Keeping state-of-the-art healthcare on the cutting edge of technology is a difficult feat. Advances and discoveries in healthcare are happening every minute of every day. The same is true in information technology. Computers emerged in healthcare in the early 1970s (Becker’s Health IT & CIO Review 2015) after legislation enacted Medicare reimbursement, but it wasn’t until the late 1970s that computers became widely used. (USF Health 2017)
Over the last fifty years IT in healthcare has evolved far past the use of a desktop computer and local storage to the limitless capabilities of cloud-based computing. The advancements in these technologies have opened the door to Electronic Health Records (EHR), automated infusion pump systems, computerized physician order entry (CPOE), decision support systems (DSS), and the list goes on and on. (Harrison, Journal of American Medical Informatics Association 2007)
Healthcare Information Technology (HIT) is credited with enhancing safety, quality and patient-centeredness care, containing costs and increasing efficiency. Managers and clinicians (physicians and nurses) in healthcare delivery systems too often blame undesirable consequences and implementation failures on the performance of the newly introduced technology. (Mandel 2016)
Technology performance is directly impacted by the infrastructure supporting it. However, more often than not, it’s overlooked with routine maintenance. Early detection is the best defense against many diseases. The same is true in IT. A healthy IT infrastructure requires health checks and updates to run smoothly and efficiently. The problem is, many of these updates require “down time” or service outages during updates, which is difficult for an environment requiring 24-hour patient care. How do you prioritize HIT maintenance and upgrades to get the maximum benefits with the least disruptions to service? Understanding the present environment is the best way to create and execute a plan for a healthy IT infrastructure supporting innovative technologies. (Mandel 2016)
Platform Application Network Assessment (PAN)
A PAN assessment is a holistic approach to viewing all the interdependencies of the IT infrastructure and how they work together as a whole, then dives deeper into the nuances of each individual platform, application, and network. A systematic approach for improvement is then identified outlining, and prioritizing tasks for increased performance with the least amount of downtime.
A healthy IT environment is the keystone of successful installations and executions of healthcare specific technologies such as computerized physician order entry (CPOE), decision support systems (DSS), and Electronic Health Records. If the IT environment is not healthy and up to date, the risk of undesirable consequences and implementation failures is high. (Harrison, Journal of American Medical Informatics Association 2007) This is especially true of Electronic Health Records (EHR).
Electronic Health Records (EHR)
Effective January 1, 2014, all public and private healthcare providers have been required to adopt electronic health records (EHR) to maintain existing Medicaid and Medicare reimbursement levels. Since that date, EHR has spread worldwide. State-of-the-art healthcare has growing and ever-changing needs. As institutions face changing with growing needs, providers find the level of support they need from their EHR system changing. As the EHR space grows more competitive in the marketplace, providers have more options choosing an EHR system that fits their individual institution’s needs. (Becker’s Health IT & CIO Review 2015) There are many things to consider when choosing the right fit such as cost, scalability, adaptability, and functionality, but one of the most overlooked things to consider “is your institution’s IT environment ready to support the change?”
Cerner and Epic hold about 50% of the EHR market share, while smaller companies like Meditech, McKesson, and Athena Health make up the other 50%. (Cerner 2017) One thing they all have in common is that to run successfully, they require a healthy IT environment.
A Case Study
In 2016, Conway Medical Center moved away from their existing EHR system(s) and consolidated to the Cerner Platform. As with any major change, much care and consideration went into preparing for the go-live date slated for one year out, July 1, 2017.
Much of their environment needed updates and upgrades — to avoid service outages, layers of workarounds were in place, causing the environment to be volatile. They needed to get their environment healthy to support the new EHR system coming in the next year. It was at this point they enlisted eGroup to perform a Platform Network Assessment or PAN.
During the PAN Assessment, experts mapped and diagrammed the current Platform, Applications, and Network, creating a plan to execute recommendations thoughtfully. The completed PAN assessment became a roadmap for Cerner readiness.
