Monitoring Tools Can Boost E-Health Record Systems PerformanceMonitoring Tools Can Boost E-Health Record Systems Performance

With federal stimulus programs waving a $20 billion carrot in front of health care providers, it's a sure bet that many more hospitals and medical practices will be deploying e-medical record systems over the next several years. But many health-care organizations will likely discover that implementing these systems is one thing; keeping the technology performing to the satisfaction of clinicians is another.

E-medical record systems require doctors and nurses to make huge changes in the workflow habits involved with patient care. That in itself is a tough sell. But if systems performance problems prevent clinicians from accessing crucial patient data or ordering drugs or tests in a timely way, that can become a matter of life or death.

Performance monitoring tools that help IT staff quickly identify and diagnose application, infrastructure, and other systems performance problems before the trouble impacts users can greatly boost clinicians' satisfaction, say health care IT leaders who have deployed e-medical records and other health IT systems.

"It takes a lot to ask nurses and doctors to change their workflow and adopt computerized systems for patient care, they put all their trust that these systems will be reliable and high performing," said Barry Runyon," a health care analyst and VP of research at Garter.

If these systems aren’t performing to the service levels clinicians expect, "they'll revolt," said Runyon, who, prior to joining Gartner, had first-hand experience deploying clinical systems for doctors and nurses several years ago while he was CTO at University Medical Center in Tucson, Ariz.

Typically, e-medical record systems from specialty health care software vendors "don't include sophisticated tools" that monitor all systems, applications, and infrastructure in complex clinical enterprises, Runyon said.

So, IT service management tools, including performance monitoring tools from vendors including CA, IBM, Hewlett-Packard, and Compuware, can help identify "functional gaps" in large clinical enterprise environments, such as hospitals, medical centers, and integrated health systems. At Partners Healthcare, a Boston-area integrated health-care system that operates hospitals such as Brigham & Women's and Massachusetts General, Compuware Vantage tools "improve our visibility into systems at a fine level of granularly, providing a picture of performance levels of systems for our diverse users," including primary care doctors, specialists, nurses, researchers, and office staff, Partners CTO Steve Flammini said.

Partners' use of Compuware Vantage "gives us transparency into our user-level performance metrics," he said. The tools "help detect hot spots before the user sees" performance issues, he said. For instance, the tools can indicate where a performance issue is occurring, whether it's with a particular server or software program, so that the issues can be addressed even before users report trouble.

"Performance is subjective, there are a number of things in regard to clinical workflow," said Flammini. The Vantage tools "allow us to set specific [service-level agreements] and measure ourselves against those SLAs," whether it's the speed and systems availability for drug ordering transactions, accessing patient data, or doctors using practice scheduling software, he said.

Monitoring the performance details of clinical systems has been particularly helpful when Partners rolls out new releases of software or new functionality, allowing Partners' IT staff to quickly identify systems performance for deviation in service levels.

"This allows us to isolate [the problem] so that users won't see the problem in production," he said. It also identifies where a problem is occurring in the infrastructure, such as a particular local server rather than a wider systemic problem, he said. At Detroit Medical Center, Compuware Vantage is used to monitor performance across 600 servers, IT infrastructure, and 300 clinical applications, said the medical center's CIO, Mike LeRoy.

"In the old days, IT was reactive, I'd wait for the call" from users reporting problems, he said. "Before it was, 'Oops my server just went down.' Now we have tools to stay two steps ahead."

DMC regularly runs simulated or mock application transactions to monitor how clinical systems are running, he said. "We correct problems before users complain, and if they do call, we're already addressing the issue," he said.

IT support staff overseeing the systems receive automatic alerts, including e-mails and pages, when Vantage detects a problem.

DMC started using Vantage to monitor performance of clinical systems a few years ago after the medical center's CEO launched a program to market 29-minute emergency department services. It's not uncommon for patients at other hospitals to wait for hours to be treated by busy emergency room staff, and DMC wanted to clearly set itself apart from that stereotype. Keeping DMC's emergency department promise to patients depends on the IT running smoothly, said LeRoy.

Systems problems -- such as radiologists having trouble viewing digitized images -- that in the past might've "taken hours to a week to pinpoint" can now be addressed often within an hour or minutes, said LeRoy. "Within minutes, we can get a vendor to come in and fix it," if it's a problem requiring outside help, he said.

Compuware also sells Vantage into other vertical markets, including telecom and retail, but the company's Vantage software for the health care market is tailored for the needs of clinical system monitoring.

Vantage pricing varies depending on installation, including the number of licensed beds a hospital has, said Compuware.

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