Wednesday 23 January 2019

Explainer: How the 'less than' symbol caused a nationwide HSE software glitch

(Stock picture)
(Stock picture)
Denise Calnan

Denise Calnan

The HSE has hit headlines after thousands of people may be affected by a software glitch which saved incorrect medical records.

How did this happen, and what happens next?

We've answered all your questions here.

What happened?

The software fault occurred on the HSE's Nimis (National Integreated Medical Imaging System) system and it omitted the 'less than' symbol from exported reports.

According to the HSE national clinical advisor for acute hospitals Dr Colm Henry, most clinicians work off the radiology information system which is where the medical report is requested and stored. However, there is also a picture archive, which is another version of the report. This is not the master version but an exported copy. It was here that was missing the 'less than' symbol was spotted.

Dr Henry explained that an example of the error would be the ultrasound of vessels to detect the degree of narrowing of the vessels, the report may be less than 50pc but it will read 50pc on the incorrect report copy.

Who noticed the error?

An eagle-eyed consultant radiologist working in one of the hospitals spotted the error last week and brought it to the attention of the software company and the HSE.

What happened then?

The radiologist informed the system providers, then the HSE.

The HSE's first response was to inform all radiology departments and hospitals. According to Dr Henry, the second response was to fix the error by working with the software provider.

Now an investigation will begin to determine the clinical impact or significance.

How many reports have been affected?

At least 25,000 X-rays, MRIs, CTs and ultrasounds taken since 2011 are affected by the error. According to the Irish Times, thousands of people may need to have their medical tests redone while others may have received unnecessary treatment as a result of the glitch. The glitch affected all 40 hospitals on the network.

What are the HSE saying?

Dr Colm Henry spoke on RTE Radio One's Morning Ireland this morning and assured listeners that any patients affected by a HSE software glitch will be "contacted immediately".

"It is important to emphasise to listeners and patients that big decisions are never made based on written reports alone. Clinicians in this day and age frequently look at original imaging and discuss the reports before embarking on treatment," Dr Henry added.

What next?

The HSE have now launched an investigation into the glitch. The investigation will begin with an analysis of a "large sample" to determine if the clinical risk is high.

"The first phase is to see if there is any difference between the master copy which is correct and read by most people, and the exported copy," Dr Henry said.

"This will be completed by the end of August, to see if there is any difference there.

"What we do in any such case is assess the clinical risk. We think there is a relatively low clinical risk, however if the percentage is greater than we expect, we will progress to study all cases."

Any advice for concerned patients?

Chairman and co-founder of the Irish Patients’ Association [IPA] Steve McMahon said they are now calling on the HSE to make sure GPs nationwide are equipped with the information to help patients with any concerns.

"We will be spending something in the region of a billion eiro in the next few years on the healthcare system, patients need to know they can have absolute trust," Mr McMahon told Morning Ireland.

"The fact they they are missing a 'less than' sign in the system is raising a whole load of questions for another forum.

"They key thing is to inform patients as soon as possible so they aren't unduly stresses, particularly if any delayed diagnoses have had effects on them."

He added; "Certainly if patients have concerns about a test they may have had, they will be contacting their GP or consultant.

"For a lot of patients, their first port of call will be the family doctors.

"We'd hope that the HSE are making contact with the IMO, the National Association of GPs and making sure that GPs are armed with information."

Any reaction?

Fianna Fáil spokesperson on health Billy Kelleher has called for a full review of the HSE's capacity in technological areas.

"It puts huge pressure on the system again... We need to have a full review on the HSE's capacity in the technological areas to firstly draft contracts for purchase of software, but also to assess software and the implications of because we are moving into the digital era," Mr Kelleher said.

If you are potentially affected by this software glitch, please contact us at or through our official Facebook page

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