Optimizing Healthcare App Performance
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** If you would like to download a copy of the slides- please email jessica.murphy@compuware.com and she will send the slideset to you via email.** For health services provider Christus Health, poorly performing applications are never an option. Just as medical equipment cannot fail, the applications supporting Christus Health must operate flawlessly. In order to avoid lost revenue, decreased clinical productivity and increased risk to patients, Christus employs an end-user perspective to application performance management. Join Christus Health CIO George Conklin in this Compuware webcast to learn: • What impacts healthcare app performance has on customer experience and business goals • How Christus IT and the business teams optimize customer experience • Real-world best practices for improving user experience without slowing down your healthcare processes and procedures What You Will Learn: George Conklin, Senior VP and CIO of Christus will share real-world experiences and Christus Heath’s best practice approach for ensuring users in their healthcare system have the best application performance possible.
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Optimizing Healthcare App Performance
- 1. CIO Insights: How to Optimize Healthcare Application Performance George S. Conklin Larry Angeli Sr. Vice President and CIO Vice President Healthcare Solutions CHRISTUS Health Compuware Corporation February 15, 2012
- 2. Agenda • Introduction & Welcome • Best Practices for Optimizing User Experience Across Complex Healthcare Environments • George Conklin –Senior Vice President and CIO, CHRISTUS • Challenges of Managing Business Critical Applications • Larry Angeli, Vice President Healthcare Solutions, Compuware • Q&A session – Use Webex ‘chat’ to ask your questions at any time 2
- 3. 3
- 4. The Impact of Poor End-User Experience on Healthcare Delivery Bad EMR availability responsiveness issues 1 Reduced clinician productivity 2 Decreased clinician satisfaction 3 Partial clinician Waiting for adoption transactions to process Slow logins The fundamental reason there is a value gap is that clinicians are having a poor end-user experience
- 5. The EHR Performance & Adoption Challenge The Real Business Impact Physician Recruitment and Retention and possibly their patient base because of satisfaction Loss of Revenue from reimbursement and transactional based workflow Expense line costs in problem discovery and resolution Quality of Patient Care and Safety 5
- 6. Key Healthcare CIO Issues Maximize the Value of EHR Investments New User Expectations for IT Performance Managing Mobile Device Diversity
- 7. Best Practices for Optimizing the End User Experience Communicate to Clinician Use All Community Relevant Data Monitor the Entire Measure End- Application User Delivery Chain Define Experience Acceptable Performance 7
- 8. Best Practices for Optimizing User Experience Across Complex Healthcare Environments George S. Conklin SVP and CIO CHRISTUS Health
- 9. Overview • What impacts healthcare app performance has on customer experience and business goals • How CHRISTUS IT and the business teams optimize customer experience • Real-world best practices for improving user experience without slowing down your healthcare processes and procedures 9
- 10. US Market 24 Acute Care facilities- identified below 17 Long Term Care Hospitals Santa Fe (1) 9 Home Health and Hospice facilities Texarkana (1) Shreveport (2) Alexandria (2) SE TX (3) Lake Charles (1) San Antonio (6) Houston (2) Corpus Christi (6)
- 11. Where is my information? PCP PATIENT SPECIALIST SPECIALIST RADIOLOGY LAB PHYSICAL THERAPY
- 12. CHRISTUS Health Healthcare IT delivery is a complex chain of elements How do we optimize performance and ensure a great user experience across the entire Application Delivery Chain Cloud Patients Private Public Browsers Data Center Local Facilities 3rd Party/ ISP Virtual/Physical Environment Cloud Services DB App Web Load Servers Servers Servers Balancers Major ISP Storage Network Content Delivery Networks Web Mobile WAN Services Components Optimization Mobile Remote Carrier Locations Devices ER UNIT Clinicians Employees Employees Partners Suppliers
