Vol. 24 • Issue 6
• Page 6
Computers have become an indispensible part of a laboratorian's workday. You rely on them to acquire data, validate test results, perform QC checks, transmit reports and a myriad of other functions. However, computers, like people, are not infallible. When you, as a medical technologist user-not an information technology (IT) guru-are confronted with an apparent computer error, slowdown or hang-up, what can you do to help diagnose the problem? Fortunately, you don't have to be a computer expert to assist.
Common Causes of Error
The most common causes of computer problems or errors are:
- Erroneous data entry: The most common cause of computer problems is user error (i.e., entry of inconsistent or invalid data). Good computer systems will detect such errors and provide a message explaining the issue and, often, how to remedy it. One example is "insufficient decimal places in entered result."
- New software releases: Too often, insufficient testing is performed by the vendor before releasing the software to the users (who most assuredly will find the problems). Be particularly vigilant for errors after a new release has been installed.
- Overloads of computer capacity: An under-configured computer system with insufficient capacity to handle the laboratory workloads can result in extensive "slowdowns" in computer response times. Slowdowns may be consistent or only occur during certain processes or busy times of the day. If slowdowns occur, record what processes are being used.
- Interface changes: In today's environment with multiple information systems interacting with one another, interfaces can be problematic. Unless detailed and careful coordination of changes to interface message content or format is done, strange and unpleasant things will occur. If external data received is garbled or inconsistent, check with your IT team to find out if any interface changes have taken place.
- Rarely used applications or process paths: Despite rigorous testing, there may still be "bugs" in the software. This is most likely for processes that are infrequently performed. Ask IT to test and validate processes and transactions used.
Steps to Detection
So what should you as a medical technologist do when you detect a computer problem? Several helpful steps can be taken.
First, try to reproduce the error. Carefully re-enter the data or repeat the process that failed. If it's OK the second time, it probably was a simple data entry error. If not, carefully, specifically and completely record the data entered, the process performed and the erroneous outcome. Avoid generalities such as, "the computer hung-up." Instead, use something like, "When I entered xyz and pressed the return key there was no change in the display and I did not get a confirmation message that the data had been entered successfully." If you know how to get a "printout" of the screens displaying the problem, do so. Call your IT helpdesk, describe the problem and submit your analysis to IT support.
If the problem persists and this is a process that has worked just fine in the past, ask IT if a new release of software has recently been installed. If so, that is the likely culprit and IT will have to resolve with the software vendor or, if critical, revert back to the earlier version of the software.
Laboratorians are great at figuring out workarounds for glitches, whether computer or human caused. However, slow computer performance is very difficult, if not impossible, to work around. If the slowdowns consistently occur during certain hours or when certain processes are in use, be sure to document that evidence. If, however, slowdowns are constant and are severely impacting productivity, this issue must be escalated to laboratory management and remedies requested from IT.
Rely on IT Team
In many hospital settings, the computing environment is very complex. Several information systems are provided by different vendors, in addition to the LIS, all operating and exchanging data with one another. Examples include the electronic medical records (EMR), physician order entry (CPOE), pharmacy, radiology, ADT, billing/accounts receivable, among others. Unless there is disciplined and well-planned coordination of any changes to the format and/or content of messages transmitted to or from these systems, errors can occur.
As a laboratorian, the best thing to do is document errors that occur promptly and report them to IT. Before releasing new software, the vendors try very hard to ensure that the software is error-free. The bulk of the pre-release testing often focuses on the most frequently used processes. If you, as a user, happen to initiate processes that are rare or unusual, you may encounter an error that was not previously detected. Again, document carefully the specifics of what has occurred and submit to IT for resolution.
Murphy's Law states that if something can go wrong, it will. No matter how highly recommended or successful the laboratory information system has been, you can be assured that some problems-whether from user errors, insufficient capacity, interface changes, insufficient testing of new releases or previously unfound "bugs"-will arise.
Dennis Winsten is president of Dennis Winsten & Associates Inc. (DWA), a healthcare systems consulting firm specializing in laboratory information systems, with headquarters in Tucson, AZ (www.dwinsten.com). An ADVANCE editorial advisory board member, he has more than 30 years of computer experience, including over 25 years in healthcare systems.