- A performance baseline establishes normal operating parameters to gauge system health and isolate problems. It involves testing system resources, networks, operating systems, databases, and applications at regular intervals when problem-free.
- A structured approach for upgrades involves separately testing upgrades in a test environment before rollout, working closely with vendors to resolve issues, and scheduling rollouts during non-peak hours. It is important to have a dedicated team available after rollout to resolve any issues.
- Developing a strong, long-term client-vendor relationship is essential for successful EHR implementation and continued support. The relationship becomes more complex once an organization is dependent on the EHR. It is important to understand the vendor's culture and financial stability before purchase
The document outlines 12 steps for selecting an electronic health record (EHR) system: 1) identify decision makers, 2) clarify goals, 3) determine functional and technical requirements and write a request for proposal, 4) determine proposal recipients, 5) review responses, 6) attend vendor demonstrations, 7) check references, 8) rank vendors, 9) conduct site visits, 10) select a finalist, 11) solidify organizational commitment, and 12) negotiate a contract. Key steps include gathering requirements, writing use cases, sending a request for proposal, checking references, and negotiating a contract that can span 10+ years.
Computer validation testing involves verifying that IT and network equipment such as servers, routers, switches, and cabling are installed and operate as intended. The document discusses validation procedures including installation qualification (IQ) to check proper installation, and operational qualification (OQ) testing including hardware diagnostics, startup/shutdown, power loss simulation, and communications redundancy checks for servers. Regulatory compliance and ensuring consistent system performance are the goals of validation.
The document provides details on Anthony Sewell's background and experience. It includes information on his education, technical skills and certificates, as well as descriptions of his various roles providing IT support over 18 years in both private sector and government contracting. His experience includes help desk support, systems administration, network engineering, security management, and technical project lead roles.
VMworld 2013: Gaining Insight in Meditech with vCenter Operations Management ...VMworld
The document discusses using VMware vCenter Operations Management Suite to gain insight into performance issues reported in Meditech, a common electronic health record (EHR) system. It describes how an adapter was created to integrate Meditech-specific metrics and terminology into vCenter Operations, allowing IT administrators to troubleshoot EHR issues based on how clinicians describe problems. This provides a single dashboard view of the virtual infrastructure and Meditech environment that helps correlate performance data to specific systems, modules, and statistics. Alerts can also be configured based on key performance indicators to more proactively address potential issues.
This document provides an introduction and overview of computer validation training. It discusses why computer validation is important for business, safety, and regulatory reasons. It explains that computer validation has been a regulatory requirement for over 20 years, but scrutiny has increased significantly in recent years. The document outlines the basics of what constitutes a computer system and the validation process, who plays key roles in validation, and why defects in computer systems can have more severe consequences than other equipment problems.
This document provides a summary of Joseph R. Williams' experience as an IT Service professional and ServiceNow Administrator with over 20 years of experience implementing and maintaining IT service management tools. He has extensive experience designing and configuring ServiceNow platforms to improve incident, change, problem and asset management processes.
Michael Meitner is an IT technical analyst with over 15 years of experience implementing and supporting complex healthcare IT systems including PACS, RIS, cardiology, and oncology systems. He has a proven track record of managing system migrations, upgrades, and deployments. Currently he is a senior PACS engineer at Wheaton Franciscan Healthcare where he provides technical support for various radiology, cardiology, and oncology systems and acts as a liaison between different IT teams. He has comprehensive experience with technologies such as Windows, Linux, SQL Server, and healthcare applications like GE Centricity PACS and Horizon Practice Plus.
The document provides guidance on preparing for a computer systems quality audit by outlining key elements of a quality assurance program including standard operating procedures, a change control program, and computer systems validation. It describes the components and purpose of the change control program and committees. It also lists important documents needed for a computer systems validation program including plans, procedures, and project documents.
The document outlines 12 steps for selecting an electronic health record (EHR) system: 1) identify decision makers, 2) clarify goals, 3) determine functional and technical requirements and write a request for proposal, 4) determine proposal recipients, 5) review responses, 6) attend vendor demonstrations, 7) check references, 8) rank vendors, 9) conduct site visits, 10) select a finalist, 11) solidify organizational commitment, and 12) negotiate a contract. Key steps include gathering requirements, writing use cases, sending a request for proposal, checking references, and negotiating a contract that can span 10+ years.
Computer validation testing involves verifying that IT and network equipment such as servers, routers, switches, and cabling are installed and operate as intended. The document discusses validation procedures including installation qualification (IQ) to check proper installation, and operational qualification (OQ) testing including hardware diagnostics, startup/shutdown, power loss simulation, and communications redundancy checks for servers. Regulatory compliance and ensuring consistent system performance are the goals of validation.
The document provides details on Anthony Sewell's background and experience. It includes information on his education, technical skills and certificates, as well as descriptions of his various roles providing IT support over 18 years in both private sector and government contracting. His experience includes help desk support, systems administration, network engineering, security management, and technical project lead roles.
VMworld 2013: Gaining Insight in Meditech with vCenter Operations Management ...VMworld
The document discusses using VMware vCenter Operations Management Suite to gain insight into performance issues reported in Meditech, a common electronic health record (EHR) system. It describes how an adapter was created to integrate Meditech-specific metrics and terminology into vCenter Operations, allowing IT administrators to troubleshoot EHR issues based on how clinicians describe problems. This provides a single dashboard view of the virtual infrastructure and Meditech environment that helps correlate performance data to specific systems, modules, and statistics. Alerts can also be configured based on key performance indicators to more proactively address potential issues.
This document provides an introduction and overview of computer validation training. It discusses why computer validation is important for business, safety, and regulatory reasons. It explains that computer validation has been a regulatory requirement for over 20 years, but scrutiny has increased significantly in recent years. The document outlines the basics of what constitutes a computer system and the validation process, who plays key roles in validation, and why defects in computer systems can have more severe consequences than other equipment problems.
This document provides a summary of Joseph R. Williams' experience as an IT Service professional and ServiceNow Administrator with over 20 years of experience implementing and maintaining IT service management tools. He has extensive experience designing and configuring ServiceNow platforms to improve incident, change, problem and asset management processes.
Michael Meitner is an IT technical analyst with over 15 years of experience implementing and supporting complex healthcare IT systems including PACS, RIS, cardiology, and oncology systems. He has a proven track record of managing system migrations, upgrades, and deployments. Currently he is a senior PACS engineer at Wheaton Franciscan Healthcare where he provides technical support for various radiology, cardiology, and oncology systems and acts as a liaison between different IT teams. He has comprehensive experience with technologies such as Windows, Linux, SQL Server, and healthcare applications like GE Centricity PACS and Horizon Practice Plus.
The document provides guidance on preparing for a computer systems quality audit by outlining key elements of a quality assurance program including standard operating procedures, a change control program, and computer systems validation. It describes the components and purpose of the change control program and committees. It also lists important documents needed for a computer systems validation program including plans, procedures, and project documents.
