Friday, October 10, 2008

Helpdesk Tango

Working with your EMR company's Helpdesk is a bit like dancing the Tango. If done well, it can be quite good, but if your partner drops you during a dip, it can be a disaster.

We have had our ups and downs with the Helpdesk. They were very helpful at the beginning (we got to know several people by name); then there was a period when the phones were not being answered. Now we live in an uneasy truce with them.

There seems to be a fair amount of turnover in that department. I think it must be a very stressful job: when a physician or staff member calls, there is something wrong and they're not happy. New releases always seem to cause problems and everyone calls at once, so the helpdesk is overwhelmed and messages get re-routed to call answer; people are even less happy.

Having a super-user around decreases the number of calls to Helpdesk. We can often help our colleagues faster than they can, as we are familiar with our local setting. I now seem to be in charge of managing our VPN access. As well, I send periodic updates on how to use the software. A colleague in a very well managed large group practice told me that his group made a decision as to who calls their Helpdesk, so that they don't get the same calls repeatedly; his EMR company rewards groups with less than the average number of calls financially--not a bad idea. I wish Helpdesk kept a list of key contacts for each group and managed those calls a bit better.

We had an issue with our label printers not working properly after one of the upgrades. Our FHN administrator figured out what the issue was; she sent out an email, and was able to help several offices fix the problem.

If the EMR went down, we often didn't know who to call. The failure could be because the SSHA Internet connection was down (call SSHA), because the application was causing a problem (example, running a report that was too large), or because the server needed to be re-booted. Over time, between our two FHNs, we worked out processes to deal with this. Each FHN has one person responsible for calling (and a back-up in case the physician is away or not available). If there is no service, we log in to Google (check the Internet). If that works, then it is the server or the application. It is not always possible for us to know; our IT guy told us to phone him first, as he can check the server remotely. If the server is ok, then we notify the EMR company.

We sometimes have problems with our labs coming in. To get lab results, the server uses what I have been told is a very old, phone-based application (Winblast). This application can get easily turned off, and sometimes seems to go off on its own. If it is off, then no labs come in. Helpdesk then get calls and emails, and they have to go in to turn the program back on; due to security issues, we don't have direct access to this program. This has happened repeatedly. Our IT guy finally put together a small program that automatically checks and turns the phone application back on; problem solved.

We are trying to manage as many issues as we can; we don't like calling Helpdesk. Calling takes time that could be spent on patient care, and they can't always help. However, when we do call, we don't want to be dropped on our back. It took quite a long time for us to figure out the processes we now use; perhaps EMR companies should develop a list of common issues, and help physician groups develop workflows to make things work more smoothly when problems do occur (an ounce of prevention). Some problems are likely very common; I am sure Helpdesks keep call statistics (or they should). Sending out information about common problems and solutions may help; helping the local super-user help their colleagues, and investing in the development of local skills certainly will help.

As users, we have had to learn to manage our Helpdesk. I think this department must be expensive for the EMR company, and they are certainly a cost centre (every call costs them money). There are things they can do to manage those costs without antagonizing physicians through deficient service, but this requires planning. Perhaps one of the factors for survival in the current EMR wars will be service: how to keep users satisfied without having Helpdesk costs go through the roof. Only the smartest companies will survive.


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