June 6, 2016
Bad Healthcare IT And Cardiovascular Risk: What Could Possibly Go Wrong?
By Michael D. Shaw
The British media is full of stories regarding the serious failures of the QRISK2 Calculator in SystmOne. Permit me to decipher:
QRISK®2 is the latest version of QRISK, a prediction algorithm for cardiovascular disease (CVD), first introduced in July, 2007. Updates to QRISK®2 are issued each April. This algorithm uses existing traditional risk factors (age, systolic blood pressure, smoking status, and ratio of total serum cholesterol to high-density lipoprotein level) for CVD; but also incorporates deprivation, family history, antihypertensive treatment, and body mass index. Patients judged to be at high risk can be prescribed suitable treatment, including statins.
While a QRISK calculator is readily available for free use as a standalone product online, it is also incorporated into SystmOne, a healthcare IT system sold by TPP, widely deployed throughout the UK. A few weeks ago, the Medicines and Healthcare products Regulatory Agency (MHRA) explained that the problem stemmed from the interaction between QRISK2 and SystmOne. Presumably, the calculator per se works just fine.
According to UK general practice magazine Pulse…
“Hundreds of thousands of patients have potentially been given an incorrect cardiovascular risk estimation after a major IT system error. The MHRA has told GPs they will have to contact patients who have been affected by a bug in the SystmOne clinical IT software since 2009.”
MHRA is blowing this off, averring that “a limited number” of patients may be affected, and the risk to patients is “low.” But Pulse reports that “the 2,500 practices using SystmOne are having lists sent to them [by TPP] of around 20 patients per partner who may need to be taken off statins, or be put on them, after their risk is recalculated.” And, by the way, if medical records are confidential, exactly how does TPP know which patients in each practice are affected?
Scot Silverstein, MD—healthcare IT guru and friend of this column—doesn’t hold back…
“At best, it’s good that only a ‘limited number’ of patients were affected. I guess they feel they can justify a ‘limited number’ of patient harms for the glory of a medical Cybernetic Utopia. At worst, how do the regulators know exactly who was affected? Answer: They don’t and this is boilerplate BS meant to CYA.”
MHRA stated that “We are working closely with the company responsible for the software to establish the problem and address any issues identified.” To which Silverstein dishes: “The problem is incompetence and negligence. One wonders what testing was performed before this was unleashed on the public in the UK.”
Maybe, one of TPP’s programmers could have, you know, compared the online QRISK2 results with those within SystmOne. Heck, that would have taken perhaps ten minutes, or even an hour if one wanted to be extra thorough.
Who knows how many patients who didn’t need the side effect laden statins were put on them? Not to mention how many who supposedly needed the drugs were not given them? Since this error goes back to 2009, could deaths have occurred because of it?
As in the US, British healthcare policy is mostly run by non-physicians, and the results—not surprisingly—are comparable. Grotesque amounts of money are spent; horrific errors are committed on a routine basis; the level of care is mediocre; and there’s near zero accountability. Talk about your incentives to take ownership of your own health and stay out of the hospital…