The document outlines the key phases and activities for developing a pharmacy management system using a software engineering approach. It discusses planning the project, gathering requirements, designing the system architecture and database, implementing code to develop the core functionality, testing the software, and deploying the final system. The goal is to design a user-friendly application that can manage inventory, process prescriptions, and automate tasks to improve efficiency for pharmacists.
The document outlines the key phases and activities for developing a pharmacy management system using a software engineering approach. It discusses planning the project, gathering requirements, designing the system architecture and database, implementing code to develop the core functionality, testing the software, and deploying the final system. The goal is to design a user-friendly application that can manage inventory, process prescriptions, and automate tasks to improve efficiency for pharmacists.
Test Engineer_Quality Analyst_Software Tester with 5years 2 months Experiencepawan singh
Pawan Singh has over 5 years of experience in quality assurance and software testing. He has expertise in manual testing, functional testing, database testing, and testing across various domains including healthcare, banking, and telecommunications. He is proficient in testing tools such as QC and bug tracking tools like JIRA. Pawan seeks a challenging role in quality assurance with an organization of high repute.
The document discusses challenges related to software operation knowledge (SOK) integration. It describes how SOK data can be collected from various sources and used to improve software processes. However, challenges exist around visualizing and analyzing large amounts of technical and usage data, aligning business and technical metrics, handling big and real-time data, and addressing errors at different levels of software. The document advocates for continuous refinement of SOK integration objectives and requirements to optimize results.
Prerit Gupta has over 3 years of experience as a web developer and systems engineer working on projects in Java/J2EE development, data warehousing, ETL, and analytics. He has worked on projects for clients like Quest Diagnostics, developing applications, performing requirements analysis, designing databases, and conducting testing. His technical skills include languages like Java, SQL, and technologies like Servlets, JSP, XML, and tools like DataStage, Oracle, and Unix.
Software Development Life Cycle (SDLC).pptxsandhyakiran10
The document describes the system development life cycle (SDLC) process. It involves several key phases: problem definition, feasibility study, system analysis, system design, system development, implementation, and maintenance. In the system analysis phase, requirements are gathered through interviews, documentation review, and other techniques. System design then specifies how the system will meet requirements through elements like the user interface, data design, and process design. The system is built during development, tested, and then implemented, which may involve training, file conversion, and evaluation. Maintenance keeps the system meeting needs with ongoing support. Accountants can be involved throughout by specifying needs, testing, and using the new system.
The document provides an introduction to software engineering and discusses key concepts such as:
1) Software is defined as a set of instructions that provide desired features, functions, and performance when executed and includes programs, data, and documentation.
2) Software engineering applies scientific knowledge and engineering principles to the development of reliable and efficient software within time and budget constraints.
3) The software development life cycle (SDLC) involves analysis, design, implementation, and documentation phases to systematically develop high quality software that meets requirements.
The document summarizes a project presentation for a Hostel Management System. It includes sections on the introduction, existing system, project scope and goals, software process model, and tools and technologies. The introduction discusses how the system provides an online platform for hostel staff and customers. The existing system section compares the proposed system to current manual processes. The project scope outlines functionality for administrators to manage customer profiles and announcements, and for customers to view their information. The goal is to remove paper-based work and provide an interactive interface. The software process model is waterfall and the tools include MySQL, XAMPP, NetBeans, Java, and hardware requirements.
The document summarizes a project presentation for a Hostel Management System. It includes sections on the introduction, existing system, project scope and goals, software process model, and tools and technologies. The introduction discusses how the system provides an online platform for hostel staff and customers. The existing system section compares the proposed system to current manual processes. The project scope outlines functionality for administrators to manage customer profiles and announcements, and for customers to view their information. The goal is to remove paper-based work and provide an interactive interface. The software process model is waterfall and the tools include MySQL, XAMPP, NetBeans, Java, and hardware requirements.
The document discusses various aspects of software processes and life cycles. It describes three types of reusable software components: web services, object collections, and stand-alone systems. It also outlines common phases in a software life cycle like requirements analysis, design, implementation, testing, deployment, and maintenance. Incremental delivery approaches are discussed where early increments are delivered to customers.
The document discusses various aspects of software processes and life cycles. It describes three types of reusable software components: web services, object collections, and stand-alone systems. It also outlines common phases in a software life cycle like requirements analysis, design, implementation, testing, deployment, and maintenance. Incremental delivery approaches are discussed where early increments are delivered to customers.
George, a system administrator, was having trouble completing a deployment that was taking all morning. He had contacted colleagues, experts, and developers for help but was still unable to resolve the issue. System administrators play a critical role in maintaining computer infrastructure but troubleshooting problems can be challenging and time-consuming. Expert performance analysis tools like onTune that collect real-time system data and monitor all processes can help administrators identify issues faster and save organizations time and money compared to general system management solutions.
This document discusses key concepts in software engineering including the software engineering paradigm, software processes, verification and validation, computer-based systems, and system engineering hierarchy. It defines software engineering as the application of engineering principles to software development. Software processes involve specifications, development, validation, and evolution. Verification ensures the right product is built while validation ensures the product meets needs. System engineering analyzes systems from a top-down world view to specific technical components.
1) Application software maintenance accounts for 70% of IT budgets and involves maintaining large, mission-critical systems like ERP over time as needs change.
2) Using queueing theory, the document proposes allocating maintenance resources efficiently to minimize backlogs and improve productivity through skills training and documentation.
3) A key insight was reducing the arrival rate of new bugs through comprehensive initial testing and validating data inputs to catch errors earlier. This allowed many teams to reduce headcount over time while satisfying customers.
This presentation explores a broad cross-section of enterprise Postgres deployments to identify key usage patterns and reveals important aspects of performance, scalability, and availability including:
* Challenges organizations encounter most frequently during the stages of database development, deployment and maintenance
* Tuning parameters used most frequently to improve performance of production databases
* Frequently problematic database maintenance processes and configuration parameters
* Most commonly-used database back-up and recovery strategies
The document summarizes the results of performance testing on a system. It provides throughput and scalability numbers from tests, graphs of metrics, and recommendations for developers to improve performance based on issues identified. The performance testing process and approach are also outlined. The resultant deliverable is a performance and scalability document containing the test results but not intended as a formal system sizing guide.
Shashank Srivastava has over 7 years of experience as an IT Quality Analyst and Software Test Engineer. He has worked with several companies including UnitedHealth Group, ITC InfoTech India LTD, SSS Softech Pvt. Ltd., and Hungama Digital Entertainment Pvt Ltd. testing various web and mobile applications. His responsibilities included requirement analysis, test case creation, defect reporting, and ensuring projects were completed according to deadlines.
The document discusses the information system development life cycle (SDLC) which includes various phases from problem definition to maintenance and review. It describes each phase in detail including system analysis, design, development, implementation and post-implementation maintenance. It also provides an overview of database management systems (DBMS), their basic concepts and why DBMS are used to manage organizational data and address issues with traditional file-based systems.
