Curbside Consult with Dr. Jayne 7/1/24

This weekend was all about me fighting technology in its various incarnations and being philosophical about whether we are actually better off with all the bells and whistles that we have come to use in our daily lives.

My first struggle was prompted by the fact that I’m over a certain age and my vision prefers a large monitor compared to my laptop. I have a monitor connected via a docking station, so I really only use the laptop for its camera capabilities, along with being a separate screen for third-party messaging apps and other windows that I don’t want to inadvertently share while on a web meeting. Most of my clients prefer online meetings without video, so that wasn’t really an issue. However, I recently started collaborating with someone on a book (which is an interesting experience in itself) and she prefers on-camera interactions, so I decided to get a separate webcam to put on my primary monitor so I wasn’t always looking sideways on our calls.

After doing my usual comparison shopping and polling friends about their experiences, I narrowed it down to a couple of options that were available locally. One of the three was on sale at a shop a mile from my house, so I jogged over and had it in hand in short order. Everything I read indicated that I should be able to just plug it in to the docking station, tweak a setting or two on the laptop, and be on my way.

This was easier said than done. I struggled to get the camera to mount securely because my monitor has a curved housing on the back. It was downhill from there as I couldn’t get it to work using the docking station regardless of how many settings I tweaked. I resorted to connecting it directly to the laptop, which although functional, created a wiring mess that I was trying to avoid.

From there, I had a battle with some permissions on a client-provided laptop. The agent at the other end of the call was clearly following a script and didn’t fully understand what she was advising. She recommended that I “press and hold the power button for 60 seconds.” I attempted to clarify that she was asking me to restart the computer, therefore I would need to finish some work and get back to her. She advised that no, the computer was not going to restart, we were just “rebooting the power.”

I let her know that I would need to call back at another time and went about my business. I restarted after finishing my work and the problem was resolved so I didn’t need to call back, but it just emphasizes the importance of having people in your call center who actually understand the advice that they are giving and who aren’t just reading from a script.

The issues really hit the proverbial fan when my power had a momentary blip, knocking the internet offline close to midnight. I was half asleep reading a book anyway (“Project Hail Mary” in case you’re interested), so I manually turned off the lamp rather than having Alexa do it, and figured I would address it in the morning. My internet gateway rebooted without a hitch and my hardwired devices were back up, but the wi-fi had renamed itself and reset the password. That required tracking down the magical website where I should have been able to rename the network and change the password back, but I couldn’t figure out how to make my changes save. I’m stuck, in the short term at least, with a goofy 30-character password and a different network name.

Now I need to visit all my internet-enabled devices and get them reconnected, including my thermostat, a couple of Alexa devices, phones, a thermostat, and my smart TV so I can figure out how “Bridgerton” is going to continue to unfold without having to sit at my desk. I didn’t have time for that budgeted on my schedule today, so getting the phone connected was the best I could do for now.

With all that, I was more frustrated by my labor-saving devices than anything, and it was in that mood that I read Mr. H’s mention of the Sunrise EHR error in Australia that incorrectly calculated more than 1,000 pregnancy due dates. Regulators are investigating whether patients were harmed by the incorrect dates, which could have led to premature inductions of labor or mismanagement of patients who spontaneously entered labor well before their due date.

For example, when you’re concerned that a pre-term birth is imminent, there are treatments you administer to try to improve fetal lung function. Those are only indicated between very specific dates as far as fetal age. The issue affected public birthing hospitals in South Australia during the six months prior to June 5. SA Health is performing its own medical records review in parallel to the independent investigation. Approximately 100 patients have yet to deliver, so hopefully their dates are being appropriately updated. Patients have not yet been informed of the issue. 

Details on the incident are slim, with the article noting that due date fields in maternity notes were overridden by a calculation that was based on the last menstrual period. I haven’t used Sunrise since the late 1990s, but I’m guessing the system has a hierarchy for how it populates due dates, which might be determined from a last period, ultrasounds, other medical records such as assisted reproductive technology notes, patient-reported date of conception, or a combination of data available. However it manages those different data points, something went awry.

Back when I was delivering babies as part of full-scope family medicine, we would note all of those data points on this magical fold-out paper form and then document our final estimated date of delivery in a specific place on the form. It wasn’t sexy, but it was accurate, and the only way for it to be overridden involved a strike through and someone’s initials.

My question as a clinical informaticist is this: what happened six months prior to June 5 that caused it to be inaccurate? Was there an upgrade, an update, or some change to a template? What processes were in place (such as two sets of eyes checking on changes to critical patient care content) to prevent such an issue, and what went wrong?

If it is determined that patients were harmed by the issue, I certainly feel for them and for their families, because issues during pregnancy care can lead to a lifetime of “what if” questions that haunt parents. My experience transitioning obstetricians from the paper folding forms to EHR was that they planned to hold onto the paper until the last possible minute because it was a system that just worked. It would be interesting to see whether the benefits of electronic maternity documentation have been shown to provide improved clinical outcomes compared to paper documentation, but I doubt that study has been performed.

I could search for it, but instead I’ll be using my spare time to try to fix my household so that Alexa can once again turn on my bedside lamp.

What’s the technology you miss the most when it stops working? Leave a comment or email me.

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