Brittleness

This entry is part 1 of 43 in the series Words

The Whorf-Sapir hypothesis says that our language shapes our thoughts. (Recently, there was a segment on NPR news about how important dinnertime was for kids, mostly because the discussion is a great place to learn new words and concepts.)

So here’s a vocabulary word to use and contemplate as you think about ED systems: “brittle.”

When I hear the word, I think of peanut brittle; of shiny cast metal faucets that break, and the dull, greyish metal exposed in the break (“pot metal,” the plumbers call it). What do you think of?
Read the rest of this entry
»

Share

Robustness

This entry is part 2 of 43 in the series Words

Robust. My dictionary defines it as

ro·bust, adj.

1.strong and healthy; hardy; vigorous: a robust young man; a robust faith; a robust mind.

2.strongly or stoutly built: his robust frame.

3.suited to or requiring bodily strength or endurance: robust exercise.

4.rough, rude, or boisterous: robust drinkers and dancers.

5.rich and full-bodied: the robust flavor of freshly brewed coffee.

For ED systems (including computer systems), what does “robust” mean?

Many ED computer systems are “rude” (in an interpersonal relations sense, that is; see the works of Alan Cooper such as The Inmates are Running the Asylum). But that’s not the point of this essay. Instead, let’s concentrate on the term “hardy.” If I look this up in my dictionary, I find a definition that reads

capable of enduring fatigue, hardship, exposure, etc.; sturdy; strong: hardy explorers of northern Canada.

Read the rest of this entry
»

Share

Diversity

This entry is part 3 of 43 in the series Words

Redundancy vs. diversityIrish potato famine Bridget O'Donnel

Redundancy with a stock of identical parts to replace failed components is a standard way to make industrial processes more reliable.

For an ED mission-critical computer system, which needs to be up and running 24/7/365, one way to implement this is to have a backup server always ready to go, with recent copies of the databases. This could be used also for “downtime” when changes must be made to the system. However, this is expensive in terms of hardware, software licensing (though that really shouldn’t be an issue if the software vendors knew what was good for them), but most of all in terms of system maintenance. Read the rest of this entry
»

Share

“Niche” Computer Systems

This entry is part 4 of 43 in the series Words
Shaker Cabinet:Woodgrain Vinyl::"niche" ED system:HIS ED module

Shaker Cabinet:Woodgrain Vinyl::"niche" ED system:HIS ED module

At the EDIS Symposium each year, a big question for attendees is “should we install the ED module of our hospital-wide information system (HIS), or should we install a ‘niche’ system that’s designed specifically for the ED?”

Traditional wisdom has it that the “niche” systems, also known as “best-of-breed,” will work better than the ED-specific module of a big HIS. This is true. Surveys by KLAS show this, and certainly my personal experiences with four or five different EDISs bears this out.

However, there are reasons why the ED module of a HIS can actually be better, at least in some ways, than a dedicated niche/best-of-breed ED system – integration. For instance, where I worked in the ED at Mercy Hospital of Pittsburgh (~60,000/year ED visits, Level I Trauma/Burn/tertiary care teaching center), we had Wellsoft, the KLAS top-ranked niche EDIS. We used it for tracking, nurse charting but not physician charting (we use Dictaphone EWS for physician charting), and a whole host of other purposes in the ED. It was extremely well-liked by all. However, the hospital was doing poorly (in financial terms) and it merged with University of Pittsburgh Medical Center, becoming UPMC Mercy. The ED was forced to abandon Wellsoft and adopt Cerner FirstNet, the ED tracking module of the UPMC-wide Cerner HIS. Users complained about this “downgrade” and of how “klunky” FirstNet was compared to Wellsoft – and indeed this is borne out by FirstNet having a much lower KLAS rating than Wellsoft. Read the rest of this entry
»

Share

Downtime

This entry is part 5 of 43 in the series Words

“Downtime.”

What an ugly word. Wiktionary defines it as The amount of time lost due to forces beyond one’s control, as with a computer crash.

Just the thought makes one down, makes one depressed.

Most “niche” (best-of-breed) Emergency Department Information Systems (EDISs) are justly proud that they don’t go down.

That is, unless there is a massive problem like a power failure with both backup generators failing. That actually happened at Mercy Hospital of Pittsburgh once. Luckily I do cave and mountain rescue and always have some spare headlights in my truck. I was able to get them from the truck and they certainly helped us keep going. If you’re interested in the topic of emergency lighting for hospital disasters, check out my essay on the topic.

Read the rest of this entry
»

Share