The next eleven months were full of all-hands-on-deck execution of recommendations. Both the CMC and eGroup teams worked together following the roadmap. Together with a plan in place they worked through each recommendation using maintenance windows efficiently to maximize changes needed with the least amount of risk in the least amount of time.
The PAN Assessment outlined recommendations that not only prepped the HIT Infrastructure for the Cerner Platform but also made the Infrastructure run more smoothly with less end-user issues, ultimately saving time and money.
Conway Medical Center relied on a legacy vendor platform to perform all system backups within the environment. This environment was complex and often required multiple hours per day from an administrator to ensure satisfactory back-up of all systems.
The PAN Assessment recommended upgrading their Platform to a more efficient system allowing them to manage all their data in one place. The result was an upgrade to Rubrik with automated protection policies and Ransomware recovery, along with other benefits. Faster and more reliable backups and instantaneous restorations meant the IT team could focus on other tasks, saving time and money.
Conway Medical Center uses a VDI platform form VMware. There are over 300+ concurrent users signed into the platform to assist clinical users to provide patient care. VDI before remediation was the platform that no one wanted to use due to the issues. Conway Medical had been dealing with multiple issues with their VDI deployment, including black screens, session disconnects and slowness.
Based on the importance and high volume of users for the VDI platform application, the PAN assessment encompassed a deep dive into uncovering all the issues that various user groups were experiencing and factored them into the solution. eGroup built the clinical image from scratch, following VMware best practices to ensure a “pristine” image. Once users migrated over to the new image, VDI became the platform of choice for all clinical staff. The VDI platform allows clinical users to open a desktop anywhere in the hospital and have it follow the clinician to any patient room, thus allowing more time with patients.
The wireless network had been in place for many years. Both the coverage and capacity did not keep up with the demands of changing technology. The load of devices and applications on the network were causing dropped connectivity, latency, and the nonresponse of applications.
After surveying, mapping, and assessing the wireless environment, a wireless plan for medical-grade standards emerged. During the process end users such as doctors, nurses, and clinicians helped identify further needs and requirements. Some key recommendations focused on coverage, capacity, N+1 redundancy, and 5 GHz optimization.
Surface tablets, workstation-on-wheels (WOWs), and IV Pumps now ran smoothly without latency, making them ready for the move to Cerner. The return on investment was immediate, with staff able to do their job with improved efficiency and patient care. Medical institutions often miss their go-live date or exceed their budget when switching to a new EHR system. (Go-live gone wrong 2013) Proper planning is essential to update the IT environment. A little money spent upfront goes a long way when hitting deadlines and meeting budgets. A Platform Application Network Assessment is an effective way to do it.
2015. Becker’s Health IT & CIO Review. April 13. Accessed September 21, 2017. http://www.beckershospitalreview.com/healthcare-information-technology/.
Cerner. 2017. Open Platforms. Accessed September 29, 2017. https://www.cerner.com/solutions/open-platforms.
Earl, Elizabeth. 2015. Epic vs Cerner: 9 key Comparisons. April 13. Accessed September 20, 2017. www.beckershospitalreview.com.
2013. Go-live gone wrong. July 31. Accessed September 29, 2017. http://www.healthcareitnews.com/news/go-live-gone-wrong.
Harrison, Michael. 2007. “Journal of American Medical Informatics Association.” Journal of American Medical Informatics Association 14 (5): 542-549.
Harrison, Michael. 2007. “Unintended Consequences of Information Technologies in Health Care—An Interactive Sociotechnical Analysis .” Journal of the American Medical Informatics Association 1: 542-549.
Mandel, Joshua C. 2016. “SMART on FHIR: a standards-based, interoperable apps platform for electronic health records.” Oxford Academic 23 (5): 899-908.
USF Health. 2017. Accessed September 16, 2017. https://www.usfhealthonline.com/resources/healthcare/electronic-medical-records-mandate/.