Problem to Solve – My healthcare organization is deploying an Electronic Medical Records (EMR) solution as per federal regulation. What can I do if there are performance issues with it?
Ah, the Affordable Health Care Act. What a fun, enjoyable and often times politically charged topic for our friends in the healthcare industry. Well this blog is not about politics, so do not be alarmed. 🙂 No, we will simply stick to the facts, reality, and use cases.
Reality #1 – The Law
The Affordable Health Care Act (AHCA) was passed in 2010. By law, healthcare organizations are mandated to have an Electronic Medical Records (EMR) or Electronic Health Records (EHR) solutions deployed and operational or face fines and penalties. There are many EMR’s and EHR’s commercially available and I frankly have heard exceptionally positive things regarding their actual performance, reliability and throughput. Each institution needs to decide if they will purchase and deploy their own solution or opt for a hosted solution. Again, there are pros and cons with each deployment model, but bottom line is that an EMR/EHR must get deployed and the clock is ticking. More detailed info available — http://www.myemr360.com/emr-mandate-2014
Reality #2 – Performance
From my experiences with my larger healthcare customers, the EMR/EHR system itself runs with high degrees of reliability and performance. Typically, these systems will have a server or cluster of servers acting as an application server with direct communications to well tuned database engine. The transaction rates that these solutions can run at are substantial with very low response times. When you think of the number of patients, nurses, physicians, clinicians, administrators, etc. from the many locations – floors – remote sites – emergency rooms – surgical rooms etc ….. the performance of these EMR systems become all the more impressive.
Reality #3 – Complexity
Again, speaking from experience here, just because your EMR systems has a ridiculously fast performance, does not mean that you can close the IT help desk. Quite the opposite actually, and I am sure that you are now asking, “Why?” And that is because Healthcare organizations are quite complex in function, especially when you consider the number of disparate systems involved. Here is where it gets pretty crazy … as there are patient telemetry devices, wirelessly connected patient beds, smart IV pumps, radiology images, robotic surgery, MRI images, blood analysis devices, dictation systems, oncology lab systems, appointment scheduling systems, billing systems, emergency room communications, and I am just getting started. Now, consider the wide-spread use of voice over IP (VoIP) based communications and the soon-to-be explosion of video traffic to be used in Telemedicine offerings. Mix all those different systems and their relevant information into interfacing directly with the EMR …. and you officially have yourself a patient care party.
Reality #4 – Efficiency and Accuracy
The Affordable Health Care Act has introduced the notion of value based care. In a nutshell, healthcare organizations will no longer be paid on a fee-for-service model, but rather on a value based reimbursement. This basically means that if you get sick and go to the doctor, the provider will only get paid for the diagnosis and care they provide for the sickness at hand. If you go back to the doctor in two weeks for the same issue, this time they will not get reimbursed for the treatment. For the medical staff, this means they have to efficient in their triage and accurate in their diagnosis for treatment.
Ya ya, so I have riddled off a few facts, kept the politics to a minimum, and threw out some buzz words and technology. So what is the big deal here? The big deal here IS “Patient Care” and the need to do it with high levels of care, efficiency and accuracy. So the question that I always find myself asking is that “if your medical staff must triage their patients effectively in order to provide a proper diagnosis and treatment plan, why not apply that same methodology to your IT Services that support Patient Care?”
As I mentioned, this blog is not about politics but about solving complex problems. Any APM / NPM solution set worth it’s salt must be able to triage IT services effectively, and that involves getting to probable cause as soon as possible. (Personally, I dislike the term “root cause” because in my opinion it is one of the most overused and thrown around terms in our industry.) Because there are so many systems and services that literally interface together inside of the healthcare environment, it makes it very difficult to determine or triage when there are slow downs, timeouts, response time issues, etc. If you really think about it, the “ecosystem” within healthcare includes services from technology like DHCP – DNS – LDAP – SMB – NFS – FTP – HTTP – Citrix – HTTPS – DICOM – HL7 – Oracle, and I just hit a few pieces of them. Whether the situation involves an EMR/EHR solution is really not the point. What matters here is that any system inside of the Healthcare organization that is “patient critical”, must be up, functional and performing optimally. If it is not, then there is a risk to the patient.. period. I am not suggesting that APM / NPM tools will save a patient’s life. But I have seen with my own eyes where a critical application (that runs over the network) did not perform or was down, and patient care was affected. Think about how your organization has deployed your APM / NPM solution and think about it with this set of glasses on … “Is my solution deployed in such a way that I could limit and reduce patient impacting service issue?”
Put on a second set of glasses over top of that and ask yourself, “what if my daughter – son – wife – husband – mother – father were being treated for some life threatening ailment, and a critical patient care system wasn’t performing properly?”
APM / NPM tools don’t seem quite so nerdy when you put on those glasses do they?