Managing the user needs during the EHR implementation in Buenos Aires City.
The Helpdesk Role
Alassia, La, Palermo Ca,Recondo Fa, Giussi Ma, Stieben Aa, Baum Aa, Gonzalez Bernaldo de Quiros Fb
a
Dirección de Informática Clínica, Estadística y Epidemiológica, Health Ministry, Buenos Aires City
b
Health Cabinet Adviser, Health Ministry, Buenos Aires City
Abstract
Enablement, guidance and proactive preparation for a new IT
system implementation has proven to be a smart way to
prepare people to embrace change. These activities are
closely related to change management approaches which seek
to help people understand and adopt specific behaviors. That
being said, investing on such activities become the
cornerstone of the success of the project. Leading IT
companies around the world include in their strategy for new
services and offering deployments a proactive Helpdesk
service. This not only helps build long lasting/trusted
relationships between end users and IT sectors but also helps
with cost reductions and to maximize Return of Investment. A
streamlined process and easy to use/fluent communication
channels between parties are, without doubt, powerful risk
management/Quality Assurance and Continuous Improvement
tools. In this paper, we address the example of a helpdesk
support team put in place in a city scaled Electronic Health
Records implementation
Keywords
Health Information Systems, Workflow, Argentina
Introduction
Helpdesk support is key to set in motion a successful
implementation of any IT system. Not only does it help with
User Experience and Satisfaction but also helps with the ROI
associated to the funds allocated to the IT system per se. a
well-qualified Helpdesk would be not only fixing technical
issues but also ensuring their root causes are tackled
accordingly and prevented from reoccurring in the future,
working side by side with developers. An IT system
implementation is not just a junction of applications. There is
consensus among the private and public sectors a successful
implementation depends on organizational factors[1][2],
including the ability to answer to the needs of users directly or
indirectly involved in the implementation process.
An information system attempts to accurately reflect and
streamline processes and, also, bring them to life as they are
executed. The IT system is meant to prove it’s worth by
adding value to the process and impacting the (and the overall
Organization) positively [3][4][5][6]. Implementation reports
and practices show there is a continuous life cycle adaptive
evolution between work processes and the applications of an
information system, requiring appropriate Change
Management in the first case and the establishment of
continuous improvement cycles in the second [2][7]. In this
context, Help Desk implementation (understood as a tool
leveraged to support the operational line) is part of the
Organizational Strategy. A Help Desk combines technologic
and human resources which provide services to manage and
solve incidents/Scenarios and/or requirements related to
Information and Communication Technologies (ICT). Clinical
Information Systems (SCI) involve several ICTs as well as
different types of users, who need adequate support and
training to ensure the successful use of such systems[8].
In addition to the Helpdesk’s benefits to supporting the
operational aspects through a fluid communication with the
central level and contributing to increase user experience/
satisfaction, Helpdesk also presents itself as a management
tool. It allows Management to gather feedback from end users
regarding areas of improvement, recurrent scenarios,
automation opportunities, etc. which mean empower them to
be able to sort/label problems and allow, through reporting,
accurate and up-to-date information to be available for
Leadership’s smart decision making, both for corrective and
preventive actions [9].
This paper’s objective is to describe a Helpdesk
implementation process and its’ benefits to Operational
Management & Excellence applied to Primary Care Level for
Buenos Aires’ Public Health System.

Methods Implementation Process and Management

Design Fifty two days passed from the first to the last link between
CeSAC & the Helpdesk (from 21/4 to 13/6). The tickets were
This is a cross-sectional study. A secondary analysis of
labeled based on: Problems (Category), and Priority (Low,
Helpdesk’s database was performed.
Medium, High and Critical). Given some tickets could not be
included within existing categories, Help Desk Managers had
Setting
ownership of the generation of new categories, making them
available for future similar scenarios.
The Autonomous City of Buenos Aires (CABA) is
Argentina’s capital city. According to the 2010’s national
Table 1– Generated Tikets to November 2016
census, the population of the city is 2,890,151, and the
population of its’ urban cluster/outskirts, (locally named Category N % (n=1400)
Greater Buenos Aires), is around 12,801,364; making Buenos
Aires the largest urban area of the country and the second Supplies 367 26.21%
largest one from South America [10].
Patient Indexing 318 22.71%

