In many practices and organizations, the equipment behind the scenes supporting the Electronic Health Record is underappreciated. The EHR servers, storage, and supporting infrastructure (network, desktops, Citrix) need to be monitored regularly, and also re-assessed periodically to ensure that they are sufficient to meet demand. This is crucial for organizations which are still adding practices and providers to their EHR. Doing so ensures that your EHR environment remains stable and free of performance issues, and grows appropriately as your organization grows.
Monitoring your EHR servers first requires an understanding of the Enterprise EHR server roles. Then, on an individual level, you must grasp the significance of the organization’s different EHR servers and which roles they are fulfilling. Knowing what each server is responsible for will lead to an understanding of how the logs and performance metrics on a particular server affect the EHR infrastructure as a whole. Galen’s free Webcast series regularly covers the EHR server roles, with an expert EHR technician reviewing the server role in detail and answering questions.
A member of the EHR or IT staff of your organization will need to review several logs and queues daily. Some are obvious, such as checking the in-application print queue to ensure that print or fax jobs are not failing and backing up. Others are less obvious, especially to those without a strong technical background. The most crucial of these are on the database server, the “heart” of the EHR, and include checking the status of SQL Agent jobs for failures such as backups or re-indexing. Checking for success of the Delta Process daily is also key, as it is responsible for running Day Close and updating clinical data in the EHR. All servers should also have their Windows system and application logs reviewed daily for errors, reporting any anomalies to Allscripts Support.
A “deep dive” into advanced metrics should occur on a weekly or monthly basis. This begins by using Windows Performance Monitor to establish a baseline of metrics on every production server, and then regularly capturing current data for comparison. Key collection points are disk usage, CPU utilization, memory consumption, and database transactions per second. Having a baseline will allow you to detect and trend changes in performance and resources, and will be a clear warning before your organization’s needs overwhelm your EHR servers. This regular review of systems is also a good time to take security and Windows updates into consideration.
As EHR Technicians at Galen, my team and I regularly perform maintenance, monitoring, and performance assessments of Allscripts Enterprise EHR environments large and small. I recently wrapped up a 3 month monitoring engagement with a medium-sized practice lacking technical staff. In addition to weekly monitoring and trending of the performance metrics of all of their EHR servers, I also reviewed print queues, application and system logs, and the health of interfaces. Not only was the raw information beneficial to the client, but I was able to lend my expertise by identifying and explaining the severity of issues found, and recommending best paths forward for resolution.
To find out more about the technical services we offer, including maintenance and monitoring, EHR environment creation and upgrades, conversions, and interfaces, please check out our website and contact us. We’d be happy to discuss how we can help with nearly anything Enterprise EHR related.