Throughout our Patient Care Performance Management (PCPM) series, we have reviewed individual performance management categories. When I consider the notion of “Advanced APM”, I see it as APM (based in traffic flow data) combined with a “service based” mentality. This leverages APM+ metrics of client and server communities with their associated applications, and then grouping them as a “service”. An excellent example would be SharePoint as it is comprised of web, application and database tiers. When combined together, they can easily be represented as the service ‘SharePoint’. While this is not necessarily an all-inclusive list of SharePoint infrastructure, it serves as an easy-to-understand example.

Example of HL7

What is your largest patient critical service inside your medical environment? Most likely it is the EHR system. The EHR must have the ability to communicate with nearly every other medical health system within your institution. That being said, if your tool set is only configured to review a single (or limited number of applications such as Citrix), it represents a great foundation. However, this approach likely misses the vast majority of the service as a whole, as Citrix likely only makes up your client front end. If the HL7 interfaces aren’t performing adequately, and you’re not monitoring them, then you may think your EHR is malfunctioning when it is actually an engine issue. The opposite scenario is also quite true.

If we expand this service coverage to include service enablers (DHCP, DNS, LDAP), customer front end (Citrix), backend application servers, database, and HL7, we start to paint a picture of a complete service. Why is this service view so valuable? Maybe you’re not responsible for HL7, or DNS, so why do you care? Because you’re part of a team, a team delivering services to sick and injured patients. It is no longer about which IT system is broken or malfunctioning, it’s about providing proper medical treatment to your patients. If you break down the silos of the service in this manner, you can leverage advanced APM+ to benefit the business.

By having each component of your service properly identified, you can quickly triage and focus efforts on the application of your service that is causing the problem. Or better yet, you can determine which components are NOT causing your problem.

The “Budget” Reality Check

A common question and concern arises when we start talking about budget. Not every IT department has the budget to implement a complete solution or even an individual product (NPM,NPM+,APM,APM+) corporate wide. The reality is you must start somewhere, and if you attempt to “boil the ocean” you will most likely fail. Instead of that approach, focus on a particular “hot spot” of troubleshooting activity. In the past 30 days, where has your IT department focused the majority of it’s time? A good approach is to Implement there, and focus on a facility or an application.

We will get more into this subject in our next article, but I felt it necessary to address it here. Don’t let a “lack of budget” prevent you from creating a beach head. A beach head approach allows you to document your wins, so you’re able to expand and cover the entire service. Most importantly, be honest with your leadership concerning the present state of coverage.

Voice and Communication Systems

When you mention voice service, most people envision a traditional handset telephone. But in today’s evolving medical institutions, we see many wireless initiatives as it relates to telephony.  A big surprise, few resemble or even act like a traditional telephone handset. Many of these communication systems are deployed to enable the caregiver to “never touch the telephone”, thus limiting the cross contamination risk. These types of hands-free solutions are greatly beneficial to the caregiver, and allow them to focus on the patient. However, this also means that critical patient care communications now flow over the network infrastructure. The reality is that this communication service uses multiple services and protocols and dependencies (i.e. VoIP, DHCP, LDAP/Radius, and more). If there are performance challenges with these services, it directly impacts patient care. Note that with many systems such as Jabber and Lync/Skype for Business, these systems are even more complex.

So what do you do? You create a service which includes our NPM+ (DHCP, DNS) components, and then we also add in our directory services, and authentication. If you are leveraging a more complex solution such as jabber or Skype for Business, you will also need to add service members corresponding to the additional backend systems.

The Call to Action …. Apply Advanced APM in Healthcare

To enable more productive and coherent teams, you must break down the silos and increase collaboration. In healthcare, this is especially important as the mission is so critical to saving lives. By leveraging Advanced APM+ and adopting a service triage mentality, you are able to work off the same information across technical disciplines. The network, database, application, operations teams, etc. are able to act off the same information and eliminate “wild goose chases”.

By providing a complete view of a service, we now are able to determine components that are experiencing good or bad performance. How often has your team had to enter a “war room” and all the APM / NPM tools were showing red status? Or conversely, all the same tools were displaying a status of green? It usually leaves folks feeling a bit lost, much like being on a boat without a captain. The call to action is to empower your teams and your institution by reviewing the recent advances as it relates to the healthcare APM+ market. Enable your caregivers to triage the health of their patients, not the health of the services in which they rely.