Organization Partner

Buying a clinical information technology system challenges every organization’s senior management team. Unlike other administrative applications that help manage a facility, the clinical information technology system touches directly the lives of patients and the work flow of physicians, nurses, and other clinicians. Careers and entire organizations can be ruined by poor vendor choices and botched implementations (e.g., installation of the software and hardware) and deployments (e.g., introduction of applications to end users). Poorly chosen clinical information technology systems can drive physicians to competitor institutions, impact facility accreditation, and in some cases invite litigation due to unexpected morbidity or mortality.

As frightening as this task is, the best way to be successful is to be humble. Senior executives must accept the fact that full investigation of the features and functionality of clinical information technology systems before purchase is impossible. No individual or committee has the technical expertise and available time to effectively evaluate and fully review the capabilities of a comprehensive clinical information technology system. Therefore, organizations must base their decision to purchase systems on factors that function as surrogates for the usefulness and appropriateness of the systems in its institutions. These may include such items as the source of clinical content included with the system, list of organizations using the system, and perceived ease of use of the application.

Evaluate Live Systems

Although information technology vendors utilize demonstrations of their software to educate clients about their products, viewing working systems deployed in patient care areas offers the most valuable information. Unfortunately for both vendors and purchasers, the competitiveness of the healthcare information technology marketplace, couple with the complexity of these systems, encourages vendors to showcase software products during demonstrations that are either partially completed or are in beta version.

Therefore, often what is seen in these demonstrations does not accurately represent the features and functionality currently available. It is important to take vendors at their word when they declare that the demonstrated software is representative of features and functionality under development.

Focus on Deployed Working Systems Only

To increase the probability of purchasing a product that will satisfy the needs of an organization, institutions most focus on existing, working, deployed, and implemented versions of the applications being considered for purchase. The best way to evaluate current-state versions of applications is to visit current clients of each vendor and to witness the daily use of the various applications. Organizations must be patient and allocate adequate time to see the systems working under all conditions. This includes visiting multiple hospitals and various patient care areas throughout each hospital.

Forge Solid Vendor Relationships

For most organizations, it is more prudent to engage in relationships with vendors that have established working applications that can be immediately deployed and utilized. Although working, released software will have its inevitable share of problems, it is likely there will be fewer problems and solutions will be readily found.

In some cases, it may be advantageous to engage in relationships with vendors that are offering software that hast just been released or is under development. In these instances, organizations must enter the agreement recognizing the potential benefits from such arrangements but also the problems and delays in the software that may be associated with purchasing new, untested software. Organizations that do not have extensive information technology infrastructure and departments should be wary of entering into these types of arrangements.

The following sections outline a recommended process for choosing clinical information technology for an institution.

Review and Embrace Strategic Vision

The purchase of all clinical information technology tools must be driven by the clinical strategic vision of the organization. The strategic vision represents the views and aspirations of the board of directors, the medical staff, and other clinical professionals in the organization. Clearly, cost control is always a consideration, but the importance of patient safety and quality healthcare overwhelmingly drives decision making.

Broadly Explore Options

A high level of evaluation of your organization will quickly identify the potential suppliers of the application software required. In almost all cases, there will be a relatively small number of vendors who provide software that meets the needs of an organization. Identification of these vendors can be done through a request for information process ( RFI ), searching the Internet, and contacting colleagues at institutions similar to one’s own.

Understand the Vendor

As relationships with application vendors extend far beyond the implementation phase, a strong, open, and trusting relationship is necessary to be able to ensure that implemented software will deliver the expected results to an organization. Because problems will arise, a positive relationship is required to ensure that problems are resolved. A good relationship with a vendor, as exhibited by respectful an honest interactions with all representatives of the organization, unequivocally trumps perceived advantages in features and functionality that might be seen in other products.

Evaluate The Product

The best way to evaluate clinical information technology applications is to actually see them functioning in a real working environment. Unless an organization is working as a development partner with a vendor, various client organizations, comparable to the purchasing institution, should be available to be visited to observe the applications being used by clinical professionals.

