Software Quality Concerns with Electronic Medical Records in 2009 Economic Stimulus

To reduce the health risks to patients, quality assurance must be an immediate consideration for hospitals receiving aid from the Economic Stimulus package. Recent problems at VA Hospitals highlight concerns about software quality in health records. 

Feb 16, 2009 – Software Quality is essential for accurate and secure electronic medical records.  As a $20 billion portion of the economic stimulus plan approved by both the House and Senate this week, the software supporting those electronic medical records will need to work properly every time.

In his January 8, 2009 speech, President Obama assured the American people that electronic medical records will “save lives by reducing the deadly but preventable medical errors that pervade our health care system.”  

Less than a week later, the Associated Press covered the incorrect doses, delays in doctor’s orders for hospital patients, and extra doses of potentially fatal medications which were caused by software glitches that appeared in the VA system in August of 2008, and were not eradicated until December 2008.   This unfortunate event emphasizes the need for Software Quality Assurance programs from the onset in hospitals and clinics nationwide.  

The VA’s systems appear to have been upgraded in August 2008 with insufficient regression testing - the kind of software test that’s used to ensure that an upgrade won’t cause problems with a system that is already in use.  That the system’s problems were not eradicated until December of 2008 means that the VA most likely spent a great deal of IT system developer’s time troubleshooting and fixing the errors. Ideally, many of these regression tests can be automated to save time and money prior to upgrading the systems, and to prevent grievous errors following the system upgrades.  

“Applications like medical records require a much higher level of testing than other systems because the consequences of defects in the system could be devastating.” says Paul Mandel, Project Manager for Tescom’s team of software quality assurance experts working at a major health organization in Atlanta, Georgia.  

Proper quality assurance for electronic medical files would require a team of professionals who are familiar with healthcare and hospital computer systems in addition to SQA expertise.  

The VA Hospital case is an unfortunate example of what happens when software quality assurance best practices are not put into effect early on in the development, implementation and integration stages of a major software initiative such as instituting system-wide electronic health records.

One of the goals of the American Recovery and Reinvestment Act has been to convert all of the USA’s medical records to electronic format by 2014.  It is not entirely clear how the $20 billion earmarked for this purpose is going to be funneled to healthcare providers.  One of the current recommendations is to create local extension offices to help with the transition. Any extension office or medical facility receiving funding from the 2009 Economic Stimulus package toward the end of digitizing health records must consider bringing in a third-party Quality Assurance team as early in the project as possible.