Ask the Expert: Why is the New EMR So Slow? The Challenges with Clinical Application Support

June 26, 2017 Bob Zemke

The EMR has become the nucleus app that clinicians spend most of their time in. It’s often connected to dozens of other applications and systems that a hospital might use, and that clinicians are dependent upon for patient care. When it’s slow the impact is far reaching and the frustration levels of clinical staff are high.

So, why is the new EMR so slow? It turns out that there can be many reasons, many of which are of no fault of the network...

In this ‘Ask the Experts Series’, healthcare director and expert, Bob Zemke, takes us through the most common reasons for a slow EMR app and gives us the number one prescription that will remedy a slow EMR every time!

Top 3 Reasons for a Slow EMR

As hospitals move from paper workflow to a reliance on intelligence from real-time healthcare applications and connected devices, how these apps perform becomes critical. If one app is slow, everything else tied to that workflow is slowed down. When IT gets a complaint that an app was performing slow for a just a few minutes, they can spend days trying to figure out where and what the issue was. Meanwhile, the frustration of the clinical staff continues to grow.

Why are new apps like EMR slow and what can be done to prevent this? Based on my past experience of working in the hospital IT and my current role of working directly with our healthcare customers, here are the most common issues I see.

1. There’s a learning curve - Anytime new technology is introduced, there is a learning curve for the staff. It can be very frustrating to learn a new system and the clinical staff often feels it is slowing them down. This is why the most important step before moving to a new system is to first have a baseline of the performance of the old system. I have seen cases where a CIO is under pressure because of claims the new application is slow, but comparing the baselines of the old and new systems shows that the apps are not slow at all, but rather that the new workflow is slow.

Complaints of slow app performance can threaten to take down IT’s credibility and without the visibility that allows for the capability to report on how well they are delivering new application services, it comes down to subjective data (the perception of clinical staff) vs. objective data (the actual flow of app data). Because “it’s all about perception”, it is never a good thing when a slow workflow is causing a poor perception about a well-performing system. If IT has visibility into application performance and can identify that workflow might be the cause, then the solution might be additional user training or workflow optimization review.

2. It’s the cloud provider – Hospitals are increasingly moving to cloud-based data centers. One of the top reasons I hear for this move is that they are hoping to deliver more reliable services.  However, the same issues that impact on-site applications can impact applications in the cloud.  I have witnessed,on numerous occasions, a new application that had issues and the cloud provider blamed the hospital and demanded proof before acknowledging missed SLAs. A few hospitals have first upgraded their internal network, when in fact the issue was not with the network at all, but with the cloud provider (although they will never willingly admit to it). The clinical staff doesn’t care where the app resides and who’s to blame when it’s not working efficiently, they only care that it is working well and all fingers point to IT to get to the bottom of it.

One hospital spent two years fighting the cloud provider about a slow cloud-hosted EMR that could not be documented. The cloud-provider refused to take responsibility for the issue. It was only when the IT department finally gained visibility into their network using Extreme Analytics and they were able to prove that the hospital network was working efficiently, that the cloud provider finally owned the issue and agreed to do something about it. One customer coined this new strategy with using Network Analytics as, “Evidence-based IT service delivery.”

I have had conversations with clients about why they are upgrading the network and they tell me it’s because even after switching to a new cloud-based EMR system, it is still slow. Using the visibility inherent with Extreme Management, we look at their configurations, and combined with ExtremeAnalytics, we can see that every other app is working fine. In cases like this, it’s probably an issue in the cloud-based data center where the EMR was hosted and when the provider is given this evidence, they will finally act. Evidence is power!

3. The network was an afterthought - A lot of healthcare IT leadership came from an applications background, so naturally, that is their focus. As a result, the infrastructure side is often overlooked and money is spent on the application or clinical devices and not the underlying infrastructure required to support those systems. The reality is that the network is critical and how well it is working becomes so important to the success of these apps, systems and connected devices.

I have seen numerous occasions where a large investment is being made and it’s going to be a big disruption to the hospital and as they get close to the go-live date they start to think, “Wait, what’s going to happen? Are we prepared? Is this going to work?” This common panic right before the go-live can be avoided when a hospital has visibility into their network. They can prepare by asking questions like, “How many people, computers and printers are going to be logged into this?” They can answer those questions by looking back and viewing a benchmark of network traffic.

After the go-live, another common reason for slow EMR is that the workstations and computers are underpowered. These networked devices weren’t properly upgraded to support the new system. Maybe it’s only the Windows 7 workstations experiencing problems.  By having visibility, IT can rule out the network and then rule out the applications as potential sources of the problem. From there, they can begin to look at the individual devices to see if they are the reason for the problem.

Visibility: The Prescription for a Fast EMR.

Today’s digital hospitals can’t approach IT services the way they did 10, or even 5, years ago. IT has to re-evaluate how they are supporting clinicians. Tight on resources and time, IT doesn’t have the time to spend hunting down problems reactively. In order to be able to scale to handle the workflow demands of clinicians, the IT staff needs to identify problems while they are happening, and ideally before they are happening, so they can be addressed before patient care is impacted. 

In addition, executive IT leadership is now frequently asking for the capability to report back on how well they are delivering application services, so that their reputation isn’t subject to perceptions.  Armed with the facts, the CIO can demonstrate to clinicians that they care about their concerns and show what they are doing to resolve them, as well as report back on the value of the investment to the board and show that they are spending the budget wisely.

From making smarter decisions, to solving problems, to demonstrating the value of IT investments, it is clear that visibility is so important. With visibility and control of the network and all its users, devices and applications, IT will have an understanding of the flow of app data so that they can optimally support it and improve the experience of the clinical staff and patients.

Want to learn more about gaining application intelligence and control your hospital network? Read the Solution Brief.

About the Author

Bob Zemke

Bob is the Director of Healthcare Solutions at Extreme Networks. An IT professional with a broad span of experience in healthcare, Bob has over 15 years working both within hospital IT and as a consultant in next generation network design, deployment, and management.

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