November / December 2005
How Much Pain is Normal? How Can Clinicians Help?
Healthcare software will continue to be a strong driver in improving the quality of care for patients. This good news for patients often comes with its own set of challenges for the caregivers who use the software, especially during implementation.
Implementing new healthcare software can be painful. Care processes change, and the software itself may need adjustment. How can you determine when it’s appropriate to raise a red flag about a problem with new software?
Here are some steps clinicians can take to evaluate the “rough spots” and decide whether they are to be expected or need immediate attention:
- Determine if the problem is a bug or a “feature.”
- Understand how critical the problem is and if it demands immediate attention.
- Communicate serious problems in a helpful manner.
- Recognize a poorly managed implementation.
- Help the next implementation go more smoothly.
Is this a bug or a feature?
You look in your hospital’s computerized physician order entry (CPOE) system for the standard order set for strep throat, and you expect it to be under “strep throat,” as decided in the meeting you attended. You find
it under “sore throat — antibiotic treatment” and it contains penicillin, although you remember it was decided in a previous meeting that
the treatment would be erythromycin. Bug or feature? It could be either. Maybe the chief of medicine walked into the room where the implementation team was working and demanded this change, or perhaps the implementation team used draft notes from a previous meeting to set up the system.
Clinicians should ask the implementation team if the information in the CPOE program is correct and if so, how that decision was reached. There is no point in berating them for a mistake before finding out how this change happened. Either it is a mistake that will be fixed, or it is something that needs to be brought up to the hospital’s medical decision-maker.
Often, providers do not agree how the software should be set up. Typically, after numerous meetings, a final plan is approved by those who attended the last meeting. However, there may be confusion about the final decisions because so many possibilities have been discussed and some people haven’t been to all of the meetings.
What priority should your problem take?
We all feel that the problems bothering us are important. How can you determine if your problem needs to be moved to the top of the implementation team’s priority list?
Here are some ways to tell if your problem is critical and should be brought immediately to the implementation team’s attention. The more “yes” answers you supply to the following questions, the higher priority the problem should have.
- Has it put a patient into an unsafe situation?
- Has anyone else in a similar role experienced the problem?
- Is there no safe workaround?
- Does a knowledgeable co-worker agree that this is a serious problem?
- Is the implementation team unaware of the problem?
- Is the implementation team working on less serious problems (i.e., medication dosages aren’t correct, and the implementation team is working on making the reports look better)?
- Is the problem in the emergency department, surgery, or an ICU?
- Does it prevent you from doing your job?
How can you communicate serious problems quickly and effectively?
You’ve determined that your problem is important. Now, how can you communicate it quickly and effectively?
- Write down what happened step by step, with as much detail and as many screenshots as possible.
- Talk with your peers to make sure this problem hasn’t already been reported and that there is no workaround for it.
- Report the problem in a positive manner through these two channels:
- Report problems through the implementation team’s official process. Make sure to get and record a confirmation number and the full name of the person taking the call.
- Report problems through your organization’s management hierarchy (i.e. your supervisor) to ensure that your problem is prioritized appropriately according to its potential medical consequences.
- Follow up early and often. Consider using different ways to follow up, such as email, in person, and on the phone.
Is your implementation poorly managed?
Here are a few ways to recognize a poorly managed implementation:
- If your problems are not being worked on, is the implementation team working on problems that are more critical than yours? If not, then there may be a problem with how problems are prioritized. Problems may have been prioritized by date or arbitrarily.
- Do implementation team members hear status updates after the medical staff gets them? If so, communication within the implementation team may be poor.
- Are there numerous high-priority problems that are taking days to fix? If so, it means that either the software is difficult to implement or your implementation team is not strong.
- Do you hear back from the implementation team when your problems are addressed or, with a progress report. If not, then the system for managing or documenting problems may be poor.
How can you help the next implementation run more smoothly?
Here are some things you can request that will help your next implementation run more smoothly:
- Request that decisions about how the software will be implemented are captured in a generally available document to lessen the chance of confusion between bugs and features.
- An online method for entering and tracking problems.
- Extensive user training for the software.
- Information posted at all workstations about the process of prioritizing and reporting problems and tracking their progress.
- Medical leadership to work at all times with the implementation team to prioritize the problems based on medical concerns.
- For each medical team using the new software, a dedicated expert to handle questions.
- Additional software expert available to help with any remaining questions or problems.
How fast will you see the benefits of your new software?
Frustration with the initial implementation of healthcare software is common. However, after a few months of using the new software, clinicians often wonder how they ever worked without it.
One of the key things to remember is that change is difficult. It is difficult to deal with process changes that new software brings. However, without change, it is not possible to improve the quality of care for patients. Software will continue to be an important component of raising the quality of care that you provide to your patients.
Andrew Needleman (firstname.lastname@example.org) is managing partner of Claricode in Newton, Massachusetts. His firm develops integrated custom solutions exclusively for the healthcare industry. Among his recent projects was a Web application for second opinions designed for Partners Telemedicine, a unit of Partners HealthCare in Boston, which was recognized as an Intel Solution Blueprint for best practices in healthcare with Microsoft technologies. More recently, he designed crucial coding improvements in a leading CPOE product that sped it up 100% to 250% across the entire application.