Arnab Chakraborty has over 9 years of experience as a Java Technical Lead. He is seeking a challenging role to effectively deliver projects for a reputed IT company. He has extensive experience in software development using technologies like Java, J2EE, Spring Framework and leading teams of developers.
Culture of healthcare_ week 1_ lecture_slidesCMDLMS
This lecture provides an overview of the culture of health care. It defines key terms like health, disease, illness, and health care. It explains that culture refers to integrated patterns of human behavior within groups, and defines the culture of health care. The lecture outlines several themes in the literature on the culture of health care, including patient and workforce diversity and various professional cultures. It emphasizes that health care involves a complex mix of cultures that are not always apparent from within.
Unhappy customers can significantly impact a company's bottom line through negative word-of-mouth advertising and lost sales. Studies show that 68% of unhappy customers felt disinterested or indifferent, and one dissatisfied luxury car owner can cost a dealership $100 million in annual revenue from lost sales. As social media has made it easier for customers to share negative opinions, companies place high value on resolving issues with challenging customers to maintain satisfaction and minimize financial losses.
The document outlines the key phases and activities for developing a pharmacy management system using a software engineering approach. It discusses planning the project, gathering requirements, designing the system architecture and database, implementing code to develop the core functionality, testing the software, and deploying the final system. The goal is to design a user-friendly application that can manage inventory, process prescriptions, and automate tasks to improve efficiency for pharmacists.
The document outlines the key phases and activities for developing a pharmacy management system using a software engineering approach. It discusses planning the project, gathering requirements, designing the system architecture and database, implementing code to develop the core functionality, testing the software, and deploying the final system. The goal is to design a user-friendly application that can manage inventory, process prescriptions, and automate tasks to improve efficiency for pharmacists.
Test Engineer_Quality Analyst_Software Tester with 5years 2 months Experiencepawan singh
Pawan Singh has over 5 years of experience in quality assurance and software testing. He has expertise in manual testing, functional testing, database testing, and testing across various domains including healthcare, banking, and telecommunications. He is proficient in testing tools such as QC and bug tracking tools like JIRA. Pawan seeks a challenging role in quality assurance with an organization of high repute.
The document discusses challenges related to software operation knowledge (SOK) integration. It describes how SOK data can be collected from various sources and used to improve software processes. However, challenges exist around visualizing and analyzing large amounts of technical and usage data, aligning business and technical metrics, handling big and real-time data, and addressing errors at different levels of software. The document advocates for continuous refinement of SOK integration objectives and requirements to optimize results.
Prerit Gupta has over 3 years of experience as a web developer and systems engineer working on projects in Java/J2EE development, data warehousing, ETL, and analytics. He has worked on projects for clients like Quest Diagnostics, developing applications, performing requirements analysis, designing databases, and conducting testing. His technical skills include languages like Java, SQL, and technologies like Servlets, JSP, XML, and tools like DataStage, Oracle, and Unix.
Software Development Life Cycle (SDLC).pptxsandhyakiran10
The document describes the system development life cycle (SDLC) process. It involves several key phases: problem definition, feasibility study, system analysis, system design, system development, implementation, and maintenance. In the system analysis phase, requirements are gathered through interviews, documentation review, and other techniques. System design then specifies how the system will meet requirements through elements like the user interface, data design, and process design. The system is built during development, tested, and then implemented, which may involve training, file conversion, and evaluation. Maintenance keeps the system meeting needs with ongoing support. Accountants can be involved throughout by specifying needs, testing, and using the new system.
The document provides an introduction to software engineering and discusses key concepts such as:
1) Software is defined as a set of instructions that provide desired features, functions, and performance when executed and includes programs, data, and documentation.
2) Software engineering applies scientific knowledge and engineering principles to the development of reliable and efficient software within time and budget constraints.
3) The software development life cycle (SDLC) involves analysis, design, implementation, and documentation phases to systematically develop high quality software that meets requirements.
The document summarizes a project presentation for a Hostel Management System. It includes sections on the introduction, existing system, project scope and goals, software process model, and tools and technologies. The introduction discusses how the system provides an online platform for hostel staff and customers. The existing system section compares the proposed system to current manual processes. The project scope outlines functionality for administrators to manage customer profiles and announcements, and for customers to view their information. The goal is to remove paper-based work and provide an interactive interface. The software process model is waterfall and the tools include MySQL, XAMPP, NetBeans, Java, and hardware requirements.
The document summarizes a project presentation for a Hostel Management System. It includes sections on the introduction, existing system, project scope and goals, software process model, and tools and technologies. The introduction discusses how the system provides an online platform for hostel staff and customers. The existing system section compares the proposed system to current manual processes. The project scope outlines functionality for administrators to manage customer profiles and announcements, and for customers to view their information. The goal is to remove paper-based work and provide an interactive interface. The software process model is waterfall and the tools include MySQL, XAMPP, NetBeans, Java, and hardware requirements.
The document discusses various aspects of software processes and life cycles. It describes three types of reusable software components: web services, object collections, and stand-alone systems. It also outlines common phases in a software life cycle like requirements analysis, design, implementation, testing, deployment, and maintenance. Incremental delivery approaches are discussed where early increments are delivered to customers.
The document discusses various aspects of software processes and life cycles. It describes three types of reusable software components: web services, object collections, and stand-alone systems. It also outlines common phases in a software life cycle like requirements analysis, design, implementation, testing, deployment, and maintenance. Incremental delivery approaches are discussed where early increments are delivered to customers.
George, a system administrator, was having trouble completing a deployment that was taking all morning. He had contacted colleagues, experts, and developers for help but was still unable to resolve the issue. System administrators play a critical role in maintaining computer infrastructure but troubleshooting problems can be challenging and time-consuming. Expert performance analysis tools like onTune that collect real-time system data and monitor all processes can help administrators identify issues faster and save organizations time and money compared to general system management solutions.
This document discusses key concepts in software engineering including the software engineering paradigm, software processes, verification and validation, computer-based systems, and system engineering hierarchy. It defines software engineering as the application of engineering principles to software development. Software processes involve specifications, development, validation, and evolution. Verification ensures the right product is built while validation ensures the product meets needs. System engineering analyzes systems from a top-down world view to specific technical components.
1) Application software maintenance accounts for 70% of IT budgets and involves maintaining large, mission-critical systems like ERP over time as needs change.
2) Using queueing theory, the document proposes allocating maintenance resources efficiently to minimize backlogs and improve productivity through skills training and documentation.
3) A key insight was reducing the arrival rate of new bugs through comprehensive initial testing and validating data inputs to catch errors earlier. This allowed many teams to reduce headcount over time while satisfying customers.
This presentation explores a broad cross-section of enterprise Postgres deployments to identify key usage patterns and reveals important aspects of performance, scalability, and availability including:
* Challenges organizations encounter most frequently during the stages of database development, deployment and maintenance
* Tuning parameters used most frequently to improve performance of production databases
* Frequently problematic database maintenance processes and configuration parameters
* Most commonly-used database back-up and recovery strategies
The document summarizes the results of performance testing on a system. It provides throughput and scalability numbers from tests, graphs of metrics, and recommendations for developers to improve performance based on issues identified. The performance testing process and approach are also outlined. The resultant deliverable is a performance and scalability document containing the test results but not intended as a formal system sizing guide.