Purchasing organizations must budget more than one day to visit these client organizations and see the applications being used at a variety of times during the day. Workloads vary, with morning physician rounds often presenting the greatest demands upon systems because of their high number of new patient orders and the need for patient care documentation. In addition, evening use represents a time when information technology staffing may be low or system maintenance may occur.

Organizations should request that their representatives be allowed to visit patient care areas unencumbered and be able to ask questions of the various users of the applications. The more institutions visited, the better the information that can be collected to evaluate the applications and the vendor.

Understand Pricing

Vendor pricing is greatly influenced by the level of ongoing maintenance payments, the strategic value of the organization to the vendor, and market forces. Therefore, in negotiating products with vendors, be sure to take a very broad and considered view of the products, services, and support being provided.

Cost of ownership includes not only the purchase price of the software but also the ongoing maintenance fee to the vendor and the cost of implementing, deploying, and maintaining the system during its life. Finally, the importance of the quality of the relationship with the vendor cannot be overemphasized, as it will have the greatest impact on the success of implementation and, eventually,clinician adoption.

Secure Adoption

Implementing clinical information technology without broad involvement and support by the clinical staff-requiring focus on all stakeholders, including physicians, nurses, pharmacists, and other health professionals-all but guarantees a failed and wasteful deployment. Clinical information technology systems alone do not fix clinical problems, advance safety, or reduce costs by themselves. These systems provide tools that can be used by clinicians to change how they deliver care. Only with clinician creativity, insight, and experience molding the implementation can new processes deployed with these tools deliver acceptable work flows and generate good outcomes.

If deployment is poor and disruptive, clinicians will create work-arounds to these failing system processes, a development that guarantees medical errors and unacceptable waste. By securing adoption, organizations can be assured of usable systems that are embraced by clinicians and that are able to deliver expected and much-needed clinical and financial outcomes.

When someone develops the mental health disorder known as PTSD after living through one or more traumatic events and he or she has a partner, that partner suffers right along with the other. In fact, while those who develop PTSD may experience depression, anxiety, difficulties related to role changes, communication problems, physical health issues, and turn to abusing substances to try and manage PTSD symptoms, did you know that the partner can develop these same problems? However, if the partner is provided the knowledge and skills needed to become resilient, or to better adapt and cope with the challenges the unwanted guest of PTSD invariably brings into a relationship, these potential negatives could be avoided. Furthermore, the partner may discover that positives evolve from striving to effectively cope with the partner, the PTSD, and its impact on their relationship-such as a sense of mastery or self-efficacy.

Challenges the Partners of PTSD Sufferers Face

What challenges do partners of PTSD sufferers face? They typically fall into one or more of these categories:

•coping with the changed personality and behaviors of the loved one with PTSD
•the lack of information and supportive services for partners of PTSD sufferers
•new financial strains and the likely burden of having to meet these alone
•the emotional or psychological strains associated with prolonged care-giving
•the social stigma of having a partner with a mental health disorder
•challenges working with professionals providing services to the loved one with PTSD

Let’s look at each category briefly, shall we?

Handling the Changed Personality and Behaviors of a Loved One with PTSD

PTSD changes the sufferer. That’s not surprising when you consider that the disorder is defined by categories of symptoms that can have severe behavioral consequences. They are re-experiencing, avoidance, and hyperarousal.

What do we mean by re-experiencing? The PTSD sufferer is apt to have flashbacks of the traumatic event and/or to experience nightmares about it. Flashbacks, because they make the person believe he or she is in the midst of the traumatic event again, are something that PTSD sufferers want to avoid. Also, because PTSD sufferers do not know what will trigger their brains to engage in flashbacks, they often avoid activities or events they enjoyed previously-such as victims of sexual assault may want to avoid sex whereas war veterans may want to avoid crowds at malls and movie theatres.

Of course, the PTSD symptom of emotional numbing doesn’t help matters, either. It results in PTSD sufferers not enjoying things they did previously. So, when you combine this with the desire to avoid situations that could potentially trigger flashbacks, doesn’t it become more obvious why the PTSD sufferer may disappoint the partner and other family members by electing to stay home time and again versus going and doing things with them?

