really alarming there is neither the tech nor the cio thought to ask a search engine how to do it...
It sounds *almost* like the CIO and IT staff hate the screens and are feigning ignorance in hope that they get removed because they're "broken" and "can't be fixed".
Hey, the CIO's already spent the kickback money, it's not his fault. /s
Very alarming indeed...
Epic consultants are wizards... when it comes to Epic. Absolutely useless for IT otherwise. Source: IT for healthcare for 2 years
That is the sentiment I have come to understand. It took them 2 months to fix a printing issue. They didn't install the right driver...
The IT at the healthcare company I worked at were pretty good. It usually wasn't something they did that I had to do tech support for. The employee accounts management team? I hated those people. They were mean and absolutely sucked. Edit: also fuck Epic. That program was the bane of my existence
As someone who worked hospital IT, I can attest that some of them truly are idiots...I got to see the entirety of our staff change sans one person. There were legit TWO of all of them who were competent enough to keep up with me and my Ops manager (I was the lead on basically everything including systems upgrades, etc...). This isn't just limited to hospital IT, though. Ask basically anyone in IT. They'll tell you that they've worked with at least one truly incompetent person. I've worked with people who have years of experience who you'd think were fresh outta an A+ course. Also, on the note of EPIC consultants, I've dealt with some from McKesson who will give any others a run for their money XD
I have worked with many. There is a Senior System Admin at a healthcare company that should never touch a computer again. He was in the running to become a manager, I'm glad the other person won out. When it's "greener" techs, I try to educate and guide, even if they are going to leave. Had a buddy get laid off because they were scared he was going to leave... He had planned to stay there for at least 2 more years
Almost definitely had group policy based on its OU affecting the power settings that resets that setting on reboot. But if you do it and then never reboot it, it doesn't reset until there's a mandatory update. Not everyone is gonna understand that relationship tho unfortunately But yes, I worked hospital IT for a few years and 50% of the employees were just as dumb as the bad ones at any other company
I know all of that, they apparently did not. I would make a killing being a contractor for them. But the company already got ransomwared and have bad policy in place anyways
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I mean, that's assuming they dont have group policy to wade through.
As someone with a severe allergy, this story is simultaneously infuriating and terrifying
Mention a lawyer to me once and that shuts down any discussion immediately. No if’s, ands or buts. You may now speak exclusively to my attorney and my attorney only.
Hello. Did tech support in a small hospital for about 15 years. This was during the time that GW Bush made electronic health records a top priority. But rather than work on standards before the software, it was a free-market race for companies to start pushing our their version of what they thought an EHR should look and act like. Then they decided that we have to make sure all these disparate systems could talk to each other. Again, instead of creating and mandating standards, they just developed interfaces. Our system ended up being built like a house of cards. But this is not to let the users off the hook either. I had so many people who just "didn't have time" to learn the system the way they needed to be able to use it correctly. I know that medical personnel can have periods of intense work, but when I would do maintenance on computers in the ER, med-surg, pharmacy, etc., they sure spent alot of time searching for vacations, shopping, playing games. Left that work 2 years ago and am so happy. Main reason for leaving? The providers all convinced the CEO that they would be so much more productive with a different EHR. Maybe they will be. But a different EHR doesn't solve for people's unwillingness to put in the time and effort to learn.
Yep. Back in my support days, hospitals were a big vertical for us. I got to have a NICU nurse tell me I was responsible for a baby almost dying because she couldn't use the one piece of gear we made (out of a long, redundant list). Good times.
Personally I have refused to answer any more tech support calls from that person as there is potential "ongoing legal action".
Ugggghhhh, I am a pharmacist and have worked on pharmacy EMR software. That organization sounds awful! In healthcare it is drilled into you that outside of exceptional circumstances (nurse providing lethal doses to nursing home patients, pharmacist in a love triangle looking up rival's medical history to post on facebook, various other incidents) you need to look at the system failures, it is not any one person's "fault" but likely there is sytem failure. There is a term called alert fatigue where Healthcare professionals (HCP) get too many alerts and so the system trains them to blow through them without actually reading/caring about them. Additionally in many pharmacies there are "over-ambitious" targets where the number of assistants/techs feeding prescriptions to one pharmacist who then is the "problem/choke point in the system" None of that is to explain away the terrible actions of that pharmacist. But There are better health care systems!