- 13. Why Application Performance Is So Important? • As we move increasingly to automated support for clinical care. Both costs and quality will be driven by access to information. When systems are unavailable cost and quality will be impacted • Slow or no systems availability raise the possibility of adverse events 13
- 14. Performance Impacts Affects Us! • Value based purchasing of services could be impacted as a result of chronic system downtime or slowness • Prolonged login times • Affect clinicians’ ability to effectively manage patient care • Rapid decisions that affect the well-being and even the very lives of patients must be supported by systems that keep up with workflow and decision making processes in order to ensure safe, effective delivery of quality patient care • “where of care” component 14
- 15. Performance Matters to the End Users! Ensure that problems are identified and isolated proactively Maximize access to information Ensure best quality care is provided at the lowest price
- 16. Best Practices Checklist Define Acceptable Performance • Learn from end-users • Baseline performance Measure End-User Experience • Monitor every real user on the EMR application • Drive synthetic “control” measurements Monitor the Entire Application Delivery Chain • Measure actual performance vs. agreed baselines • Isolate fault domain Use All Relevant Data • EHR application • DB and network device tools • Integrate other APM data Communicate to Clinician Community • Build trust by reporting performance against mutually-agreed goals • Advise clinicians of corrective actions in progress – before they ask 16
- 17. “Summary: How Compuware can help” Larry Angeli, Vice President - Clinical Systems
- 19. Compuware ‘Customer Command Service Center’ Providing end-to-end visibility of data service quality Single view of service quality across the delivery chain Proactive notification of customer impacting failures across the delivery chain Measures service quality from the end-user perspective Open access allows for shared visibility and communication Enables service managers to perform trusted first-line analysis Provides drill-down capabilities for business impact and fault identification 19
- 20. Gartner Positions Compuware as a Leader in APM Magic Quadrant Gartner, Inc. Magic Quadrant for Application Performance Monitoring Sept 19, 2011 Will Cappelli, Jonah Kowall . This Magic Quadrant graphic was published by Gartner, Inc. as part of a larger research note and should be evaluated in the context of the entire report. The Gartner report is available upon request from Compuware. The Magic Quadrant is copyrighted 19 September 2011 by Gartner, Inc. and is reused with permission. The Magic Quadrant is a graphical representation of a marketplace at and for a specific time period. It depicts Gartner's analysis of how certain vendors measure against criteria for that marketplace, as defined by Gartner. Gartner does not endorse any vendor, product or service depicted in the Magic Quadrant, and does not advise technology users to select only those vendors placed in the "Leaders" quadrant. The Magic Quadrant is intended solely as a research tool, and is not meant to be a specific guide to action. Gartner disclaims all warranties, express or implied, with respect to this research, including any warranties of merchantability or fitness for a particular purpose.
- 21. Q&A Send questions via ‘chat’ More information: Contact me: larry.angeli@compuware.com Web site: www.compuware.com Gartner MQ: http://www.gomez.com/gartner-positions-compuware-in- leaders-quadrant-for-application-performance-monitoring/ 2 Minute Explainer: http://www.youtube.com/watch?v=nnsr6pMpokc 21
- 22. 22 © 2011 Compuware Corporation — All Rights Reserved
Editor's Notes
- For over 40 years our health system ran on paper-Physicians required to study on paper-Track patients on paper-Prescribe on paperIf those files could talk…..11K plus medication errorsOver 100K deaths a year from medical errors. (That like a 747 crashing every week)We spend over 2 Trillion a year on healthcare. A full 17% of our Gross Domestic Product. Most estimates put over $700B in waste.