Another category of symptoms, hyperarousal, might be viewed as the PTSD sufferer’s body essentially remaining in a fight or flight mode-or hypervigilant-long past the traumatic event. Because of hyperarousal, the PTSD sufferer may act irritated or angry much of the time. Needless to say, this can be quite upsetting to the partner who is trying to be loving and supportive.

Lack of Information and Supportive Services

Services have typically focused on the PTSD sufferer and tended to ignore the partner even though PTSD sufferers can benefit immensely from the support of a knowledgeable loved one. And of course, since both partners form a system that is adversely impacted when either partner is not functioning normally, partners should be seen as in need of help and services, too. The resiliency of the partner of someone impacted by PTSD can be enhanced via education-about the mental disorder of PTSD, how it is treated, how to find the professionals who can provide the best treatments possible, as well as how to work with the helping professionals encountered. He or she can also then use this new knowledge to benefit the loved one with PTSD-as well as their relationship.

The partner of the PTSD sufferer not only has a lot of information to process, but the partner likely needs to develop some new skills. A self-help book I wrote, designated one of the “BEST BOOKS OF 2009″ by the Library Journal, and entitled The Post-Traumatic stress Disorder Relationship: How to Support Your Partner and Keep Your Relationship Healthy, provides the type of help partners need. It offers necessary information as well as teaches and models helpful skills. But then, part of the intent of this book is to help the partner to become more resilient in the face of challenges PTSD invariably brings into the relationship-a relationship which can suddenly seem as if it’s with a stranger versus a loved one.

Coping with New Financial Strains

A PTSD sufferer may be incapable of attaining and maintaining the same type of job he or she did prior to developing this mental disability. Furthermore, many do not want to work around people as they did previously and instead, may seek to be outdoors working in nature, for instance. Certainly, such an environment may prove both calming and healing to the PTSD sufferer. That said, there also may not be jobs available that the PTSD sufferer can perform, they may pay less than the person made previously, or they may only be part-time. As a result, the burden of supporting the family may well fall on the partner’s shoulders at a time when costs are likely increasing due to medical and other needs.

Where does the partner turn for help to learn how to cope with these new financial challenges? There is some information in The Post-Traumatic Stress Disorder Relationship that can help. However, government, state, and/or local agencies or not-for-profit organizations may be able to provide some necessary assistance-although many budgets are certainly being cut these days. Also, there’s a government organization typically found in every county of this country that provides helpful information and guidance in this area-as well as others that should prove benefit couples impacted by PTSD. It’s called Cooperative Extension. The partner can search for the nearest office by putting in the county’s name, the state, and the words, Cooperative Extension. The local Extension Agent should be able to provide sound information that can help with budgeting, cost-cutting, and much more.

Combating the Emotional or Psychological Strains of Prolonged Care-Taking

For the PTSD sufferer to become more resilient in the face of his or her PTSD, it helps to pursue a lifestyle that is balanced or heals the body, mind, and spirit. This is certainly true for the partner as well. So, the PTSD-impacted couple may want to pursue some of these activities jointly-such as exercising regularly together. Or, for both of them to get in better touch with that part of the inner self that perpetuates healing and spiritual growth, they may want to spend time meditating or engaging in iRest Yoga Nidra together. iRest Yoga Nidra was developed by psychologist Richard C. Miller, Ph.D., and it has been used with enthusiasm and success by wounded warriors at Walter Reed. In fact, Dr. Miller told me when I called to ask him about this program, that many asked if their partners could participate in the classes with them.
The resilience of both individuals will also be enhanced by proper nutrition, adequate rest, and relaxation. Again, Cooperative Extension can provide information about preparing healthy meals-as can organizations such as the American Heart Association (AHA). In fact, AHA can also provide information about heart-healthy and stress-busting exercise. Needless to say, iRest Yoga Nidra will help with relaxation.

