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5/9/2014
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Monitoring, Workflow Apps Crucial To Healthcare IT

Two IT tools helped Seattle Children's Hospital and Catholic Health save time and money and improve healthcare for patients and their families.

Easy-to-Mock ICD-10 Diagnosis Codes...
Easy-to-Mock ICD-10 Diagnosis Codes...
(Click image for larger view and slideshow.)

Electronic health records, computerized physician order entry, and automated pill dispensers may grab headlines, but there are countless less-sexy but critically important technologies that healthcare IT departments use every day to access the tools they need. If IT doesn't have the right monitoring or workflow software, for example, millions of dollars in infrastructure could be at risk.

Seattle Children's Hospital's 350-person IT staff supports more than 8,500 users across 25 physical locations and more than 900 different applications, ranging from slick software from multibillion-dollar developers to "two men in a garage" apps, CIO Wes Wright told InformationWeek. The hospital uses Epic and Cerner EHRs, Lawson for financials, a private cloud, and a virtual desktop infrastructure (VDI) to deliver almost 3,000 Windows 7 desktops in a Citrix environment.

[Was delaying the ICD-10 transition a mistake? Read ICD-10 Momentum: Let It Roll.]

The VDI resolved issues Seattle Children's was having with speed in patient areas, but the hospital could not get the performance and stability it needed, says Wright.

Every time there was an incident, the IT team had to launch separate monitoring tools since the hospital did not have a tool that provided real-time, contextual insight into wire data. As a result, the IT department's infrastructure team spent about 20% of its time attempting to diagnose non-obvious problems that affected nurses, doctors, and other medical, scheduling, and billing staff.

Then Seattle Children's discovered ExtraHop, which enhanced the VDI's performance and stability almost immediately, according to Wright.

"[ExtraHop let us] see across that virtual desktop all the way to that electronic health record. It tells me where something is out of normal," he says. "What made it very cool is it is agentless. It just sits on the wire and listens. I don't have to load an agent on every device. When you have 5,500 zero client devices that you can't load anything on, it's very important you get to every user device without loading an agent."

Wright estimates ExtraHop saved Seattle Children's about $336,000 -- or $28,000 per month -- in its first year. More importantly, he now feels secure enough about the VDI's performance that he can consider moving it into the ICUs and other sensitive areas of the hospital. "We knew if a VDI deployment was going to be successful, it had to be stable. We knew the success of the further deployment of VDI was going to be limited by our stability."

Seattle Children's uncovered some surprises along the way. When users noticed that network performance suffered most in the morning, ExtraHop determined that one doctor was unwittingly pulling down 2 GB of photos stored in his My Pictures folder every time he logged on, slowing log-on times to up to 15 minutes instead of seconds.

"We found a lot of single points of failure in the way we had architected our VDI suite. Some of those we found on our own; some we found the hard way, by our SQL database failing or something like that. We did a failure effects node analysis on our VDI stack to see where potential failures are and what are the risks and impact of those probabilities."

Project workflow
Tony Papagallo, director of project management and clinical engineering at Catholic Health System in Buffalo, N.Y., doesn't track down problems in VDIs. He tracks projects scattered across four hospitals and about 60 long-term care facilities, lab sites, and primary care centers in western New York. The job requires a lot of organization and the right technology -- and spreadsheets just weren't cutting it anymore, Papagallo says.

"Right now I have 32 projects going on," he tells us. "Most of them we'll finish this year. Some are multiyear projects. We always have a good 30 to 35 [projects] going on simultaneously with IT involvement."

Papagallo's projects range in scope and complexity, from implementing enterprise resource-planning software to equipping several nurses' stations with new cabling, computers, and phones. "It's a constantly moving target," he says. "There are a lot of components. We like to say we're ready from an IT perspective."

As part of a 140-person IT department, Papagallo oversees four project managers who run most internal ventures with IT involvement. Previously relying on spreadsheets, Papagallo turned to Innotas's project portfolio management software to track project management and IT employees' time. He notes that Catholic Health also uses the software to track maintenance hours, time off, and training time, as well as other tasks it previously did in BMC Remedy.

"A big part of the planning process is to do a capital project review. Innotas helps us figure out how we're going to staff those projects. Some want to start in January, and we have projects from the prior year that are tiering over. It really helps us plan our resources so we know where the roadblocks are -- so we can put together a roadmap with some intelligence behind it."

Although the team continues to produce a monthly spreadsheet, it populates the file with data from Innotas. "It really gives us a lot of reporting capabilities to look at the information from many different perspectives," says Papagallo.

In the future, Papagallo says, his team may integrate financial data with Innotas's project information. "If you're going to produce a report that says, 'This is how my projects are doing' and I pull status and schedule information from Innotas, it'd be good if I could also pull the financial data from the tool as far as what's been spent from the project."

What tools could your IT department not live without? Which ones do you wish you had? Let us know in Comments.

Download Healthcare IT In The Obamacare Era, the InformationWeek Healthcare digital issue on changes driven by regulation. Modern technology created the opportunity to restructure the healthcare industry around accountable care organizations, but ACOs also put new demands on IT.

Alison Diana has written about technology and business for more than 20 years. She was editor, contributors, at Internet Evolution; editor-in-chief of 21st Century IT; and managing editor, sections, at CRN. She has also written for eWeek, Baseline Magazine, Redmond Channel ... View Full Bio

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Tyson S
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Tyson S,
User Rank: Apprentice
5/9/2014 | 2:42:00 PM
Visibility into performance is critical for VDI
VDI performance is especially critical in healthcare where caregivers may log in to dozens of "workstations on wheels" (WOWs) during a shift. Kudos to Seattle Children's for taking care to see that VDI performance is reliably fast. That's hard to do especially as VDI deployments grow in scale. As the environment gets more complex, it can be difficult to track down the root cause of interrelated performance issues. 
Alison_Diana
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Alison_Diana,
User Rank: Author
5/14/2014 | 10:20:50 AM
Re: Visibility into performance is critical for VDI
Absolutely, @Tyson. Seattle Children's wanted to expand its VDI for all the benefits virtualization brings. But it realized it couldn't do so, unless it resolved the problems it was having. After all, bad enough to have issues with VDIs in any area of a hospital -- but absolutely impossible to consider in the ICU. Now it has addressed that issue, the hospital can continue its VDI rollout, benefiting the organization, its IT department, and end-users.
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