Correspondence

Computer Crash

N Engl J Med 2003; 348:2365-2366June 5, 2003

Article

To the Editor:

The Perspective article by Kilbridge regarding a computing-system crash at Beth Israel Deaconess Medical Center in Boston (March 6 issue)1 is very disturbing and provides insight into a serious problem. Technology that is critical to patient care must be managed by the health care system, including physicians. Financial institutions have taken an aggressive approach to installing and managing critical information systems. The health care system must set standards for itself in the creation, management, and surveillance of information systems. Physicians must be engaged with hospital executives and their boards to ensure the safety of patients' health care information and the logic of the health information infrastructure. The voice of the physician is critical in defining the path that is taken and in ensuring day-to-day compliance.

Edward M. Fleegler, M.D.
McKesson Health Solutions, Broomfield, CO 80021
edward.fleegler@mckesson.com

1 References

1
Kilbridge P. Computer crash -- lessons from a system failure. N Engl J Med 2003;348:881-882
Full Text | Web of Science | Medline

To the Editor:

As Kilbridge points out, we are becoming increasingly dependent on information technology. The disaster that happened at the Beth Israel Deaconess Medical Center is not unique and can occur in any hospital. The truth is that no matter how much we invest in the right hardware and software and in maintenance, our investments will only lessen and never eliminate the chance of system disruption. Whether or not the lessened risk will justify the additional resources remains a question for further study. What we should have is a protocol to handle the situation when it arises. We all participate in fire drills — why not an “information-technology–independence drill”?

Kittisak Kulvichit, M.D.
Chulalongkorn University, 10330 Bangkok, Thailand
kittisak.k@chula.ac.th

To the Editor:

Kilbridge fails to address one important matter: the qualifications of information-technology personnel working in hospitals. In general, no health care background or certification is required for such positions. Business information-technology personnel with no experience in medicine serve as chief information officers, project leaders, and information-technology workers in clinical settings.

My concern about this issue originated from personal observations of information-technology personnel who were leading clinical computing projects and wielding considerable authority over clinicians on decisions affecting medical environments and resources.1 It was unclear what criteria were applied to ensure that such workers had the competence required in mission-critical hospital settings. This situation may result in continued difficulties with clinical information technology and delays in realizing the benefits of information technology in clinical settings. Perhaps it is time for this situation to be formally investigated.

Scot Silverstein, M.D.
2615 Wister Ct., Lansdale, PA 19446
scotsilv@aol.com

1 References