Computer crash--lessons from a system failure.

Although executives and physicians at the Beth Is-rael Deaconess Medical Center in Boston have had reason to take great pride in their advanced clinical computing system, they recently had a wake-up call when the system suffered a full-scale failure. Before the crash, the medical center's information-systems staff had designed and implemented a variety of applications to aid clinicians in caring for patients. With this system, clinicians throughout the medical center and the six affiliated CareGroup hospitals can gain access to laboratory results, radiographs, and electrocardiograms electronically, using a secure Internet browser. Patients also have secure access to their test results over the Internet. Since 2001, physicians at the medical center have been placing all inpatient orders through the system. Before Wednesday, November 13, 2002, many members of the current class of interns at the hospital had never written an order on paper. On that date, a researcher at the hospital who was sharing data with colleagues inadvertently flooded the network with large quantities of data, causing it to slow drastically. The information-systems staff scrambled to solve the problem, flying in equipment and experts from the network vendor, Cisco Systems. These efforts resulted in a partial recovery of the system, but then it slowed down again. Twenty four hours into the crisis, the decision was made to shut the network down and revert to manual processes throughout the hospital. The outage lasted four days. During this time, hospital staff members from ward clerks to the chief executive officer hand-carried patient records, laboratory-test results, and countless other documents around the hospital in order to maintain clinical operations. The delivery of care continued; contrary to early reports, the emergency room remained open, and routine and emergency admissions and transfers continued at the usual volume. Chief information officer John Halamka talked early and openly with reporters about the outage, which received widespread coverage in the local and national media. What should we learn from this event? Although some lessons can be drawn from specific aspects of the CareGroup experience, the increasing reliance of hospitals on information technology raises larger questions about the vulnerability of clinical and administrative operations to technological disruption. In the fall of 2002, the Beth Israel Deacon-ess Medical Center was operating an extended computer network designed to meet the requirements of a much simpler environment. In addition, some network equipment was old and needed to be replaced. The principal point of …