I just had the privilege to meet anesthesiologist and intensivist Dr. Patrik Hansson at Linköping University Hospital in Sweden. The meeting came as a result of a long conversation on Facebook, where Patrik expressed his frustration with the long time needed to login to the different IT systems each time he needed to access test result or images for his patients.
As an anesthesiologist he often handles life-threatened patients where time is a matter of life and death. Fast access to the patient’s latest lab results and images is absolutely critical to make the right decisions at the right time to stabilize and improve the patient’s status. Patrik illustrated the importance of quick access like this:
“Working with critical patient cases is like driving a car with Google Maps. You need Google Maps to tell you to turn at exactly the right moment—a few minutes’ delay makes you end up in a place you don’t want to be. It is very similar in critical patient cases. Blood test result and images are only valid for a very, very short time.”
As Sectra is the system used to handle all medical images at the hospital, I visited Patrik to watch him work, and I could immediately see what his frustration was based on. Patrik showed me that he needed a remarkable four logins to reach test results and images, as well as needing to use his ID card and waiting for each program to boot up.
Of course, this could be devastating in an emergency situation. He mentioned an example from the week before when a very ill patient came in to the ER with a punctured lung. Patrik needed to rapidly access the CT images to know which lung was punctured and suck out the liquid before anesthetizing him for surgery. Spending five minutes logging into the different systems to access the CT images would put the patients’ life at more risk.
So, what did I conclude from this visit?
The specific login for the Sectra image viewer just took a couple of seconds, exactly as it is designed to do. But the steps needed before that included authentication to the operating system, the EMR and several supporting systems. I understand there is a good reason to govern patient integrity making sure no patient data is leaking out to someone unauthorized. But in emergency cases like the one Patrik described, it seems like patient integrity has preceded patient safety…
This visit made me realize the remarkable importance of reaching patient information, lab results and images quickly and smoothly when it really matters. Just like Google Maps guide me when I am driving in a new city, the clinical systems should be able to provide the right information at the right time to guide the physician. When a patient state is critical it is equally critical to access information fast to make the right decisions. The patient’s condition is dynamic—either deteriorating or improving. Data is therefore also dynamic and not static, especially in critical care.
From other visits I know that it is possible to reach the Sectra image viewer with just one login, and also to review images remotely via an iPad or tablet. So I ask myself; How did it end up like this and what can we do about it?
First of all, I think it is important to realize that no matter how good our medical IT systems look in a demo setting, they also need to work in a real clinical environment. It is crucial that the IT system design and configuration are adjusted to the clinical workflow. And the only way to achieve systems supporting the workflow is for the IT vendor to design them closely together with the end users.
Secondly, it is key that the systems handling medical images and lab results are closely integrated with the EMR to make it easy to access the relevant information when needed. Integrations should be based on valid standards and the local IT department at the hospital plays an important role in driving the integration projects together with the vendors to make them work smoothly. For example, one way to solve the many logins would be to use an Active Directory (AD). This would remove the need to log in several times to different applications, instead it would work like your smartphone—once you have authenticated through your PIN, you have access to all apps like Facebook, the weather app, LinkedIn, etc.
The third factor is beyond the power of the vendors and is related to how the local hospital IT department coordinates all necessary IT systems to create a smooth working environment for the end users. From my experience it is crucial for IT to be involved from the beginning when purchasing diagnostic systems, so they understand the clinical demands, the purpose the system will serve and the clinical workflow. IT also has an important role in defining the requirements to reflect necessary demands on IT and safety.
After meeting with Patrik, a thought hit me on my way home. Each IT system at hospitals generally has its respective owner, but who owns the responsibility for the total user experience and for creating a smooth working environment?
To sum up:
One thing to remember is that, because healthcare is complex, there will almost always be a mismatch between the clinical workflow and how the IT system serves its users. Therefore, processes need to be put in place to improve both workflow and IT system configurations over time in an iterative process. Clinicians need to spend time on articulating their requirements and work closely together with their IT department, but also engage with IT vendors to incrementally improve the systems.
I am very thankful for Patrik letting me visit him in his daily work to understand that a good IT system is not enough on its own. Users, IT vendors and the IT department need to work together in a symbiosis to empower physicians with clinical systems that support their mission to save patient lives.
This article was originally published on LinkedIn: The right information at the right time—a lifesaving symbiosis between physicians, vendors and IT in healthcare