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HSE system fault: 'We don't need a witch hunt now'

We must learn the lessons of this, but we must also keep moving forward, writes Niall Ó Tuathail.

Niall Ó Tuathail Health Reform Advisor

SIX YEARS AGO the HSE rolled out the National Integrated Medical Imaging System, a system that allows much easier storing, diagnosis and sharing of CT scans, MRIs and x-rays. Last week, a radiologist stumbled upon a serious flaw with the computer code in the system which potentially affects the treatment of 25,000 patients who have had scans since 2011.

The bug – ignoring the less than symbol “<” in test reports – meant that the right readings weren’t being given to doctors. If the radiologist reported <30%, the doctor would see 30%.

Thankfully, the first indications are that the impact on patients will be at worst overtreatment, as the error should have made doctors more conservative. As we rely more and more on technology in health, this an important reminder that we need to invest wisely in new systems.

An avoidable mistake

This was an avoidable mistake that should have been fixed before, during and after development. Sitting down and talking to doctors and technicians before a single line of code was written would have shown that data would be entered this way and the system would have had to deal with this. Any standard bug testing process during development should have uncovered the error and fixed it.

When the system went live, algorithms should have been constantly analysing the data and spotting where there were strange results before sounding the alarm. In the end, the most important check – human clinical judgement – discovered the error, albeit 6 years too late, and the system kicked into place to fix the problem.

While we need to learn the lessons from this incident, a review of what happened does not need to turn into a witch hunt to rebuild public confidence. There has been some refreshingly positive progress in the last few years in electronic health, including eReferrals from GPs to other parts of the HSE and electronic health records in maternity care.

Investing wisely in technology will save money but, more importantly, it will save lives. When we rely on paper-based records, we are actually usually relying on memory-based records of what the doctor or patient remembers. Relying on written notes means relying on understanding bad handwriting. Relying on physical test reports and images means a patient waiting an extra hour or two on an A&E trolley after the doctor requests the test.

Investment in technology can can save lives 

This potential was recognised by the Committee on the Future of Healthcare when it published Sláintecare, the first cross-party 10-year vision for our health service in the history of the state. The committee, chaired by my Social Democrats colleague Róisín Shortall TD, advocated investing €875 million in eHealth over 5 years, speeding up the current HSE plans by 10 years, as well as investing €60 million in community diagnostics.

A significant and competent investment in technology and diagnostics is a major part of building a public health system we can finally be proud of. When done right, this investment can can save lives through helping clinicians make decisions and reducing errors. When done right, it can save money through less administration work. When done right, it can relieve pressure on A&E departments as diagnostics will be instantly available for doctors to make sometimes life and death decisions.

Crucially for rural Ireland, having diagnostic machines outside of hospitals will allow healthcare to move closer to home as people will be able to have scans and tests in their local primary care centre and have them reviewed remotely by their GPs or specialists. This will be particularly important for patients with chronic conditions who need regular tests.

What was discovered this week was not acceptable. Anyone who has had a scan in recent years would understandably be worried. We must learn the lessons of this, but we must also keep moving forward. It is easy to punish mistakes that come from making changes, but we often don’t consider enough the costs of not making changes.

Niall Ó Tuathail is a health reform adviser to the NHS and will contest the next general election in Galway West for the Social Democrats.

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About the author:

Niall Ó Tuathail  / Health Reform Advisor

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