The Social Stigma of Having a Loved One with a Mental Disorder

Despite the efforts of advocates working on behalf of the mentally ill to overcome the stigma these individuals have faced in our society since its beginning, that stigma still exists. Furthermore, as many a warrior with PTSD has discovered, while the military is striving to change the attitude that some have-that the development of PTSD signifies personal weakness or a character flaw-there is still much progress to be made. Therefore, while top military leaders may increasingly realize that PTSD is perhaps best viewed as akin to a chronic physical disease such as diabetes that requires ongoing management, not all those in supervisory positions accept that the person has become a victim of his or her brain. Unless the military can discover ways to build resilience so that people do not develop PTSD in the first place after experiencing ongoing trauma in the war zone, the best we can do is to help PTSD sufferers and their partners become resilient after the fact.

The partner needs to be prepared to deal with individuals who may cling to outdated beliefs as to why people develop PTSD. So, what is the partner going to say in response that will help educate versus cause the other person to become defensive-and remain steadfast in his or her current way of thinking? For guidance with this and other challenging tasks, the partner may want to contact the National Alliance on Mental Illness (NAMI). This organization continues to battle against social stigma for all people and families impacted by any mental illness.

Challenges Working with Medical and Mental Health Professionals

Professionals are often prepared to work with the PTSD sufferer, but less well equipped to work with the partner. Some professionals, rather than seeing the partner as someone who can support the PTSD sufferer and help him or her to jump on and walk that pathway toward recovery, may instead see the partner as someone who is apt to get in the way-or make the PTSD sufferer’s recovery process more challenging yet. Of course, while this possibility certainly exists, the partner can also be educated so that as he or she becomes the professional’s ally.

That said, if you are the partner struggling to work with a professional who sees you as the enemy, you may need to asset yourself. Let it be known that you intend to be actively involved in all matters associated with your loved one’s care and recovery. Of course, there may be paperwork that your loved one needs to sign in order for professionals to talk to you about his or her medical issues. It may also be necessary for you to attain a medical power of attorney. Why is this a good idea? Your loved one may be incapable of making sound medical decisions in his or her best interest. Let me provide a rather frightening example of why this could prove important-if not life-saving for your beloved.

There have been warriors wounded by PTSD given a cocktail of medications that so heavily sedated these individuals that they died in their sleep. I have communicated with one wife who took action to ensure this did not happen to her husband. Sadly enough, four warriors wounded by PTSD that her husband knew personally had died in this way-from ingesting a prescribed, yet lethal, cocktail of drugs. This concerned wife, however, because she had attained a medical power of attorney, saw to it that her husband’s doctor removed him from these medications. But then, she had seen tell-tale signs that he was over-sedated. Needless to say, he was too sedated to take action in his own best interest.

How Helping Professionals Can Better Serve PTSD-impacted Couples

Are you a professional seeking to help couples impacted by PTSD? Well then, it’s a good idea to measure family resiliency during your initial assessment by using resiliency, coping, and adaptation inventories. Once you have this information, you can help the couple to understand the type of challenges they’re likely to face-to normalize these. then, begin to educate both parties regarding not only what they need to know about PTSD and its treatment, but teach and role-play skills that enhance sense of control and well-being-such as those found in The Post-Traumatic Stress Disorder Relationship. And certainly, teach them how to deal with other service providers. Talk about the goals they’d like to achieve as individuals and a couple-and then how to share these with professionals. What statements do they need to make, what questions should they ask?

Resiliency and the PTSD-impacted Couple

The partner of a PTSD sufferer who comes to learn healthy ways to cope with the PTSD and its impact on their relationship is apt to dismiss emotionally painful actions of the PTSD suffer as symptoms of the mental disorder versus taking them personally, will strive to do things that make it more comfortable for the PTSD sufferer to engage in activities, will help others to better accept the changed PTSD sufferer, and will elect not to dwell on the past or what the loved one was once capable of doing but instead, will come to accept that while life with a partner changed by PTSD is invariably different, their life together can nevertheless be meaningful and fulfilling.

Rather than fighting pain and change as many are inclined to do, the healthy partner of a PTSD sufferer will choose to believe that while there have been losses to endure, certainly, there have been-or likely will be- gains, too. Each negative event has a positive side or aspect, but one must look for it and seize it.
Both individuals in the PTSD-impacted couple may ultimately take pride in their ability to tackle and solve problems-or take pleasure in their newfound resiliency. And indeed, wouldn’t that be a good positive to come out of this?