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Curbside Consult with Dr. Jayne 6/13/11

June 13, 2011 Dr. Jayne 10 Comments

A good friend of mine works for a large academic medical center that has restrictive IT policies. Fiercely loyal to certain vendors, the IT gatekeepers restrict hardware choices, from server infrastructure to smart phones. Apple products are largely banned, and the popularity of the iPhone has led many employees to carry multiple handheld devices. Corporate e-mail can only be received on personal phones if the employee knows the “right” people in IT who are willing to bend the rules to make the customer’s life easier.

Although I appreciate that it’s important to discourage employees from playing Angry Birds or from Facebooking on company time, they’ve taken control to extremes. His hospital IT department seems to be missing the point that their prime role is to support staff in the safe and efficient care of patients. Making it more difficult for clinicians to do their jobs isn’t in harmony with that mission, not to mention the cost of the hospital paying for owned handhelds and then reimbursing staff for personal devices.

When I saw a recent article called Doctors Driving IT Development with their Mobile Device Choices, I immediately thought of him. I instant messaged the link to him on both his hospital device and his iPhone to see which one was read first. Of course, it was the iPhone. Surveys estimate that over 80% of physicians are using smart phones, up 11% from 2010. The article states, “Instead of hospitals and vendors telling physicians to adapt to their preferred ways of using technology, physicians are gaining the power to sway hospitals and vendors to their preferred way of using it.”

Albany Medical Center is cited as allowing physician-owned devices on their network to meet physician demand. Administrators created a project to allow physicians to test drive an iPhone, iPad, and BlackBerry over a three-month period. The Apple products were clear leaders. I’ve personally used all three, and each has its strengths and weaknesses depending on the demands placed on them by users.

Everyone talks about usability these days, although in most contexts, it is application usability being discussed. I don’t hear as many discussions about hardware usability as I used to. That’s a tremendous “miss” in my opinion. I hear a lot more discussion of the color choices for carts used in computer on wheels implementations than I do about the computers that will ride on those carts. (And for the record, if I was asked — which I wasn’t — I would have picked colors that would have helped identify which users left their carts abandoned in the hallways for me to weave through on rounds — red for phlebotomy, pink for OB registrars, green for interns, etc.)

Some CIOs I know are quick to blame software vendors for poor usability, failing to realize that hardware often plays as much a role in how usable a clinical application is as does the operation of the application itself. Case in point: an orthopedic surgeon to whom I regularly refer patients cornered me in the doctors’ lounge complaining about his EHR (which happens to be the same one I use in practice). He wanted to know how I stand “all that scrolling you have to do all day long.”

I told him I haven’t had to scroll since taking Version X of the application in 2009 and asked if he was on an older version. No, he said he was on the same version I was. Even though he’s employed by a competitor, as the designated “computer expert,” I wanted to help him. (Plus, he’s a darned good surgeon and always sends me a nice bottle of wine at the holidays.) I asked him to send me a screen shot of his scrolling problem.

After a brief phone call to explain how to do a screen shot, I had his answer. His wide-aspect laptop didn’t allow his workflow to appear without scrolling. His application fell off the bottom of the screen and he had a huge amount of white space on the right. The scope of choice allowed by his IT department is this — Tablet PC (one option) vs. Laptop (one option) vs. Desktop (one option).

For the last two years, he had been blaming the software vendor, when really it was the hardware. I sent him a screen shot of my workflow — the patient’s chart fits neatly on the screen with no problem. Although I’m sure his laptop is great for streaming Netflix, it wasn’t a good choice for his EHR.

I understand that there are a great number of choices in the market today and hospitals can’t be expected to support each and every one. It’s not practical for contracting and procurement, it’s expensive, and it’s a support nightmare. On the other hand, IT departments have a duty to provide hardware that properly displays applications and meets user needs for durability, portability, and speed.

Hardware vendors are savvy and will continue to create new platforms and expand on those already in the marketplace. Users are savvy and will always want the latest and greatest in hopes that it will make their work easier. IT teams who can temper their own needs and wants in favor of those of caregivers and end users will continue to have greater successes than those who don’t.

E-mail Dr. Jayne.

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Currently there are "10 comments" on this Article:

  1. Dr. Jayne, your point is well received. In systems as complicated as healthcare delivery, many factors contribute to the efficiency, effectiveness, and satisfaction with which each individual player in the system can accomplish the tasks he or she needs to perform. Attempting to narrow the scope to one particular component in the process can easily overlook the other contributing factors such as hand-offs, processes, division of roles, software, hardware, configuration, and environment.

