“It is a mistake to think you can solve any major problem just with potatoes.” – Douglas Adams

This is one of my favorite lines of all time. If you have kids though, I would posit that french fries have solved some major problems on long road trips. Temporarily, at least.

Sometimes though, we see IT departments missing the real point of an ‘ease of use’ conversation and maybe trying to solve their problem with the equivalent of french fries- they satisfy an immediate problem but it often doesn’t address the long term considerations.

As more hospitals bring their PACS, CPOE, HIS, and EHR systems on-line we are seeing a less-than-enthusiastic response from clinicians that now have to change the whole way they operate.

Although the push to electronic records is a very good thing in the long run, we are finding that a lot of this progress can actually hinder the doctors and nurses who already have limited time to spend the quality time with patients they need to deliver effective care.

Of course, the transition to the electronic hospital means computers… and adding computers to the mix has been, shall we say, problematic.

Instead of grabbing a chart, scribbling some notes and/or dictating into a recorder as they walk to the next patient, a doctor is forced to:

• find an available computer
• log-in to the computer using their domain credentials
• wait for the computer to log in (30 seconds to 3 minutes in some cases)
• launch the CPOE application
• wait (sometimes another 30 seconds or more)
• log in to the CPOE application using that application’s different username & password (if they remember it)
• wait
• find the appropriate patient
• weed through the some windows and select the appropriate drug & dose
• hopefully log-off
• go to next patient and start all over again

In the real world, this adds quite a bit of time, as much as 5-10 minutes per interaction. There have been documented cases of this process adding as much as two hours to a typical physician’s day. That isn’t acceptable to anyone.

The typical response of an organization to this workflow issue is to look for a Single Sign-On.  And this is reasonable. The complaint is that it takes a lot of time to enter a user and password for the domain and then every other application the clinician uses. It’s also next to impossible to get normal human beings to remember 12 sets of credentials that change on a ‘seemingly’ random basis every other month.

A good SSO will indeed make life a bit better. It will reduce frustration, reduce calls to the helpdesk to change passwords and even speed up the process a little bit. If we looked my unscientific list above, you’ll see that we have really on resolved a small portion of the total problem with the SSO.

The problem is SPEED. How long is it taking for the doctor to get to the point where she can actually start entering data? If they have to walk away, what does it take to get back to where they were?

This is why we often tell our clients that SSO is just a small piece of the overall piece of the puzzle that is clinical access to electronic data. Other problems regarding computer access also need to be solved in order to avoid being a hindrance to patient care and improve end-user experience:

1. Log-in times. Some facilities are still dealing with 45 second to as much as 3 minute log-in times. Multiply this by the dozen or so time the user has to log-in and you add quite a bit of time to the user’s day.
2. Roaming. A typical clinician’s work-flow is such that they rarely are able to stay in one place for a length of time and they often get interrupted. When they can get back to a computer, it often isn’t the same one they started at and they might be in a completely different part of the hospital.  An ER nurse I spoke to the other day summed it up nicely: “I want to be right where I left off.”
3. Consistent experience. We’ll see over and over again that a computer in the ICU will have different applications and different look and feel than a computer in MEDSURG. This is extremely frustrating to users that just want everything to be the same. Hunting for applications is no way to spend a day.
4. Kiosk Capability. In places like the ER you have a limited amount of space for computers and what seems like an unlimited amount of users. You need to be able to get users in and out of their own session in rapid succession.
5. Printing. This is one of the consistently bad experiences users have. Where does it print? Which one I need to select? Why did that 50 page report print on a label printer?
6. HIPAA. I often see patient records left open because a clinician had to attend to another patient and didn’t want to walk away and start all over again. “It would just take too long to get back in.” Patient confidentiality is paramount in most hospitals but it is sometimes being neglected in favor of time. This is not a compromise a hospital should have to make.