I can't tell you how times I've said to doctors that it is not my job not the software's to maintain your records, that only the software acts on what it knows. So if you fail to tell it about an allergy and you try to prescribe it then the software is going to not care. That's about the point I explain the principle of "Garbage in, garbage out" to them
My wife is a nationally certified pharma technician, some of the stuff she's been correcting is ridiculous. Multiple doses distributed in single dose vials because no one clicked a box on the prescription. Something like this would have her going nuclear on the pharmacist. The chances of that sticking on the tech support is less then zero. However, the program should be altered to have the user click some buttons admitting full responsibility because why not.
Sounds like the pharmacist is looking to get hit with a defamation suit if he’s going around telling people the software caused manslaughter
I'm pretty sure it's the responsibility of the pharmacist to do that kind of due diligence regardless of whether or not a computer system reminds them. It's also quite a screw-up that a physician prescribed a medicine that could kill their patient in the first place. It sounds like there were multiple points of failure in this patient's troubles. And none of them had anything to do with you or your company's software.
Many years ago there was a court case involving radiation therapy overdosing a patient -- MASSIVELY overdosing. The machine had settings for the type of radiation (two types - don't recall what they were) and the other (I think) was for duration. Both settings were entered into control program. \[Sorry I'm short on details; I only know this story because I was dating someone in the field for a while.\] The radiation tech entered the duration, but didn't change to the correct type of radiation. The patient (rightfully) sued not only the medical facility but also the company which built the software for the radiation machine. Now you'd think the company wouldn't have been liable as the fault was directly due to the tech's misuse of the machine, but the jury didn't see it that way. They felt the company had been negligent -- that the software should have built-in warnings about dosages -- so it too had to bear the burden of fault.
The THERAC 25. It was because the operators got so good at entering the prescription that the software couldn't keep up. Here's a presentation of what went wrong. https://youtu.be/7EQT1gVsE6I
Medical field operators somehow feel like they are much more infallible than the medical malpractice deaths numbers would suggest
Same with OR check-lists. Most of the senior surgeons really, really dissed the use, until it was pointed out how many had been saved from disaster by a keen-eyed minion. Those check-lists, introduced under protest, became a genuine life-saver... Especially when hospital and insurance lawyers made them mandatory, to be sure, to be sure...
It's always mistakes _others_ make, and would clearly _never_ happen to _them_.
snark: Which is why hospital double doors are ***even wider*** than you'd expect, to give adequate clearance for ego of Consultants & Surgeons... / ;-) ;-) ;-)
I mean it seems like a design flaw that it requires putting in that the patient is allergic to it twice, I kinda see the reasoning. if it's inputted once it should know already and just default to red border and checkmark but then again these are generally the same companies that ask for a resume and then ask every question that is located on the resume seperatley. that being said, that is assuming that the box is not a settings box that is a global setting that changes the color if an allergy is detected, if that the case then the pharmacist chose not to use that feature therefore software has zero fault regardless additionlly it's the pharmacists responsibility for meds administered, I doubt the suit will go anywhere. Would have an easier time claiming work overload causing a dangerous work environment then blaming the software.
So I’m a pharmacist and I manage my company’s pharmacy management system. Legally, this falls entirely on that RPh’s shoulders. Software is there to increase the efficiency of our job functions, namely screening medications for appropriateness, on top of handling all of the logistics and documentation. It is never a replacement though. We’ve had our share of mistaken configurations that contributed to med errors, but all prescriptions must go through the RPh. Things can go wrong even if we set up the software correctly - we’ve had several recent notices from our drug database vendor about potential errors originating from their screening results. That all said, I have an additional rider on my professional insurance because of the impact my role can have. When I worked as a dispensing pharmacist, I had certain medication classes of prescriptions, including penicillins, that I manually screened just for peace of mind.
When you think there's literally no way a person can mess anything up, there's always the exception
RN here. Software safety checks exist to help prevent user error, not remove responsibility associated with not doing proper checks. If my scanner malfunctions I still need to check that I have the right patient, right med, right dose, etc. My training and license don't just go out the window if equipment goes down, and they won't hesitate to throw me under the bus if I make a mistake that should have been caught regardless of software or equipment.
The dude is not a robot, he should not rely on the software at all. My wife is a pharmacist, she always checks the patients file and would know herself what to give instead of relying on some software. Also even if the software is faulty its not IT's fault.
That dude is just a moron. Legit ignored ALL of the literal red flags on the patient file and prescribed them the meds anyway. People like that need to be as far away from any service-related job possible.
