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Software Glitches a Danger to Veterans

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Washington, DCAn investigation relating to glitches in the electronic medical records of the nation's veterans has uncovered the potential for incorrect VA drug doses and other veteran drug doses at many veteran hospitals. While it has not been proven if any patient was ever harmed as a result of the error, the revelation is troubling in light of a nation-wide push towards the wholesale adoption of electronic medical records.

Medical RecordsAccording to documents obtained by the Associated Press under the Freedom of Information Act, patients at VA health centers were given incorrect doses of drugs, among other problems. One patient experiencing chest pains was given heparin for 11 hours longer than necessary.

"I am deeply concerned about the consequences on patient care that could have resulted from this 'software glitch' and that mistakes were not disclosed to patients who were directly affected," said Rep. Steve Buyer, R-Ind. "I have asked VA for a forensic analysis of all pertinent records to determine if any veterans were harmed, and I would like to know who was responsible for the testing and authorized the release of the new application."

The problems appear related to the move towards the universal adoption of electronic health records—a policy that the outgoing Bush Administration championed, and the incoming Obama Administration appears keen to complete as a means to mitigate the errors often association with paper-bound medical records. It has been found, in the past, that handwriting on charts and prescriptions can be oft times hard to decipher.

However, anyone with any experience with a computer knows that there can be significant glitches with electronic records, too. Files can go missing, sometimes updates do not take or are not properly stored, hard drives can hang and things can sometimes disappear into thin air.

Health care advocates make the case that the move to electronic records may require even closer scrutiny, and diligent monitoring, than is currently being done with traditional paper systems.

"It's very serious potentially," said Dr. Jeffrey A. Linder, an assistant professor of medicine at Harvard Medical School who has studied electronic health systems. "There's a lot of hype out there about electronic health records, that there is some unfettered good. It's a big piece of the puzzle, but they're not magic. There is also a potential for unintended consequences."

It was reported that the glitches began in August and continued until just recently—and some of those glitches were fairly significant. For example, it has been found that in some cases medical data that included lab results and active medications appeared under another patient's name on the screen. This not only suggests a security breach, but also runs the risk of a patient being administered the wrong medications, dosages, or overall incorrect care.

There were 9 reported cases of patients being given incorrect doses—six of which involved heparin drips for chest pain. There were other cases where infusions of dextrose, of sodium chloride were administered for up to 15 hours longer than prescribed.

A third of the 153 medical facilities under the VA umbrella reported a glitch of some degree, but that number could be higher as not all facilities have reported in.

The AP investigation revealed that the problems began with the implementation of a software upgrade. Such an occurrence is an annual procedure, and the software upgrade was delivered in August of last year. The glitches in the software began soon after that.
Among the problems, according to the AP report, doctors pulling up the electronic records of two different patients within ten minutes of one another found that the medical information of the first patient would often be displayed under the name of the second.

In some cases, a doctor's order to stop a medication for a patient was not clearly displayed.

The VA issued a safety alert October 10th and implemented new safety measures. The software was fully corrected by the end of the year.

A spokesperson for the VA has said that the seriousness of the issue was minimized thanks to the existence of alternative systems, and the alertness of doctors who made note of the fact one patient's record looked too similar to that of another.

Perish the thought, then that the situation could have been a lot worse. The fact remains, however that several patients were affected—and while the belief is that no veteran was harmed in the short-term, the potential long-term effects are not known.

And as veteran's hospitals join the remainder of the medical community towards a blanket adoption of electronic medical records, veteran drug doses and other medical issues will be of concern. Even advocates of the electronic medical record system stress that problems can, and will occur—and careful monitoring and oversight are vital to avoid improper VA drug doses, and other problems that could harm patients, from occurring.

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