Shashank Srivastava has over 7 years of experience as an IT Quality Analyst and Software Test Engineer. He has worked with several companies including UnitedHealth Group, ITC InfoTech India LTD, SSS Softech Pvt. Ltd., and Hungama Digital Entertainment Pvt Ltd. testing various web and mobile applications. His responsibilities included requirement analysis, test case creation, defect reporting, and ensuring projects were completed according to deadlines.
The document discusses the information system development life cycle (SDLC) which includes various phases from problem definition to maintenance and review. It describes each phase in detail including system analysis, design, development, implementation and post-implementation maintenance. It also provides an overview of database management systems (DBMS), their basic concepts and why DBMS are used to manage organizational data and address issues with traditional file-based systems.
Arnab Chakraborty has over 9 years of experience as a Java Technical Lead. He is seeking a challenging role to effectively deliver projects for a reputed IT company. He has extensive experience in software development using technologies like Java, J2EE, Spring Framework and leading teams of developers.
Culture of healthcare_ week 1_ lecture_slidesCMDLMS
This lecture provides an overview of the culture of health care. It defines key terms like health, disease, illness, and health care. It explains that culture refers to integrated patterns of human behavior within groups, and defines the culture of health care. The lecture outlines several themes in the literature on the culture of health care, including patient and workforce diversity and various professional cultures. It emphasizes that health care involves a complex mix of cultures that are not always apparent from within.
Unhappy customers can significantly impact a company's bottom line through negative word-of-mouth advertising and lost sales. Studies show that 68% of unhappy customers felt disinterested or indifferent, and one dissatisfied luxury car owner can cost a dealership $100 million in annual revenue from lost sales. As social media has made it easier for customers to share negative opinions, companies place high value on resolving issues with challenging customers to maintain satisfaction and minimize financial losses.
This document discusses key principles for effective communication between support agents and customers. It emphasizes that listening is an active skill that takes effort. Both parties must be actively involved in the interaction to ensure understanding and progress towards resolution. Trust in the relationship allows for open communication, while mutual alignment of goals establishes shared expectations for resolving issues.
The document lists several challenges that were addressed and initiatives that were implemented including stopping upselling, establishing a quality control team, enforcing support tickets, creating organizational structures, identifying talent, delegating responsibilities, developing KPIs, creating autonomous customer service units, implementing various tools like WalkMe and Izenda, conducting HIPAA awareness sessions, creating a client retention unit, using Power BI for reporting, conducting in-house marketing, and creating CRs for CureX. It also shows the results of a survey on recognition, feedback, suggestions, happiness, satisfaction, wellness, ambassadorship, relationships with managers, relationships with colleagues, and company alignment for the Operations team at CureMD.
This lecture discusses how health information technology can help facilitate error reporting and analysis to improve patient safety. It presents three key HIT mechanisms: automated surveillance systems, online event reporting systems, and predictive analytics/data modeling. The lecture also emphasizes the importance of a culture of safety that encourages open discussion and learning from mistakes without blame. Error reports are analyzed using a risk assessment model to distinguish near misses from events that cause patient harm.
This document discusses quality improvement tools for analyzing health information technology (HIT) errors, including root cause analysis (RCA), failure mode and effects analysis (FMEA), and hazard analysis. RCA is a structured problem-solving process that considers all potential causal factors of an incident. FMEA prospectively predicts error modes by assessing the likelihood and impact of process failures. The document provides examples of using RCA and FMEA to analyze HIT-related errors and identifies key areas of focus for HIT safety measures.
This lecture discusses learning from mistakes and errors in health information technology (HIT). It covers types of errors like slips, mistakes, active failures and latent conditions. It also examines unintended consequences of HIT like new or more work, workflow issues, overdependence on technology, and copy-paste errors. The objectives are to assess HIT for negative consequences and examine common HIT design deficiencies. References from AHRQ and other sources on error reporting and analysis in HIT are also provided.
This document discusses electronic clinical quality measures (eCQMs) which are designed to leverage health information technology (HIT) to improve quality measurement. eCQMs use standardized data elements and terminology to measure care quality based on information in electronic health records. Effective eCQM reporting requires structured, coded data and use of standards for measure specification, calculation, and reporting. Widespread use of eCQMs could revolutionize quality measurement by facilitating automated reporting and improving data quality.
This lecture discusses key attributes of data quality including consistency, currency, timeliness, granularity, precision, and relevancy. It provides examples of each attribute and recommendations for maintaining data integrity such as establishing data governance and defining standards for data collection. The lecture also notes that data quality is important for research and quality improvement efforts and that poor data quality can lead to errors.
This lecture discusses assessing data quality and identifies 10 key attributes of data quality: definition, accuracy, accessibility, comprehensiveness, consistency, currency, timeliness, granularity, precision, and relevancy. Poor data quality can threaten patient safety and quality of care, reduce effectiveness of decision making, and increase costs. The lecture provides examples and recommendations for ensuring each of the 10 data quality attributes.
This lecture discusses assessing data quality and improving it through health information technology (HIT). It identifies common causes of insufficient data quality, such as unclear definitions, incomplete data, and programming errors. Both systematic and random issues can negatively impact data quality. The lecture outlines best practices for preventing, detecting, and improving data quality issues. Standardizing terminology, structuring data entry, and utilizing technologies like voice recognition can enhance data quality. Overall, high quality clinical data is important for healthcare decisions, and HIT professionals can implement strategies to enhance data quality.
This document discusses strategies for implementing health information technology (HIT) systems. It compares "big bang" implementations, where a system is launched system-wide at once, to "staggered" or phased implementations. While big bang implementations have faster rollout, they carry higher risk. Staggered implementations have lower risk but slower return on investment. The document also emphasizes the importance of user training and long-term support during and after implementation to ensure success. Contextual factors like organizational culture and individual user needs must also be considered in planning. Nested implementation teams and designated super-users or internal consultants can help provide support.
The document discusses effective health IT implementation planning. It outlines characteristics of effective implementation teams, including communication, understanding roles, and practical expertise. Three key strategies for health IT implementation are reviewed: single vendor, best of breed, and best of suite. Clinical workflows and the needs of different care settings like primary care and critical access hospitals are also addressed. The goal is to assist organizations in designing customized implementation plans that meet their unique quality and safety needs.
This document discusses a lecture on how health information technology (HIT) can impact patient safety culture. The lecture covers strategies for adaptive work that can be useful for HIT initiatives, including being unwavering in goals while inviting others to help achieve them, addressing real and perceived losses from changes, and assuming healthcare providers want to help patients. References are provided for images and content used in the lecture.