  2. “I understand that there are a great number of choices in the market today and hospitals can’t be expected to support each and every one. It’s not practical for contracting and procurement, it’s expensive, and it’s a support nightmare. On the other hand, IT departments have a duty to provide hardware that properly displays applications and meets user needs for durability, portability, and speed”

    Judging from the previous 9 paragraphs, no you don’t. IT is understaffed and has a low budget. Yet everyone demands a personal IT staff for themselves (that’s what it would come to unless you standardize on a solution that can be supported well). Regarding the hardware, you forget that the hardware might have been purchased to support one application, then another application gets bought and the upper echelon expects the existing hardware to do the job. Was there additional money and especially time factored in when the plan was made for the new application? How about you give IT all the budget, FTE’s, and *time* needed to do what all the Dr’s want, and *then* complain if it doesn’t get done. Of course, that might mean getting a 100 time increase on IT budget, but then your demands would be realistic.

    I’d like to see Dr Jane work as an IT person for a while, endure the abuse the IT staff gets from doctors, see what how they have to make due with their tiny budget, and then maybe she’d really understand.

  3. The IT gatekeepers are actually fiercely loyal to maintaining security over their patients’ records, not to the vendors. iPhones are usually banned becuse of their lack of adequate security mechanisms, unless carefully configured by IT professionals (we’re working with Apple to plug a hole we found in their security now). The issues re: alternate devices is that it takes time to adequately test and secure these off-standard devices and then it takes staff time to answer all of the questions that continually arise afterwards when the users have problems. An IT organization has to be able to find the balance but expecting them to adopt or authorize every request or user with a new device and a perception that it would be better is not realistic with todays’ budgetary and staffing requirements.

  4. Hmmm, a bit one sided Dr. Jayne. Most IT shops (or at least the good ones) try to balance risk (security mainly) with client satisfaction and productivity, but are often compromised with budget and skill set gap.

    Your example of the screen resolution is a good one that may expose an IT team not familiar with the best choice for viewing the EHR app or a “computer expert” at a hospital that doesn’t know how to take a screen shot much less ask the appropriate party for help.

  5. This is a fairly frustrating article to read. Foremost, as it typically describes the physician’s perspective of IT, the “just make it work” mentality, no matter the support or administrative effort it takes.

    Specifically, BYOD (Bring Your Own Device) is not just an IT diligence issue. It’s a HITECH Act issue. It’s a privacy and compliance issue.

    Read the OIG report on hospital security lately? Probably not, since most physicians don’t have to read it. They have IT people who have to do those things. And the stark reality is BYOD, Apple, Android, and all the litany of consumer devices physicians want IT to support and allow onto the hospital network introduce IT support and security complexity. In big ways.

    Those hospitals actually getting meaningful use money and staying in compliance won’t sanction BYOD, will fiercly fight to protect network security, and have standards to mitigate complexity.

    I just don’t want to be the first guy that the OCR fines because of a BYOD security incident. Or a sanctioned Apple iPad security incident.

    Physicians need to be working with IT and understanding why these things are important. I just don’t see that collaboration, nor interest in having collabortation.

    As demonstrated by the tone of this email.

  6. Dr. Jayne, I think your friend’s AMC has an IT Governance problem. Either the CIO has been given too much voting power, or the investors (like the CMO/ CMIO) have been given too little. Or maybe, your CMIO friend never developed the winning business case that got the doctors what they need.

    I’d like to see the CMIO’s business case (not that I wouldn’t support it – I’d want the same thing if I were a doctor). And in the time when you can’t enlarge the “IT spending pie” – only redistribute it, I’d like to hear the CMIO’s argument that someone else in the health system will have to give up a piece of their IT pie so the CMIO can have a bigger piece.

    If the CIO has the right funding and is not meeting expectations – well, that’s another problem that can be solved by good IT Governance. If there is a better way of managing the IT investment of an organization, I’d like to know.

  7. I think others have stated my position. The notion that IT should support any technology that a physician wishes to use does not consider the whole picture. The example cited where the device did not properly support the application should not happen. But a policy of supporting devices based on physician preference would eacerbate such occurences, not improve the situation.

  8. I agree that this is unfair and a little discouraging to read as a CIO. Thanks to HITECH, we’re all struggling with encryption at rest requirements along with the security concerns we’ve always had. I can’t have a mobile device in my environment that might contain PHI that isn’t encrypted. I have researched Apple, Android and Blackberry devices and have personally pleaded with some of the vendors of these devices to help us address this big security gap so that we can safely utilize these in the health care industry.

    If your IT staff is like mine, it has been hit with requirements that have increased exponentially even while the staff has been cut by a third and the budget slashed to nothing. I can’t even afford to replace 8 year old computers at this point. We are doing the best we can with what we have.

  9. I have been preaching to my staff that we need to get to a Bring You Own Device (BYOD) environment. They keep stumbling with the technology mix we have to work with.

    Most core vendors are scrambling to adjust to ARRA and the ONC technical standards (which i applaud the ONC for this effort). The development dollars are not focused on UI at this point, but rather, on meeting the requirements set forth by the ONC.

    Dr. Jayne, you are correct, a BYOD environment is where we would all like to be. IT departments are searching for ways to balance the user experience, the technology available, and the security challenges. Ubiquitous data, with roaming clinicians, and a cornucopia of devices create a security and compliance nightmare.

    It is a problem. It is not the IT department’s unwillingness, it is the industry position at this time.







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