Over an hour’s breakdown in the information system is a catastrophe

Tykslab's IT Director and Chief Chemist Ari Törmä spoke at the Nordic Congress in Clinical Chemistry in Helsinki on 14 June 2018.
Tykslab's IT Director and Chief Chemist Ari Törmä spoke at the Nordic Congress in Clinical Chemistry in Helsinki on 14 June 2018.
Ari Törmä
Ari Törmä

Tykslab has found through experience that in some respects, even a fire can be less disruptive than a long, unexpected breakdown in the information system.

In June 2008, Turku University Hospital’s (TYKS) laboratory, Tykslab, experienced the longest information system breakdown in its history. The laboratory’s information system was out of service for three and a half days.

At around ten o’clock in the evening, one hard disk broke down and the fault could not be fixed before nine o’clock the following morning. Soon thereafter, it became apparent that the faulty disk had prevented use of the database.

The hard disks were too old and too full. When one of the hard disks broke down, the others could not make up for it, believes Ari Törmä, IT director and chief chemist at Tykslab.

According to Törmä, laboratory activities were all but paralysed because of the faulty hard disk and the resulting break in information services. The laboratory was flooded with sample tubes that could not be tested quickly enough, since the data to inform testing had to be recorded manually and automated services could not be used.

In September 2011, Tykslab faced another catastrophe when a fire broke out in the central laboratory. Surprisingly, apart from the first couple of hours after the fire, it had a lesser effect on customer service than the breakdown in the information system.

Five hours after the fire, we had blood bank operations up and running in another building. After two more hours, we were doing the first urgent laboratory analyses in temporary facilities.

The fire was less disruptive because samples could be sent to other laboratories for testing. When the information system was out of service, no laboratory could take the sample tubes without the proper stickers and information.

This illustrates how important a laboratory’s information system truly is, Törmä says.

”Desperation hit on the second morning”

After that three-day breakdown of the information system, Tykslab has experienced several other, shorter disruptions in the information system. Through them a one-hour limit became apparent: If the laboratory’s information system was unexpectedly down for more than an hour, it meant a catastrophe for the laboratory.

If the disruption lasts under an hour, the laboratory struggles but pulls through. The situation is alleviated by the automation laboratory’s middleware, which receives some data in advance from the laboratory’s information system.

If the disruption lasts over an hour, however, the whole hospital is in trouble. The data stored in the middleware will be used up and all laboratory tests will have to be done manually. At this point, no more sample tubes should be sent to the laboratory than is absolutely necessary.

Tests should be prioritised before making a lab request. The laboratory does not have sufficient information to assess which tubes are most urgent, Ari Törmä points out.

An information system breakdown lasting several days is a crisis that Törmä would rather not see repeated.

Desperation hit on the second morning. I hope I will never again have to experience a similar event.

Be ready for the impossible

An identical event is unlikely to occur again since information technology solutions for hospitals have changed so much. Nonetheless, a long breakdown may occur for another reason.

The incident taught us that we need to be prepared for situations that we cannot even imagine. We do not know what kind of problems might await us in the future, when they will happen or how long they will last. Nevertheless, we should be prepared for them, Ari Törmä says.

Clear and sufficiently generalised instructions should be drawn up in advance for exception conditions. Moreover, suitable people should be nominated for the most important tasks, so that they can take control in crisis situations.

Törmä recommends writing a message in advance asking clients only to make the most critical laboratory test requests. When a crisis hits, the message can be sent immediately.

When something impossible happens, do not hesitate too long and act according to plans made in advance. Remember to always put the patient first, he emphasises.

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