- So, let me explain what we at Compuware see as the five best practices for achieving optimal EMR performance…
- Overview of our markets Discuss the importance of aligning with the physicians in our markets
- Last updated or created: August ’11Added dynaTrace contentKey themes:Compuware provides the most comprehensive solution to span the app delivery chainWe provide a solution at every logical and physical layer in the chainThe solution is driven by measuring the end user experience– the most important part of APMEliminates blinds spots so you can find and fix the largest number of issues to ensure optimal performance, availability, and qualityTalk trackCompuware addresses your APM needs with a solution called the Gomez platform, a family of products that spans the applications delivery chain and covers every layer – both inside and outside your firewall.<click to animate>Real-user monitoring: We start at the users’ end of the application delivery chain with a real user monitoring solution that runs in your users browsers and mobile devices. This works in every commercial browser, and also in mobile applications. It’s essentially a very small tag (i.e., javascript) you can put in any or all of your Web pages or mobile applications. This tag runs in your actual users’ browsers and mobile devicesand will give you performance analytics that will tell you key information such as actual page load time (by browser or device), perceive page load time (by browser or device), where your users are located, etc. This works for every browser or mobile device in any location around the world.<click to animate>Gomez Last Mile: Gomez provides you access to 150K+ consumer-grade desktops around the world, in 168+ countries, running behind 2,500+ local ISPs and major mobile carriers around the globe. This is the largest testing network in the world, and it’s growing organically every day. Gomez is the only vendor that offers this true “last mile.” You use these computers two important ways:Monitoring-- run automated, synthetic transactions against your website on a scheduled, regular basis to detect if you’re having any issues. These computers represent what your users experience in the real-world because they are consumer-grade machines in typical consumer situations. You can isolate specific geographies to localize your testing. This type of “real-world monitoring” gives you the greatest insight into issues specific to geographies, bandwidth, ISPs, mobile carriers, and CDNs. Load Testing: You can also use these computers to generate “real-world” load for load testing. Because this load comes from actual computers at the “edge of the internet,” it gives you the greatest insight into what your end users will truly experience.<click to animate>Virtual test bed: we provide a virtual test bed running “in the cloud” that lets you automatically test your Web and mobile application on over 500 combinations of browsers and operating systems and over 5,000 mobile devices. This helps you ensure compatibility and performance without the cost of maintaining your own extensive testing infrastructure.<click to animate>Backbone: We have 150+ enterprise-grade nodes (each of which can have multiple computers) located around the globe on the Internet Backbone. These are high-performing, finely-tuned, very reliable machines that are calibrated for consistency. You can use them two basic ways: Monitoring: run automated, synthetic transactions against your website on a scheduled, regular basis to detect and warn you if you’re having any issues. Because all the nodes are calibrated to be consistent, you get reliable, accurate information about any performance issues and deviations from your standards.Load Testing: These same computers and cloud locations can be used to generate high-volume load against your Web application to ensure it performs properly under load. When you combine this high-volume load with the real-world load from the Last Mile, you learn the most about how your application will truly perform. No one else offers these two types of load testing.Now, let’s step inside your private enterprise.<click to animate>Enterprise. You can install hardware and software throughout your enterprise – inside or outside your WAN – to monitor enterprise applications from the perspective of your employees, partners, suppliers, etc. This can be done from any office or location. The various offerings from Compuware allow you to create your own private synthetic agents, essentially duplicating the “backbone” capability mentioned earlier and creating your own “private last mile.” this allows you to monitor the performance of your enterprise applications.<click to animate>Now, let’s look inside your data center – what we call the “first mile.” We allow to completely cover the APM aspects of your data center with a variety of offerings and capabilities.Agentless real user monitoring lets you monitor ALL of the real user traffic entering your data center, from any application, user, transaction, or location. This is useful for enterprise apps used inside your private network (e.g., Oracle, SAP, CERNER, etc) as well as web apps used by customers. <click to animate>Multi-tier analysis lets you monitor all your transactions across ALL of your tiers. Most data centers today have multiple tiers – many more than the three traditional tiers – and our agentless monitoring lets you monitor transactions across EVERY tier. BTW, this monitoring and the agentless real user monitoring can all be done with a single device.