The Age today reported on page 5 substantial concerns by anonymous whistleblowers that Victoria’s Healthsmart IT including its patient management and clinical systems which are still being rolled out to hospitals, are not as functional as hoped and too expensive.

I am not sure the adjectives printed in The Age are totally appropriate, but certainly it does suggest there is significant frustration with the systems and perhaps the process of ensuring adequate functionality and efficiency that meets the needs of users, and in the end, patients.

Much has changed in expectations of IT systems since these systems were selected in the early years of this decade, and people now expect an efficient, nice to use, user interface where data is entered only once and with a minimum number of mouse clicks, and that real life processes will have been examined and the IT system really support it to improve its efficiency.

It is unlikely we will get a beautiful user interface experience like the iPhone, but there is no reason why this could not be possible, or at least attempted – instead of an interface of the late 1990’s – but even with such interfaces, they can be made efficient.

Unfortunately, I missed the DHS forums on the clinical system earlier this month (see previous blog) so I can’t really comment on these systems having not used them personally, but I do suspect, given the amount of pressure placed on health care workers to do their normal jobs, perhaps they have not been given sufficient time to have inputs into system design, and perhaps the motivation that their time will result in change.

Doctors would not have been likely to attend design stages of the patient management system because generally they do not directly interact with these systems as this is generally left to clerks – but they now may find that their lack of input may impact upon them in other ways such as the amount of time it will take clerks to do simple chores such as admitting a patient to a ward from ED, transfer to another campus, or get an outpatient appointment.

These repeated tasks which happen hundreds of times each day should not take dozens of mouse clicks and cognitive decision making at each step to achieve but should be achievable by just a few mouse clicks perhaps via speed buttons for common tasks with default values inserted and the ability to over-ride these for special circumstances.

Patient allergies and alerts systems need to be centralised so that third party department systems (eg. EDIS) can read and write to the centralised data system.

Likewise third party reporting should be able to read data from a data warehouse repository containing PMI data to allow managers to produce accurate live reports to ensure they have the best data available to make timely decisions to improve clinical systems – currently it seems such functionality is NOT available and that hospitals are expected to extract data from the live system each night into their own data repositories – this is not an acceptable solution in this era.

Systems which force medical and nursing staff to almost totally rely on IT systems such as electronic ordering of pathology/radiology, electronic prescribing, electronic clinical notes have substantial change management issues for staff – not the least is the need for almost a dedicated computer per staff member and available at the bed side or nearby, rapid security authentication, 100% 24×7 reliability even on days of 47degC when the power systems fail, and above all efficient data entry which minimises the time staff members spend on computers instead of attending to patients.

Ensuring IT systems work well for you is not a simple matter, and requires attention to the small details – something that most ED clinicians will not be too keen to involve themselves in, but which may be critical to the success of these systems – unfortunately, such ability to make changes seems to primarily sit with the original “lead agencies”.

By nature, governments tend to push for systems which they can most accord and which provide them with their required data irrespective of how onerous it is on hospital staff to enter, hospital IT departments tend to push for IT systems which make their work easier such as generalised whole-of-hospital systems instead of dedicated departmental systems designed for end-user efficiency.

It is up to end-users to ensure they have a say in ensuring that the user interface suits their needs and will work well for them – it may not be too late.

It is worth pushing to remove even small annoyances and inefficiencies as these usually do not take much programming effort (although money may be needed) but will impact users for years to come unnecessarily.