ABOUT MEGeoff Boyce- Director at Precision IT- Specialising in: - Infrastructure design - Backup and disaster recovery solutions - Service delivery
WHAT YOU NEED TO IDENTIFYEstablish your needs, not just now but in 5 years’ time?• Key current requirements • Mobility • Multi Site • Consolidation• Business direction • Growth Plans? • Expansion into other specialties?• Data storage • Evaluate current data growth• Data Compliance requirements • Statutory, Internal • ISO Certification etc
PURCHASING HARDWARE3 Critical factors of choosing hardware- White label vs. Mainstream Vendor (HP, IBM, Dell)- Long term vendor support- Quality of vendor support- Proven hardware configurations- Replacement part availability- Time to Repair- Capacity Planning- Cater for the unexpected- What are the expansion options- Consider Performance- Is the hardware suited to the implementation? - Database server needs disk speed - Storage server needs slower larger disks
CAN VIRTUALISATION HELP?What is Virtualisation.Separation of the operating system (ie windows) from the physical hardware
BENEFITS OF VIRTUALISATIONServer Consolidation- Better hardware utilisation- Run more with lessSmaller Footprint- Reduce running costs with less hardware, less power, less cooling etc- Reduced Hardware CostsFlexibility and Agility- Easily run multiple operating systems,- Simplify system upgrades- Snapshot technology
COMMON MISTAKESDon’t over consolidate- Over utilisation leads to poor performance- Larger exposure- Give yourself breathing space!Make sure hardware is suitable- Supports virtualisation- Capacity to run multiple systems- High speed hard disks etc
IS YOUR PRACTICE REALLY PROTECTED?Q: How do you know your systems are protected- Do you receive any reporting on the success of backup jobs?- Is you backup data actually valid?- Is your process suited to the media you are using?- Does the human factor weaken your backup strategy?
HAVE YOU EVER CONSIDERED …Recovery Time Objective- How long is an acceptable timeframe to recover from a server failure?Recovery Point Objective- What is considered acceptable data loss?Cost Benefit Analysis- Understand how your expectations around recovery will impact cost
COMMON PITFALLS OF A BACKUP STRATEGY§ Relying on copy scripts § To complex § No reporting § Prone to failure§ Using desktop/basic backup software on servers § No support for Database / email applications§ Relying on USB disks / USB dongles § Most common component to die in a computer is the hard disk § Moving parts, do not handle being knocked. § Susceptible to heat / magnetic interference.
BUSINESS CONTINUITY IS THE GOAL,DISASTER RECOVERY IS THE PLAN,BACKUP IS THE MEANS TO GET IT DONE.- If you rely on backups alone, your practice is at risk- Have a plan in place for difference levels of disasters, including: - Database corruption - Server failure - Major disaster (theft, floods, fire)- How will your practice continue? - Temporary practice location - New/Temporary equipment - Turn around time
ONGOING SERVICE A CRUCIAL ELEMENT TO ANY IT SOLUTIONSystem monitoring - Prevention is the key- Detect problems before they become headaches- Clear visibility to the health of your systemsUpdates / Hotfix Management- Patch against system vulnerabilities- Update Testing – parallel upgrades & failback strategy- Version control (MIMS, Clinical/Practice Management Software – same versions)- Technical Support- Remote and onsite support levels- Response and resolution times
INVENTORY MANAGEMENTLicensing Maintenance- Importance of being compliant- Company Audits occurring more oftenInventory tracking- Document your equipment- Hardware lifecycle management, avoid impact of failures- Procurement plans, suitable hardware (printers, scanners)
ACCOUNTABILITY OF SERVICE PROVIDERS- Service Visibility - Don’t be blind to the health of your IT systems- Decent issue tracking systems - Issue prioritisation - Show Assigned Resources - Clearly defined case status - Regular Communication / updates- Clearly defined Service Level Agreements (SLAs) - service levels should you expect from your providers - Implications for not reaching targets- Don’t be afraid to ask! - Ask for service reports - Backup failure reports - Performance reports
ABOUT MEGerard BuscombeDirector at Precision ITSpecialising in: § New and emerging technologies § Cloud computing § Integration of Medical applications into the Cloud § Mobility solutions for doctors.
NEW TECHNOLOGIESSo what exactly is Cloud Computing?- Online Applications - Web based application IE Google docs, Xero Accounting, SalesForce.- Infrastructure as a service (IaaS) - Hosted services such as Exchange email, online virtual servers (VPS) etc- Storage as a service (SaaS) - Storage providers and online backup solutions IE DropBox, Share file, SkyDrive- Desktop as a service (DaaS) - Access your complete desktop in the cloud IE Precision Cloud
GENERAL BENEFITS OF CLOUD COMPUTINGHigher Service Availability- Cloud services are delivered with availability targets- Expect high service uptimeBuilt on large enterprise scale platforms- As service providers support many customers on the same hardware, systems are built on higher grade hardware, incorporate server and storage farmsSwitch Capitol Expenditure to Operating Expenditure- No more purchasing server hardware- Monthly subscription billing models- Follows the needs of your business
USING CLOUD TECHNOLOGY IN MEDICAL PRACTICES Desktop as a service – most suitable for GPs and specialists - Capable of running most clinical and practice management applications - Scanning can be fully functional - Pathology applications - Cloud Services need to include: - Software Licensing (all but clinical/PM software) - Backups & DR Strategy. - Technical Support Services. - Service Level Agreement – At least 99% uptime guarantee! - Increased ROI on equipment - BYOD – bring your own device – Great for Locums and Part-timers. - Extend the life of existing desktop equipment - Bring windows applications to Apple devices and more - Provides greater mobility for doctors - iPad/Tablet Access in hospitals / nursing homes (printing can also be setup). - Access from anywhere – 3G/4G wireless.
