Friday, March 9, 2012

Tips from a road warrior (21): You have to deal with the car you are given.

I have probably taken hundreds of cab rides in many different cities all over the world. Most of them were rather uneventful, however, some of them I will never forget. For example, the ride from Boston’s Logan airport in a cab that was tailgating (as they usually do) while the road surface was very slick, and, when the driver had to brake, he slid into the car in front of us. I saw it coming and threw myself with my back against the front bench seat so I was not hurt.
One ride in New York City was also scary as the cab’s front door flew open every time the driver took a sharp curve while empty soda cans would roll out from the floor. Then there was the one when we were packed into a VW bug with four people in Mexico City (don’t believe the circus trick about packing many people into a VW as there is no way you can fit more than four). And then there are many times I was ripped off or overcharged, which is an issue in Middle Eastern and Asian countries. In any case, when stepping out of an airport terminal to take a taxi, one is totally at the mercy of who happens to be at the front of the cab line. You have to deal with the cards (or car) you are dealt.
Similarly, you can be taken for a ride by a vendor you have barely met when your institution is selecting a healthcare IT system. There are multiple drivers, technologists, physicians and others, who all steer in different directions while you are in the back seat. One suggestion is to move up to the front seat and actively get involved with the direction and speed that your system is moving. In many cases you might want to deliberately slow it down.
A good example of slowing down is when installing new releases, upgrades, or connecting new modalities. One of my rules is to never install a new release that is called “x dot zero”, for example, 5.0 or 6.0. Always wait until it reaches x.1 or, even better, x.2. One PACS administrator in my hometown is even more conservative. He waits until the vendor no longer supports the current release before he upgrades his system. His institution might miss out on some of the latest bells and whistles, but his system is rock solid, he has not had to reboot his PACS database for more than a year.
The same applies to operating systems. We all know people who went to Microsoft Windows Vista very soon after it came out, and regretted it. Unfortunately, one sometimes has to pay a premium for getting previous releases, as an example, when one wants to have XP on a PC instead of windows 7. I. In many cases, medical devices and/or software do not turn over as often as the operating system, and support for those devices with new operating systems require a lot of validation and testing, which is why the medical device industry is seemingly slow with adapting new technologies and operating systems.
Slowing down and doing due diligence also applies to installing new devices and/or systems. No reason to rush, but, rather, validate the system first on paper comparing all of the interface specifications such as IHE profile definitions, HL7 specs and DICOM conformance statements with the devices it will have to interact with. Then, one should do extensive testing within a test environment.  After that, run it in a test mode using test transactions instead of the regular production messages. If the system generates images or other objects such as structured reports, load those from a CD or flash drive onto the system that is supposed to be rendering and interpreting those to make sure there are no issues.
In conclusion, in some cases you might feel a little bit that you are not in control, but there is a lot you can do to steer a system and organization by taking the front seat and actively being involved in the direction that it should take to provide safe and efficient patient care.