Hi Matt, Comments in text.
Regards! -Thomas Clark Matt Evans wrote: >Dear all, > >I would be grateful for some advice on an issue that has been troubling me >for some time. I am a clinician currently on secondment full time to an EHR >project. I do not wish to name the software house we are using but they are >a major EHR developer with an interest in the UK. > >The application on which we are currently basing our documentation strategy >seems to have a flaw. The following is a made up example but I hope it >illustrates a point. > >The application allows the creation of documents with standard windows form >controls (e.g. drop down lists, multiselects, radio buttons etc). When I >open a document it pulls though the appropriate value to each field from a >previous form. Let's say I have a free text field that says 'Reasons patient >unfit for surgery' and I have entered "pneumonia" as the value. I save the >document and can view the information from the document viewer. > > > Sounds like a database retention/persistence problem. Q: How are the documents stored? Caution: Document translations can get munched as well as the primary database, e.g., create and save a document. A week later you retrieve 'a document' and it is different. One can blame it on the database but it may be the procedures used to store the document permanently. Try creating a document and immediately retrieving it. Assuming no problems, logout or get off the system and after some number of hours get back on and access the document. This proves enough time for the document to be flushed out to permanent storage. Too soon and you are likely accessing a cache memory. Try again 'once' each successive day and verify that the document can be correctly retrieved. A problem might show upon after the next application 'update' process, e.g., flush the data. If everything looks OK then focus on how the document is being archived and how it is being retrieved when you notice the errors. If different versions of the document are contained with the system or storage subsystems there is a change that the retrieval process has a bug, e.g., you update and one or more others access the document. Audit trails catch this stuff. >A month later I review the patient and they no longer have pneumonia. I open >the pre-op assessment document (which pulls through pneumonia to the >relevant field) and delete it. The form is therefore either saving a zero >length string or null value. The amended document is saved and the correct >information can be viewed in the document viewer. > >Now, the patient phones up with some additional information which I wish to >add to the assessment. I open it up to add that info. On a different page >of the document however the 'reasons not fit' box pulls through not the last >value (null or "") but the last non-null or "" value i.e. pneumonia. When >the document is signed the author has unwittingly signed the fact that the >patient is unfit for surgery as that is the value in that field now. The >system automatically runs a theatres scheduling query and that patient is >permanently rejected as being unfit for surgery. > >This is one of a number of significant problems with the system that in my >opinion make it at best inconvenient or in some cases unsafe to use. All >control types are affected and the solution we have been offered thus far is >that you don't pull any values through. Therefore you have to retype all the >information every time! The other worrying thing is the number of hours >spent by Trust staff and IT staff on designing and building all the >documentation is phenomenal and has resulted in very little. > > > Here you are, at least, are making updates. The application likely has a version control system that is supposed to keep this straight and correct. Q: Can you rollback to prior versions of the document? If so, then you definitely need to talk with the Administrator. Also check the commands you present to the application. >The UK government has spent an estimated ?2.3 billion on systems for the NHS >for the first 3 years of a 10 year contract. This causes me concern given >the above issue may be the tip of the iceberg. > > Comment: Bet you did not receive a guarantee or a warranty. Q: Was this application submitted to a rigorous Software QA procedure? Q: Does the application have a 'Bug' Tracking system? You may not be alone! > >I am something of an amateur dabbling in the world of IT so would appreciate >some informed opinion... > >Thank you. > >Matt > > > >- >If you have any questions about using this list, >please send a message to d.lloyd at openehr.org > > > - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
