Yesterday the Royal Australasian College of Physicians @TheRACP held its’ annual written exam, a 5 hour long barrier exam for progression to the viva voice examination that progresses the candidates to advanced training in medical sub-specialities. For the first time the college chose to use computer-based assessment rather than written assessment and engaged @PearsonVUE to undertake the process. It went spectacularly wrong with the software essentially seizing up towards the end of the first half of the examination. The problem has been attributed to an as yet unknown glitch. The exam was called off and is now re-scheduled as a paper based test on the 2nd of March. This was also not the only problem with a process that included inconsistent supervision, inconsistent mobile phone policy, misinformation, failure to take into account the needs of the candidates (like expressing breast milk) and lack of a back-up plan. The consequences are manifold. Trainees planned holidays immediately after the exam and these are now put on hold, no doubt with financial loss. Extra time off the wards will be required. There may be interruptions to other training events scheduled a year in advance and recruitment that commences in August/September for the subsequent academic year could in theory be disrupted. This is all not to mention the psychological distress caused by the most important test of their lives (apart from the viva).

Can any good come of all of this?

All of these future physicians are entering an age of completely digitised medicine. In fact they are the first generation where all hospital based records and prescribing will be undertaken electronically and private practice is fast moving in the same direction. Some of these future physicians will hold titles in their healthcare organisation like Chief Information Officer and hold higher degrees in health data management and analytics. I think for those candidates who suffered the events of yesterday there is a teachable moment. Just as the RACP simply cannot afford for the digital assessment system to fail as health care providers we cannot afford for our digital systems to fail. Downtimes in the electronic health record (EHR) are a bit like the computer aided flight systems on a plane failing. Cyberattacks or power-outages might results in critical system failure. How can we look after a patient if even for short periods of time all their health-related data is not accessible? People will have infusions running when computers crash. Operations will be underway. Critical life-saving information could be unavailable. Patients lives might hang in the balance just as trainees sitting the exam might see their futures hanging in the balance.

Trainees who experienced the digital failures of 19/2/18 who go on to take responsibility for digital healthcare will reflect on their experience with terror. They will manage the risk and work hard to ensure that their digital health care environment is as safe as possible. Catastrophic failure is never 100% preventable but due diligence, user testing, good risk management and risk mitigation could have prevented these calamitous events.