By Theresa Miller, Citrix CTP, VMware vExpert, Microsoft MVP

Telehealth use has become a prominent and preferred method of patient care since the COVID-19 outbreak.  What happens though when technology becomes a barrier to adequate care? For example, your Electronic Health Record (EHR) Telehealth application is working too slowly or is randomly disconnecting.  This not only looks bad to the patient trying to meet with the physician, but it makes it impossible to deliver a quality patient experience. How can IT get a true understanding of where the problem is when a ticket is opened indicating that the EHR system (Cerner, Epic, MEDITECH, Allscripts) is slow?  Let’s take a closer look at how monitoring all the backend infrastructure, the user experience, and the Electronic Health Record (EHR) solution from one toolset can create monumental success.

Electronic Health Record (EHR) Ticket in Queue for Slowness: Finding Root Cause

When a clinician opens a support ticket indicating that their Electronic Health Record (EHR) application is slow and they cannot initiate their telehealth visit with a patient, it doesn’t mean the EHR application is the problem.  The reality is that the problem can be anywhere in the architectural infrastructure of the deployment, an issue on the device, a problem with the network connection, or even a result of clinician behavior.  Whether the EHR system is on-premises or in the cloud, it is almost always presented through a virtualized desktop and application infrastructure (Citrix or VMware Horizon). There is great complexity in getting all technologies to work together to deliver a seamless clinician experience and fast access to their EHR system. Just because the problem manifests itself to the clinician as “my EHR system is slow” doesn’t mean it is the fault of the EHR system.

End Citrix is Slow Complaints with Goliath

In my experience, I have seen success in quickly finding the root cause when there was a proactive monitoring solution that was able to monitor everything from the endpoint, to clinician behavior, to the virtualized environment through to the backend data center. The health IT team would be alerted of the issue, saw it was actually related to the network, and able to resolve before it impacted a patient appointment.

Breaking Down the Clinician Experience Challenges

Having been in a situation where only native monitoring toolsets were used; I personally have seen how challenging it can be to manually work through troubleshooting a clinician performance issue. Thinking back on this, there was a time where there was a persistent performance issue for one doctor. I saw nothing as the Citrix admin, the application team said the EHR application was working fine for everyone else, the network team said wasn’t there issue. Finally, after hours of digging, I found the issue was related to the clinician’s profile. But without a single tool to see all aspects, I had to extend my search and talk to all teams beyond doing my own digging. It can take a long time to figure out where an issue in the technology can be.

Any standard telehealth and EHR architecture is complex and has many layers.  The full infrastructure required to support telehealth likely includes virtualization architecture infrastructure, EHR servers and infrastructure, unified communications tools, networking, Active Directory, policies, DNS, and more.  Now imagine you have to manually troubleshoot all of this without a solution that provides critical data in a single pane of glass; you would need to look at all of the following, and it could take hours to figure out the answer to a problem.

Manual troubleshooting checklist:

  • Check all servers event logs
  • Research any errors found
  • Bring in members of other teams for systems managed by them
  • Contact vendor support if needed

When making decisions around toolsets that help with problem resolution, initial price will be a factor, but know it will be more costly overall if your IT team cannot resolve an issue quickly to get the telehealth system functioning properly in an expedited way.

The Solution: Purpose-Built Tools for Monitoring and Troubleshooting Clinician Experience

Thankfully, there is a better way than what I had available to me. There are now purpose-built tools that monitor and troubleshoot end-user experience regardless of where applications or users are located. The best tools for Health IT are the ones that not only correlate data from the delivery infrastructure and clinician behavior, but also pull in specific performance data from the EHR system itself. When I see health systems deploy monitoring solutions that can monitor everything from the EHR application to the virtualization environment, I find they are more proactive and avoid many end-user performance issues altogether. With proactive monitoring, IT knows about an issue early and can have the problem fully resolved before patient care is impacted.

Purpose-built tools that have embedded intelligence and automation also bring data together from all IT elements that could potentially impact an end-user session. Now IT admins don’t have to hunt and peck for root cause like I did; instead, they have immediate access to data that can identify if the issue is with the application, network, server, hypervisor host, end-user behavior, or within the Citrix infrastructure. By having full visibility in a single screen, all the finger-pointing across teams is stopped and issues are resolved more quickly in a collaborative fashion.

Concluding Thoughts

With intelligent monitoring and troubleshooting software for Health IT, admins get expedited insights into root cause of where the technology problem is located when a ticket is opened around EHR or session performance issues.  In evaluating software, the solution should be able to quickly identify the issue anywhere in your technology stack.  It also must know healthcare systems and have the ability to extract performance data from the EHR system (Cerner, Epic, MEDITECH, Allscripts, etc). This is even more critical given the emphasis of telehealth today. With increased visibility, IT professionals can more easily anticipate, troubleshoot, and document end-user experience issues. This ensures that your IT administrators can keep systems online, ultimately keeping your business online and delivering a seamless experience for clinicians and patients.