Plagued by Performance Problems?

Your EMR users have experienced performance issues on and off again for some time now. Individually, the database, network, hardware, and end device folks, along with your EMR vendor have thoroughly investigated this issue and have conclusively determined that their piece of this puzzle could not possibly be the cause of the problems. But, the end users remain Plagued by Performance Problems.

We have all heard all the excuses and reasons to dismiss the problems -

  • “You have enough bandwidth to drive a Ferrari”
  • “Heat map shows excellent coverage”
  • “The laptops far exceed the vendor’s specs”
  • “Server load balancing is…perfect”
  • “All database calls execute in sub seconds”
  • “The citrix profile has not changed”

Sound familiar? While these may all be factual statements, the painful reality is that the performance problem persists. As with many issues, the path to the solution lies in admitting that a problem actually exists. 

 A multidisciplinary team approach is the only way to tackle this problem. Finger pointing needs to stop; pull your head out of the sand, and get to work. Everyone needs to believe that their area of expertise and responsibility is equally suspect until proven innocent. In many instances, there will be a multitude of root causes that have contributed to this reliably unreliable performance experience for the end user.

Need a game plan? Try these steps:

  1. Pick the low hanging fruit to start your road to recovery. Perform a current state analysis of hardware and infrastructure. Neglected workstations with bloated hard drives do exist. 
  2. Ensure all hardware, from servers to end devices, meet or exceed your EMR vendor’s specifications.  Ancillary software and browser version requirements and compatibility should all be evaluated and standardized. 
  3. Once these items have been remediated, allow for a stabilization period. 
  4. Continue to monitor: does the performance problem persist? Is it user specific? Is it time of day/week specific? Is it location specific? The constant monitoring and ability to pick up subtle patterns will lead you in the direction of the solution. 

Convincing a vendor that there was a problem with the wireless protocol on their mobile printers was not easy.  First we heard “it’s your network”; then we heard “it’s your EMR.” With no real proof one way or the other, we had no option other than to rule those out. It took a multidisciplinary team to acknowledge that despite their finely tuned piece of the puzzle, the lab labels still did not reliably print. With constant monitoring of the wireless network and the EMR interfaces, the only likely suspect remaining was the printer itself. The vendor sent 3 engineers onsite for several visits to diagnose the exact wireless driver problem and code a fix.  Funny enough, we were no longer plagued with our performance issue!

This just goes to show, you have to evaluate each step and resource in your process to find the fix!



Colleen Leahy, BSN, RN-BC, PMP



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