Interview: Systems failure can paralyze the hospital, yet health care has to keep going

How is IT in healthcare different from other enterprises? What specific issues do you have to resolve?

There are plenty of specifics to IT in healthcare compared to other sectors. One of the things we have to deal with is the huge quantity of diverse hardware and software. This is because in the healthcare sector you’ll find very many companies supplying medical technology and equipment. For example, taking just X-ray machines, there are a lot of different modalities (CT, magnetic resonance, PET/CT), each of which can have a different manufacturer. Many of them feature remote supervision, governing that modality. The manufacturer or health technology department is responsible for the equipment. Such a device is often connected to a monitor or active element that may or may not be our responsibility. For us this means the job is largely about ‘networking’, the supplier’s remote access, and especially security.

To maintaining a unified IT environment is sometimes very difficult. Naturally enough, the hospital is primarily concerned with people and health care. In practice, it often functions like a million islands, with communication lagging behind. Take, for example, when a new device for treatment is bought, and only afterward we find it needs some connection to the network, extra disk capacity, a server… That’s the situation we’re trying to change. Legacy hardware and software also causes problems. On many computers we have to maintain truly prehistoric software for specific devices, while the manufacturer no longer guarantees any maintenance or development.

What about logistical problems? I expect you can’t just come to the operating theatre whenever you want…

All service interventions and maintenance measures do need to be well planned. For example, if the task is to boost the wifi in the operating room, we can’t go there the very next day and start pulling cables. We have to wait, sometimes even a month, until they have a sanitization day. And then there are rooms for cytostatic treatment (irradiation) where no one is really allowed at all. The terms and circumstances of access have to be agreed in advance. Exceptionally, there are situations when a monitor needs replacing right away, during the operation. In such a case, the technician must get completely disinfected and dressed-up like the medical staff. Our context can manifest in such small things as having to choose more durable stickers for labelling the computers, to withstand being wiped not just with water, but with disinfectants etc.

What are the critical systems in the hospital? What happens if there is an outage? What will be the consequences, for patients?

When critical systems fail, the running of the hospital can be paralyzed. That’s not to say the health care stops. Operations will not be interrupted because of this. The patient will be treated nevertheless. But it does affect all the communications relating to the treatment. The hospital information system contains the patient’s medical records. It is also printed and stored in hard copy archives, but who would go to the archives nowadays and keep the patient waiting? Similarly, the system for evaluating X-rays these days is only in electronic form. When further treatment depends on the findings, then without an information system the information would have to be relayed by telephone or on paper. Then there are places such as a laboratory, haemo-dialysis or the pharmacy. A specifically pharmacy-related issue is that of the refrigerator temperatures, which need to be constantly monitored. A longer outage there could cause losses in the order of millions of crowns, because of the biological treatments and other expensive drugs held. Of course, all this presupposes there’s been a failure of prevention. Overall, I might compare the outage to when your car loses its turbo. You won’t come to a halt, but until you fix it, you’ll drive at 20 km/h. Not to mention that after the incident is resolved, you would have to complete and update all the missing data records.

You mentioned the main focus in the hospital is on people, not technology. There tend to be only a few computers on a ward, how do you deal with security and login, practically speaking?

In this, the hospital resembles a factory operation. There is a computer on the ward, where doctors and nurses take turns. For the staff, working with an information system is just one of many steps. For example, the nurse may record having given the patient medication and immediately goes on to do other work. But this way of working has pitfalls, both security and practicality related. In our IT, I generally follow the trend of linking everything to the user, not to the device, because the device is anonymous. For Windows we use what are known as universal accounts. To make it secure, we have to demote the PC to kiosk mode, with greatly restricted functions. On Windows, you get logged into one universal account, but cannot do anything within the system until you identify yourself. We try to maintain the necessary security, but at the same time not to complicate the normal working of doctors and nurses.

From my own visits to hospitals, I get the feeling that nurses and doctors are the last remaining users of matrix printers in the country. How are hospitals doing, in terms of technical facilities?

As for the printers, that’s an easy one. Some types of multi-layered documents, such as sick leave notes or prescriptions for opiates just need an impact printer. And that’s a good way to explain the situation in hospitals, by way of example. Of course, we could replace them with laser printers, but a toner cartridge costs 1000 crowns. Whereas matrix printer ribbon comes to 60 crowns. So, you live with the fact it’s noisy, forget about looking stupidly outdated and the long time it takes, and save money on printing. The ideal solution, of course, would be electronic sick notes. These are to be mandatory from 1 January 2020, so this digitization is following on from ePrescriptions. In general, however, IT in hospitals is several years behind. I have also experienced cases where data was carried from the hospital to the insurance company on a CD, even though it could have been sent electronically. Elsewhere, the IT team had the ‘server room’ in their office. I would say that IT is very underfunded in hospitals in the Czech Republic. In Jihlava, IT is part of the management and we have an investment budget in addition to the operating budget, which allows us to develop IT services in the long term. We are more of an exception than the rule among hospitals, though. In some hospitals, IT doesn’t even decide about buying toner. This pushes up the admin costs of decision-making and IT is terribly constrained overall. Many find that demotivating and leave the job, for the private sector.

We talked about critical systems. Can you afford to spend time on small everyday improvements?

Of course, IT can also contribute to patients having a better stay in the hospital. In Jihlava, we strive for high-quality WiFi coverage, since that is the most utilized ‘service’ for patients. The trouble is that ensuring high-quality, fast, secure WiFi networks is very expensive and time-consuming, yet the hospital has to find the resources for itself – such things are not really covered by health insurance. Another service that we are providing more and more of is TV in the recovery room, built on IP technology – centrally managed and delivered completely via a computer network. We currently have more than 170 of them.