the practical guide to healthcare infrastructure, a comedy by tom deaderick director, onepartner

The practical guide to healthcare infrastructure, a comedy

by

Tom DeaderickDirector, OnePartner

www.onepartner.com© 2008 OnePartner, LLC.

geek self-test

Technology is evil

You know…like the Devil.

Technology is nirvana

No. It isn’t.You need therapy.

Technology can begood or bad.


all the other stuff…

EMR selection complete


all the other stuff…continued

Image used by permission. (www.despair.com)


getting started

ImmediateSystems you interact with

NetworkSystems that support org

StrategicMethodologies

We’ll work our way out.Starting with the systems you

interact with most directly.


tablet computers

advantages

A physician carrying a tablet avoids the situation where they must walk into the patient exam without basic background.

Tablets enable physicians to dictate using Dragon Naturally Speaking without returning to their office.

disadvantages

During heavy EMR usage, batteries typically last 4 hours or less.

Requires wireless network hubs, adding to management costs.

Physicians who are very interactive with EMR (e.g. using templates, eRX, etc). Smart-type systems typically work best with keyboards.

Tablets typically represent a cost increase (terminals in exam rooms still required).

www.onepartner.com© 2008 OnePartner, LLC. Image used by permission.

terminals

recommendations

Place terminals in each exam room, even if using tablets. (tablet reliability, battery life are important factors).

Terminals or “thin clients” recommended rather than PCs. Storage and processing are all on the server, providing lower total cost of ownership (long term maintenance) and simpler administration.

Laptops with docking stations in physician’s offices.


freedom vs. security/reliability

You need security/reliability…

The volume of malware, spyware and junk applications ensure that the perfectly functioning and fast machine rolled out today will be a dead slow, zombie clunker after a few month’s use.

When users are free to install software at will, your IT staff burns troubleshooting resources and users are frustrated with poor-performing and unreliable computers.

Image used by permission.


freedom vs. security/reliability

…but you also need freedom.

The common approach used by the IT department is to lock down user’s computers, so they can’t…

Install malware, zombies, etc

Which means they also can’t…

Install useful applications, online training resources or use some online applications without calling an IT representative for help.

This makes users feel powerless, frustrated with IT and doesn’t encourage utilization of free resources.



freedom with security/reliability

recommendations

Deploy a centralized management tool, with replaceable standard images.

Faronics Deep FreezeCreates a default computer “image” for the whole organization.

Users are free to install software as needed.

To refresh a computer with the standard image, simply reboot the system.

Also provides remote management tools.



encrypted hard drives

Simple security

Encrypted hard drivesThe Seagate Momentus FDE.2 drive replaces your laptop or desktop hard drive.

The Windows password is sync’d with the hard drive password, so stolen or lost computers cannot be mined for patient/business data.

This system is approved for use within the National Security Agency (NSA).

Cost: about $200

Requires Microsoft Windows XPCheck with computer vendor for compatibility.


network systems







“turnkey” EMR systems

yeah, that’s a myth

A “turnkey” system is one that’s installed fully complete and ready to operate.

You’re as likely to see as el chupacabra or Bigfoot as a turnkey EMR.

Systems & a preconfigured workflow can be installed quickly (hours to days).

Adapting these workflows to the way your office practices takes time.

Don’t shortchange training & configuration.

el Chupacabra using a “turnkey EMR”


asp?

Traditional software/equipment purchase

Your practice purchases the necessary hardware and software to run the EMR system.

This includes supporting applications such as Microsoft Windows Server, SQL Server, Citrix, etc.

Typically maintenance and patching are your responsibility via direct IT staff or contract resources you allocate.

Can be financed, typically 36 months.

Application Service Provider model

Software vendor or third party packages hardware, software and hosting into a single contract with a monthly fee per physician.

Third parties may include IT contractors, hospitals, EMR resellers or data centers.

Maintenance and patching is responsibility of the ASP.

Typically ideal for web-based applications.


Backup? We don’t need no stinkin’ backup.

offsite backup

A challenge for smaller, single location practices.

Tapes may be lost or stolen.

As patient files increase, data storage may demand multiple tapes per backup, requiring tape library devices ($3-5k).

Periodic tests are a good idea.

Backup is not the same thing as disaster recovery (covered later).


Digital Linear Tape (DLT) about $50 each


strategic methodologies







where did my EMR go?

oh boy…

Last night’s storm shorted the air conditioner in the server room.

Without the air conditioner, the room overheated within a few minutes.

We braced the server room door and put two fans in there, but the high temperatures must have damaged something else because…

fire up the time machine!!

Easy, cheap and ingeniousHolston Medical Group created automated system that creates PDF file for each of the next day’s patients, saved on a desktop machine in each office. If the system is down they print out the PDF files as needed.


fire up the time machine!!

Easy, cheap and ingeniousHolston Medical Group created automated system that creates PDF file for each of the next day’s patients, saved on a desktop machine in each office. If the system is down they print out the PDF files as needed.

More challenging & robust, Business continuity

ReplicationSynchronous = nowAsynchronous = later


locating a secondary system

Ideal distances for secondary data centers

20 Miles Minimum60-120 Miles Maximum

“The OnePartner ATAC in Duffield, Virginia is currently the sole U.S. company providing outsourced commercial data center services (including colocation and disaster recovery) that has been awarded a Tier III Design Certification by the Uptime Institute.” - Julian Kudritzki, Certification Manager

Disclaimer: Yes. I have a data center.

will you be able to help?


Man is not a rational animal, he is a rationalizing animal.

- Robert A. Heinlein

server care


Pandas require dedicated teams to create the an environment to sustain them.

Servers are like pandas.

They must be kept in carefully maintained environments with teams of highly-trained caretakers, or they die.

seek professional help


Regional companies that can help you.

Computer system supportBCTI (Bailey Computing)Johnson City, TN (www.bcti.com)

Interface developmentLucentGlowKingsport, TN (www.lucentglow.com)

SecurityDeliberareMendota, VA (www.deliberare.com)

Data Center/Disaster RecoveryOnePartner (Tier III)Duffield, VA (www.onepartner.com)

BVUBAbingdon, VA (www.bvub.com)

Legal/HIPAARandall Sermons, Attorney At LawJohnson City, TN (www.randalle.us)

contributors


Special thanks to

Chip ChildressDirector, Information TechnologyHolston Medical Group.


Tom DeaderickDirector, OnePartnerhttp://[email protected](423) 863-8708

the practical guide to healthcare infrastructure, a comedy by tom deaderick director, onepartner

Documents

onepartner slide

users computers

network systems

tablet computers

stuffcontinued image

install malware

default computer image

online applications