<click to animate>Transaction and component analysis lets you dig deeply into Java and .NET applications to diagnose and resolve performance issues<click to animate>Network and Server monitoring allow you to monitor your database, web, and application servers, and all your network segments and infrastructure devices. Not just the hardware, but the actual software running on the servers to detect any issues in a physical or virtual environment. This can be used in an n-tier architecture with as many tiers as you have<click to animate>Transaction tracingallows you to trace every transaction for every user: from the complex interactions in a browser to the specific paths in the multiple tiers of a data center. This is enabled by PurePath, the technology from dynaTrace (which Compuware acquired in July 2011). It is used to trace all transactions, from all users, all the time, even in production.<click to animate>Together, these combined offerings allow you to find and fix the broadest set of issues across the entire application delivery chain. You can detect performance issues and eliminate them before they impact your business. You have visibility and actionable diagnostics for all these issues, allowing you to have a zone of control that spans all the way from the First Mile -- your data center -- to the Last Mile – your end user. This level of visibility and control is unique to Gomez and one of our key differentiators.Although the Gomez solution covers the entire ADC, you don’t have to implement all of it. You can start wherever you want and grow.Notes to the SpeakerDon’t overdue this slide by talking about any one item too much. There’s a lot here, and that’s on purpose: we’re trying to convey the breadth of what Compuware APM can do.
- “where of care” component:in that clinicians can’t be tethered to hard-wired devices in order to interact with systems and obtain information they need for decision making. Delivery of information must meet the needs of a variety of clinical settings both within hospitals and in non-acute settings.
- Having the capability to report and analyze specific end user experiences. This means that for the end user, we can proactively monitor and see performance or service issues through the use of automated agents that replicate real user actions. This allows us to then respond to and address performance and availability issues before the end user may experience them personally. Additionally, we can do a deep, end-to-end analysis of the performance experience of end users on a per user bases or as a group. This will allow us to identify the poorly performing components of the entire application experience and provide more reliable, predicable, and consistent application performance. Finally, we can trend performance and availability over time, and this will enhance our ability to forecast and plan for additional capacity and service improvements by providing a baseline and a measurable level of service delivery (with respect to the baseline). This allows communication of overall health of the service monitored, as well as empirical data that shows the effects of changes to the environment and the direct impact on the service delivery.
- Fault Domain: just because EMR is running slowlyPerformance MeasurementProblem ResolutionPerformance ImprovementProduction ReadinessPerformance Reporting
- Last updated or created: Sept‘11Key themes:Gartner recognizes Compuware as a leader in the APM market and the company with the most “completeness of vision.”Talk trackIn Sept ‘11, Gartner published this year’s update to their APM Magic Quadrant report. The report evaluates 29 APM vendors on “ability to execute” and “completeness of vision.” The vendors are placed in one of four quadrants depending on their evaluation results.Gartner placed Compuware in the Leader’s quadrant, and you can see from the placement that Gartner gives Compuware the highest rating for “completeness of vision.” No other company even comes close on this scale. Why? Gartner gives Compuware high marks for our “First Mile to Last Mile” strategy that covers the entire application delivery chain. No other company has this vision, and it places Compuware clearly in the top position for vision and strategy. It means that Compuware is building a future for its customers that will allow them to retain the competitive advantage they get from maximizing the performance of their applications.Compuware also ranks very highly on the “ability to execute” axis.Compuware’s position in this evaluation moved up substantially from last year’s report. The movement reflects the value that Gartner places on our overall vision and strategy, which includes our major product releases and our acquisitions and integrations.Gartner may be the most respected analyst firm in the world. It’s clear from their analysis that Compuware is in a leadership position in the APM market.Please note that this evaluation did NOT include the benefits of the dynaTrace acquisition, which happened in July 2011 and was too late to be included in this MQ. We believe that when dynaTrace is rolled into the Compuware positioning next year, it will only improve our placement, especially on the “completeness of vision” axis.The entire APM MQ report is available for viewing from the Compuware website.Note to the speaker:This is an incredibly powerful message, and it should be delivered to every prospect.