Electronic Schedules 210 15%

Health Care Network and Public Health System in
CABA Maintenance 203 14.50%

Three subsystems coexist in Argentina’s Health System. In Informatics Support 87 6.21%

addition to the Public Subsystem, there is healthcare coverage
Process Support 68 4.86%
derived from Social Security, which assists the population
with formal jobs and, lastly, Private Health Coverage, funded Pharmacy 38 2.71%
with contributions from its’ users. The Public Health
subsystem is funded by the government (local, provincial or Other 31 2.21%
national) and provides health care for free to the population.
The CABA health network has 33 Hospitals, 44 Primary and Security 23 1.64%
Community Health Centers (CeSAC) and Neighborhood
Medical Centers which are divided into 4 regions. Each Health
Region is subdivided into areas which include a General Table 2– Tickets by month (workdays)
Hospital and the local CeSAC . The CeSACs are part of the
city's Primary Health Care network (APS), which provides Month N Tickets/Workdays
services to approximately 500,000 medical queries per year.
April-May (from 21/4) 58 2
50% of them correspond to the Pediatricians’ specialty and the
other half are carried out by Primary Care Physicians and June 142 6.45
OBGYNs . In addition, CeSAC provides services to
approximately 260,000 non-medical specialization queries, July 102 4.86
including Nutrition, Social work, Psychology, Obstetrics, and
Dentistry. Based on data from 2014, 17.8% of the population August 175 7.61
living within CABA receive assistance only from this system.
September 324 14.73
This percentage rises to 31.2% in the South of the City. The
network also takes care of people residing in the outskirts of October 357 17
Buenos Aires metropolitan area and , also, in other provinces,
although to a lesser extent. [11]
November (till 14/11) 237 23.7
Results
Until November 14th - the final cut-off date for this study -
1400 requests were made to the HelpDesk, coming from the
44 Primary Care Centers of the City of Buenos Aires. The
overall analysis of these orders is shown in Table 1, which
lists the total number and percentage of tickets sorted by the
main Categories.
Considering the context of progressive implementation, we
also analyzed the qualitative difference in terms of ticket
categories and the rate of ticket generation adjusted by
business days in the month. This analysis shows the
fluctuation of the requests, motivating the ticket generation
routed to the central level, quickly change. Regarding the
labeling of the reported problems, in the first two months of
Most used Categories up to Aug 1st and Nov 11th
Figure 1 - Most used categories in the first 3 months and at the 7th month.
implementation, the root cause of tickets generated was related
to legacy issues ( supplies orders and maintenance issues), a
trend that changes from the third month onwards towards
issues related to operational support of the actual
implementations (Patient Indexing and electronic scheduling
represent almost 40% of orders).
As for the number of tickets generated per day, the value
accounts for a mildly increasing trend during the initial
months with a steep increase in September, keeping its’
increase rate until the cut-off date. This trend is best observed
when adjusting the number of orders per working days of the
month (Table 2), going from an average of 7-8 orders / day in
August to 23 orders / day in November. This phenomenon
correlates with computerized processes with remote enabled
support
As far as the number of orders generated per day is
concerned, the indicator shows a small trend increase at the
starting months with a sharp increase in September, keeping
its increase rate until the cut-off date. This trend is best
observed when adjusting the number of orders per business
day of the month (Table 3), going from around 6-7 orders /
day in August to 23 orders / day in November. This
phenomenon correlates with the support provided to
computerized processes whose support was enabled remotely.
Discussion
As previously mentioned, a help desk has different capabilities
and purposes, depending on the kind of users under
consideration within scope. Analyzed in the context of the
present implementation, the Helpdesk is used as a change
management tool. In addition to serving as a sensor of
operational needs, the Help Desk also becomes an indirect tool
to satisfy (totally or partially) the most pressing needs of
health centers.
From a management point of view, the central level
represented by the Ministry could quickly have a diagnosis of
the needs in the first level of care. This led to operational
decisions aimed at formalizing the processes to resolve these
problems, outlining specific responsibilities (where
applicable) and establishing supervision over external third
party vendors (outsourced). With regards to historical
problems, most were reported in the first few months, action
was triggered by the central level focusing on their resolution,
especially on the Maintenance issues, which were addressed
mostly through regular follow up meetings with the office
accountable for the third parties’ supervision. We then
proceeded to standardize response times for the most
frequently incoming tickets (supply chain and basic
maintenance issues), which allowed the generation of
continuous improvement cycles of issue resolution quality
assurance processes.
In alignment with this progress of the overall implementation,
the Help Desk also becomes the channel for reporting errors
that require corrective actions as well as suggestions for
procedural or computer improvements, with the empowerment
of users in general.
The present work has several boundaries. Because of being a
cross sectional study, the results should be interpreted as being
potentially impacted by factors not being considered within
the scope of this study. On the other hand, although all the
CeSACs have the help desk implemented, half of them have
not implemented HCE applications and Electronic scheduling;
The mentioned scope corresponds to the 2017 agenda. Finally,
the user satisfaction was not measured with a qualitative
methodology. This could have made the work presented in this
paper even richer.
Conclusion
As Health Informatics Project for Buenos Aires City advances,
we conclude the Helpdesk is a valuable tool, not only for
management but also for change facilitators. Results in our
study will be used to plan further implementations as we move
forward throughout different settings.
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Address for correspondence

Leandro Noer Alassia

lalassia@buenosaires.gob.ar
+5491152572102