CLOUD - QUESTIONS THAT NEED ANSWERSYour Data- who actually owns my data if its stored outside of my business?- Where is my data physically stored?- If overseas, what legal implications does this pose?- How private is my data?Internet Connectivity- If its on the internet, will it be slow?- What if my internet goes down?Backup and DR- How is my data protected?- What is the RTO and RPO?Support- What support do I get with a cloud service?- Will support cost me more?
NATIONAL BROADBAND NETWORK + 4G WIRELESS NBN - one of the largest infrastructure projects to be rolled out nationally. - Will provide high-speed fibre optic access to 93% of Australian Premises, the remaining 7% to receive satellite and fixed wireless services - Speed increases of up to 100 time faster than existing ADSL connections 4G wireless - Speed increases of up to 5 times faster than existing 3G services - Can achieve higher speeds than ADSL2+ in coverage areas
NEW OPPORTUNITIES FOR MEDICAL PRACTICESTelehealth with NBN- Go beyond the traditional geographical boundaries of your practice- See patients who are unable to travel / are in remote locations- Greater patient / doctor accessibility- Increased patient care with better technologyMobility with Cloud and 3g/4g wireless- Increased access to information from mobile devicesDecentralise your practice- Doctors can consult from virtually anywhere- Easily expand to new practice locations
QUESTION & ANSWERSFeel free to interrogate me…
SOFTWARE Cameron Jaffrey§ Development and Testing processes§ Software Architecture§ Data Security and Integrity§ Stability of Systems§ Hidden Costs
MODERN SOFTWARE ARCHITECTURECompatibility with latest hardware and OS changes § Virtualisation § Cloud computing, both public and private § Ongoing development with support for the latest Operating Systems and Database Engines § 64bit, large memory availability § Modern language and techniques to leverage new emerging technologiesGreat opportunities for mobile computing § Web service based communicationsEnhanced security § No user access to databases required, all access via Web ServicesLeverage server Clustering for Load Balancing and High Availability
DEVELOPMENT AND TESTING PROCESSESISO accreditationRigorous Release Management and Testing § ITIL; Information Technology Infrastructure Library § ISTQB; International Software Testers Qualifications BoardConsistency, personnel independent
DATA SECURITY/INTEGRITYEnhanced security model § No users require direct access to databases, all access via Web Services § No need lock practice out of their own data § Unrestricted backup and DR optionsFinancial integrity; accounting standards § Financial transactions cannot be modified or deleted § True date based accounting § True Enterprise accounting model § Full audit trail of changes
STABILITY OF SYSTEMS§ Enterprise grade § Enterprise grade Operating System, Database Engine etc. § Scalable § Scale Up § Scale Out§ Ease of system Maintenance§ Backup & Disaster Recovery Options
HIDDEN COSTSLevels of serviceWho is responsible for installing updates § Monthly data updates § Periodic application updates § Reference data updatesSupport
Software Functionality Carla Doolan § Identify the areas of potential risk § Understanding the processes § Automate processes using Action/To Do functionality § Continually improving and optimising your practice efficiencies § Goal – Minimising adverse events
POTENTIAL RISK AREAS IN PRACTICES§ Recalls and Reminders§ Diagnostic result reviewing§ Referral Tracking§ Patient compliance with diagnostic test requests
PROCESS DRIVEN ENVIRONMENTS Processes Processes Processes!! § Define the purpose § How to achieve this § Expected outcome § How to measure the outcome
EXAMPLE OF A RECENT LITIGATION CASE§ HIV test§ Wrong address on recall letter§ Pathology result overlooked§ Incorrect information to patient§ Patient then infects partner§ Partner sues doctors§ Doctors sue practice§ http://www.smh.com.au/national/healthcare-giant-must-pay-300000- in-hiv-test-mixup-20110520-1ewra.html#ixzz28sYUR9PT
RECALLS + REMINDERS§ Prompts when making and appointment and linking the Recall /Reminder to the appointment§ Prompts when opening and closing the Health Record that a current Recall or Reminder is due§ Ability to automate recall processing, emails etc.§ Provide a list of non actioned Recall/Reminders§ Full audit available on status and when and who actioned recalls§ Recalls should remain on list until cancelled or complied.
DIAGNOSTIC TESTS§ Track if your clinicians regularly review results using an alerts system§ Pathology and Radiology Audit§ Define your process for tests which are ordered and have not yet had results returned
TASKS/TO DO’S§ Communication variables within a practice§ View or print the list of Actions/To Do’s§ Ability to assign Action or To Do to various staff§ Show a full audit of who has done what and when to that Action or To Do§ Prompts for clinicians if an action or to do is due when opening the Health Record§ Customise for each user§ Record every Action /To Do in patient record
REFERRAL TRACKING§ Referrals – what is the process in your practices?§ Action or To Do feature?§ Can you audit this?§ Use the software to help your practice be proactive
TO SUMMARISE….§ Software is more sophisticated and smarter now§ Optimise it to work for your business§ Audit your processes and setup§ Continual review and improvement plan in your organisation§ Remove the stress of adverse events occurring