This document discusses health information technology (HIT) and its impact on patient safety culture. It provides learning objectives on adaptive leadership, frameworks for patient safety culture, and differentiating technical and adaptive change. It also summarizes a 2013 medical error case study where a patient received a 39-fold overdose due to a 50-step error-prone process. Root causes of use errors with HIT are identified, such as patient identification errors and data accuracy errors. Frameworks for risk assessment and classifying human interaction with HIT systems are presented. The document concludes that HIT has potential to reduce errors but also introduce new opportunities for errors and overreliance on technology.
This document is a lecture on how health information technology (HIT) can impact patient safety culture. It discusses applying quality improvement tools to analyze HIT errors. It highlights the success of efforts led by Dr. Peter Pronovost to reduce central line bloodstream infections through standardization, independent checks, and learning from defects. Checklists, data collection, and adopting practices from high-reliability industries like aviation and Toyota have helped significantly reduce infection rates.
This document provides an overview of quality improvement methods and tools. It describes several common quality improvement models including the API model, Baldrige criteria, FOCUS-PDCA, PDSA cycle, ISO 9000, Kaizen, Lean thinking, and Six Sigma DMAIC. A variety of basic quality improvement tools are also outlined, such as flowcharts, cause-and-effect diagrams, control charts, Pareto charts, and checklists. Finally, potential mistakes in quality improvement initiatives are reviewed, including choosing an inappropriate topic, lack of defined roles/expectations, and failure to sustain improvements.
This document provides an overview of quality improvement methods for healthcare settings. It describes strategies for quality improvement, including the role of leadership in creating a culture that supports quality improvement. The document discusses concepts like the PDSA cycle and foundations of quality improvement developed by thinkers like Shewhart, Deming, and Juran. The goal is to introduce methods that can be used to identify and redesign processes, collect and analyze data, and make improvements to eliminate problems and strategically change healthcare systems over time.
- Alerts and reminders have the potential to improve patient safety but can also cause clinician frustration and "alert fatigue" if too many are nuisance alerts that provide little benefit.
- Successful alerts are specific, sensitive, clear, concise and support clinical workflow, allowing for safe, efficient responses. They include drug and lab alerts, practice and administrative reminders.
- Research found that drug interaction alerts, disease-drug contraindication alerts and dosing guidelines improved prescribing behaviors while unnecessary lab test repeats dropped with test result reminders.
- Clinical decision support (CDS) aims to improve healthcare decisions and outcomes by providing clinicians with relevant patient information and clinical knowledge. However, CDS has not been widely adopted by clinicians.
- Effective CDS provides the right information to the right person in the right format through the right channels at the right time. It can take many forms, including alerts, order sets, and guidelines.
- CDS helps with administrative tasks, managing clinical complexity, controlling costs, and supporting clinical decision-making. However, poor design can also lead to unintended consequences like alert fatigue.
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VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdfVedanta A
Air Ambulance Services In Rewa works in close coordination with ground-based emergency services, including local Emergency Medical Services, fire departments, and law enforcement agencies.
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NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTblessyjannu21
Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
It is a type of chronic obstructive
pulmonary disease.
It is a progressive disease of lungs.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
CHAPTER 1 SEMESTER V COMMUNICATION TECHNIQUES FOR CHILDREN.pdfSachin Sharma
Here are some key objectives of communication with children:
Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
Encourage Expression:
Enable children to articulate their thoughts, feelings, and experiences.
Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
Strengthen the bond between children and caregivers, peers, and other adults.
Support Learning and Development:
Aid cognitive and language development through engaging and meaningful conversations.
Teach Social Skills:
Encourage polite, respectful, and empathetic interactions with others.
Resolve Conflicts:
Provide tools and guidance for children to handle disagreements constructively.
Encourage Independence:
Support children in making decisions and solving problems on their own.
Provide Reassurance and Comfort:
Offer comfort and understanding during times of distress or uncertainty.
Reinforce Positive Behavior:
Acknowledge and encourage positive actions and behaviors.
Guide and Educate:
Offer clear instructions and explanations to help children understand expectations and learn new concepts.
By focusing on these objectives, communication with children can be both effective and nurturing, supporting their overall growth and well-being.
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1. Installation and Maintenance of Health
IT Systems
Troubleshooting; Maintenance and
Upgrades; Interaction with Vendors,
Developers and Users
Lecture b
This material (Comp 8 Unit 8) was developed by Johns Hopkins University, funded by the Department of Health
and Human Services, Office of the National Coordinator for Health Information Technology under Award
Number IU24OC000024. This material was updated in 2016 by The University of Texas Health Science
Center at Houston under Award Number 90WT0006.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.
2. Troubleshooting; Maintenance and
Upgrades; Interaction with Vendors,
Developers, and Users
Learning Objectives
1. Identify and implement an effective troubleshooting procedure for
reporting, evaluating, fixing, deploying, and follow-up of errors,
problems, or limitations for the system (lectures a & b).
2. Integrate downtime schedule for OS, network, database, and client
application maintenance and updates (lecture b).
3. Develop a process for communicating requirements and supplying
updates between vendors/developer and users (lecture b).
4. Create a baseline for system performance measurement and
comparison for troubleshooting (lecture b).
2
4. Troubleshooting:
Diagnosing Complex EHR
Infrastructure Issues (cont’d)
• Use the logs
• Develop a timeline
• Stick to the Plan…Set deadlines for
escalation
• Stay focused on resolving the problem.
• Don’t be too quick to declare a problem
resolved.
(Halamka; AHRQ, 2011)
4
5. Troubleshooting: An Example
• User contacts the EHR Helpdesk about
slow EHR…
– Start with the local machine
o Recent Updates or Patches
o System and Application Logs
o Wireless/ Ethernet Connectivity
5
6. Troubleshooting: An Example
(cont’d)
• If the issue is more widespread…
– Network or ISP Issues
o Misconfigured switch, router, ISP Connectivity
– Erroneous OS Upgrade/ Misconfigured Server
– Server Hardware Error/ Upgrade Needed
– Application Upgrade Error
o EHR Design
o EHR Software Code
6
7. Performance Baseline
• Generated after completion of
performance baseline testing.
• Shows normal operating parameters of
your system under normal load conditions.
• Used to gauge overall system health &
assist with isolating performance
problems.
(Wunder)
7
8. Performance Baseline: Testing
• “Benchmark testing”
• Compare performance of new server/system
against standard (e.g., existing measurements
or software specs).
• Test at regular intervals, when problem-free:
– System resources (server & hardware)
– Network architecture
– Operating system
– Database applications
– Client applications
(Sqlserver, 2009)
8
9. Performance Baseline:
Utilities Available
• Work with vendor to determine
best method for your EHR.
• Many third-party utilities
available.
• Windows built-in utilities:
– System Monitor (collect & view
real-time data on usage of
memory, disk, processor)
– Performance logs & alerts
– Task Manager
– Event Tracing for Windows (ETW;
trace & log events raised by user-
mode applications & kernel-mode
drivers; export most SQL Server
events.)
• Databases often require
special utilities.
