Health Information Systems: evaluation and performance of a Help Desk

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1 536 Digitl Helthcre Empowering Europens R. Cornet et l. (Eds.) 2015 Europen Federtion for Medicl Informtics (EFMI). This rticle is published online with Open Access by IOS Press nd distributed under the terms of the Cretive Commons Attribution Non-Commercil License. doi: / Helth Informtion Systems: evlution nd performnce of Help Desk Lendro PINTOS,1, Adrin STIEBEN, Gbriel GARCIA, Agustin BRIATORE Agustin BERTOIA, Soni BENITEZ, Diego GIUNTA, Anlí BAUM, Fernán GONZALEZ BERNALDO DE QUIROS Hospitl Itlino de Buenos Aires, Abstrct. A Help Desk (HD) is crucil in computerized hospitl. Objective: to describe the performnce of HD. Design: retrospective cohort study Results: the sociodemogrphic chrcteristics of users, s well s their reltionship with the institution influence behviour when requesting support to HD. Also we observed reltionship between the flow of users request nd the functioning of hospitl services. Conclusions: complexity of HD process relizes the need to identify nd define stndrds to ensure qulity of service. Keywords. Helth Informtion Systems, Helth Informtion Technologies, Cohort studies, Medicl Informtics Applictions Introduction The helth informtion system (HIS) involved different Informtion nd Communictions Technology (ICT) nd different kinds of users (dministrtive stff, physicins, nurses, physicl therpists, phrmceutics, nd others) who should hve n dequte support nd trining to ensure proper use of those systems [1,2,3]. The lck of support in complex scenrios like helth cre orgniztions could interrupt ptients cre workflow cusing disstisfction on them nd even more impcting in their helth cre [4]. Users work dy by dy with different softwre (SW) pplictions, need different kinds of support nd required different response time bsed in their functions nd needs [5]. This dequte support requires humn nd technologicl resources cpble to serves, mnge nd solve ll the possible problems of ICT. Severl studies underlying tht the support nd the trining re importnt components of the HIS implementtion [6,7]. The Help Desk (HD) is core component of the support system [8], however nowdys we hve not found enough evidence tht described support systems in these complex helth cre scenrios. The trget of this study is to describe the performnce of the HD t university hospitl with HIS during Methods A retrospective cohort study of ll HD tickets during The setting is HIBA network. A highly complex institution integrted by two hospitls (Centrl nd Sn Justo) nd 23 peripherl medicl offices. The network hs 750 beds, 900 home cre 1

2 L. Pintos et l. / Helth Informtion Systems: Evlution nd Performnce of Help Desk 537 beds, nd give service to 3 million outptient visits. The HIBA hs 7000 members, 5400 helth cre professionls nd 1600 dministrtive stff. In 1998 the Helth Informtics Deprtment (HID) strted the development nd implementtion of Helthcre Informtion System (HIS) tht involves outptient, emergency, in-ptients nd homecre ptients, ppointments, phrmcy system, hospitl dmissions between others. The HID hs 150 members distributed in 9 res. The informtics prk consists in 4000 personls computers, 1500 devices (printers, scnners, tblets). The users of these informtics systems cn request support to the HD when they hve problem with hrdwre (HW), SW, trining, etc. Also they cn do it to obtin informtion for reserch nd mngement. For ech request, users get ticket tht goes to technicin for resolution. HD workflow ws described in prior pper [4] The study vribles re: Tickets (mount, hour, dy of the week, month, priority, physic plce, ticket modifictions, closed ticket, mount of technicins, ctegories, derivtion time nd response time). Users tht got t lest one ticket (mount, sex, ge, specility, seniority, slried work, mount of tickets, proportion of chnged nd qulified tickets). Technicl Support (mount, ge, sex, seniority, work re, closed tickets, derivtives tickets, priority, qulifiction). For dt nlysis we used descriptive sttistic, minly frequency mesurements. All the informtion ws extrcted from the HD dtbse. Results During 2013 were mde tickets. The 86% were mde in the Centrl Hospitl, 7% in Sn Justo Hospitl nd 7% in the peripherl medicl offices. The tickets were clssified by high priority (73%) or norml priority (27%). The tickets were grouped into ctegories (Tble 1). Tble 1. Tickets ctegories Tickets ctegories Helth cre HW nd Administrtives Bsic SW App systems networks App systems N % 31,81 29,55 28,90 14,9 Applictions systems tickets were 61% wheres 39% were due to HW nd bsic SW. The 15% (9.150) of the tickets were modified before being derived. This mens tht the originl problem didn t ws the ctul problem tht user declre. Help desk technicin closed 12% (7.407) of the tickets without derivtion. Tht mens they know how to resolve the problem. More thn one technicin evluted 25% (15.150) of the tickets; with n verge of 2 technicins by ech resolved ticket. The distribution of the tickets oscilltes between 6% nd 10% by month (Figure 1). Tickets distribution by week is shown in Tble 2. Tble 2. Tickets distribution by week Tickets ctegories Mondy Wednesdy Sundy Weekends N % ,4 Time distribution is shown in Tble 3. The lrgest mount of tickets ws mde 9:00 m nd 10:00 m with 12.6% (7617) nd 13% (107563) respectively.

