10 ms·

i'll admit i have no idea what i'm talking about but isn't there some Plan B options? something that's more manual? or are surgeons too reliant on computers?

nubinetwork 2y ago
I don't know about surgeons, but nursing and labs have paper fallback policies... they can backload the data later.
- regularfry 2y ago
  It's often the case that the paper fallbacks can't handle anywhere near the throughput required. Yes, there's a mechanism there, but it's not usable beyond a certain load.
Bjartr 2y ago
I think it's eventually manageable for some subset of medical procedures, but the transition to that from business as usual is a frantic nightmare. Like there's probably a whole manual for dealing with different levels of system failure, but they're unlikely to be well practiced. Or maybe I'm giving these institutions too much credit?
zamadatix 2y ago
There are plan B options like paper charting, downtime procedures, alternative communication methods and so on. So while you can write down a prescription and cut a person open you can't manually do things pull up the patient's medical history for the last 10 years in a few seconds, have an image read remotely when there isn't a radiologist available on site, or electronically file for the meds to just show up instantly (all depending on what the outage issue is affecting of course). For short outages some of these problems are more "it caused a short rush on limited staff" than "things were falling apart". For longer outages it gets to be quite dangerous and that's where you hope it's just your system that's having issues and not everyone in the region so you can divert. If the alternatives/plan b's were as good or better than the plan a's then they wouldn't be the alternatives. Nobody is going to have half a hospital's care capacity sit as backup when they could use that year round to better treat patients all the time, they just have plans of last resort to use when what they'd like to use isn't working. (worked healthcare IT infrastructure for a decade)
- sqeaky 2y ago
  I am talking out my ass, but... Seems like a possible plan would be duplicate computer systems that are using last week's backup and not set to auto-update. Doesn't cover you if the databases and servers go down (unless you can have spares of those too), but if there is a bad update, a crypto-locker, or just a normal IT failure each department can switch to some backups and switch to a slightly stale computer instead of very stale paper.
  - regularfry 2y ago
    Can only speak for the UK here, but having one computer system that is sufficiently functional for day-to-day operations is often a challenge, let alone two.
  - mehrau 2y ago
    Yes buy the more high available you do the more it costs and it's not like this happens every week.
    - sqeaky 2y ago
      As I was finishing my previous costs it occurred to me that costs are fungible. Money spent on spares is not spent on cares.
  - devilbunny 2y ago
    My hospital's network crashed this week (unrelated to this). Was out for 2-3 hours in early afternoon. The "downtime" computers were affected just like everything else because there was no network. Phones are all IP-based now; they didn't work. Couldn't check patient histories, couldn't review labs, etc. We could still get drugs, thankfully, since each dispensing machine can operate offline.
  - zamadatix 2y ago
    There are often such plans from DR systems to isolated backups to secondary system, as much as risk management budget allow at least. Of course it takes time to switch to these and back, the missing records cause chaos (both inside synced systems and with patient data) both ways and it takes a while to do. On top of that not every system will be covered so it's still a limited state.

nubinetwork 2y ago

I don't know about surgeons, but nursing and labs have paper fallback policies... they can backload the data later.

regularfry 2y ago
It's often the case that the paper fallbacks can't handle anywhere near the throughput required. Yes, there's a mechanism there, but it's not usable beyond a certain load.

Bjartr 2y ago

I think it's eventually manageable for some subset of medical procedures, but the transition to that from business as usual is a frantic nightmare. Like there's probably a whole manual for dealing with different levels of system failure, but they're unlikely to be well practiced. Or maybe I'm giving these institutions too much credit?

zamadatix 2y ago

There are plan B options like paper charting, downtime procedures, alternative communication methods and so on. So while you can write down a prescription and cut a person open you can't manually do things pull up the patient's medical history for the last 10 years in a few seconds, have an image read remotely when there isn't a radiologist available on site, or electronically file for the meds to just show up instantly (all depending on what the outage issue is affecting of course). For short outages some of these problems are more "it caused a short rush on limited staff" than "things were falling apart". For longer outages it gets to be quite dangerous and that's where you hope it's just your system that's having issues and not everyone in the region so you can divert. If the alternatives/plan b's were as good or better than the plan a's then they wouldn't be the alternatives. Nobody is going to have half a hospital's care capacity sit as backup when they could use that year round to better treat patients all the time, they just have plans of last resort to use when what they'd like to use isn't working. (worked healthcare IT infrastructure for a decade)

sqeaky 2y ago
I am talking out my ass, but... Seems like a possible plan would be duplicate computer systems that are using last week's backup and not set to auto-update. Doesn't cover you if the databases and servers go down (unless you can have spares of those too), but if there is a bad update, a crypto-locker, or just a normal IT failure each department can switch to some backups and switch to a slightly stale computer instead of very stale paper.
- regularfry 2y ago
  Can only speak for the UK here, but having one computer system that is sufficiently functional for day-to-day operations is often a challenge, let alone two.
- mehrau 2y ago
  Yes buy the more high available you do the more it costs and it's not like this happens every week.
  - sqeaky 2y ago
    As I was finishing my previous costs it occurred to me that costs are fungible. Money spent on spares is not spent on cares.
- devilbunny 2y ago
  My hospital's network crashed this week (unrelated to this). Was out for 2-3 hours in early afternoon. The "downtime" computers were affected just like everything else because there was no network. Phones are all IP-based now; they didn't work. Couldn't check patient histories, couldn't review labs, etc. We could still get drugs, thankfully, since each dispensing machine can operate offline.
- zamadatix 2y ago
  There are often such plans from DR systems to isolated backups to secondary system, as much as risk management budget allow at least. Of course it takes time to switch to these and back, the missing records cause chaos (both inside synced systems and with patient data) both ways and it takes a while to do. On top of that not every system will be covered so it's still a limited state.