• SQL Server built-in utilities:
– SQL Trace
– SQL Server Profiler
– SQL Server Management
Studio Activity Monitor
– SQL Server Management
Studio Graphical Showplan
– Stored procedures
– Database Console Commands
(DBCC)
– Built-in functions
– Trace flags
(Microsoft, 2011; Technical, 2005) 9
10. Performance Baseline:
Measurements & Next Steps
• Measurements
– Peak vs. off-peak hours
– Production-query, batch-command response times
– Database backup and restore completion times
• Next steps
– Compare baseline statistics to current server/system
performance.
– Investigate if numbers far above or below baseline.
(Wunder)
10
11. EHR Maintenance & Upgrades
• Upgrades crucial for extending EHR
functionality & overall system lifespan.
• Improperly planned/managed upgrade
procedures can severely damage system,
reducing performance.
• Use highly structured approach in
upgrading any major, critical production
system.
11
12. EHR Maintenance & Upgrades:
Structured Approach
• Upgrade team
– Works with vendor.
– Reads upgrade documentation.
– Analyzes functional enhancements.
– Works with vendor on unknown variables.
– Makes plan to configure & test affected applications.
• Technical team develops alternative testing environment
(test bed).
• Upgrade team compiles pre-installation & installation
checklists, determines downtime.
• After first testing, logs reviewed & errors/discrepancies
reported to vendor.
12
13. A Structured Approach (cont’d)
• After vendor resolves issues, upgrade process
retested, ensuring data integrity.
• Consider software to simulate workflow & users;
track data for performance analysis.
• Unified spreadsheet to track issues.
• Once testing complete & upgrade approved,
final documentation prepared & training
scheduled.
• Installation team finalized & assigned roles.
• Upgrade scheduled during off-peak times.
• EHR “shadow copy” (read-only, without real-
time interfaced results) accessible during
upgrade. 13
14. A Structured Approach (cont’d - 2)
• Upgraded system tested immediately after
completion.
• Once testing complete, help desk notified
& systems brought back online.
• Dedicated team available for several
business days to resolve issues.
• (Follow similar processes for upgrades to
server OS, workstation OS, databases.)
14
15. Interacting with Users
• Stay up to date
• Set realistic expectations
• Value your user’s time
• Be friendly, but stay on task.
• Listen Closely, and acknowledge the
user’s issue
• Use the opportunity to educate
• Be patient
(Boyer, 2005)
15
16. Client-Vendor Relationship
• Essential not only for successful implementation, but
also for continued success of product.
– Issues will arise beyond scope of your IT workforce.
– Routine upgrades needed.
– Vendor plays pivotal role in these & other events.
• Successful partnerships built on mutual goals, trust.
– “In this together”.
– Success of vendor depends on success of product.
• Long-term commitment between organization & vendor.
– Relationship becomes complex once organization
dependent on fully embedded EHR.
(Boyer, 2005)
16
17. Client-Vendor Relationship: Before
Purchase
• Understand vendor company & culture.
– Visit headquarters, talk with as many as you can
(including development & support).
– Follow the money. What drives revenue stream?
– Dependent on support fees? Understand support-fee
structure.
– Financially solvent enough to provide long-term
support?
• Hosted and SaaS (Software as a Service) solutions:
understand vendor’s upgrade strategy.
– Will it conflict with your business practices?
• Impressions of vendor’s support staff
(Boyer, 2005)
17
18. Troubleshooting; Maintenance and
Upgrades; Interaction with Vendors,
Developers, and Users
Summary
• Performance baseline
– Helps gauge system health & isolate problems.
• Structured approach for upgrades
– Separate environment for testing upgrades prior to
rollout. Work closely with vendor to resolve issues.
Rollout during non-peak hours.
• Client-vendor relationship
– EHR purchase brings long-term commitment.
Complexity once dependent on EHR. Understand
vendor & culture before purchase.
18
19. Troubleshooting; Maintenance and
Upgrades; Interaction with Vendors,
Developers, and Users
References – Lecture b
References
Boyer, E. and M. Soback (2005). Production Support. Implementing an Electronic Health Record
System. J. M. Walker, E. J. Bieber and F. Richards, Springer London: 95-100.
http://www.springerlink.com/content/n520ghg078416463/
Event Tracing for Windows (2011). Microsoft.com. [Internet]]. http://msdn.microsoft.com/en-
us/library/ff545699.aspx .
AHRQ. (2011). Guide to Reducing Unintended Consequences of Electronic Health Records [Online].
https://healthit.ahrq.gov/sites/default/files/docs/publication/guide-to-reducing-unintended-
consequences-of-electronic-health-records.pdf
Halamka, John. 10 tips for troubleshooting complex EHR infrastructure problems. KevinMD.com.
[Internet]. http://www.kevinmd.com/blog/2010/09/10-tips-troubleshooting-complex-ehr-
infrastructure-problems.html.
Technical Comparison of Oracle Database 10g and SQL Server 2005: Focus on Manageability, May
2005 (2005, May). Oracle [Online].
http://www.oracle.com/technetwork/database/manageability/ss-1.pdf
19
20. Installation and Maintenance of
Health IT Systems
Troubleshooting; Maintenance and
Upgrades; Interaction with Vendors,
Developers, and Users
Lecture b
This material was developed by Duke University,
funded by the Department of Health and Human
Services, Office of the National Coordinator for
Health Information Technology under Award
Number IU24OC000024. This material was
updated in 2016 by The University of Texas Health
Science Center at Houston under Award Number
90WT0006.
20
Editor's Notes
Welcome to Installation and Maintenance of Health IT Systems, Troubleshooting; Maintenance and Upgrades; Interaction with Vendors, Developers, and Users, This is lecture b.
This component, Installation and Maintenance of Health IT Systems, covers fundamentals of selection, installation, and maintenance of typical Electronic Health Records (EHR) systems.
This unit, Troubleshooting; Maintenance and Upgrades; Interaction with Vendors, Developers, and Users, will discuss ways you can implement an infrastructure for troubleshooting, and maintaining EHRs and their existing infrastructure.
The objectives for this unit, Troubleshooting; Maintenance and Upgrades; Interaction with Vendors, Developers, and Users
are to:
Identify and implement an effective troubleshooting procedure for reporting, evaluating, fixing, deploying, and follow-up of errors, problems, or limitations for the system
Integrate downtime schedule for OS, network, database, and client application maintenance and updates
Develop a process for communicating requirements and supplying updates between vendors/developer and users.
Creating a baseline for system performance measurement and comparison for troubleshooting.
In the first part of our lecture, we discussed some IT support infrastructure strategies seen in many of today’s healthcare institutions. In the second part of our lecture we will discuss troubleshooting maintenance & upgrade strategies as well as the importance of creating a baseline for measuring system performance.
Finally, we will talk about interactions between vendors, developers, and users, and the importance of developing a process for communicating requirements and supplying updates. We will briefly discuss the importance of client-vendor relationships and offer some suggestions for ensuring a healthy and long life together.
