Portal de Periódicos da CAPES

The Downside of Software as a Solution

2023; Lippincott Williams & Wilkins; Volume: 45; Issue: 6 Linguagem: Inglês

10.1097/01.eem.0000942544.21473.fe

1552-3624

Thomas M. Cook,

Big Data and Business Intelligence

Figure: software, technology, EPs, efficiency, time, diagnosis, productivity, IT solutions, SaaS, apps, information technology, emergency medicine, health care, metricsFigureThe evidence says technology drains EPs' time, efficiency, and engagement My first patient on my first day of internship in 1990 was a woman with chest pain. I carried a clipboard holding a single sheet of paper that I used to document her history of present illness, past medical history, social history, medications, allergies, physical exam, lab results, diagnosis, and even discharge instructions. I would write orders for the nurse on this same sheet of paper. What about medical decision-making? The term had yet to be invented. I could only use the front of this sheet of paper. I had to write in the margins if I ran out of space. This process was used on every patient, regardless of pathologic complexity. If you performed a procedure, you simply stated that you did. There was not enough room on the page for a procedure note. The workplace stimulated the development of numerous tools to assist with running a business. Typewriters, staplers, three-ring binders, multiple telephone lines, answering services, copy machines, fax machines, highlighters, and even sticky notes are just some of the innovations created to increase work productivity. The era of big data and the relentless drive to improve efficiency and production, however, created an exponential increase in information technology solutions that radically changed how business is conducted. Unfortunately, these IT solutions are slowly making many of us more and more miserable at our jobs. This is typically how it works: Someone, usually an administrator, discovers a problem that limits productivity, increases costs, or puts the business at risk for bad outcomes. Before IT was developed, a solution might involve the coordinated efforts of multiple individuals working in harmony. The problem is that if any of the flawed human beings providing the fix did not do it right (or got sick or quit), that fix could cause more trouble than benefit. A SaaS Explosion Information technology, as it became more refined, however, provided dependable solutions to common problems affecting all businesses. For example, I check my EMN column for spelling and grammatical errors at grammarly.com before submitting it. It is much easier than sending it to a human for review, and that human might not find all the mistakes. We all rely on these software as service (SaaS) applications in our professional and daily activities. It can generate an expense report at work or deposit money in our checking account at home. We use SaaS for convenience, 24-hour service, and avoiding human error. SaaS use has exploded. The average number of SaaS applications used by organizations worldwide increased from eight in 2015 to more than 100 in 2021. (Statista.com. Feb. 16, 2022; http://bit.ly/3H2uziZ.) This number can be much higher at larger companies. But what happens when companies attempt to solve every problem using SaaS? Is this good for business, and more importantly, what is the effect on employees? I read an article a few months ago that said shifting between multiple apps to get stuff done drains workers' time, efficiency, and engagement. (Bloomberg.com. Oct. 18, 2022; http://bit.ly/407bmWm.) I subsequently thought about how many different SaaS apps I use at work. It goes beyond using the EMR to document patient interactions (even though the complexity of this SaaS takes months to comprehend). We use SaaS apps to communicate with consultants, view medical imaging, get our paychecks, manage our employee benefits, sign contracts, review endless corporate policies on everything from active shooters to encouraging breastfeeding, request funding for business travel, and document our vaccination status. I use SaaS apps as a program director to make budget requests, submit regular reports on residents' performance, file annual program evaluations, manage our match application process, send surveys, and attend countless virtual meetings. All this SaaS stuff makes me much more efficient and productive compared with how I did things back in the old days. There rarely is any paper involved in my work, and I can provide much more feedback to our residents and faculty on their performance. We are making strides as a department in efficiency and quality that were not possible in the past. But what is the cost of all this progress? One App to the Next Our life at work has become an endless journey of moving back and forth between SaaS apps to do more and more work. Each time one of these solutions creates some quantity of efficiency, someone in the company gets an idea for another SaaS app that will potentially produce a tiny benefit. The result is that you get another SaaS added to your work life. And that's not to mention that each of these things comes with its own user ID and password. Like many people, I have a spreadsheet with all my user IDs and passwords. Ironically, many folks use SaaS to create secure passwords for all their SaaS apps. My hospital has had some success using a single user ID and password for many of the SaaS apps, but there are often hiccups in the operation of this. All those years ago in residency, I arrived at work, picked up a chart, and saw a patient. Today, we all begin logging into multiple apps before practicing medicine. And we are often forced to review correspondence, sign charts, and review performance metrics before we can get to the “business” of caring for patients. The entire process creates a feeling that all we do at work is click from one app to another to feed the beast that is our employer. It is exhausting. DR. COOKis the program director of the emergency medicine residency at Prisma Health in Columbia, SC. He is also the founder of 3rd Rock Ultrasound (http://emergencyultrasound.com). Friend him atwww.facebook.com/3rdRockUltrasound, follow him on Twitter@3rdRockUS, and read his past columns athttp://bit.ly/EMN-Match. Share this article on Twitter and Facebook. Access the links in EMN by reading this on our website: www.EM-News.com. Comments? Write to us at [email protected].