3 538 L. Pintos et l. / Helth Informtion Systems: Evlution nd Performnce of Help Desk Tble 3. Tickets distribution by hour Tickets ctegories 07 m to 1:59 pm 02 to 5:59 pm 06 pm to 6:59 m N % 67,5 26 6,6 The minor mount ws mde 4:00 m with 0,06% (38) nd 5 m with 0,08% (51) (Figure 2). The mximum mount of tickets in one dy ws 357 nd the minimum 2. To evlute the derivtion time ws selected tickets. The 94% (48.470) were derived within the first 30 minutes, nd from those 47% (23.869) were derived within the first 5 minutes. The 90% (54.536) of the tickets were solved before the first 21 dys, nd from those, 43% (26.056) were solved the sme dy it ws requested. The 31% (19.134) of the closed tickets were qulified. The physicins rte 21% (4.072), nurses 4% (805), the remining of helth cre professionls 7% (1268), nd 68% (12.989) of dministrtive stff. The 94% (18.026) were rted positively. Users nd technicins chrcteristics dt re shown in tble 4. Tble 4. Users nd Technicins Chrcteristics Dt Chrcteristics Users (5065) Technicins Mle 35.6% (n=1805) 65% (n=86) Age rnge Age verge Slried workers Independents workers Seniority rnge Seniority verge Helth cre stff Administrtive stff Tickets verge High priority tickets verge 44 75% (3793) 25% (1272) % (3404) 33% (1661) % (133) % (28) 79% (105) Despite ge rnge ws between 19 nd 70 yers, users between 21 nd 40 yers old mde 60% of the tickets. Most users were helth cre stff, but dministrtive stff requested more frequent: 64% (39.244) wheres physicins requested 24% (14.947) of totl tickets. A gret proportion of users tickets hd to be chnged by technicins: 13% (4944) for dministrtive stff nd 20% (2917) for physicins. The remining helth cre professionls requested 6% (3718) nd 14% (516) hd to be chnged (Figure 3). Also 31% (19.146) of the tickets were re-ctegorized nd 39% (23.855) were derived between technicins. Ech technicin derived 197 tickets. Tickets were qulified by 55% (2804) of users, 45% (1262) were dministrtive stff nd 55% (1542) were helth cre stff (73% physicins, 15% nurses nd 12% others). 2. Discussion Centrl hospitl ws the plce with gretest tickets of the HD. This could be due to the greter number of visits; hospitliztions nd dditionl studies re conducted here. In fct, it hd the lrgest number of employees nd devices of computer equipment. The lrgest proportion of the tickets ws high priority. This could be relted to the impct of the disruption of the workflow during ptient cre nd how the user perceives the need for quick nswer to their problems [4,5].

