How UHS uses availability and performance monitors to ensure Cerner is optimal for its physicians

Universal Health Services runs more than 15,000 tests per day to ensure that patient-critical applications and records are available for physicians and clinicians.


Universal Health Services is one of the 10 largest for-profit health systems in the United States, and it relies heavily on Cerner to deliver EHR application services to healthcare professionals all across the country.

UHS was faced with several challenges related to application failures and slowness, which impacted clinician and healthcare worker end user experience. More important, there was no solution in place for troubleshooting and/or providing advance warning when issues surfaced.

“Like any other IT department supporting a health system, we want to achieve consistent access to patient-critical information from our Cerner EHR system,” said Justin Monnig, general manager of Crossings Healthcare Solutions, a subsidiary of Universal Health Services. “This is challenging due to the distributed nature of our facilities and users.”

The challenge was to change the typical IT support paradigm, which is reactive and engages only after a problem impacts users, he said.

“We needed a solution that proactively identifies problems before our users and patients are impacted, and one that provides the key details we need to quickly pinpoint the root cause and troubleshoot the problem in a complex environment that relies on multiple systems and vendors,” he explained.

UHS selected the Goliath Application Availability Monitor because, Monnig said, it acts as an early warning system and proactively exercises and tests the entire complex delivery infrastructure required to successfully deliver Cerner and other critical applications.

“This system installs at our facilities and ensures all systems are working together smoothly — or pinpoints the specific failure point and alerts our IT team with the details and screenshots required to troubleshoot the issue,” he explained.

The availability application integrates with the Goliath Performance Monitor, which provides detailed troubleshooting of end-user experience issues, from UHS end-user locations through its data center and even into the Cerner Remote Hosting Option data center.

“This provides true end-to-end visibility of any issue or system degradation before our physicians or patients are impacted, improving patient care and reducing physician burnout,” Monnig stated.

There are many vendors on the market today that offer availability and performance monitoring tools. Some of these vendors include AppDynamics, Dynatrace, EG Innovations, IT-Conductor, Quest Software, and VictorOps.

To start with, UHS deployed the availability monitor to 10 remote locations. It installed it on a variety of devices depending on the site — spare laptops in some cases, virtual machines in others. Once those devices were deployed, all future management of test parameters and schedules were handled centrally from the data center. This meant that the IT team had complete control of the different tests running from each facility.

“The tests themselves proved to be quite robust,” Monnig said. “We were able to cover all possible options by testing infrastructure and virtual applications and desktops. We also ran tests for different user groups to ensure their access permissions were configured properly.”

Since the tests were automated, it helped free up resources for other tasks. If an issue was identified, the team received an alert through the ticketing system immediately. It was like having a full-time system administrator at each location running tests and documenting the results, Monnig said.

“The tests included a timing element so we could identify areas with slow logons then use the integration with the Goliath Performance Monitor to troubleshoot and resolve those issues,” he added.

    Image above shows Goliath’s early warning system in production at Universal Health Services. 

    UHS quickly expanded the project to include more than 50 sites worldwide and now runs more than 15,000 tests per day to ensure that patient-critical applications and records are available for physicians and clinicians.

    “The screenshots and details of key performance metrics provided by Goliath are very helpful when working with vendors, partners or even other internal IT teams,” Monnig said. “We now have clear evidence that pinpoints the problem, and we know exactly when to collaborate with other vendors and IT groups to resolve the issue.”

    Previously, staff would open tickets with vendors without being sure the vendor was even at fault or involved. Now, when staff contacts another group, it’s with the evidence they need to respond quickly, Monnig said. This has improved the working relationship with Cerner and other vendors significantly, he added.

    “The result is the most accurate representation of what an actual end user will experience when they access the Cerner application,” he explained. “All of the metrics generated during the simulated session are reported back to the central end-user experience support team at UHS in real-time. These metrics allow the UHS team to take immediate action whenever trouble arises.”

    “Healthcare IT leaders take great care in choosing the right electronic health record system for their health system; however, they deliver these systems with virtualization technologies like Citrix,” Monnig observed. “It’s important to invest in tools that ensure these technologies are working together properly and delivering a quality end-user experience. This benefits your physicians and clinicians by making their jobs easier, and ultimately benefits your patients.”

    When looking for these tools, Monnig has three suggestions. First, look for tools that understand the specific challenges facing healthcare organizations. Second, healthcare organizations work closely with EHR vendors; choose a monitoring and troubleshooting vendor with the relationships and expertise to work for both.

    And third, while there are many free tools that might solve one problem or cover one system, to be successful, look for a solution that will scale with the organization – that can cover an entire environment and work for one’s IT organization — not add to one’s workload.

    Twitter: @SiwickiHealthIT
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