Monday, October 20, 2008

The Disjointed Servers of Health Care

Here's how we serve health care in 2008:
Need to read an echo? Sign on to the KINETDX echo server.

Need to read an EKG? Sign on to the MUSE EKG server.

Need a cath report? Sign on to the APOLLO server.

Need to read a chart? Sign on to EPIC.

Need to check a pacemaker? Sign on to the PACEART server.

Need to read an Xray? Sign on to your local PACS system.

Need to check your e-mail? Sign on to the in-house intranet.

Need to read your e-mail from home? Sign on to the CITRIX server.

Need to sign your charts? Log on to the Electronic Patient Folder server.
And that's just the beginning.

* Sigh *

It's no longer an "electronic medical record" we're using but rather a sea of electronic medical servers.

Now let's see, what was that password again?



The Happy Hospitalist said...

I couldn't agree more. I spend a good 2-3 minutes every single time I have to log into the daily chart, then the electronic record, then the radiology system, then the dictation system.

And the HIPAA rules log me out after just a few minutes of inactivity.

Give me one system. Give me one log in. Make it voice recognizable. Make it wireless. And make it fast and I could double, no I could triple the number of patients I see in a day.

You want us docs to be efficient. Stop making us waste so much damn time standing around doing nothing.

Anonymous said...

And of course, for security purposes, your password needs to be changed on a frequent basis. Obviously the servers are not in sinc with each other, so you never know when your old password is required to be changed. And, of course, you can't use anything close to any other password previously utilized. Where do you store all those passwords?

rlbates said...

I agree--just one, not the sea.

Anonymous said...

AND every hospital has different servers! I currently work at 2 hospitals, and I have to know every server at both hospitals. Wouldn't it be nice if at least they could be consistent with every hospital in the state having the same programs? The worst is when you forget a password, have to call the IT help desk and they spend 20 minutes trying to reset your password. talk about inefficient!

DrWes said...

The issue runs even deeper. Now, we must log on to each server to check for "non-verified" readings that need to be electronically "signed." Because there is no centralized location to know which server has non-verified reports that need to be electronically "signed," we must log on to each server to check for outstanding reports EACH DAY. We assume the entire liability for the presence of this "signature."

It now seems as though each subspecialist is becoming a subspecialty server specialist.

And that, as they say very tongue-in-cheek, is "special."

Anonymous said...

It is ridiculous that you accept this. If you roll over, IT geeks run all over you. If you demand excellence they will provide you with it.

Anonymous said...

Art_Vandelay - Dr. Wes - a couple of recommendations:

1. Ask if the plan is to migrate to the Cardiology Module - Cardiant. It is definitely less robust than each of the best-of-breed systems you've mentioned but it is quickly getting to the "80/20" function level (i.e., 80% of the most needed functions to do the ROUTINE processes are there). If/when you get this going, ensure they allow you to "result" and "electronically sign" the individual results still generated in each of these best-of-breed systems (e.g., MUSE).

2. With the systems you mention, this actually is a result of point solutions being implemented for medical image and waveform capture (i.e., an information system being connected to a biomedical device (EKG, echo) to capture the non-standard data flowing from the device). This gets into a whole other scenario of FDA certifications, vendors who don't want to work together, biomedical engineering vs. IT, purchasing standards, etc. These systems will not go away anytime soon BUT you can:

* Have the waveform images sent to Epic (GE has an interface for this with some nice options)
* Have the Cardiology Picture Archiving and Communication System (PACS) images sent to your organization's PACS repository or to Epic (e.g., from Siemens KinetDx, Caths). Cardiology vendors typically use a more proprietary form of "DICOM standards" which are used to integrate any image into a PACS repository. Minimally, a pointer record (like a web hyperlink) can be stored in Epic and if you click on it in the results area, it will automatically launch the PACS application and view the specific image (a little slower but it can work)

3. Since you will still need to go into these hybrid biomedical-IT applications for some time for the other 20% of the work (and because it won't be as often, you'll really likely forget your password) ask for a single sign-on (SSO) application or a CCOW application (this will log you into the different applications and can call-up patients automatically between the applications - i.e., if you have my record up in Epic, ALT-Tab to MUSE, my EKG records will come up in MUSE)

It really sounds like you are at the beginning of the transformation journey. It can be very very painful for users if workflows, system interfaces, and log-on's are not considered together. Some organizations elect to make trade-offs between types of users and specialties. My recommendation would be to ask the plan and the timeline. If possible, get engaged or get the Cardiology Administrator engaged to carry your message forward. Also, be sure your biomedical engineers/clinical engineers are talking with your IT department.

Best wishes... an IT geek who hears your pain.

DrWes said...


Thanks so much. We are very fortunate to have electronic access to so many applications and their associated information. But, like you say, the doctors are experiencing significant "growing pains." Hopefully IT administrators can use this feedback to understand the needs of those of us on the front lines to improve efficiencies as system (and server) integration continues to move forward.

Anonymous said...

Dr Wes - you bring up a great point. And Art Vandelay also makes some great points too. Probably the best one is to lobby for a SSO application (big bucks there). It's expensive and most institutions don't think it's worth the investment. Your job is to convince the higher ups with the control over the $.

The upshot? The physicians need to get involved in the process, not just complain about it. And involved doesn't mean complaining louder or more often. It means working actively with IT and on the selection and evaluation committees. (Yes, it means giving up some time to help the process along.)
And contrary to popular belief, the "IT Geeks" really don't want to deal with you; especially when you're in a rush, mad and already frustrated. Trust me, we're not trying to add to your pain. We honestly DO want to fix your issue if we can. So answer the questions nicely. Remember - there's a PERSON on the other end of the phone. Thanks!

Anonymous said...

You need to get your organization to support single log on (SLO). We have over 1400 disparate information systems, most of which do not speak to one another but we all access the applications we need with a single user ID and password. The SLO launches along with the application once you log on to the PC so as the application opens, it signs you on.