Deadly Errors (10 page)

No?

Tomorrow night. I’ll stop tomorrow night. I just need some sleep.

Tyler swung his legs out of bed and headed for the bathroom and the amber bottle of white Ambien tablets in the drawer just to the left of the sink.

T
YLER HURRIED INTO the crowded cafeteria and checked his watch for the fifth time in two minutes. Four minutes late. Not like him. He bee-lined for the latte stand, eyes searching for a likely Jim Day, saw a man the color of bittersweet chocolate and about his age and perhaps two inches shorter standing, latte in hand, with an expression of anticipation. Tyler approached and asked, “You Jim Day?”

The man turned and studied Tyler a moment. “Dr. Lawrence?”

Tyler extended his hand. “No. Actually, Dr. Lawrence called you last night for me. I was busy in the ICU.” He paused, looking for a place to carry on a conversation. “Sorry I’m late. Got delayed on rounds. How about that booth over there.”

Day gave a sarcastic grunt. “No way we’re broaching that subject out here where someone might hear. My office.” He started toward the exit.

T
YLER WAITED UNTIL they were seated in the small cramped office before broaching the subject. He got straight to the point by explaining the discrepancy between Larry Childs treatment dosage recorded in his PDA and the one in the EMR. Next, he explained the consequences—a lethal case of radiation necrosis. Not that he had pathological confirmation yet, but there could be no other reasonable explanation.

Day said, “I believe you about your patient … that he has a serious problem and all. That much is obvious. I just can’t believe someone outside the system could change the data field once it had been populated. The only way that field could’ve been changed is someone holding EMR privileges changed it. Even then, they’d have to have superior privileges and that could only be a doctor with direct responsibility for the patient. Even then it’s hard to do, what with all the crosschecks and all. And if they did, there’d be a record of it.”

“I can’t imagine a doctor changing that dose. It just doesn’t make sense. I mean, for what possible reason?” Especially considering Larry Childs was such a low-profile person. “You can check that, can’t you?”

“Sure.”

“When?”

Day shrugged. “Later today, I guess … possibly tomorrow.” He studied Tyler a second before asking, “Why,” his eyebrows furrowed, “you want me to check it out this minute?”

“Hell, yes. My patient died this morning. Don’t you think that makes it a priority?”

Day shrugged. “Fine. I’ll check it.” He turned to the computer and started typing.

“Let me ask you something. Instead of a physician, doesn’t it seem more likely it’d be someone else fooling around in the system? Maybe someone who didn’t realize how serious a seemingly simple change might become?”

Day hit a key hard, then looked up. “Your hacker theory?”

“Why not?”

Day’s look hardened. “Because, my man, that system is one impenetrable sonofabitch. It’s that simple.”

The answer surprised Tyler. No computer system connected to the outside world was impenetrable. “You honestly believe that? I sure as hell don’t.”

Day sighed, gave a resigned let-me-explain-it-to-you look. “Doc, listen up. I know what you’re driving at—that old theory that no network’s secure? Maybe true for just about everything outside the NSA, ‘cept this one? This one insecure? Uh uh, nooooo. I’ve never seen security like this one. That, my man, is the absolute strong point of the Med-InDx system. That and its database engine.”

“Sure, easy for you to say. The company signs your paycheck every two weeks. Your 401k’s probably overflowing with stock options.”

“Hey, man, lighten up.” Frowning, Day held up his hand, his expression one of genuine hurt. “I’m telling you straight up, breaking that system’s security is harder than knocking off a Federal Reserve Bank.”

“So you say. But I have a patient whose brain rotted out from a radiation overdose and the dosage field says he got 200 gray. So are you going to check it out or what?”

“Sure, I’m checking it out as we speak. You got me interested now.” He held up a wait-a-minute finger and returned to his computer. A moment later, “Nope. No evidence that field was altered.”