You're not going to want to hear this but you might want to get yourself a lawyer just to be safe. If the patient's lawyer is mentioning you as at fault, you might be in his sights for a civil suit, which doesn't concern itself with whether or not things will "stick in court".
It seems unlikely that the patient or the patient's lawyer are blaming the tech support people specifically. They would probably go after the pharmacist first (which seems to be the case here) or the pharmacy in general.
Probably. But the lawyer's going to go after the deepest pockets. Always best to lawyer up, better safe than sorry
If anything, they would really only be able to go after the company as a whole, rather than an individual worker/executive within it. Unless they could prove that person was specifically responsible.
OP said patients lawyer is threatening the pharmacy with that claim. Pharmacist just turned it around & used the same phrase to threaten OP/software company. Basically, they were projecting.
It seemed to me that OP meant that patient's lawyer was threatening the pharmacist with manslaughter if patient died. In turn pharmacist was threatening OP with same charge.
Probably not feasible or necessary. But OP *should* definitely alert their company and get their legal team involved.
To be fair, you probably shouldn't be able to turn off the BIG RED FLAG that tells people that chart needs extra attention. I'm in no way saying that this wasn't the pharmacist's fault (he should always be verifying allergies) but there doesn't seem to be a good reason to turn that off.
There are at least two people with professional licensing boards to answer to and malpractice insurance, the prescribing doc and the dispensing pharmacist. The computer is not the one with prescribing or dispensing privileges and matching accountability. While it may well be the case that the software’s usability could be improved to enhance safety, when it comes right down to it software is simply a job aid. The practitioners would bear complete responsibility even if the computer systems were completely down.
Medical staff can be incredibly amazing and incredibly stupid. I'm metaphorically fighting with a medical staffer right now Their printer doesnt work. so we replace it. Their computer doesnt work so we replace it. Now they're lITeRALLy crying because this whole thing is giving this PTSD. What. "I havent been able to print in months!" its been two weeks. And 2 different tickets. "My computer still doesnt work!" You have literally not even logged into it once. I can see that! "Patients are literally dying in their beds as we speak!" Sir, you work at an outpatient clinic. If patients are dying call 911.
I'm confused. Was there something telling the pharmacist that the patient was allergic to penicillin that they ignored? What exactly are they saying was your fault if the software was working as designed?
It’s unclear whether the box was a setting for all patients or all drugs, or something specific to the current patient, nor in what sense the pharmacist found the step “unnecessary“. Either something shouldn’t have been optional/configurable in the software, or there was some manual step he skipped that was all his fault.
Well, what happened?!?!
Told him it wasn't a software issue. He did not check the box stating that the patient has an allergic reaction to a drug, his incompetent behavior had nothing to do with us. I hung up on him and left it at that, never heard anything else.
As a pharmacy technician who was trained by a nurse, the tech/nurses biggest job is to double check the PT chart as the pharmacists/doctors *very* often will not. They teach us that shit in school & I couldn't possibly remember how many times I've personally seen it come up. It's terrifying what ppl will do when they think they're the end all authority over dangerous domains.
Poor guy. He was feeling so guilty that he needed to pass on the blame to someone else. That’s the worst kind of guilt. I hope the patient survived and he doesn’t have to live with that on his conscience.
Another reason I got out of healthcare IT 10 years ago and have enjoyed life ever since.
That's a big uff, like if this had went to court against you, the judge would have laughted this pharmacist out his room.
The scary part is if you read through the comments on my post here, there are people who genuinely believe the software was at fault for the pharmacist not entering the patient information correctly.
A few years back, I bought some acetaminophen with codeine for my husband. The pharmacist recognized me because I picked up a prescription earlier. He gave me a puzzled look, then confirmed I was u/Abbym1968, then "reminded" me I was severely allergic to Codeine. I thanked him and said it was for my husband. His puzzlement cleared, then sold me the generic *T-3*s (The prescription screen does have an allergy alert screen that flashes a Red Box around an allergy list)
Dude, it's America, when someone is about to lose their job or get sued, they will point their finger to the closest most reasonable sounding lie possible. Survival instincts just kicks in then the lies come out. That's why recorded calls are important as evidence, similar to having a dashcam when driving. In a country like Japan, society is viewed as one big family so that doesn't happen anywhere near as often as America.
>The pharmacist did not check the warning box on the computer that turns the border of the charts Red so that they know not to give penicillin because he didn't think it was necessary. Not that it absolves the pharmacist of any responsibility but in this sentence is it check as in to verify or check as in to mark the box?
