Give Me a Crash Course In ... The HSE’s computer glitch

What's all this about the HSE's computer system? One day last week, a radiologist working in a country hospital noticed something strange. When the scan being reported on was sent for archiving in the HSE's National Integrated Medical Imaging System (NIMIS), the version viewable onscreen had developed a small, but subtle change. Whenever a numerical value such as "<50%" was used, it appeared merely as "50%".

Is that such a big hill of beans? It meant the €40 million system used by the HSE used to store millions of X-rays, ultrasounds and scans was not accurate. The different components of the system, which allows doctors in different parts of the health sector to access vital information about a patient electronically, did not appear to be communicating properly with each other. In medicine, you cannot afford to be "nearly right".

So what happened then? The HSE was informed, software experts were brought in and the patch was fixed. But it quickly became apparent that the problem had existed since the system went live in 2011 and that 25,000 faulty scans had been stored.

A team of senior officials was convened to investigate the incident, tasked primarily with establishing the effect on patients.

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Hey, surely there's "<" than meets the eye about this problem? It's only a single mathematical symbol, after all. Ha, ha. In fact the consequences could be serious, though their exact extent have yet to be determined. The HSE is examining whether patients might need to have their past medical treatments reexamined. The Canadian manufacturer of the system has told customers worldwide there is potential for "incorrect clinical decisions" to be made through the omission of the symbol.

How? A doctor might have decided, based on the incorrect information thrown up by the system, that a patient's condition was more serious than it actually was. On the basis of this, treatments could have been ordered that were, in hindsight, not necessary. This scenario seems more likely than one in which a patient could have missed out on required treatment due to the error.

Maybe we should just go back to the old paper- and film-based records? The error does point to the limitations of electronic, screen-based reporting of patient information. Some doctors feel they should have been provided with hard-copy printouts of electronic records in patient files, and suspect their absence is a moneysaving device designed to offset the €40 million cost of the system.

In reality, there is no going back to a completely paper-based system. Where a patient is rushed to emergency, for example, that department needs to be able to quickly pull up information about the patients’ previous medical history, in that hospital and others. The NIMIS system allows that to happen effectively.

The health service doesn't have a very happy history with computers, does it? The PPARS scandal of more than a decade ago – when the cost of a personnel and payroll system went from €9 million to €220 million – has inhibited subsequent spending on computers in the health service ever since.

As a result, as numerous reports have made clear, Ireland lags far behind other countries in the introduction of e-health, and there are dozens of different systems in the health service that do not communicate, or barely communicate, with each other.

The HSE is looking for €1 billion to play catch-up over the next decade, but the Government has been slow to offer up the money so far. It is hard to say whether this latest controversy will make it more or less likely, to cough up the cash.