By Stephen Aleksza, PMP | Post-Acute EHR Advisory | In Partnership with HealthTECH
This article is part of our Expert Insights series, where experienced healthcare IT consultants share practical perspectives from real engagements.
Stephen Aleksza, PMP is a post-acute EHR advisor with nearly 30 years of vendor-side experience at Netsmart, Allscripts, and their predecessor platforms, where he led product management and professional services for home health and hospice. He partners with HealthTECH to help hospice, home health, and palliative care organizations navigate EHR selection, optimization, training, and migration.
Ninety days after go-live, the support queue is the most honest record your agency keeps.
Workarounds and training gaps and failing interfaces all end up there as tickets. Most teams read the queue one case at a time, close what they can, and move on. Almost nobody adds it up.
A Pareto chart is how you add it up. Sort your issue categories from most frequent to least, run a cumulative percentage line across the top, and mark where the line crosses 80%. The categories left of that mark are where your attention belongs, and it is usually a shorter list than people expect. Everything to the right is real. It is just not where the leverage is.
The chart is older than any of the software. Vilfredo Pareto noticed in 1896 that about 80% of Italy’s land belonged to about 20% of its people, and kept finding the same lopsided pattern in other economic data. He treated it as an observation about economies, not a management tool. The chart came later, out of quality engineering.
Joseph Juran applied the distribution to defect data and named the principle after Pareto, and Kaoru Ishikawa put the chart in his seven basic quality tools. It was still core curriculum when I did my Black Belt. Pareto was counting who owned Italy. You are counting help desk tickets.
The work is in the categories
The chart is the easy part. The work is reading each case and categorizing it by what actually got fixed, not by what the user reported. Your mind picks up on the trends quickly, and you get faster and faster at categorizing each ticket. Getting through 90 days of cases can be done in a day, sometimes only a few hours.
I ran professional services at Allscripts. The complaint field records what a user believed at their most frustrated moment. A ticket logged as a system error often closes as a training gap. A ticket logged as user error turns out, some of the time, to be an interface that had been failing quietly for weeks. Categorize from the complaint field and the chart ranks your users’ guesses. Categorize from the resolution and it ranks your problems.
Count is the first cut. Eight permissions tickets at five minutes each are not the same problem as a dozen interface failures that block clinicians at the point of care and take half a day each to chase down. If you track resolution time, run the ranking again weighted by hours and put the two charts side by side. Whatever leads both is your priority.
The workbook
Open the tool in Google Sheets and make your own editable copy → Open Google Sheets Template
Prefer Excel? No Google account required → Download the Excel version
I built an Excel workbook that handles the mechanics, which you can access and download using the links above (no email required). It comes loaded with 90 days of simulated support volume for a hospice and home health EHR, 132 cases, already turned into a Pareto chart with both 80% cutoff lines drawn in.
Run it more than once. Configuration drift and workflow gaps tend to resurface in new forms as an implementation matures, so the same analysis in three or six months will probably hand you a different chart.
Have you run this on your own queue? I would like to hear what came out on top, and whether it surprised you.
I spent nearly three decades at Netsmart and Allscripts on the platforms that generate these support queues. If your post-go-live case volume is not coming down, or the same categories keep leading it, I can help you find out why.
Connect on LinkedIn | Email Stephen | Contact HealthTECH