Tyler thought about that a moment. “Bear with me a moment on this. If a hacker had enough access to change the data field, couldn’t he also have enough access to cover his tracks?”

Day’s eyes widened. “You mean, like, alter the validation fields? You out of your fucking mind, man? No way.”

“I want you to check it out.”

Day studied him a moment. “You’re serious, aren’t you?”

“My patient just died. Of course I’m serious.”

“I don’t know if it’s possible to really check that out, but to do it right I’ll have to go back over a few of the oldest back up tapes. They’re stored off site. A place outside Salt Lake City. I’ll have to request they upload them for me to take a look at. That’ll take a few hours at best. At best,” he emphasized. “Assuming of course, I can whip up some enthusiasm from the unlucky bastard who gets my request.” He slid out of the chair, an obvious sign the meeting was over. “You can wait a day or so, can’t you? No way I’m going to get that answer for you sooner.”

Tyler stood up also. “Hell no, I can’t wait a day or two.” He flashed on a potential hot button that might get Day’s attention. “Besides, this has to be reported as a sentinel event. Which means a root cause analysis with—at this very moment—you in the spotlight. That means getting JCAHO involved. Understand?” Anger flickered across Day’s eyes. Good. Maybe that would get some action out of him. “If I don’t have word back from you by tomorrow, I’ll report it as a suspected hacker intrusion. Then it’s your problem to prove otherwise.”

Day’s expression grew even harder. “I wouldn’t advise that.”

“Then get me the information so I can file the report accurately.” Tyler turned and stormed out of Day’s office.

“C
AN YOU BE a little more specific about the exact reasons you and several of your committee members are in Seattle at this particular time, Doctor Vericelli?” The reporter glanced down at the glowing little red RECORD light on her portable Sony cassette recorder.

Sergio Vericelli straightened his posture and elevated his goateed chin an inch—a posture he felt befitting his stature as committee head. He cleared his throat while reaching for the nearby glass of water. Both well-rehearsed ploys to kill extra seconds while mentally reviewing his answer for potential chuckholes. As a full-time employed physician for the Joint Commission on Accreditation of Healthcare Organizations—otherwise known as “Jay-Ko” by health professionals in the trenches—he was a press conference combat veteran. However, he knew full well this was not just your usual lightweight collection of hacks from the local rag and television station of some Podunk Hollow community whose 100-bed hospital just passed accreditation. No indeed. This was The Big Time. He recognized the stringer for
the Wall Street Journal
, the
Forbes
writer, the cute CNBC reporter in a miniskirt with her video cameraman joined to her shoulder, to name just a few of the industrial-strength media at the other end of the highly polished boardroom table.

Sergio flashed his newly whitened teeth in a benign smile. “Maria,”—he loved calling her by her first name—“that’s a fairly open-ended question. Could you be a bit more specific?” He knew exactly the point the question was intended to ferret out, but wanted to toy with her a moment, see if she was really as bright on her feet as rumors indicated.

“Fair enough. We all know your committee is charged with making a decision about the new JCAHO EMR, eh, electronic medical record system, requirements within the next thirty days. And it’s no mystery your committee’s been looking very seriously at the Med-InDx solution. Is there any reason to believe this trip signifies any problems for the Med-InDx product?”

Sergio’s smile widened. Perfect. “No, Maria. In fact, quite the contrary. To answer your question, we are here to review the last four months of data from Maynard Medical Center. I must admit,
those
data continue to demonstrate an outstanding consolidating decline in medical errors.” He loved to emphasize the correct grammatical plural of datum since so many illiterates missed this particular fine point. “In particular, it demonstrates the remarkably low level of common medication errors that can be achieved with a high-quality, comprehensive EMR.”

