Purna Prasad: Finding a ‘Happy Marriage’ in Your Service Workflow

The arrival of electronic medical records (EMRs) has disrupted the traditional service workflow of information technology (IT) and healthcare technology management or clinical technology (CT). The idea that CT starts at the bedside and IT starts at the network, and the two sides play nice on the monitor is gone. When it comes to EMRs, CT and IT are merged. They are responsible as a single service provider to shepherd a seamless flow of monitoring, diagnostic, and therapeutic data from the bedside through the network to the EMR, finally displaying that data on various end devices. Such devices include traditional desktop PCs, laptops, tablets, smartphones, and electronic dashboards.

Outputs from clinical systems are displayed on traditional IT desktops. When a desktop goes down, clinical monitoring is disrupted. Previously, a nonworking desktop was a medium or low priority call. With today’s architecture, a broken desktop displaying physiological signals is a high priority call and requires expedited resolution.

Technicians working a high priority call have no time to document it. Patient care is in jeopardy; the care team needs the problem fixed ASAP. But a lack of documentation gives rise to a breakdown in communication. Teams in the merged IT/CT department are in the dark about the down desktop. The application team, the network team, the interface team, and others have no idea about the working of the ticket. The traditional IT process is incapable of quickly resolving clinical issues.

There is a need for optimizing a support structure that combines the excellence in IT documentation and process with the efficiency of CT problem resolution. The two workflows need a happy marriage. The prerequisite for a happy marriage is to recognize each other’s strengths and optimize them to resolve the weaknesses of each. Compromise in legacy practices to achieve superior clinical support is the secret sauce.

This is easier said than done. IT and CT come to the table with a baggage. This baggage consists of egos that cloud pragmatic views, emotions that cloud the ultimate goal, and ignorance of domain knowledge that presents a hurdle to response structure composition.

A new support structure should start with the renaming the help desk to service desk. The service desk should have a biomedical technician available 24×7 to handle calls from clinicians. The technician would resolve the problem while an IT colleague would be on the call as well to document the proceedings. Imagine a call from the OR involving an anesthesia problem. There is a patient on the table; expedited response to resolve the problem is mandatory.

The technician might page a clinical engineer and direct him to the OR. Such a workflow would resolve the problem, while also taking care of the necessary documentation. The traditional IT workflow of opening a bridge line, paging all teams, and waiting for them to get on line delays the resolution. If network and other teams are required, the on-call person should be automatically brought online with a single person-to-person call. With this methodology, the traditional workflow of an IT help desk is optimized for rapid response with comprehensive documentation.

Purna Prasad, BE, MS, PhD, CCE, is the director of clinical technology & biomedical engineering at Stanford University Medical Center in Stanford, CA.


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