Today, well-managed hospitals have learned that the impact of EHRs and other computer systems is at least as significant to hospital staff — in particular, clinical users — as it is to the institution’s technical infrastructure. Many hospitals have not yet incorporated a knowledgeable, dependable clinical component in their service desks, to the frustration of physicians.
Historically, physicians have not been strong proponents of EHRs and they still aren’t in far too many institutions. Oft-labeled “helpless desks” designated to provide system support but don’t adequately meet physicians’ needs are the last straw for many. Quality of medical care and overall physician satisfaction with the IT environment hangs in the balance. Isn’t it time for your service desk function to catch up with today’s hospital systems complexities?
Developing and maintaining a highly qualified 24 X 7 X 365 clinical service desk is a critical success factor for physicians and other systems users. It is not unusual that users are unhappy, even irate, not only with new systems but with the IT department overall. With the right research and planning, you can make cost-effective service desk upgrades that will quickly help your users to resolve what are often relatively minor issues, and to begin regarding new systems in a new and favorable light. Your service desk may even transform itself into a strong positive in the daily work life of users, instead of a last unpleasant resort.
Inadequate problem resolution is a painful fact of life for many EHR users, especially in hospitals where MU incentive deadlines created heavy pressures to implement first, and pick up missing pieces later. Overhauling service functions typically was not in the playbook or the budget.
Also, IT users in hospitals with multiple systems (and inadequate clinical service desks) have discovered that navigating the support network is harder than ever, because questions on specific applications may be relegated to different application analysts, rather than a central support resource. Mary Smith might be the person to call about a Siemens financial system issue, but not for a Cerner EHR problem. And, vice versa for John Jones. When John leaves the organization, poof! will go his Cerner support specialty. If a hospital doesn’t have a dedicated clinical service desk, the IT department must parcel out specialized service calls among their various application and hardware analysts (who have other responsibilities.) In these arrangements, few if any service level standards exist, processes and documentation are inconsistent, and accountability is limited.
Other hospitals have attempted to upgrade their service desk systems and procedures to more organized, discrete internal service desks, only to be disappointed. Some hospital executives think that setting up a or choosing a strong service desk function should be a no-brainer. It’s all about a few people sitting with headphones and answering questions, right? Not so. Poor research, inappropriate solutions and lack of educated leadership have often contributed to failure of these expensive initiatives. This “solution” to the old problems has created a whole new source of inefficiencies, poor performance, and user dissatisfaction.
A majority of hospitals are outsourcing their technical support functions, according to a 2018 report by Black Book Research. But, 60 percent of hospital IT leaders say that EHR vendors and third-party outsourcers are not meeting tech support expectations, and “falling short in their responsibilities to ultimately allow patient care improvements through well-trained delivery personnel.”
The hospital clinical service desk function today represents a highly specialized profession of its own. This means that your service desk, whether internal or outsourced, must be led by an experienced clinical support professional who understands that EHR support requests are different than old-time “help desk” calls. Outsourced service desk contracts must be with vendors with deep experience in hospital operations and clinical systems and processes. Requests from physicians and other clinicians often are related to clinical workflow and process versus simpler technical questions. If, as an example, a physician calls with questions about entering an order, the service desk agent must immediately realize that the question is not simply technical; it is related to patient care. This, in turn, requires the agent to understand the physician’s EHR screen flows and workflow.
Clinical service agents need continuous training to understand users’ objectives and needs, as the hospital’s systems environment evolves. Agents also must know how to work intuitively with physicians who may be hurried, impatient and exhausted. On a metrics measurement level, call response time should be shortened where possible and other KPIs may need to be adjusted due to new issue complexities. Also, the staff’s knowledge “bucket” of solutions may need greater customization. Physicians expect state-of-the-art capabilities, knowledge of patient care realities, strong user respect, immediate problem resolution, and an unconditional will-do attitude.
Today’s hospital IT support model must follow the customer-oriented structure and standards of the IT Infrastructure Library (ITIL) to meet the needs of modern healthcare professionals. ITIL is an established set of concepts and policies for managing information technology infrastructure, development, and operations, and is the most widely accepted best practice approach to IT service management in the world. It details how IT resources should be organized to deliver business value, documenting the processes, functions, and roles of IT Service Management (ITSM).
ITIL-based service organizations shine because they focus on outcomes and accountability, as opposed to process alone. ITIL includes event, incident, problem and change management, which together provide a basis for developing metrics that are used in creating service level agreements (SLAs) with end-users. SLAs set the expectations for users and service staff. The ITIL structure also enables diligent service desks to continuously build a shareable knowledge base derived from root causes of problems and methodically derived solutions. Re-inventing the wheel is not an acceptable approach in a well-run service desk.
Not long ago, I spoke at length to the CIO of a 200-bed Cerner hospital, one of Phoenix’ Clinical Service Desk clients, who recounted his past experience with a deeply dysfunctional external service desk firm. Though the hospital had graduated from a casual internal service environment to a well-recommended external service provider, problems became rampant after an initial honeymoon period. Users were miserable and angry. Some of the problems the CIO noted:
- Low level of knowledge — the service desk provider was not healthcare specific and did not properly educate its staff on the hospital’s systems
- “Horrible” on-hold times, e.g. frequent 30 to 45-minute waits
- Very low first contact resolution rate
- Inconsistent responses from a “different agent every time”
- No standards of performance, including SLAs
- Perceived lack of concern and lack of courtesy, i.e. unprofessionalism
The CIO’s overall assessment: “Almost everything was wrong.”
Long story short. The CIO went looking for a healthcare-specific external service desk that provided proven, high-quality clinical support, that is, support for its specific EHR and a focus on physician needs. By then, he had done his homework; he knew the services had to be ITIL-standards based, and needed to include advanced infrastructure and application monitoring systems to anticipate problems and enable their speedy resolution. Yes — to be immodest — he chose us. ( I am happy to acknowledge that there are other good HIT service desk outsourcing firms out there.) In our service environment, agents are trained extensively on the hospital’s systems, a knowledge base bucket is continuously added to, weekly call resolution times are exceptional, trend analyses are ongoing, and weekly reporting and idea-sharing between the client and service desk leadership are the norms. According to this client, he has seen a “complete 180% turnaround” in every area. Especially in physician satisfaction.
But, this post is not about Phoenix’ Clinical Service Desk, as proud as I am of it.
The point here is that hospitals’ challenges to keep systems, networks, and applications in peak operating health — and to support physicians, nurses and others in using them — are exponentially increasing. The growing complexity of EHRs and brand new related systems, e.g. data analytics applications and new security systems, has exacerbated already poor service performance in many organizations. Where hospitals are transitioning from old platforms to new systems, a qualified service desk must be there to provide assistance both during the “before” and the “after.” And, always in the background are at least three formidable questions:
- How is existing service desk performance impacting patient safety and quality of care?
- Are we continuously improving clinical systems support cost-effectively?
- Are we meeting the needs of our physicians and other users?
The answers always should be yes.
If you’d like to know more about Phoenix’ Service Desk solutions, please contact us.