He cleared his throat again and readied himself to launch into his dog-eared speech. “By EMR I am referring to an Electronic Medical Records—not a complete clinical information system such as offered by the Med-InDx company. JCAHO’s emphasis on the switch to computerized charts represented a drastic change from the time-honored clinical chart so characteristic of medical record keeping for the past 100 years. As I’m sure you are all aware, in November 1999, the Institute of Medicine concluded a study entitled, ‘To Err Is Human: Building A Safer Health System.’ It focused attention on the issue of medical errors and patient safety. The report indicated that as many as 44,000 to 98,000 people die in hospitals each year as the result of preventable medical errors. But the point is, very little progress has been made to correct this problem. Think about it. If the airlines had the same record of crashes, who would fly?” He glanced around the room knowingly and smiled as this thought sunk in.

“Look what happened to American auto manufacturing when they got sloppy. Several automakers went bankrupt. The big three lost a huge market share to the foreign automakers. Well, it’s time to reform the error rate in hospitals.

“The Institute’s report estimated that medical errors cost the nation approximately $37.6 billion each year; about $17 billion of those costs are associated with preventable errors. About half of the expenditures for preventable medical errors are for direct health care costs. These preventable errors are exactly what electronic medical records are intended to reduce.”

The
Wall Street Journal
stringer piped in. “Hold on a moment, Doctor Vericelli, you’re straying from the point of the last question. Some of us would like to drill down on this. Would you share the exact figures with the group?”

He raised his eyebrows in mock surprise. “Figures?”

“Yes. What are the error figures for the Med-InDx system.”

Sergio shook his head with a good-natured grin. “You know I’m not at liberty to disclose data of that nature at this time. Once the committee has reached their final decision and made their finding public, those data will be released as a matter of public record. But until then, the committee can not disclose proprietary information, especially in a case such as this where the company’s public offering is slated only days after the committee’s ruling.”

Frowning, the journalist shook his head. “That’s ridiculous, Doctor. With the timing of Med-InDx public offering so close to the committee decision, it is unreasonable for you to withhold this information. One has to wonder if there’s more than mere coincidence here.”

Other reporters murmured agreement.

Sergio hesitated, unsure of the reporter’s intent. “I understand your eagerness for some preliminary indication of the committee’s findings, but even I, as committee chairman, have no knowledge of what that decision will be since there has yet to be a vote.”
There, that should answer the bastard.

“But,” the reporter interrupted, “surely you’re aware of the committee’s sentiments. If the Med-InDx product truly is as superior as rumors have it, then the decision is all but made.”

Too smart to get suckered into that game, Sergio shook his head, “Sorry,” and nodded at the next reporter. “Next.”

“Any truth to the rumor that so far results clearly favor the Med-InDx product? That Prophesy’s solution isn’t even considered in the running anymore?”

“I thought I just answered that question, however differently you might have phrased it.” Sergio wagged an admonishing finger before turning to Bernie Levy. The Med-InDx CEO sat staring out at the reporters with vacant eyes and a Bill Gates haircut. “I’m sure Mr. Levy would like that to be the case, but so far all I can tell you is the committee believes both products are excellent. This also means there is no clear leader as far as the committee has determined.”

Another reporter asked, “If you can’t give us the figures, perhaps you can let us know any areas in which Med-InDx shows particular strengths?”

Sergio’s face grew serious. He stroked his salt and pepper goatee in a manner he believed demonstrated thoughtful consideration. Which was far from the case. He knew the figures cold, but intended on leaving a very different impression. After an appropriate pause, he said, “Their product shows solid strength across the board in all areas in which a complete EMR might be anticipated to compete. Using their solution,” tossing in a little Silicon Valley buzz word, “we have seen a dramatic lowering in patient ID confusion, particularly for those patients with the same last name. The committee has seen a significant decrease in miscommunication among caregivers and an absolute zeroing of wrong-site surgery in the past 12 months. There are other areas of improved performance too, such as medication delivery, especially with infusion pumps. But most dramatically, the Maynard Medical Center trial has demonstrated a remarkable and statistically significant drop in medication and blood product mix-ups when compared to the same period of time preceding the implementation period.”