To give you some authentic insights into healthcare IT, we asked several hospital IT managers what challenges they face and how they address them. They agree that the demands on the quantity and quality of IT services provided are constantly on the rise, along with pressure to keep staff resources down. A number of IT managers had to make qualitative changes in the IT organization and at the same time set clear expectations of just what the ICT departments are able to provide and on what terms. These changes mostly concern the transition to process-managing the provision of services, often supported by an information system and other IT tools.
Urgent solutions and IT operations 24×7
One of the most significant distinctions here is the need for urgency when solving IT problems. Just as hospitals have an accident and emergency unit for acute cases, IT teams in hospitals also face urgent situations that need to be addressed immediately, so as not to endanger a patient’s life and keep the hospital running smoothly. Hospitals never stop, which is why IT also has to be constantly available. IT is on standby on weekdays, through nights and at weekends. Continuous 24×7 supervision means having services on your phone ready to start working on a solution to any problems at once. Whether remotely, or hands-on.
“One of the specifics of running clinical information systems in hospitals is their continuous operation and system accessibility. Any incidents must be dealt with in real-time, without shutdowns. You thus have to monitor the system and infrastructure constantly,” says Jan Nechojdoma, ICT Administrator, Pardubice Hospital a.s.
Large sites with hundreds of rooms
Hospital complexes represent a labyrinth of buildings, corridors, wards and rooms. Hundreds of rooms on several floors in dozens of buildings are not uncommon. Working in a hospital also brings with it a number of logistical problems. Device location data is helped by unambiguous and visible labelling on computers and enabling remote access to them. If the computer or device cannot be remotely accessed, we need to locate it quickly. In such cases, it helps to have systems featuring maps or other traceability options. In addition to standardized location info such as the building floor, room, department etc, it is useful to use an informal name e.g. ‘IC Nurse’. It often happens that such descriptions are included in support requests, and the technician needs to know where to find the given place.
Other logistical problems are posed by the hospital environment itself, where hygiene is naturally of much greater concern than in other kinds of premises. Keeping things clean brings unexpected problems, such as the wearing away of computer labels, so technicians have to choose more durable materials. The planning of service interventions must also take into account the strict hospital regimen. Some things simply get to wait until the sanitization day, and there are also departments accessible only by prior arrangement.
Complex organization and shift-work
A specific feature of hospitals is their intricate organization, partly akin to factory working, when several different workers (typically nurses) take turns using the equipment within each shift. The next shift then uses the same device. Meanwhile, the asset is often registered to yet another person, such as one of the departmental doctors. This often makes it well-nigh impossible for IT to trace a device by its user. Equally, a request made by the nurse on the night shift will have to be dealt with a completely different person during the day, since the first nurse is now off work. In addition, the head nurse needs to have access to the IT requirements that other nurses have raised. Without rigorous records the IT team can easily become disoriented, or its functioning become dependent on particular individuals, who manage to hold relevant information ‘between their ears’.
This also brings problems in licensing, because many manufacturers today try to license primarily ‘per user’. Quite another topic is the notion that nurses should need to log-in, since it is impractical for a new user to constantly have to log into windows for each entry, yet to make entries to the hospital system you need clearly authorized users.
To this day we continue to find hospital information systems that are not unified and are made up of several disparate solutions more or less integrated together. This requires more demanding management and maintenance. We need to keep several different vendor request queues for software development or patching.
Hospitals work with very confidential information. This means having to thoroughly record any requests for changes to authorizations. We also have to log any changes in patient records, which has proved to be very useful even for detecting fraudulent reimbursement claims for medical care that was not actually provided.
Hospital systems also quite intentionally restrict some data changes to patient records, as this could be precarious. Such operations are then performed by the IT team based on formally raised requests and sometimes only after these have been given confirmatory approval.
Prevention of medical equipment outages
Preventing or resolving outages at an early stage is essential in a hospital environment. This is helped by systems that automatically notify of any devices that need to be inspected, based on a regular inspections schedule. Naturally enough, equipment or parts that need to be replaced because their service life has ended have to flag up a warning to that effect. Monitoring systems are also becoming common practice, alerting to potential outages even before such an outage occurs. This significantly helps to increase the overall reliability of IT services and of the medical devices.
David Zažímal, Head of ICT Department at Jihlava Hospital, says: “ICT staff have more capacity to deal with requests in a meaningful way. They aren’t jumping from one thing to another and getting distracted. All tasks are recorded, whether they are requests from users or within the IT team.”
IT managers are no longer overwhelmed by maintenance and technology swapouts and have more time to plan and implement proactive measures. They can use statistical records to identify frequent problems and plan the necessary measures. “Making the requisite changes to ways of working needs more energy at the start, but lets you move from ‘fire-fighting’ to actually preventing such fires.”