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No Sour Notes

October 1, 1998
by Alan Joch
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It’s not surprising that IS professionals and medical workers sometimes clash. Each comes from a distinct world, one built around computer code and circuits, the other around patients and medical procedures. Unfortunately, clashes between these two groups can sometimes bring a medical operation to a standstill. "I have seen nurses actively sabotage their hospital computer systems because of [IS] attitudes that portray disinterest and disrespect for nurses," explains Linda Goodwin, Phd, an RN and nursing informatics scientist at the Duke University Medical Center, Durham, N.C. Once in an emergency room she saw nurses pour Coke over a computer keyboard, an act of protest against a PC and a help desk staff that were both deemed unresponsive.

Talk about "what have you done for me lately." IS professionals at healthcare organizations can feel like they’re constantly fighting to keep sophisticated--and in some cases--faulty hardware and software working efficiently in the pressure-charged atmosphere of a hospital.

Doctors, nurses and medical support staff, on the other hand, expect reliable computer systems that are simple to use and don’t present roadblocks to the fundamental task: caring for patients. From the clinicians’ perspective, computers aren’t always in top shape and the IS staff--in fact or in perception--isn’t always ready to act on user complaints. "The most consistent complaint I have heard over the past two decades is that the IS department fails to provide responsive, adequate and timely support," Goodwin reports.

Sometimes the problem is real incompatibilities in software or breakdowns in hardware; other times, it’s because user expectations are beyond what hardware and software vendors are delivering--no fault of the IS department.

In the vortex of these opposing forces is the hospital help desk, the real-time thermometer of how well IS systems and medical personnel are getting along. "Users perceive all the efforts of IS through a 15-inch PC screen," says Robert Warren, senior manager for First Consulting Group, a Long Beach, Calif., systems integrator specializing in healthcare clients.

The key to portraying a world of harmony on those screens, according to consultants and IS managers, is breaking down divisions between technologists and end users. Here are some reasons why medicine and cyberspace don’t always work in concert, and five ways to hammer out harmony in a world of petulant PCs.

Clinical complaints
The complaints doctors and nurses have about hospital computer systems aren’t that different from what you’d hear in the average corporate office: Computers are arcane, unreliable and unintuitive. Worse, there’s the nagging fear that computers represent a new way of working, but ultimately don’t make us more efficient at our jobs. In short, the promise of PCs is appealing, but they haven’t yet become integrated into the workflow of healthcare. "It would thrill me to take vital signs and have a computer automatically collect the data," says Margaret Cox, nursing and clinical informatics coordinator at Children’s National Medical Center, Washington, D.C. "I hate having to type the results into the computer."

Worse still is redundant data entry some doctors and nurses cope with because clinical applications, like HIS and lab programs, often reside in separate systems that can’t share information. "In one of my previous lives, I worked with a team to build an allergy documentation application, and we found the nurses were supposed to manually enter the same patient allergy data on eight different forms," Goodwin says. An added insult is the fact that medical applications demand to receive data in specific formats but often can’t give it back in ways doctors and nurses need for medical reports.

In addition to wanting seamless integration of systems and applications, medical workers also bristle at having to sign on to multiple systems each day, according to Warren. "They want to enter their name and password once on one networked PC and be able to call up any data or application for which they have access privileges," he explains. "I can’t name one healthcare organization that has implemented a single sign-on system."

Add inconsistent computer interfaces to the list of complaints. "Nurses get annoyed when in one program they press F1 to open a screen, and in another program they have to hit a different key to do the same task. The lack of consistency is frustrating," Cox says. People would like to see computers make their jobs easier, not harder, she says. "That’s a challenge for the computer industry, which doesn’t have a great track record in healthcare."

Underlying problems
Fortunately, some healthcare and IS professionals understand that finger pointing won’t solve pesky technical problems. Getting a better understanding of each others’ responsibilities, however, can ameliorate some troubles.

Programmers, some clinicians charge, don’t understand medical workflow. "They need to understand that our schedules and assignments vary, so we’re not at the same desk using the same PC every day," Cox explains. "And we may work 12 hour shifts three days a week--not a traditional business day."

Goodwin adds that nursing knowledge and expertise are hard to define, measure and communicate. "There is a vast body of knowledge that expert nurses use to provide high-quality care to their patients. But extracting and representing that mostly embedded knowledge and structuring it for a computer system remains difficult," she says. Working toward systems that support what nurses know and providing decision support for what nurses do will remain a prime IS challenge for the next decade, she predicts.