Tuesday, March 22, 2011

More IT Follies


Having just visited a friend in need, Mrs. Dalai and I decided to keep on driving, and found ourselves in this sub-tropical beach paradise. There's nothing like a few days of R&R with sun, sand, and a few Landsharks to keep us going.

But I can never quite leave the office and PACS completely at home (although I'll give it a good try this summer).

A thread on AuntMinnie.com started by Midwest Eastern Rad has been gnawing at me for a while, and now is as good a time as any to grace you with my thoughts on the subject. M.E.R. sounds a bit like me and some of my partners, not to mention some of my friends around the world:

I want a discussion relating to one's attempting to change workflow (improving ergonomics) vis-a-vis institution reluctance to adapt and change.

Basically, how can a radiologist supplement the "out of the box" software settings for workstation to work in his/her favor, by creating personalized more ergonomic workflows? This can involve hardware--such as your own USB mouse with programmable buttons, or an input device such as a gaming mouse or ShuttlePro. Can involve Windows display or mouse settings. Also may involve installing small software programs on the host computer (macro programs, mouse software in order to program the buttons). This is all driven by wanting to reduce repetitive motions, reduce mouse clicks, avoid eye strain (i.e. increase DPI on 5 MP monitors so you can actually read the text or increase text size, all Windows properties), reducing excessive mouse motion (i.e. 3,4,5 monitors vs. 2), and trying to rid myself of the body aches that I have gotten from work.

My experience has been that IT support has no interest, and I don't want to be problem for them, but I need to take it on myself to improve ergonomics, and don't know how to proceed. The manufacturers (PACS, VR, hardware) also have no interest that I have found.

How do people deal with trying out new devices, new workflows, changes in the PACS settings, automated steps (macro creation) to try to eliminate the excessive number of mouse clicks that we undergo when using PACS (and RIS)? I ask this especially in light of the restrictions that IT people put on the PACS workstations to not allow access to key areas in Windows OS or even locking down USB plugs, programs, windows, etc. Do you do it "behind the back" of IT? What if there is lockdown? How much do you fight for yourself?

If IT does not wish to work with you (which I suspect many IT people do not want to do because it complicates their lives), how do you proceed? If we all stayed stagnant, we'd be doing the same thing we did 50 years ago, yet often, I find that pushing the envelope on standard workflow gets you into trouble. Hard to put into words, but I'd love to hear comments.
Gee, M.E.R., this sounds rather familiar, and I haven't even tried to do anything with mice or other hardware enhancements. I have, however, had they joyous experience of having my right click cut off by IT so as to keep me from defacing the desktop's AGgravating logo from their FAvorite vendor. (Fortunately, I'm much more resourceful than that, and it turns out to be rather simple to circumvent this little problem.) I was also told that I couldn't deploy a simple macro to keep open a RIS window that would otherwise close after 30 minutes because someone might use the program to circumvent a password entry. I'm reminded of my friends in Western Australia, whose IT departments progressively cut off all input paths to their workstations so as to block the installation of a "foreign" PACS client, as this might "void the warranty".

Do read the various responses to Midwest's post. Of course, I have some comments on the topic as well.

The friction between Radiology and IT is a world-wide phenomenon. You should have heard the chuckling and grunts of agreement when I presented Dalai's XIth Law of PACS at RANZCR in Perth last year:
XI. If IT doesn’t like something, it will be termed a security risk.
And herein lies the rub. Actually, there are a number of problems, really, which fall into several general categories. One or more may apply at your particular shop.
  1. IT doesn't want to do the work of accommodating the rads.
  2. IT has a paranoid-level level of anxiety about any possible security breach.
  3. The vendor has made life difficult via threats of voiding the warranty and/or FDA certification.
  4. IT is afraid of what any (and I mean ANY) change might do to the vendor's software.


Before we go any further, two elements need to be brought to the forefront of the discussion. First, everything we do is intended to promote patient care. Second, we all need to work together toward that end.

I have what IT might consider a biased view: PACS exists to help the radiologist perform his or her job of caring for the patient. It is frankly asinine for IT to take complete ownership of PACS in such a draconian manner as to limit its use to whatever IT thinks appropriate. This is not acceptable. I am the radiologist. I have to use this technology to care for my patients. I am the one who will face legal remedies if something goes wrong. There is no justification for being told "NO" when asking for something reasonable.

But I'll be conciliatory here. Not every idea is a good one, even those hatched in my devious little mind. Some might possibly impact security. Not many, but maybe some. And some might truly interfere with PACS software. Which gets us into another discussion.

PACS software is extremely complex, lying somewhere on the continuum between Microsoft Office and Windows 7. Now, give me an honest answer: If Word acted weird when you plugged in a new mouse, would you blame: a. Yourself for being such a stupid fool as to have tried this; b. Your computer for malfunctioning; or c. Microsoft for writing poor code. I'm picking c. You would be on the phone to Bangalore immediately trying to get Microsoft to fix their glitch. And if Peggy on the other end of the phone tried to tell you that your plugging in the non-Microsoft mouse might have voided your warranty, you would jump through the phone all the way to whatever subcontinent was appropriate.

