Healthcare IT Blog

While You Were Out Pursuing ARRA Money...

Published on 07/12/2013 by Jim Fitzgerald
Category: Healthcare IT

Summer brings the magic of longer days, gentler weather, smoking grills….and, for some, a break from the ARRA rat race. You deserve it! So when that last sip of lemonade has been taken, and that last vacation day has melted into a fabulous yellow, red, pink, and orange sunset, here are some things the ghosts in your machines might be whispering to you:

VMware got a LOT better……if you are still running 4.X.Something, best upgrade soon. Newer versions have a bug or two stomped out, handle memory and I/O management more effectively, integrate better with your SAN, and feature better security and resiliency of vCenter.

MEDITECH added a lot of features to support M.U. Certification….and those features created new demands on storage, networking, and security…frustrated friends of ours at MEDITECH say end-users don’t read the notices about system requirements….the growing number of phone calls to our sales team asking about “emergency installs” seems to validate this notion.

Your system administrators “helped” add virtual machines…..putting you under recommended thresholds for performance headroom, and putting performance of your MEDITECH applications at risks. For important features like vMotion, Affinity Rules, and DRS to operate properly, you need “headroom” – extra capacity where busy or stressed VM guests can land. Most systems installed by PPI start out with N+2 – that is, two more physical servers than our MEDITECH-specific VM application workload calculators say they need. Outrageously wasteful? Not hardly. Consider that in the “physical era” a not atypical MEDITECH hospital data center had 30-50 physical servers. Today in time the range is generally 6-10. A little performance insurance goes a long way to ensuring happy end users. If you haven’t  created one yet, a simple requisition requiring request and sign off for the creation of a virtual machine might be a good idea. These can be tracked, and then linked to a change control or capacity management program that tracks the virtual loading of physical servers. When your headroom percentage is under threat, time to order a new physical server for the cluster. Some IT shops even have found a way to get departments to accept bill back for virtual machines – the tracking mechanisms are all right there in vCenter….Just remember, virtual ≠ free!

The HIPAA and HITECH act are still there…..and only 2 out of 10 MEDITECH hospitals have a HITECH-compliant Disaster Recovery plan. Misbegotten fools bomb “our” Boston Marathon. Tornados, wildfires, and a record-breaking Hurricane season forecast. Where is your data replicating?

MEDITECH began “strongly recommending” and even “requiring” 3-tier access for Client/Server 5.X and 6.X sites with core LAN latencies greater than 1-2 ms. And about VMware…it really makes the network into your computer….so if you are running it on a network more than 3 or so years old…time to take a hard look.

Six out of ten sites running MEDITECH’s most advanced software explained in a survey that they had never done a test restore….of these, many could not confirm that they were getting good backups. This is an old problem. The survey was prompted by two widely-publicized multi-day downtimes where the restore technology, for very different reasons, did not meet its RPO, resulting in days of data loss that had to be reconstructed manually. Might be time for a BURA (backup, recovery, and archiving) healthcheck….and after that, a recovery test.

MEDITECH’s 5.6.6/6.0.7 updates for MAGIC and Client Server often rode along with the addition of a web server for Patient Portal, prompting internal debates about DMZ’s, VLAN’s, firewalls, and security. It may be a good time to take a look at your network security posture. Head up, shoulders back, encryption certificates carefully balanced on your head…..

A cynic may consider these “teasers” somewhat self-serving, as these are all things our engineers, consultants, and “cloudies” here at Park Place can help out with, if needed. I guess the bottom line is, we would rather help out before your CMIO sounds Defcon One at a board meeting. I had the unexpected pleasure of enjoying a healthy, energetic Paul McCartney at Fenway Pahk the other night….with my two sons…multi-generational magic…the sing-along, appropriately enough was “Obla-di-obla-da-life goes on….” and so it does. Wishing you and yours a peaceful summer.

Jim Fitzgerald is Executive Vice-President of Park Place International.