4 L. Pintos et l. / Helth Informtion Systems: Evlution nd Performnce of Help Desk 539 There were more tickets for pplictions systems tht HW. This could be bsed on the filure of n ppliction ffects multiple users, while HW filure ffects single worksttion. Technicins modified the fifteen percent of the requests mde by users. This my be due to communiction problems, lck of technicl knowledge or the complexity of tody's computer system. The mount of tickets to the HD ws regulrly throughout the yer. Vritions in the months of Februry, July nd October could be relted to vction, entry of new residents nd updte of the computer prk. Most tickets were mde from Mondy through Fridy morning. This could be relted to the opertion of hospitl services nd the min dministrtive tsks. Hlf of the tickets were derived fter 5 minutes of requested. It is probbly due to the need of technicins to contct the user for more informtion nd understnd the problem. About hlf of the tickets were resolved on the sme dy. This does not llow us to infer tht the response time is stisfctory to users or how impcts on the different hospitl services [8]. The limited number of qulified tickets does not llow us to know the ctul user stisfction. Most tickets were mde by young dult women who work s employees, with n verge seniority of nine yers, which could be relted to smller digitl divide, the number of hours remining in the institution (30-45 hours per week), culture nd orgniztionl commitment. Most users who mde tickets were physicins while dministrtive did more often. This could be becuse there re more mounts of physicins nd they use different pplictions. Technology nd implementtion resolved mjority of the tickets. This is consistent with the min problems reported by users (pplictions nd hrdwre). Hlf of the tickets needed two technicins to solve them due to the complexity of HIS nd the technicin necessity to clrify the user problem. There is little evidence in the literture to chrcterize HD in helthcre orgniztions with HIS. Tht s the reson why, lthough these results re closely relted to the specific chrcteristics of our orgniztion, we considerer shre this experience nd believe importnt tht other institutions do the sme in order to generte evidence to identify nd define stndrds for such services in these complex scenrios. References [1] J. Arts, H. Doorewrd, M. Berg. Understnding implementtion: the cse of computerized physicin order entry system in lrge Dutch university medicl center J Am Med Inform Assoc,11(3),2004, [2] M.J.Vn Der Meijden, H.J. Tnge, J. Troost, A. Hsmn, Determinnts of success of inptient clinicl informtion systems: literture review. J Am Med Inform Assoc [Internet],10(3),2003, [3] J.S. Ash, P.Z. Stvri, R. Dykstr, L. Fournier, Implementing computerized physicin order entry: the importnce of specil people. Int J Med Inform [Internet].,69(2-3), 2003, [4] N.M. Lorenzi, R.T. Riley, Orgniztionl impct of helth informtion systems in helthcre. Stud Helth Technol Inform, 65, 2002, Review. [5] A. Bum, S. Figr, J. Severino, D.Assle, B.Schchner, P.Otero, D. Lun, A.Gómez, F. Gonzlez Bernldo de Quirós. Assessing the impct of chnge in the orgniztion of technicl support system for n Helth Informtion Systems (HIS). 11th World Congress of Medicl Informtics. Sn Frncisco, USA, MEDINFO, [6] R. Shrm, P. Yetton. The Contingent Effects of Mngement Support nd Tsk Interdependence on Successful Informtion Systems Implementtion. MIS Qurterly 27(4), 2003, [7] A.M Sumner. Criticl success fctors in enterprise wide informtion mngement systems projects. Proceedings of the ACM SIGCPR conference on Computer personnel reserch, 1999 [8] M. Dumy, R. Groeneweg, Implementing help desk for the CUSAT with use of ITIL, Project Report, Delft University of Technology, Fculty of IT nd Systems, Dept. Computer Science, 2001, Avilble from:

5 540 L. Pintos et l. / Helth Informtion Systems: Evlution nd Performnce of Help Desk Annex 1 Figures Figure 1: Monthly distribution of the tickets Figure 2: Dily distribution of the tickets Figure 3: Reltion between mde nd chnged tickets by type of users

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