Hospital IT issues heighten the risk of misdiagnosis

Recurring IT issues within the laboratory computer system at Cork University Hospital have heightened the risk of misdiagnosis and inappropriate treatment, internal documents seen by the Irish Examiner reveal.

The likelihood of major errors occurring within the pathology department due to a “corrupt database” is outlined in the hospital’s pathology risk register — a management tool to identify and manage risk.

The problem of database corruption and its potential effect on pathology results and, consequently, patient treatment, is flagged in the risk register in 2012, 2013, and 2014.

It shows the IT problems have been ongoing for some time. Potential for error is not limited to misdiagnosis — other risks highlighted include “delayed return of results to ensure safe delivery of cancer care”.

When the hospital’s CEO, Tony McNamara, wrote to the State Claims Agency on August 27 to put it on notice that it could face liabilities on foot of five failures of the Laboratory Information Management System so far this year, he described the situation as “very serious”.

GPs were also advised the hospital could not stand over all patient test results due to a computer crash in August that lasted over a fortnight.

However, despite issues with the lab IT system at least as far back as 2009 — a pathology management review from that year describes the server as “running at 80% capacity” — no investment was made before 2011. At that stage, 25,000 went towards addressing “initial deficits”.

This was two years after a power cut caused a legacy system to crash with the loss of laboratory results from 1998 to 2002. Those results had still not been restored by 2009. The Irish Examiner asked the HSE if these results had ever been restored, but received no answer.

A pathology management review from 2012 described the server as “on its last legs” and said that it either needed to be replaced or significantly upgraded “as a matter of urgency”.

In 2012, a replacement server was commissioned by the HSE at a cost of approximately €100,000 which culminated in an upgrade in February 2013.

However, Mike O’Regan, CUH information services manager, wrote in an email to management that they had begun to experience “issues with the system in Dec 2013”.

When asked why it had not invested sooner in upgrading its system, CUH said it had envisaged the 2012 investment would be enough to keep it going until a new national laboratory system was rolled out in 2017. However, that had “not proven to be the case” and approval has now been given to invest €400,000 in upgrading “the whole environment”.

In the meantime, the existing system is fully restored since mid September, according to the HSE.