Submitted by PeterElias on Fri, 04/15/2011 - 06:00

When we were a group of four primary care providers it was easy to share information, communicate and work collaboratively. Having grown to ten, we struggled. As our lives became more hectic, our time scarcer, and the number and complexity of issues grew, it became impossible to manage practice governance, pursue QI projects, develop work flows, and deal with directives from our parent organization. Keeping everyone in the loop was simply not possible. Even if we could get all ten providers in one place for an hour/week, the task was too large to squeeze into an hour a week.

The solution seemed straight forward. Use 21st Century collaborative tools that facilitate information management and allow asynchronous communication and collaboration. 

Our needs were pretty basic: a mechanism to post updates on projects or problems we were working on, a place to upload/store/download documents relevant to our practice, and a forum for ongoing discussions. If this worked well, we could add a Wiki to collaborate on and document policies, protocols and workflows. And it would need to be private, accessible only to pertinent staff.

The cost seemed low: there are numerous FOSS options, a domain name costs ~$10/year, we had access to free hosting, and one of us does this as a hobby. A simple site with basic collaborative tools was built (using Zikula). We planned to test it with the managers, add some content, and then roll it out it to the providers. 

And that’s where it stopped being simple. We are no longer an independent practice, having been acquired three years ago by the local medical center. Our internet access is now managed by the medical center’s IT department. The IT Department answers to the CFO. A recent reorganization of the medical staff resulted in a decrease in access by medical staff or practices to the decision making processes by IT. And here’s what happened next.

On the day of the planned roll out to the managers, I discovered that the site was blocked by IT ‘for security reasons.’ Huh? A locked down site accessible only to 10 providers and 3 managers, with one article, an empty forum, and no content. Blocked for security reasons? It wasn’t because of the software: a quick test showed that 5 other sites using the same software (including the public site for our practice) were not blocked.  It wasn’t the host: again, a quick check showed multiple other sites on the same host were not blocked. It wasn’t the site name: the name of our practice and ‘Croo’  the nickname we have for ourselves. 

A call to the help desk was not helpful: this is not something the help desk can handle, and I was advised to submit a ticket.

I submitted a ticket, explaining that we had created a small private portal site with standard collaborative tools, to be used within the practice. I requested that it be unblocked. The next day I received an email saying a ticket had been created.  A day after that I received a second email saying that the ticket has been assigned - but not to whom, and with no way but a link to see the status.  Another two days passed and someone in IT had accepted responsibility for the ticket. The ticket system does not name the person owning the ticket, does not provide any status information beyond received, assigned, accepted, pending, resolved. And there is no method for providing or obtaining more information other than calling the help desk – which generally is not helpful following up on an existing ticket (it works for submitting a ticket). 

A week went by and nothing happened. Contacting two members of IT to try an end run around the system was unproductive. I sent an email to the three managers in the command chain above me (two of them physicians and one an administrator) asking for help and did not receive a reply from any of the three. (Communication and accessibility are not strong points in our organization.) Another week passed. Then another. The ticket showed no change, and there was no apparent way to get more information or initiate a conversation. I did not even know what had triggered the security block. My friend Google suggested it might be related to the fact that the site was built on a brand new domain name, so I checked multiple domain names registered on the same day. Bingo. All blocked. Another week passed, and I checked the site every morning. Suddenly, one day, it was no longer blocked. The ticket still said pending, so it appeared that IT had not even addressed our issue, but our site is available - along with all the previously blocked sites with domains registered on the same day.

Our practice is finally in the process now of starting to test our collaborative tools. Eventually, when IT gets around to looking at the ticket, I wonder what they will say. Our practice recognized the harm being done by dysfunctional information management and communication and was working in a plan to improve things. And IT? I would ask them - but they don’t communicate much.


Update (April 27th). Now I know what IT will say when they eventually get around to looking at the ticket: not much. After watching my ticket sit for a full month, apparently untouched in pending-land, I received an email telling me the ticket would be closed unless I resubmitted it. No comment on its status and no information about the issues it raised. (Judging by the date, this appeared to be part of a formulaic 1-month ticket housecleaning.) I resubmitted the ticket, explaining that I felt it was inappropriate to close a ticket without closing the loop and informing the ticket submitter of the reason the site was blocked, how, when and by whom the blocking was addressed, and what the outcome was. This is simple common courtesy, as well as good service. My re-submitted ticket was duly logged, but there continues to be no response…


Update 2 (5/4/2011): The resubmitted ticket remains pending, and no one has contacted me with information about why the site was blocked or how/why the issue was resolved. At some point I will give up addressing this with IT and raise the issue with the Board, instead.


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