I have a rather complicated connection to our CIO, our transformation to a larger system has turned my once solid line of reporting to a light colored dash. However we still meet as a team and individually so I am exposed to many of the IT initiatives and projects that are going on within the facility. It is breathtaking to me that there are so many things going on. Many of the projects have a common purpose, to make us more efficient. As I think about these items and the projects my team has completed lately, I am not so sure that the “efficiencies” ever actually materialized.
Technology in general is growing and improving at a feverish pace, daily advances in technology open doors to innovations we have never seen or dreamed before. In today’s world, we can connect a computer to just about anything to gather, analyze and report data. Almost daily I hear about a new product that will interface medical equipment to a computer, collect vitals and electronically upload data into a patient’s record. The promise is speed and accuracy; no longer will pen and paper be needed in your organization.
However, as I look at the growth of the IT workforce and my own experiences, I wonder if all these things really save time? What I am noticing is the advancements seem to do more shifting of labor than actually saving it. It starts with the project planning, a group of stakeholders and technical folks are convened to discuss and implement the software. This group is never less than six people and some projects here have had more than ten. The time commitment is usually a two-hour biweekly meeting, plus homework for 90 to 120 days. The man-hours to get a project implemented can easily exceed 250 depending on the complexity. However, the largest demand and transfer of labor is in the form of technical support.
We have implemented a surgical information integration program to capture vitals electronically during surgery and the recovery of patients. This system eliminates human entry errors and allows users to be more efficient and increase their focus on the patient. However, to achieve these gains, super users and a program administrator are needed to manage the system. When the system doesn’t work correctly, someone from IT or my team is called to help identify and fix problems. What I am also discovering is that problems quickly become complex because a single department/service line doesn’t own the system. We all have parts of the system, my staff is called for the medical equipment, IT hardware is called for the interface computer and IT software or super users are called when there are program problems. The OEM also complicates the issue by falsely indentifying whose problem it is when staff calls them. When I add up all the time needed to solve problems on this system, I actually think we spend more time on it then the time it took to manually document it. So, essentially, we just moved the labor to someone else. I have other examples; our wireless temperature monitoring is another good one. Before wireless temperature monitoring, staff checked refrigerators every shift and recorded the temperature. Now, it is done automatically so they do not have to write it down. However, my staff has to assign, calibrate and replace batteries on the tags. The labor to do this is quite substantial; I would bet it is more than writing down the information.
I am not advocating that these projects are not worthwhile; removing the human element from recording data improves consistency and accuracy. This translates into reliable records that improve patient care. I am just stating that advocating for these systems on the premise that they save time and labor is flawed.
Another element to all of this automation is that people are slow to change. Imagine, hypothetically, spending $1 million to implement a system that is designed to do a function automatically. To remove a tedious task of writing entries or filing papers, to collect data without user intervention. Then, imagine after six months of implementation the staff is using both the old written system and the new automatic system. I have witnessed this, the staff doesn’t trust the new system, or the system doesn’t exactly address their need which causes staff to keep using the old method. Sometimes it is an interpretation of a regulatory requirement that also prevents people from giving up the old system. When staff continue to run both systems the workload increases and nobody wins, money is wasted and ultimately the vendor supplying the product will receive negative feedback.
My purpose for writing about this is to share with you that these advancements in integration and technology may impose a labor demand on your operation. This fact is seldom pointed out by the vendors when selling systems to our customers. Most of the requests I see for these types of new products always include labor savings in their justification. However, as I have pointed out, the savings may only be within the clinical department because every system needs support. I am not suggesting we should be resisting these advances, we should be engaged and asking the question, “Who is going to support it and how much time will it take?” There is a higher success rate asking for labor before implementation than after, when your department is the only one suffering because of the workload. I think that as health care continues to be squeezed people are capitalizing on technological advancements to reduce labor and be more efficient. We need to be ready to address the labor shift that is sure to come our way.
Jim Fedele, CBET, is the director of clinical engineering for Susquehanna Health Systems in Williamsport, Pa. He can be reached for questions and/or comments via email at email@example.com.
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