Notes: Installation and Maintenance of Health IT Systems – Lecture b

Learning Objectives

  • Identify the core elements that comprise an EHR system (Lecture a)
  • Describe the use of client and server hardware for access to and storage of EHRs (Lecture a, b)
  • Describe network needs for access to and storage of EHRs (Lecture b)
  • Identify the application software and back-end data storage software needed for a comprehensive, effective health IT System (Lecture a, b)

Typical Server Elements

  • Types of servers:
    • Application server: computer on which the EHR/PM (Practice Management) application resides
    • Database server: computer on which the database software resides
    • Citrix or terminal server: computer that supports thin client network
  • Application, database, and terminal services may reside on the same computer for small installations ($<10$ users) (Kleaveland)

Server Software Elements of the EHR

  • IOM: Eight Core Components
    • Health information in database
    • Results management
    • Order entry and management
    • Decision support
    • Electronic communication/connectivity
    • Patient support
    • Administrative processes
    • Reporting and population health management

EHR Clients

  • EHR systems make medical records available to multiple simultaneous users.
  • Tablets, laptops, and PCs allow instantaneous access by healthcare staff as they move around health centers.
  • Clients use application software to securely connect to and pull data from the EHR server to fulfill user requests.

EHR Hardware – Defined

  • Hardware is: the physical components that make up a computer system.
  • necessary to make the computer work and run properly.

EHR Hardware – Most Common

  • Servers
  • Workstations
  • Laptops
  • Tablets
  • PDAs/smartphones
  • Flat-panel monitors
  • Scanners
  • Printers
  • Storage and backup
  • Shredders
  • Medical diagnostic and treatment items

EHR Hardware – Servers

  • The server(s) are the “home base” of the core EHR system, with components including:
    • Storage of patient database (index)
    • Real-time, dynamic compilation of patient information from varied sources
    • Modules for parsing user requests
    • User management tools
    • Customization tools

EHR Hardware – Servers cont’d

  • Picking the right server – Consult your IT staff, hardware & EHR vendor(s), and/or consultant to determine the hardware specs required for your organization.
  • Important items to consider include:
    • Reliability
    • Performance
    • Scalability

EHR Hardware – Servers cont’d – 2

  • Storage requirements depend on EHR/PM application, volume of scanned documents
  • Check with your EHR vendor.
  • Rule of thumb: 5 GB/year/provider5\ \mathrm{GB/year/provider}

EHR Hardware – Servers cont’d – 3

  • Purchase considerations:
    • Brand e.g. Dell vs “white box”
    • Operating system (OS) e.g. Windows $8$ or $10$ or Linux
    • Processors e.g. Intel Core i7-7700 Processor (8M Cache, up to 4.20 GHz)

EHR Hardware – Servers cont’d – 4

  • Purchase considerations (cont’d)
    • RAM e.g. $8\ \mathrm{GB}$
    • Hard drive configuration e.g. RAID or network storage
    • Network card e.g. $1\ \mathrm{GB/s}$ or higher
    • Accessories: monitor, keyboard, CD/DVD drive, UPS (Uninterruptible Power Supply)

EHR Hardware – Servers cont’d – 5

  • Category Internal External/Hosted
  • Cost Higher initial costs Monthly fees
  • Management Need staff to implement & manage server(s), perform software/hardware maintenance & backup
  • Dependent on vendor for scheduled maintenance
  • Power Internal: Capable of utilizing full power of server; External/Hosted: Often share resources with other institutions
  • Connectivity Internal: Control speed & connectivity to server(s); External/Hosted: Remote locations, so connectivity may be shared with other customers, reducing speed

EHR Hardware – Clients

  • Fixed workstations – Connected to server via wired network – Strategically positioned throughout work environment to facilitate convenient access – Most commonly used and often already in place – Economical

EHR Hardware – Clients (cont’d)

