For the best EH software, take control of the choice

You can quantify differences in software

Do you have someone who reminds you which employees are due for TB screens or immunization updates, tracks needlesticks and highlights patterns in employee injuries, helps manage your daily workflow of patients, and calculates costs and provides analysis? You should. Those are all tasks that can be handled by a well-designed computer program.

Unfortunately, many occupational health professionals are working with software that wasn’t selected to meet their needs or isn’t being used to its potential. James K. Ross, MD, MBA, an occupational health physician and an expert in information systems for occupational health clinics, shared some basic advice for those in the market for software.

"Selecting an information system is a strategic planning effort," says Ross, who is chairman of the informatics section of the American College of Occupational and Environmental Medicine and president of the American Institute of Medical Management, a consulting firm based in Ashland, KY. "It’s not just purchasing something and hoping it will match up at the end."

Ross outlined steps occupational health professionals should take in evaluating information systems:

1. Make sure you are a part of the selection process for new information systems. That may seem obvious, but too often employee health professionals allow information technology (IT) experts to select software. The problem with that hands-off approach is that those IT experts don’t know what your needs in occupational health are. You may end up with a system that performs well for what it does but doesn’t do what you want. "You need to manage IT instead of IT managing you," says Ross.

2. Determine your major work processes, then look for systems that would improve your productivity in that work. It takes time to define each task you do in employee health, but that will be time well-spent. You want to set priorities for your needs and select a system that will help you manage the most important aspects of your work. Ask questions that might relate to common scenarios. How would you register a patient in the system when he or she reports with an ankle injury? What would you do if the employee goes to the emergency department after hours instead of to the employee health clinic?

Meanwhile, be sure the system can interface with other systems, such as the lab and human resources. "Where most people go wrong is they read the vendors list of what it says it will do, and they accept the vendor’s presentation. Then they get it in their clinic and say, This isn’t what I thought it did,’" says Ross. Once you know what your greatest needs are, you can ask vendors how their systems meet those needs.

3. Use a quantifiable method to evaluate systems. Ross has developed a list of items, such as design and technical features and operational functions, that form an evaluation method he calls Effectively Quantifying Quality in Information Systems (EQQIIS). But your list doesn’t need to be that detailed.

Your IT staff can help you list important technical features and you can identify work-flow needs, such as scheduling preplacement exams or analyzing needlesticks. Then each member of the selection team assigns a point value on a scale of 1 to 100 for how important each characteristic is and grades each possible software product in the same way. This method identifies the product that attains the highest score on the elements that are listed as most important.

4. Be realistic in your expectations of information systems. When you finish your scoring, don’t expect any of your choices to end up with an "A" or even a "B." You’ll be lucky to find a system that even merits a "C," Ross says. "We haven’t found off-the-shelf programs that meet anybody’s needs." You might use your in-house IT expertise to customize the system, or you might ask the vendor to add customized features. You may decide that the system responds to your more important needs, despite certain failings.

5. Provide adequate training. Again, this may seem obvious, but lack of sufficient training is a major reason for underuse of information systems. Hopefully, in your selection process, you identified user-friendly attributes as essential. You also should arrange for ongoing technical support, including updates to reflect major new regulatory developments (such as the Occupational Safety and Health Administration’s ergonomics standard). "It isn’t a typewriter with a screen, it really is a computer," remarks Ross. "Most of the time, we’re using it as a typewriter with a screen instead of something with embedded knowledge."

[Editor’s note: More information on selecting occupational health information systems is available in the Guidebook to Occupational Health Informatics, ($75 ACOEM members, $90 nonmembers) from the American College of Occupational & Environmental Medicine, 1114 N. Arlington Heights Road, Arlington Heights, IL 60004-4770. Telephone: (847) 818-1800. Fax: (847) 818-9266.

The American Institute of Medical Management provides informatics consulting and can be reached at (606) 329-3906 or]