Transcript PowerPoint Template - Southwestern VA Technology Council

The practical guide to healthcare
infrastructure, a comedy
by
Tom Deaderick
Director, OnePartner
geek self-test
Technology is evil
You know…
like the Devil.
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Technology can be
good or bad.
Technology is nirvana
No. It isn’t.
You need therapy.
all the other stuff…
EMR
selection
complete
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all the other stuff…continued
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getting started
We’ll work our way out.
Starting with the systems you
interact with most directly.
Immediate
Systems you
interact with
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Network
Systems that
support org
Strategic
Methodologies
tablet computers
advantages
A physician carrying a tablet
avoids the situation where they
must walk into the patient exam
without basic background.
Tablets enable physicians to
dictate using Dragon Naturally
Speaking without returning to
their office.
disadvantages
During heavy EMR usage,
batteries typically last 4 hours or
less.
Requires wireless network hubs,
adding to management costs.
Physicians who are very
interactive with EMR (e.g. using
templates, eRX, etc). Smart-type
systems typically work best with
keyboards.
Tablets typically represent a cost
increase (terminals in exam
rooms still required).
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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.
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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.
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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.
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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.
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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
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Requires Microsoft Windows XP
Check with computer vendor for
compatibility.
network systems
We’ll work our way out.
Starting with the systems you
interact with most directly.
Immediate
Systems you
interact with
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© 2008 OnePartner, LLC.
Network
Systems that
support org
Strategic
Methodologies
“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.
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el Chupacabra using a “turnkey EMR”
asp?
Traditional software/equipment purchase
Application Service Provider model
Your practice purchases the
necessary hardware and software to
run the EMR system.
Software vendor or third party
packages hardware, software and
hosting into a single contract with a
monthly fee per physician.
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.
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Third parties may include IT
contractors, hospitals, EMR resellers
or data centers.
Maintenance and patching is
responsibility of the ASP.
Typically ideal for web-based
applications.
Backup? We don’t need no stinkin’ backup.
offsite backup
A challenge for smaller, single
location practices.
Tapes may be lost or stolen.
As patient files increase, data storage
may demand multiple tapes per
backup, requiring tape library devices
($3-5k).
Periodic tests are a good idea.
Backup is not the same thing as
disaster recovery (covered later).
Digital Linear Tape (DLT) about $50 each
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strategic methodologies
We’ll work our way out.
Starting with the systems you
interact with most directly.
Immediate
Systems you
interact with
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Network
Systems that
support org
Strategic
Methodologies
where did my EMR go?
oh boy…
Last night’s storm shorted the air
conditioner in the server room.
Without the air conditioner, the room
overheated within a few minutes.
We braced the server room door and
put two fans in there, but the high
temperatures must have damaged
something else because…
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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.
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
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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
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Disclaimer: Yes. I have a data center.
will you be able to help?
Man is not a rational animal,
he is a rationalizing animal.
- Robert A. Heinlein
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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.
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seek professional help
Regional companies that can help you.
Computer system support
BCTI (Bailey Computing)
Data Center/Disaster Recovery
OnePartner (Tier III)
Johnson City, TN (www.bcti.com)
Duffield, VA (www.onepartner.com)
Interface development
LucentGlow
BVUB
Abingdon, VA (www.bvub.com)
Kingsport, TN (www.lucentglow.com)
Security
Deliberare
Mendota, VA (www.deliberare.com)
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Legal/HIPAA
Randall Sermons, Attorney At Law
Johnson City, TN (www.randalle.us)
failure can’t be an option
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contributors
Special thanks to
Chip Childress
Director, Information Technology
Holston Medical Group.
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Tom Deaderick
Director, OnePartner
http://www.onepartner.com
[email protected]
(423) 863-8708
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