  • Mobile computers – Laptops: physical keyboards; input generally via keyboard or mouse/touchpad, no touch option – Tablets: data entry & navigation including touch input, via stylus / electronic pen or finger • Slates • Convertibles • Booklets – Connect wirelessly to the network – Use rechargeable batteries (Neal, 2011)

EHR Hardware – Clients (cont’d – 2)

  • Mobile computers cont’d
    • Advantages: Additional mobility compared to workstations; Save time; Can be cheaper if additional infrastructure such as ports are needed
    • Disadvantages: Typically more expensive than fixed workstations; Subject to theft; Easily broken; Require additional support, cleaning, maintenance

EHR Hardware – PDAs and Smart Phones

  • Smart phones & Personal Digital Assistants (PDAs) combine computing and networking / cellular features into a personalized unit.
  • Like tablets, mostly pen-based, using stylus for input rather than keyboard
  • Allow users to access patient data remotely, from any location with network connectivity
  • Similar advantages & disadvantages as laptops & tablets
  • May require additional hardware/infrastructure resources

Network

  • Collection of computers and devices connected by communication channels
  • Allows users to communicate and share resources with other users
  • Important terms – Network Medium; Ethernet; Wireless Access Point (WAP); LAN (Local Area Network); WLAN (Wireless Local Area Network); WiFi; WAN (Wide Area Network); Point-to-point or fractional T1; Bandwidth; VPN (Virtual Private Network); Firewall

JetStor

  • Local Area Network (LAN)
  • Server Room(s)
  • Wiring Closet(s)
  • Wireless Connectivity (WLAN)
  • Hard-Wired (Cabled)
  • Local Users (On Premises)

Wide Area Network (WAN)

  • Corporate Offices New York City
  • Internet / ISP Connectivity
  • The Internet
  • Satellite Connectivity
  • Branch Offices Tokyo, Japan
  • Regional Offices Raleigh, NC

Network – Assessing Usage

  • Must be able to support data requirements of EHR application
  • Insufficient capabilities will degrade application performance and increase risk of user rejection

Network – Assessing Usage (cont’d)

  • Considerations:
    • How many users will need simultaneous access to the network?
    • Bandwidth requirements of the EHR system (per vendor)
    • Special bandwidth needs of scanning equipment or other medical equipment
    • Sufficient connectivity between internal and remote resources such as satellite facilities

Network – Assessing Usage (cont’d – 2)

  • Conduct a wireless connectivity survey
  • Explore remote connectivity options, including VPN

Elements of a Typical Electronic Health Record System - Summary

  • Hardware vs. Software
  • Servers – Securely Store patient data and parse requests.
  • Clients – Desktops and laptops – Mobile devices/phones
  • LAN vs. WAN Networks

Elements of a Typical Electronic Health Record System - References

  • Lecture b
  • Kleaveland, B. EHR Implementation: What you need to know to have a successful project: Part 2. Retrieved from physicianspractice.com: http://www.physicianspractice.com/files/audioconference/pdfs/id_7.pdf?CFID=1675309&CFTOKEN=75588070
  • Torrey, T. (2011, April 11). What is an EMR (Electronic Medical Record) or EHR (Electronic Health Record)? Retrieved June, 2011, from patients.about.com: http://patients.about.com/od/electronicpatientrecords/a/emr.htm
  • Wikipedia. Thin Client. Retrieved from Wikipedia.com: http://en.wikipedia.org/wiki/Thin_client

Elements of a Typical Electronic Health Record System - References – Lecture b (cont’d)

  • Charts, Tables, Figures
  • 1.1 Table: Neal, Scott. EHR Hardware – Servers. Used with permission.
  • Images Slide 15: Laptop. Courtesy Scott Neal. Used with permission.
  • Images Slide 19: Local Area Network (LAN). Courtesy Scott Neal. Used with permission.
  • Images Slide 20: Wide Area Network (WAN). Courtesy Scott Neal. Used with permission.

Installation and Maintenance of Health IT Systems

  • Elements of a Typical Electronic Health Record System (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 $90WT0006$. 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/.