Staff at at a Québec hospital are still trying to figure out how 14,000 patient X-ray reports went missing over the past year.
A “”computer glitch”” is being blamed for the mishap, but the human element is being examined in light of possible law suits.
“”Knowing the truth is going to be very
difficult,”” said Normand Laberge, chief executive officer of the Canadian Association of Radiologists. “”Everybody’s going to want to protect themselves.””
At the newly built Pierre-Le Gardeur hospital in Lachenaie, near Montréal, results of mammograms, MRIs and CT scans are stored digitally, printed and mailed to physicians. But between January and December 2004, 14,000 reports were never printed out or sent to physicians.
“”In terms of real results, 800 to 900 were positive,”” said Laberge.
In one case, there was a six-month delay in a cancer diagnosis, he said, and the time lag will likely result in a law suit.
The hospital tried to downplay the incident, saying that 85 per cent of the reports were negative and didn’t need to be sent to physicians.
“”You’re dealing with life here — an 85 per cent passing grade doesn’t cut it,”” said Laberge. “”If the tests were not important, why the hell were they issued?””
Frederique Laurier, a spokesperson for Pierre-Le Gardeur, said the hospital is dealing with its IT issues and will soon comment further on the incident.
It was a patient who wouldn’t take no for an answer that finally set alarm bells off at the hospital, after she demanded to see her results, first from her physician, then the hospital. An investigation revealed that her report was not the only one that had disappeared into cyberspace.
“”I think everybody will be shifting the blame,”” said Laberge. And that blame might shift to the IT industry. But he said this is taking the easy way out. “”You can’t blame the IT company for the end result (of the report) not reaching the patient.”” Other issues being raised are: Hospital staff didn’t double-check the computer’s work, physicians didn’t follow up with the hospital and ask for results that didn’t arrive automatically, and patients didn’t follow up with their physicians.
“”IT does not erase people, and does not reduce workload,”” he said. “”It’s not the magic bullet to everything.””
Losing data in cyberspace is an everyday event, he said. And hospitals know they lose patient records: In a manual system, the rate of loss is three to four per cent, while a digital system is one to two per cent. In a digital environment, that loss is temporary and the data can be retrieved from the system. Problems will occur, but they can be caught early on through human intervention.
By having a computer around, some people assume they don’t have to check anything, said Laberge. “”This is exactly what happened at Pierre-Le Gardeur. Three other hospitals (in Canada) have the same system but not the same problem.””
The University Health Network, for example, went digital in 2000 and now all of its X-rays are stored on a computer.
“”There’s a queue for every report,”” said John Adziovsky, the UHN’s PACS architect. The report is faxed to the physician, he said, but someone at the hospital monitors the queue, providing a human element to the system.