Each EHR system…and networking environment for that matter, is different. However, there are some standard troubleshooting practices that ring true no matter what system you are troubleshooting. Let’s take a look at some tips for troubleshooting complex EHR problems.
First…Identify the Problem. Be sure you contact the user personally and listen closely to the symptoms of the issue. Whenever possible test the application yourself, preferably from the user’s workstation and attempt to duplicate the problem.
Next, you will need to determine the size and scope of the issue. Does the problem appear to be localized to one computer or user? If so, start your troubleshooting there. Ask the user if any changes were recently made to the system, their computer or EHR access privileges, or their profile and have them recreate the error again and watch for abnormalities. Next, move on to localized application and hardware checks before looking at the system as a whole. If you are receiving multiple complaints or if the issue appears to be related to database or server issues begin to expand your search. Ask yourself what has changed recently? Are there any new upgrades patches, or procedures implemented? Any new hardware added to the network, system or server? Are there any commonalities between the affected users?
More often than not, the most complex problems are the result of a single failure. Start simple. If a light bulb is out, you wouldn’t immediately blame the circuit would you? No, you’d probably replace the bulb first. The same adage holds true in IT related issues.
Don’t waste time when a significant outage occurs and you cannot determine its cause. Have a plan in place to address outage issues so you can bring in additional resources and minimize downtime.
Remember, communication is important…both to your users and your stakeholders. Provide regular updates…perhaps hourly updates, describing what actions are being taken to find a resolution. However, it’s also important your key staff don't become overburdened with communication efforts. They need time to do their work.
Using the EHR application, system, and security logs are an important step to diagnosing an issue. Understand where these logs are stored, as well how to access and decipher them. The logs can provide additional insight about where things went wrong and usually offer some sort of explanation as to the cause.
After researching the issue develop a timeline of events leading up to the issue. This is particularly useful for issues resulting from a series of events occurring over a period of time.
IT staff sometimes get tunnel vision…they can become so engrossed on the issue that they lose track of time. Have an escalation plan in place to bring in other resources and stick to it.
It’s also important to stay focused on resolving the problem at hand. We all make mistakes. A major outage is not the time for finger pointing or for egos to get in the way of completing the task . Once the outage or problem has been resolved, you will have time to analyze the root cause and make procedural changes to help prevent similar issues from reoccurring.
Another tendency is to immediately declare an issue resolved as soon as the issue returns to normal. Generally, it’s wise to monitor the system closely…perhaps 24-48 hours before you should feel truly comfortable that you have resolved the issue.
Remember, problems and outages are just part of the job. You should gauge your reputation not on one single issue but how you and your team responds, evolves, and improves over time.
Let’s take what we’ve learned so far and apply it to a common example:
Susan, who works at the nearby clinic calls you at the helpdesk to complain about the EHR being abnormally sluggish this morning. “I could go get a cup a coffee while I wait for my query to return” are her exact words. You are currently unaware of any issues with the EHR which could be affecting performance. What would you do?
Well, from what we’ve learned we know to start with the local machine…or the user and the machine. Lets look at some things we could check:
Is the machine she is using today different in any way? Were any updates done on the machine? Did she have to contact the helpdesk recently to resolve an EHR or system issue? If she is on a different machine, does the machine meet the recommended EHR application requirements?
You should also check:
Whether the application and the system is updated and current.
You should examine the system and application logs for abnormalities.
Ensure the network card connected properly and is functioning within normal parameters.
If she is connecting wirelessly, is the wireless connection operating at optimal performance levels?
While you are on the phone with Susan, another co-worker from her clinic contacts the helpdesk with a similar issue.
Now you may begin to broaden the search:
Could there be an issue with the Local Area Network? Could a switch or router be configured incorrectly?
Is there an abnormally high amount of traffic on the network eating bandwidth this morning?
Could the ISP connecting the clinic to the EHR Server infrastructure be having issues?
If the issue turns out to be more widespread in nature, you may need to begin looking at the EHR server components themselves.
If the server infrastructure is in house you (with help from your vendor and/or server administrator) could determine:
is the memory or hard drive space on the server due for an upgrade?
Was the server recently upgraded, tweaked or configured differently?
Is connectivity to the server itself operating optimally?
If you are assisting with an EHR that is a SaaS (Software as a Service) or is hosted by a vendor, you would need to work with the vendor to determine:
Is their data connection failing?
Could an issue in the EHR design or code be the cause?
Additional diagnosis options available to you will depend on the particular EHR system your organization uses.
Since we are on the issue of troubleshooting, maintenance and upgrades, let’s spend a couple of moments discussing “performance baselines” and why they are important.
A performance baseline is generated after completion of performance baseline testing and shows the normal operating parameters of your system under normal load conditions. It is used to gauge the overall health of the system and to assist with isolating performance issues.
We use baselines to help us confirm normal system operation (say for instance, automated monitoring systems) when we think there may be an anomaly in the system and to assist us in pinpointing where to begin looking for a root cause.
Performance baseline testing, also referred to as “benchmark testing”, is typically performed by the test engineer to compare the performance of a new server, application, or system to a known standard of reference, like existing measurements or software specifications.
To take a performance baseline, you should begin by taking performance measurements at regular intervals when you believe the system is functioning within normal parameters, then begin comparing each set of measurements to the ones taken earlier. Over time you will get a gauge of normal system performance which will vary based on time of day, amount of system usage, etc.
“The following areas affect the performance of [many systems and should be considered part of your baseline strategy]:
System resources ([server and system] hardware)
Network architecture
The operating system
Database applications
Client applications”
Databases often require special utilities.
SQL Server built-in utilities:
SQL Trace
SQL Server Profiler
SQL Server Management Studio Activity Monitor
SQL Server Management Studio Graphical Showplan
Stored procedures
Database Console Commands (DBCC)
Built-in functions
Trace flags
Baseline measurements should be used to determine at a minimum:
When are your peak and off-peak hours of operation;
What are your average production-query or batch-command response times;
How long does it take to complete your database backup and restore jobs.
After you have completed and established a server performance baseline, you may then use this baseline on a day to day basis to compare the baseline statistics to your current server or system performance. When performance numbers deviate too far above or below your baseline statistics, you have cause to investigate further.
For example, if it takes longer now to execute a set of queries, then you may decide its time to determine if you can rewrite the queries or add new indices.
Upgrading system components is crucial for extending EHR functionality and overall system lifespan. However, improperly planned or managed upgrade procedures can severely damage the system, reducing performance or even bring down the entire system. Most vendors publish at least one major upgrade a year and patches throughout the year may be needed to repair issues and improve performance glitches. Upgrading any major critical production system should take a highly structured approach.
First, the, upgrade team reads over the upgrade documentation, and analyzes functional enhancements and configuration decisions, being sure to work with the vendor to address any unknown variables in documentation or due to system customization. If the upgrade involves more than one application, the upgrade team develops a plan for integrating configuration and testing the affected applications.
