Sunday, April 22, 2012

Tips from a road warrior (22): Support in Far Places

American's DC-10
My worst travel experience ever (so far) was a few years back, when I tried to return from Sao Paulo after teaching a seminar to Dallas. It involved one of those old DC-10’s who fortunately by now, are pretty much out of service.  After taxiing we were stationed to a remote area of the airport where mechanics were trying to fix an issue. This went on for 2 or so hours, till we had to go back and de-plane because the crew would have exceeded its service time if we were to take off. Not that we would have been able to, as we heard later, that a new part had to be flown in which took about 12 hours to get there. So, after checking into a hotel in the middle of the night, we were able to get out there only 24 hours later. Imagine that this would have happened in Dallas, a major hub of this airline. There would have been a spare crew in no-time (hopefully) and there would also be spare planes available. So in Brazil, we were literally out on a limb.
Similar situations with spare parts and support happen with healthcare IT systems that are installed in remote areas. When I was visiting a hospital in Alaska, they told me that it would take on the average 2 days to get a support engineer on site from the company headquarters which was based in Boston. It is imperative that spare parts are on-site and, in addition, that the healthcare IT systems can be supported remotely as much as possible. Not only are distances a barrier, sometimes geography plays a role as well. During the same trip, I witnessed a demo of a major PACS vendor failing because the service engineer was unable to connect a demonstration view station to the hospital archive to be able to pull up some of the images for the doctors to look at. Two other vendors installed it in an hour, but the poor service engineer was unable to make it work. I am convinced it was a simple addressing issue and should have been solved easily with the proper support from the home office, which was in the USA.
When I was in Mexico City, I was told as well that the same vendor had lost all credibility after it took them one month (!) to find the problem with a new modality connection. In this particular case, the PACS system would occasionally refuse to store images from a new digital modality. Initially, everyone was at odds why certain images would never be stored till they found out that the PACS would refuse any mage which did not have a valid Accession Number. I assume that subsequent upgrades took care of this issue and accepted the images and store them in a temporary “to be verified” file so a system administrator could fix these. Again of this problem had occurred in Boston, MA, it probably would have been resolved in a day or so, instead of a month. Note that Boston is farther from the company support center, which was in Dallas, than Mexico city, were it not for the magical country barrier.
It is not only service support that is often lacking in remote areas but also application support. Point in case, when I visited a small clinic in Bangalore, India, which had just installed a brand new Computerized Radiography system. It is well known that the techniques, i.e. KV and MAs to be used for getting a good image quality have to be redefined and new settings have to be determined, especially for portable X-rays. This site was unaware of this and, having gotten very little application support, it was clear that their image quality was really poor with this new sophisticated CR system just because they did not know the new techniques to be used.
It is critical in remote areas to have support and spare parts. These are not always other countries or remote states such as Alaska, but include rural areas in Louisiana, Arkansas, the Dakotas, and anywhere there are clinics that are not easily accessible. It is important to address these issues which are quite different as if a clinic was based in a suburban or metropolitan area.