Healthcare IT support: Recommendations for a critical need

With the rapid deployment of complex IT implementations in healthcare, the need for enhanced IT support services has never been more urgent — and will only increase in the near future, particularly with ARRA requirements taking effect in 2011. It has never been truer that “meaningful use requires meaningful support.”

In addition, the sophistication of current IT systems is increasing at an exponential rate. Whether developed in-house or partnered with a healthcare-specific provider, the need for an equally sophisticated support network is critical in the most literal sense. The focus should be on an enhanced help desk which is really more of a complete “service desk.”

Recommendations: the top five
In order to set up and implement this new-model service desk, the following recommendations should be helpful:

1. Staff or agents who respond to calls should learn the clinical processes used by clinicians, as they work in tandem with the hospital's IT systems. This is really “support transformation.” Because of the blurring of the lines between IT and clinical processes, service desk personnel should no longer confine themselves to just handling technical questions while referring clinical systems questions to experts. They must become experts themselves in the clinical processes so that they understand and can prioritize urgent incidents. If a new IT system is being put into place in the hospital, the service desk support staff should attend the same training sessions as the clinical staff. Although they're not practicing medicine, they need the same in-depth knowledge of the system and how it relates to clinical procedures.

2. The service desk system should employ a good remote control tool that enables an agent to take over the caller's computer screen in order to better diagnose the problem and resolve it. This “global support approach” follows the physician or clinician anywhere — hospital, office or home. Since the caller is already in an urgent situation, almost by definition, the agent can't spend the time explaining over the phone; he or she has to be able to take over and walk the caller through the actual fix. If there is time, the agent can describe how to avoid the problem again — but the primary goal is to let the physician get on with the clinical work.

Familiar call center models, while able to manage higher call volumes,
typically employ IT generalists who lack the healthcare-specific expertise
needed to support the electronic clinical systems and therefore are unable to
achieve first-call resolution of problems on a consistent basis.

3. Have the entire spectrum of IT tools integrated into the front-line service. Besides the remote control capability, staff members who man the desk and respond to the calls should be able to proactively monitor the hospital systems. When a call comes in, the agent should know immediately what area of the hospital it's coming from and if all their systems are functioning — before even dealing with the specific problem. Just as a physician must have all possible information in front of him or her to diagnose a problem, so must a service desk agent have instant access to the total picture.

4. A complete clinical and technical “support knowledge base” should be available to agents to access in real time. This knowledge base should be rich in content, with actual, immediate and practical value to the agent and the caller. A sophisticated, efficient search feature is essential, as well, to put the knowledge in front of the agent as it is needed.

5. Explore a “shared cost” solution in order to spread the investment in an enhanced service desk across a multiple-hospital system. While ad-hoc improvisation, offshoring or simply employing a bare-bones help desk may save money and seem to work well enough in the short term, such temporary solutions are not cost effective in the long term. Less support means that clinical professionals are not spending their valuable time doing what they are trained to do — and patient care can suffer for it.

The background of these recommendations is no mystery to anyone who works in today's hospital environment with its reliance on complex IT systems. A brief look at the conditions that drive the suggestions — and make them necessary — is worthwhile.

The traditional help desk modelTraditionally, hospitals have employed either an internal help desk strategy or, more recently, an external service provider not specializing in healthcare. Some have tried to capitalize on the cost savings of offshore outsourcing. In both cases, a simple call-management and triage help desk typically is established to provide support, which often lacks the bandwidth to manage multiple cases simultaneously. During off-peak hours and weekends, calls are either fielded by the operations staff or, more than likely, sent to voicemail or to the hospital switchboard operator.

Familiar call center models, while able to manage higher call volumes, typically employ IT generalists who lack the healthcare-specific expertise needed to support the electronic clinical systems and therefore are unable to achieve first-call resolution of problems on a consistent basis. While they may be able to address minor support calls, such as password resets, serious problems are often passed to a single on-call person. Worse yet, the problems end up unresolved.

Improvisation as a band-aid solution
Frustrated by the inability of the traditional help desk to deal with sophisticated clinical applications, many hospitals put together their own ad-hoc support system. As described in a January 2009 publication by the Massachusetts Technology Collaborative, “Saving Lives, Saving Money in Practice,” hospitals participating in a study of support for computerized physician order entry (CPOE) employed a combination of support methods:

Physicians can call local nurses either directly or referred from the hospital help desk. There are also designated “super users,” both among experienced physicians and trained assistants. Back-up staff is also reachable on off-hours via mobile phone and remote observation of the user's computer screen.

Internal arrangements like this can work, but also draw nurses and physicians away from their primary responsibility, patient care.

Cross-platform expertise
In addition, today's advanced service desk professional should be able to provide assistance between the major IT platforms while simultaneously dealing with the usual clinical processes. It is not sufficient to pass a question or problem off to the Cerner group or the Epic group or the GE group because of lack of familiarity. To complicate the situation, hospitals are often in transition between platforms, so they need support between the legacy applications and the new — simultaneously. It is simply not an efficient option to rely on two help desk support systems. The modern service desk should be able to do it all.

The total solution
Ultimately, the service desk support model is one that hospital staff can call upon for a wide rage of support issues. If the infrastructure is available and performing optimally, doctors and nurses can spend more time at the bedside and less time on the phone trying to understand and resolve system issues.

Clinical IT support has often been thought of as a commodity that could be outsourced to the lowest bidder. But forward-looking CIOs and hospital leadership now are recognizing that the effort required to support today's users, with increasingly complex systems and applications, is in a period of unstoppable growth — and that a truly thoughtful, advanced “service desk” strategy, keyed to the clinical process, can improve quality and reduce costs.

Karl Graham is senior director of customer support, CareTech Solutions.
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