There are some important questions that should be addressed before embarking on an upgrade project:
Is the upgrade warranted or needed to conform to regulatory policies? What new functionality or benefits will be added as a result of the upgrade?
Will additional hardware or software upgrades, if any, be needed to ensure the upgrade’s success? Is the recommended hardware or software compatible with existing components?
How will the upgrade affect your users? What should you do to minimize downtime and educate your users?
If a test bed is not already in place, the technical team develops an alternative environment closely mimicking the production environment for testing purposes.
The upgrade team compiles a pre-installation and installation checklist and accompanying documentation and determines how much downtime will be needed for the upgrade process to complete.
After the first testing is completed on the test bed, logs are reviewed and any errors or discrepancies are reported to the vendor for resolution. Working with the vendor is crucial for successful upgrade implementations.
After the vendor completes any needed improvements, the upgrade team performs another install test, being careful to follow upgrade documentation and coordinating testing with the affected application teams. Additionally, special attention is given to ensuring preservation of data integrity.
Specialized software, capable of simulating standard workflows and number of users and tracking data, helps paint a clearer picture of network performance during and after the upgrade. All of this data is sent to the vendor for analysis.
A unified spreadsheet for recording, prioritizing, and documenting issues, along with their resolutions, can be very useful for managing problems as they arise and communicating with the vendor.
Once testing has been completed and the upgrade process approved, final documentation is prepared and training is scheduled. The installation team is also finalized and assigned various roles.
Upgrade windows should be scheduled during off-peak times to minimize issues. Additionally, a shadow copy of the EHR – in other words, a read-only copy without real-time interfaced results – would ideally remain available for access during the upgrade window.
Testing of the upgrade should begin immediately after completion. Once testing is complete, the helpdesk is notified and systems are brought back online.
After the upgrade has been completed, a dedicated team should be available over the next few business days to resolve any issues the upgrade could’ve created.
Similar processes should be followed for upgrades to the server OS, workstation OS, & databases.
Your ability to interact with users is as equally important as your technical skill set. Whether at the desk side, on the phone, or communicating through email, each interaction with a user is an opportunity to build good rapport between yourself, your IT department, and your end users.
First and foremost, stay up to date. Being informed about what’s going on with the network, as well as any developments, patches, or upgrades taking place will help you serve your users better and can expedite diagnosis. Take advantage of any available training, particularly regarding new EHR upgrades or technology trends being adopted in the workplace.
Set realistic expectations. If you work in a large, fully staffed, IT setting, particularly settings involving critical care patients, you may have little say in what expectations are imposed. However if you are one of a few…or the only IT personnel in a small clinic, You will eventually find that multiple users are constantly vying for your time. It maybe unrealistic to expect you to contact a user or resolve an non-emergent issue within 15 minutes of submitting a ticket. You need time to work and it’s only fair to attempt to resolve issues in the order they are submitted. Set up realistic expectations as to when a user should expect to hear from you and when you can resolve the issue. Whenever possible, centralize the first point of contact and have that person prioritize requests to minimize disruption of busy technicians. Decide what constitutes an “emergency” (such as an outage) and devise a method for contacting support technicians if circumstances warrant it. Publish these expectations and be consistent about meeting them.
The name of the game here is maximizing reliability and productivity…for your users…the patients…yourself…and your team. Make every attempt to be punctual, particularly so when the user’s presence is a necessity, and communicate any status changes with your users promptly.
Building good relationships is important for developing links, making allies, and building user confidence…and it can be fun as well. It’s important that both users and support teams understand they are interacting with people…with concerns, feelings, and educated opinions. Start the session off by being friendly and interested but respectful and letting them know their issue is important (after all they are professionals who've work hard to be where they are too). At the same time, don’t deviate too far. Stay focused on completing your task.
Remember, when you first contact a user there’s a good chance he will already be frustrated…particularly in healthcare environments where medical professionals are often already working under stressful conditions and may also be sensitive about being placed in a subordinate role. Don’t make your users feel inferior if they make a mistake. Reassure them. This tactic can help disarm a tense situation.
As I said before…communication is important…return calls promptly and take time when you contact the user to listen carefully to what she has to say. Probe for details. Once you believe you have a handle on what exactly the user is requesting take time to clarify the issue with them and let them know how you plan to address it before beginning work in earnest.
Each opportunity you interact with a user is an opportunity to educate them. Explain to them what you are doing while resolving their issue. Also take a minute to remind them of any new procedural changes or updates which may be relevant. When you are done, ask them if there is anything else you can assist them with. Be as patient and as thorough as needed for your user to grasp the concepts. Reassure them. Remember, you too had to learn these techniques. Ultimately, you may save yourself another visit.
Using some of these tips, you should be able to use your soft skills to better understand and build good working relationships with users while effectively addressing their technical needs.
Building and maintaining a relationship with your EHR vendor is essential, not only for a successful implementation, but also for continued success throughout the product’s life cycle. Issues will arise that are beyond the scope of your IT workforce. Upgrades will need to be routinely applied. Your vendor will play a pivotal role in these and many more facets of your EHR management scheme.
Successful business partnerships are built on mutual goals, trust, and the knowledge that both entities are “in this together” and that the success of the vendor goes hand-in-hand with the success of their product.
Purchasing an EHR system brings about a long-term commitment between your organization and the vendor. These relationships become quite complex once the EHR system becomes fully embedded into the organization, which then becomes completely dependent on its capabilities. The type and nature of your relationship with the vendor will no doubt vary depending on your organization’s size and the scope of the implementation.
Here are a few tips to consider before purchasing your EHR system to help ensure your vendor selection best suits your needs:
Understand the company and its culture: Visit the company headquarters and talk with as many folks as you can, including the development and support teams. Develop some impressions about the company. Are staff engaged and enthusiastic? Does the company’s philosophy mesh well with your organization? Where is their focus: marketing, development, implementation?
Follow the money. What drives the revenue stream for the company? Are they dependent more on support fees? Do you fully understand the support fee structure they are modeling for your company? Are they financially solvent enough to provide support throughout the lifecycle of the product?
If you are planning to purchase a hosted or a Software as a Service (or S.a.a.S.) solution, do you fully understand their upgrade strategy? Will their upgrade strategy conflict with your business practices?
Lastly, have your development staff interface with theirs. After all, they will be spending a great deal of time together. Does your staff feel like they are competent and enthusiastic about supporting their product?
This concludes, Troubleshooting; Maintenance and Upgrades; Interaction with Vendors, Developers, and Users.
Establishing a performance baseline helps gauge the overall health of the system and assists in isolating performance problems.
Upgrading any major critical production system should take a highly structured approach including:
Maintaining a test bed for testing upgrades prior to rollout.
Working with the vendor to resolve issues and inconsistencies prior to rollout.
Rolling out during non-peak hours.
Finally, purchasing an EHR system brings about a long-term commitment between your organization and the vendor. These relationships become quite complex once the EHR system becomes fully embedded into the organization, which then becomes dependent on its capabilities. Learn about the vendor, its culture, its financial status, and its strategies before you make the purchase.