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Application performance monitoring diagnoses hospital network problems

Application performance monitoring tools help run down hospital network bottlenecks and keep service providers honest.

One of the goals of the federal push for a health IT infrastructure build-out is an interoperable system of health data exchange. That goal tacitly acknowledges a problem that health care CIOs have to deal with daily: The various systems running on hospital networks aren't completely interoperable yet. As providers bring new electronic health record (EHR) systems online, hospital network slowdowns and bottlenecks become more difficult to sleuth out.

In some cases, application slowdowns can be a nuisance and a drag on efficiency -- such as when a doctor can't page quickly through an EHR during a patient visit, or the billing staff has to deal with a delay in the reimbursement process. In other types of applications, such as those supporting emergency-room equipment, a slowdown can be a life-or-death problem.

Health care IT leaders at larger facilities now are beginning to see greater value in application performance monitoring tools for another reason: They can play a direct role in achieving meaningful use, said Judy Hanover, an analyst at IDC Health Insights.

"I think performance and uptime and availability really affect adoption of [electronic medical records], and keep things being documented electronically -- and hospitals are really concerned about that," Hanover said. "When they want providers to switch to documenting and ordering electronically, having better performance in those systems make it that much more likely to happen."

These tools, which usually come with dashboard-type interfaces in the data center, also can help track the adoption of EHRs, she added, proof of which is required for federal incentive and reimbursement plans.

Illustrating complexity

Performance monitoring tools keep an eye on data centers' apps and servers, as well as on end-user experiences on local networks or on the Web. Being able to monitor the latter is a secondary benefit of implementing these tools: They become useful in helping reinforce service-level agreements between  hospitals and service providers.

When [hospitals] want providers to switch to documenting and ordering electronically, having better performance in those systems make it that much more likely to happen.

Judy Hanover, analyst, IDC Health Insights

Baptist Health System Inc., a four-hospital system in Birmingham, Ala., is rolling out hosted EHR and practice management services to about 100 doctors regionally, some employed by the system's hospitals, others unaffiliated. The tools can help Baptist Health maintain its performance guarantees with the docs who purchase its IT services.

Baptist Health's EHR implementation illustrates the complexity of health IT systems: Between the EHR and its integrated order-entry, lab reporting and e-prescribing systems (which are served over the Web to doctors at 37 remote locations through the data center and various Internet providers), it's almost impossible to ferret out what causes a slowdown for one doctor when no one else is reporting a problem.

"When you start looking at downtime or system availability, we struggled," said Baptist Health CTO John West, who uses Compuware Corp.'s Vantage to stay on top of the slowdowns reported by doctors using the health system's EHR services so his team can address them quickly. "If [the EHR system] is up to 98 physicians but down to two, then really, is the system down? To me it's not down, but to them it's down at their clinic. In the past, we didn't have any tools to get that granular."

While the tool can be set to sound alarms when certain apps hit certain low-performance thresholds, its reporting features can show when less serious problems are beginning to develop that can be solved with maintenance during the next scheduled downtime, West said.

Regional EHR providers

According to Larry Angeli, Compuware's vice president of health care solutions, scenarios like Baptist Health's are developing in many U.S. metropolitan areas: A region's major health care provider becomes an EHR provider for ambulatory practices. This setup makes sense for all the parties involved: It's simpler for physicians than hosting their own EHRs, and for the hospital, it helps create a simpler network for local health information exchange.

IDC's Hanover sees similar trends: Her group's current surveys indicate that at least half of smaller health care providers are considering hosted or Software as a Service EHRs, she said.

"The outpatient setting is a much more complex environment" for IT administration than an internal network, Angeli said. "It's important to understand problems before they impact the clinicians. … [I]f there is a slowdown in the network, we can very quickly pinpoint whether it's occurring in the network infrastructure or even in the application itself, so that IT organizations like Baptist [Health's] can identify problems and rectify them before they impact the clinician and, ultimately, patient care."

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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