The practical guide to healthcare infrastructure, a comedy by Tom Deaderick Director, OnePartner

1. The practical guide to healthcare infrastructure, a comedy by Tom Deaderick Director, OnePartner

2. geek self-test Technology is evil Technology can be good or bad. Technology is nirvana You know… like the Devil. No. It isn’t. You need therapy.

3. EMR selection complete all the other stuff…

4. all the other stuff…continued Image used by permission. (www.despair.com)

5. getting started We’ll work our way out. Starting with the systems you interact with most directly. Network Systems that support org Strategic Methodologies Immediate Systems you interact with

6. tablet computers advantages disadvantages 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. 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).

7. 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. Image used by permission.

8. 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.

9. 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. Image used by permission.

10. freedom with security/reliability recommendations Deploy a centralized management tool, with replaceable standard images. Faronics Deep Freeze Creates 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. Image used by permission.

11. encrypted hard drives Simple security Encrypted hard drives The 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 XP Check with computer vendor for compatibility.

12. network systems We’ll work our way out. Starting with the systems you interact with most directly. Network Systems that support org Strategic Methodologies Immediate Systems you interact with

13. “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”

14. asp? Traditional software/equipment purchase Application Service Provider model 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. 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.

15. 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 Image used by permission.

16. strategic methodologies We’ll work our way out. Starting with the systems you interact with most directly. Network Systems that support org Strategic Methodologies Immediate Systems you interact with

17. 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…

18. fire up the time machine!! Easy, cheap and ingenious Holston 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.

19. fire up the time machine!! Easy, cheap and ingenious Holston 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 Replication Synchronous = now Asynchronous = later Primary Secondary

20. locating a secondary system Ideal distances for secondary data centers 20 Miles Minimum 60-120 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.

21. will you be able to help? Man is not a rational animal, he is a rationalizing animal. - Robert A. Heinlein

22. 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. =

23. seek professional help Regional companies that can help you. Computer system support BCTI (Bailey Computing) Johnson City, TN (www.bcti.com) Interface development LucentGlow Kingsport, TN (www.lucentglow.com) Security Deliberare Mendota, VA (www.deliberare.com) Data Center/Disaster Recovery OnePartner (Tier III) Duffield, VA (www.onepartner.com) BVUB Abingdon, VA (www.bvub.com) Legal/HIPAA Randall Sermons, Attorney At Law Johnson City, TN (www.randalle.us)

24. failure can’t be an option Image used by permission.

25. contributors Special thanks to Chip Childress Director, Information Technology Holston Medical Group.

26. thank you! Tom Deaderick Director, OnePartner http://www.onepartner.com tdeaderick@onepartner.com (423) 863-8708