Microsoft Office runs about $150 for the home version. The average PACS runs about $250,000 at the minimum. Why do we tolerate bad behavior from such an expensive product? Good question. Ask your IT people.

But this is what I mean by being conciliatory. There is a kernel of truth in IT's fear of something interfering with the PACS software, because that software might not be properly written. I've seen this happen firsthand. Our IMPAX system went wacky on the third monitor's color display when I activated "mouse trails" to better see the cursor. That, folks, is a software glitch, and tells us that something wasn't written correctly. Maybe there was a shortcut in some video card call, maybe there is some strange memory leak, or maybe "mouse trails" somehow interferes with the electrical stimulation of the gnomes that live in the CPU. Whatever. This tells us there is a glitch. I don't have to wonder if some of our other problems are due to similar weirdness. I'm of the opinion that every manifestation of this sort of thing discloses bad programming on the vendor's part until proven otherwise. Period. Thus, IT needs to work with us to identify these things, and demand patches or updates when we find them. The easiest solution, having IT lock down everything simply to avoid this sort of thing, is not the best solution, nor is it at all acceptable.

And for the record, I believe the ideal way to go forward is to work together. I've said that many times. We, the users of PACS, our IT support, and the vendors all need to coordinate our efforts. I'm not asking anyone to rewrite all PACS software to work the way I want it to work. I've found that more or less in AMICAS 6 (there are some glitches even in this program but Merge is actually listening to me and others to effect improvements), but several of my partners still pine for version 5. This goes to show that you can't totally please everyone at all times. I do have faith that my colleagues will come around to my way of thinking, or I'll throttle them. But if what happened to Midwest Eastern Rad EVER happens in one of my shops:

Well, to make matters worse, the IT folks have now disabled our "Display properties" tab on Windows, so we can no longer adjust text size larger, smaller, disable monitors, etc.  When I called and asked why, I was given a very terse answer, something like "part of the lockdown".

I asked why again, and was hung up on.

I wouldn't rest until I have the head (or at least an apology) from the miscreant in question. As Xrayer31 put it:

Sounds to me like your hospital IT dept. has forgotten how their salary gets paid. I believe billing for performed medical procedures is what gets it done. They aren't treating you like the customer you are.  Hanging up on you?  Who are these trolls? Too busy? What are they doing, arguing over whether Star Trek or Star Wars is the coolest?  Time to take it up the chain and report not only the poor customer service, but blatent disrespect and unprofessional behavior. 

Capish?

1 comment:

Anonymous said...

I'm IT manager for a private practice and used to work for a medical software company.

Problems with the software very rarely get fixed unless it is a show stopper. Mouse trails making your screen flicker? Laughable. Developers won't spend their time trying to fix something like that. It is not a good use of their time, unless the contract is up for renewal. Annoying to you but this is the way it is. And small things like this can be ignored because you're locked into a contract for x amount of years, and changing from a PACS/RIS system is a big investment with many things that can go wrong, and the vendors know this.

With regards to the IT support points, I personally do not lock down radiologists systems heavily as they are my bosses. They do know to consult with me before installing anything as many times before installing software can cause unexpected problems.

Things like not changing the background; with our agfa systems the background contains important information. IP address, storage cache levels, etc. It saves us (and you) lots of time when having to deal with support calls. I can only assume that is why they don't let you change the background.

Disabling usb ports is a bit extreme, however I have had a workstation crippled due to a virus that got onto the system and interfered with the RIS and PACS (oh, and the user thought disabling the antivirus was a good idea because "it made the system too slow"). In my job, we are afraid to make any change to a doctors reporting station, because if that fucks up, you won't be able to report. The complaint of not having an RSS reader is minimal compared to not being able to work, for example.

Security risks are always a big concern. We're dealing with peoples personal medical records. I highly doubt you understand the seriousness of this, and the amount of vulnerabilities in flaws in todays computer systems. Any preventative measure that can be taken to secure a system/network should be. The moment security is breached in your systems - you will be condemning IT for allowing it to happen. (Had this happen a number of times to myself before also, maybe you yourself will be more understanding but others will not).

I also find your use of words to be rather harsh and are kicking up a storm over trivial matters. You earn ridiculous amounts of money and are complaining about "draconian manners" such as disabling right click on the desktop. My heart goes out to you.

Generally, IT know what they are doing (some have no clue, but they are gone after a month or two usually), and the regular users don't. It doesn't sound like you have any relationship with your IT team, and most likely would come across as an overpaid, arrogant doctor with trivial demands. They won't give you the time of day.

Apologies if this is a bit all over the place, typing paragraphs in between other duties here.

Cheers