What Does The Datacenter Have To Do With Clinician Adoption?

By Phil Stravers, ICE Technologies

EHR Adoption Strategies: Have We Talked About The Engine?

Over the last few years, there have likely been millions of blogs and articles written regarding Electronic Health Records adoption. Most of these share recommendations, theories, and strategies surrounding physician champions, adequate training, workflow optimization, engaging the clinicians in design, clear plans, visions, etc. While these are important topics (especially considering the amount of investment and disruption EHR adoption has caused in the last five years), I would like to point out that there is an area constantly missing from the equation: the core infrastructure technology engine that these EHR systems depend upon.

This is akin to strategizing about improving the performance and the driver’s perception of a car by focusing on the effectiveness of the power steering, adjustable seats, air conditioning, and traction control all while ignoring the engine. These are all good things to strategize about AFTER you have determined that the engine meets the requirements and is in good working order.

The EHR Adoption Engine: The Datacenter

So, back to the question, what DOES the datacenter have to do with clinician adoption? A lot! When working with community healthcare providers, we find clinicians and end users in general don’t separate the software from the workflow, the desktop computer or laptop, or the wireless network from the servers and the storage. It’s all mashed together in a peanut butter and jelly sandwich of unmet expectations. As a technologist who has had to uncover root causes of the unmet expectations, one fundamental truth I have discovered is all of the aforementioned strategies for engagement with the EHR will produce absolutely nothing if the underlying infrastructure is not performing as it should. At the core of the infrastructure, you will find a datacenter and the daily, weekly, and monthly management and maintenance disciplines that accompany it.

Here are five examples of situations where users will stop using the EHR all because of something that failed in the datacenter … see if any of these sound familiar:

1. The “Circle of Death”: One of the quickest ways to get a physician to stop using the system is to have them wait on the “hour glass,” the “scrubber wheel,” the “circle of death.”
2. An Update Broke Something Users Liked: Another way to get a physician to stop using the system and begin throwing technology across the physicians lounge is to make sure something stops working after your last update.
3. An Update Broke Something Again: Better yet, take an update designed to fix one problem and have it break another.
4. Re-create Your EHR Entries: Even better, have the system crash or corrupt data in the middle of the day and ask a clinician to re-create all of the lost entries from memory since the last good backup.
5. Session Timeouts: Here’s another tip for alienating clinicians – have them log in 30 times each day and timeout their sessions every time they turn around. They will love you for that one!

How’s YOUR Datacenter Impacting EHR Adoption: Time To Check Your Engine?

So, do you still doubt the importance of the datacenter in clinician adoption? I’m guessing not, so what to do about it? Here are five steps that you can take to ensure your datacenter is ready for your user adoption strategies:

1. Get the datacenter performance up to snuff first. I’m all for walking and chewing bubble gum at the same time, but you can’t get people to “play along” on workflow unless they first have confidence the system will be there when they need it. And by the way, sometimes the quickest way to fixing this, might be to find a good healthcare IT outsourcing or hosting partner. Throwing new hardware at the problem might end up masking the solution if not done properly. So, take the time and spend the money to truly assess and identify the root cause of the performance issues. We have actually seen real community healthcare providers experience degraded database performance because they threw too many CPU’s at it the problem. There has been a lot of money spent for bad results chasing the wrong problem. A good packet analyzer is your friend here.
2. Leverage virtualization technology to its full potential. Virtualization technology, when built properly, can immediately improve performance, create an environment that allows flexibility, improved troubleshooting, and create the ideal scenario for resource optimization. Our requirements are constantly changing; virtualization technologies should be a key part of your IT strategy so that you can respond quickly to the changing demands. It’s critical, as with anything, that you apply a trained eye to your environment not just when you set it up the first time, but periodically to ensure you are leveraging the technologies effectively. Virtualization also becomes a key enabler to your Disaster Recover strategies and can be a contributor to limiting downtime during outages and/or maintenance windows.
3. You need a Database Administrator (DBA). With today’s terabytes of data, relational databases, interface engines, database clustering and increasingly complex audit requirements, a DBA isn’t a nice to have, they are a must have. Wikipedia defines the DBA as “an IT Professional responsible for the installation, configuration, upgrading, administration, monitoring, maintenance and security of databases in an organization.” You may not need a full time DBA, but you need access to a good one.
4. Create your own “good health” maintenance checklists and follow them faithfully. There are daily, weekly, monthly, yearly routine efforts that if not completed faithfully, accurately and fully, you will inevitably create problems during upgrades , daily use, performance, and more. Documented checklists must be followed for routine maintenance, for upgrade downtime windows, etc. These checklists must become a foundation of your quality control in the IT department. This is another example of something that can be a good reason to partner with a healthcare IT outsourcing partner for hosting or managed services, because they can bring performance standards and checklists so you don’t have to invent the wheel. By having a partner in this, you can contractually obligate them to meeting service levels while your internal IT staff focuses on end users and projects.
5. Follow a change control discipline and activate a change control policy that is rigorously enforced. This is an area that is overlooked by far too many in our industry, creating environments that subject end users to unnecessary risks, downtime, errors and frustration. There are standards in the industry that create a framework for these disciplines. Check out ITIL.org and their ISO 20000 tab for more information. Or, give us a call and we can walk you through the disciplines that might be most appropriate for your environment.

If you’re ready to address some of the core issues in your technology infrastructure, we’d be happy to help. Give us a call and we’ll talk through more of your specific questions or needs in regards to strengthening your datacenter and technology infrastructure.

About the author
Phil Stravers has been an advocate for community healthcare since joining ICE in 1995. Prior to joining ICE, he started and oversaw a national helpdesk supporting technology systems for engineering and architectural design. Since acquiring ICE with Keith in 2003, Phil has guided the development of a services portfolio tailored specifically for community healthcare providers’ distinct IT needs. Phil was instrumental in the development of ICE’s focus on community healthcare. Phil routinely presents and educates through various healthcare associations, such as the Healthcare Information Management Systems Society (HIMSS), Healthcare Financial Management Association (HFMA) and National Rural Health Association (NRHA).

About ICE Technologies, Inc.
ICE Technologies is an organization singularly focused on helping healthcare organizations with their IT challenges. We make your hospital’s IT work better. So, let us know if you need help optimizing your EHR implementation, improving your network reliability, improving your reporting or your IT strategy, or just need to fill a gap on your IT team. Find out how strategic community hospital IT helps you get more value.