Originally published on by Theresa Miller on 24×7 IT Connection

EHR implementations are typically a huge undertaking for the healthcare organizations.  In some cases, deployments can take more than a year, and the cost implication is millions of dollars.  No small task of any kind, but when it comes down to monitoring sometimes only standard monitoring tools are deployed to reduce cost.  Today we will discover how healthcare organizations with a mindset of ensuring quality outcomes, will prevail and reduce EHR system downtime for the long-term.  More specifically we will be diving into a real-world story where the correct advanced monitoring and troubleshooting tool was not deployed right away, and the challenges that were faced as a result.

Design, Architect, and Deploy

A lot of preparation and testing goes into an EHR deployment.  In this real-world scenario a virtualized environment will need to be architected and deployed.  The preference in this case was to use a Citrix XenApp environment deployed on a VMWare hypervisor.

The task list was not small, here is a high-level overview:

  • Understand the business requirements and turn this into an equipment design
  • Architect, then order equipment, once received, then install
  • Network architecture and implementation
  • Hypervisor design and implementation
  • Citrix application design and install
  • Install applications, configure and test peripherals
  • Load testing
  • Adjust and realign and the scope gets modified
  • More load testing

Once all the preparation and was completed it was time for the healthcare organization to start using the new system.

It’s Go-Live!

Even the best designs and architectures can experience the unforeseen.  As noted above countless rounds of application testing, load testing and adjustment had occurred with this environment.  However, come go-live several things came to light.  At go-live, the system would function fine for several hours and then crash.  User sessions becoming hung, and the server the user was connected to would become completely useless.  Even with redundancy in place this wasn’t a viable workaround, because all systems would eventually crash and burn.   Keep in mind that this deployment the was deployed with native monitoring tools.

All hands-on Deck!

Every person involved in the architecture deployment now needed to assess their parts of the deployment with their independent monitoring tools, because there wasn’t one centralized one that could monitor everything.  It is challenging for these tools to see the true end user experience, which relies on multiple systems working together in concert.  Also, multiple support vendors were pulled into the conversation, because all teams were coming up empty handed with answers.  Troubleshooting this issue was a challenge, because of the dispersed collection of independent monitoring tools.

Troubleshooting went on for about 18 hours before it was discovered that there were some software bugs.  Two software patches had to be created to resolve the issue this environment was experiencing.  Woah, right!

Cost of a Downtime

Next consider the healthcare organization.  Fortunately, the old systems were still in place, so practitioners could use their old workflows until this was resolved.   If this had not been the case though the cost of downtime would have been very real.

Consider these statistics:

  • According to this article and the AC Group paper mentioned “Ten hours of electronic healthcare record (EHR) system downtime in a year could cost the average 20-physician practice nearly $100,000, yet 87% of medical practices ignore vendor service level agreements and uptime requirements when purchasing EHR system software.”
  •  According to Gartnerthe average cost of IT downtime is $5,600 per minute. Because there are so many differences in how businesses operate, downtime, at the low end, can be as much as $140,000 per hour, $300,000 per hour on average, and as much as $540,000 per hour at the higher end.

Understanding the cost of a downtime for your enterprise is important to the success of your business.  Also, when proactive management and monitoring are in place a reduction in the risk of an actual major outage can be significantly reduced.

Goliath Technologies: The Health IT Standard

Now let’s look at how Goliath Technologies flips the paradigm by starting with the End User and understanding how the entire delivery infrastructure works together.  Goliath’s purpose-built EHR modules provide broad visibility to understand where a problem is coming from, and deep, detailed metrics to identify the true root cause of an issue.

As demonstrated here, the right toolset can broaden visibility across EHR performance, Citrix/VMware performance and EUE experience metrics that makes this work.   A CIO recently commented that the challenge of Healthcare IT is to deliver the systems an information required seamlessly, at the time care is provided … not 10 minutes later due to system issues.  Goliath reduces EHR system downtime which ensures quality patient outcomes.

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