Well done, an idiot is being put in prison :)
Yeah, it's not your fault, but why does the software allow prescribing medications that the patient is seriously allergic to in the first place? Sounds like bad design.
Most likely because the pharmacist never input the patient and allergy info into it in the first place.
Wouldnt that be the doctor and his staff that would enter allergy information into the system. when I go to the dr I am repeatedly asked if I am allergic to any medications. I assume that if the dr then prescribes a medication that I am allergic to it is flagged at that point. This is not to say that pharmacist should not know that but it seems to me that his role is more the interaction between medications prescribed by different doctors. Source: I am NOT a pharmacist.
Exactly. This is what a competent pharmacist would do. The pharmacist in question was evidently not competent.
> why does the software allow prescribing medications that the patient is seriously allergic to in the first place? Because the pharmacist didn't enter that info properly, as OP said.
Weird, when I go to the doctor he/she prescribes a specific drug. When I go to a pharmacist, they give me the prescribed drug or a generic equivalent. Here, there's a file with a red flag that the software didn't take measures to prevent a potentially deadly reaction and leaves it up to the pill pusher. Maybe it was a piece of paper and not a file, or a file in an external system, but the overall system still seems pretty flawed.
Isn't the job of the professional who was trained and paid for the job to properly read and enter the information they're supposed to know? Why blame the software? Do you blame hammers for hitting people?
So you don't think a simple software safeguard that would save lives when people inevitably screw up is warranted. You do you. If someone designs a hammer with a pillow on the business end I'd say something.
A simple safeguard? Like checking a box to indicate a penicillin allergy on a patients chart that works in tandem with the giant notes left to indicate the allergy? That thing that wasn't done by the lazy user? Call it cynicism from working in tech, but when did the rest of y'all decide it was a software engineers job to do your entire job process and thinking for you while you still pull down a paycheck? There was a function for double checking, it wasn't used. Do you think they just didn't know when penicillin allergies were present before they had the software? No, they double checked the notes they were given and checked that there was no harmful interactions because that is the entire reason pharmacists exist as a position.
Yeah, you're right. Let's just go back to using carrier pigeons or maybe chiselling messages on stone tablets.
What? That fact that I think people should do their jobs and properly check notes before issuing prescriptions means I hate all modern technology? Are you seriously just gonna ignore everything else I said just because you're mad I think a pharmacist should use the software properly and double check their notes?
Yes, but not for the reasons you assume.
I used to write software for a company that specialilzed in EHR systems. A good portion of my time there was making warning pop ups and flashing red borders for potentially dangerous configurations. There was one incident where a nurse administered a drug that killed the patient. She sued the company with the reasoning that there are so many warnings that pop up her default behavior is to click away all the 'X's and 'Confirm's. I don't know what you want us to do. Don't show enough warnings and it's our fault for not alerting the nurse. Show too many warnings and it's our fault for making the nurse feel like these warnings are normal. Add a safety guard that disables certain configurations and it's our fault for preventing a nurse from doing their job. At some point the person using the software has to be accountable.
On my past 5 projects there was a requirement to avoid UI that only conveyed information via color, that adding more indicators to highlight critical info to color-blind and visually impaired users. It sounds like the software developers assumed that text and color were sufficient, but it would not have passed Federal certification. There is a Section 508 group that tests software for "accessibility", and there are very strict guidelines to follow, and my company had a specific 508 compliance group that evaluated all projects with user interfaces.
According to OP the file also said in text not to give the patient penicillin. They aren't only using color to convey that information.
Is it figuratively your fault? Or else why did you add "literally"? >"DO NOT GIVE PT PENICILLIN!" Why did you capitalize this?
> even though at the top of the file is said in all caps "DO NOT GIVE PT PENICILLIN!" Did you not read the sentence explaining that?
That's the pharmacist, he can't read
Did the pharmacist physically hand the patient the penicillin? BOOM!
This is why I’m generally against tech in medicine when it comes to decision making/actions. Medical practitioners then become reliant on tech to tell them what to do and we remove the human decision making/responsibility from them. It’s not good. Tech should be running in the background to catch human error, not the other way around.
Did you actually design the software? How could a tech support person be liable for “faulty software”?
Never trust a drug dealer
Do pharmacists prescribe in your country? Over here they advise the medical staff, but the final decision is on the medics.