Guest Article by Nurse Janus - From the Hospital to the Vendor World

Nurse Janus recently left hospital practice to join a software vendor. She's been keeping a diary of her experiences and offered to share them with HIStalk readers. Let me know whether you'd like to see more from her.

I thought IT would be a fun and interesting place for an old nurse to land when I left the hospital this past year after 20+ years. It has proven to be way beyond interesting, but not always in the way I expected.

Among my beliefs when I started: 1) software works right out of the box; 2) no company would sell a software product until it is actually finished (with one exception - another story - see below); 3) CIOs wouldn't be dumb enough to buy software without actually seeing that it works first; and 4) people who develop software know something about clinical workflow. 

It has been a 'long, strange trip' learning that none of these are accurate. Now, I'm not a young woman, and I love to read business stories (last two books - reread The Smartest Guys in the Room and The World Is Flat), but it's the scope of what I've seen in IT that amazes me.

So here's the story I promised in the last paragraph. As a senior nurse, one additional project I worked on in my last hospital was our "computer charting." This was to have been implemented around four years ago. I was there two weeks ago for a visit and the place is still all-paper charting. The software engineer who went with me (it was a "follow-a-nurse" thing I had set up for my company) was appalled at the number of forms we use to document patient information by hand. But I'm getting ahead of myself.

Two nurses in every hospital unit were participants on the "Automated Charting Committee". We met with the IT company guys every week for a couple of months, and then every two weeks for another six months. The hospital was paying us nurses (hourly workers) for the overtime we were putting in on this project, but some of us were so excited that we even worked a lot of unpaid OT. What we did was create Excel spreadsheets with pick-list-type selections for charting assessment and flowsheet information to give to the developers, and also provided workflow scenarios for them. We were told that this information would help the software company "customize" our hospital's system.

At the same time we RNs started working on this, the hospital took out its old order/lab system and installed a new one. By some incredible coincidence, the company that made the new order/lab system was the same as the one which made the charting system! The new system was a little more cumbersome (slow screens, weird layout, and an additional step to enter orders), but we all put up with it, because we were told that once the new charting system was in, the order/lab system would work much better. We were all looking forward to the benefits of a nice, integrated system. (I can hardly keep from cracking up just typing this. But when I was looking for a job like this, I thought this company -- which rhymes with "Trick Messin" -- was just a fluke in the IT biz.) 

Nine months after its inception, our little committee had yet to see an actual screen on an actual electronic device, even though we were supposed to validate the "work in progress" starting at Month 2. We had finished our work. I couldn't help but wonder how much free clinical expertise we gave away (a LOT) but something went on behind the scenes which we weren't privy to. We were assured that the program was almost ready to be installed, and we would see it in the unit in eight weeks.

The hospital suddenly yanked out the new order/lab system (installed almost a year back in preparation for our wonderful new integrated system) and reinstalled the old one. Now all the people hired in the interim, trained only to use the fabulous new system, had to be trained on the old one. So did those earlier employees who had since forgotten it. Let's  see what this cost our "nonprofit" hospital:

• Charting system cost (hope it was free, considering there was nothing in it)
• Order/lab system cost
• Charting system installation
• Order/lab system installation
• 18 RNs x 4 hours/week x 36 weeks x $30/hr (yes, we work cheap)
• Training all staff on new order/lab system
• Training all staff on old system once new one was unceremoniously yanked out
• MD training time, and extra aggravation for the RNs who had to listen to them complain about the new system
• Extra time and effort expended to get things like transfusions and bedpans ordered with the crappy new system
• Many other items I can't even begin to guess at.

I won't even go into the whole intellectual property thing, but we RNs on the committee felt a bit used after the whole episode. I wonder if our combined expertise is still floating around that company somewhere? And by the way, not the hospital CIO but the next person down from him abruptly left her job.

Yes, Virginia, companies do sell bad software (or no software at all) and CIOs buy it. The software is bad because the people designing it have not "worked the floor" for years, if they ever did. The whole product/sales cycle is slowly becoming clearer, particularly after seeing HIMSS, which seemed almost Enron-esque to me. Everyone here got a short video of the HIMSS experience, and after watching it, I must say that all the display folks looked jim-darn-dandy in their lab coats and scrubs (OK, really I was nauseated, but don't tell anyone.)  

I would just like to raise awareness among the IT community of the other side of software - the low-level client side (nurses, nurses' aides, X-ray clerks, etc.) which has to muddle through trying to get medicine, lab results, and information regardless of what IT obstacles are put in their way. My wish is that perhaps engineers and marketing people will think of the night-shift Asian nurse working her 7th shift in a row because she needs the OT when designing software (and remember, she doesn't even know how to use a mouse, and no one will be able to understand her free-text entry.) No one wants the wrong blood transfusion or delays in getting their meds, but the situations I described can cause that.