1. Installation and Maintenance of Health IT Systems Troubleshooting; Maintenance and Upgrades; Interaction with Vendors, Developers, and Users Lecture a This material Comp8_Unit8a 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.

2. Troubleshooting; Maintenance and Upgrades; Interaction with Vendors, Developers, and Users Learning Objectives 1.Identify and implement an effective troubleshooting procedure for reporting, evaluating, fixing, deploying, and follow-up of errors, problems, or limitations for the system (lectures a & b) 2.Integrate downtime schedule for OS, network, database, and client application maintenance and updates (lecture b) 2 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Troubleshooting, Maintenance & Upgrades & Interaction with Vendors, Developers and Users Lecture a

3. Troubleshooting; Maintenance and Upgrades; Interaction with Vendors, Developers, and Users Learning Objectives 3.Develop a process for communicating requirements and supplying updates between vendors/developer and users (lecture b) 4.Create a baseline for system performance measurement and comparison for troubleshooting (lecture b) 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Troubleshooting, Maintenance & Upgrades & Interaction with Vendors, Developers and Users Lecture a

4. Troubleshooting: Support Staff Dedicated staff for maintenance, upgrades, & troubleshooting of IT systems, e.g. EHRs. May be in-house or contracted In-house personnel may be organized in different ways/ departments based on support responsibilities 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Troubleshooting, Maintenance & Upgrades & Interaction with Vendors, Developers and Users Lecture a

5. Troubleshooting: Support Staff (cont’d) Larger environments –More cost-effective to provide on-site staffing for most maintenance & troubleshooting of EHR. Dedicated production support team to focus on customer support issues. –Avoid temptation to share support responsibilities with development team. (Boyer, 2005) 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Troubleshooting, Maintenance & Upgrades & Interaction with Vendors, Developers and Users Lecture a

6. Troubleshooting: Support Staff (cont’d) The Production Support Team should focus on: –Being highly available and usable. –Providing rapid response to service issues. –Handling customer problems. –Managing user access requests to the EHR. –Reviewing daily interface error logs. –Doing other day-to-day duties as needed. (Boyer, 2005) 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Troubleshooting, Maintenance & Upgrades & Interaction with Vendors, Developers and Users Lecture a

7. Troubleshooting: Support Staff (cont’d) Production support team –Customer-focused, excellent “soft skills” –Versatile, with specialists in help desk, application, hardware, & network support. –Thorough understanding of application & business processes (Boyer, 2005) 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Troubleshooting, Maintenance & Upgrades & Interaction with Vendors, Developers and Users Lecture a

8. EHR Troubleshooting Workflow Image by Scott Neal 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Troubleshooting, Maintenance & Upgrades & Interaction with Vendors, Developers and Users Lecture a

9. Troubleshooting: Tiered Approach 1.Super users, help desk 2.Workstation & network specialists, technical analysts 3.Application support specialists, support consultants; often centrally located (Boyer, 2005) 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Troubleshooting, Maintenance & Upgrades & Interaction with Vendors, Developers and Users Lecture a

10. Troubleshooting: Tiered Approach (cont’d) “Super users” (tier 1) –Usually clinical staff, well trained in EHR usage & workflow strategies –Located on-site for front-line support –Promote proper security & confidentiality –Teaching & communication skills –Liaison between EHR support team & clinic (Boyer, 2005) 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Troubleshooting, Maintenance & Upgrades & Interaction with Vendors, Developers and Users Lecture a

11. Troubleshooting: Tiered Approach (cont’d) Help desk analysts (tier 1) –Provides first point of contact – Usually through phone & email support –Workstation & application troubleshooting –Documentation of issues & their resolution, for further analysis, in ticketing system –Customer relation skills (Boyer, 2005) 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Troubleshooting, Maintenance & Upgrades & Interaction with Vendors, Developers and Users Lecture a

12. Troubleshooting: Tiered Approach (cont’d) Network specialists & workstation analysts (tier 2) –Dispersed throughout system –Troubleshoot intermediate-advanced network & application issues –Interface with various team members to expedite requests (Boyer, 2005) 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Troubleshooting, Maintenance & Upgrades & Interaction with Vendors, Developers and Users Lecture a

13. Troubleshooting: Tiered Approach (cont’d) Application support specialists (tier 3) –Experts in EHR applications –Troubleshoot difficult issues –Research specific problems with vendor Production support consultants (tier 3) –Similar to application support specialists –Work effectively with clinicians & stakeholders –Recommend & implement EHR upgrades (Boyer, 2005) 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Troubleshooting, Maintenance & Upgrades & Interaction with Vendors, Developers and Users Lecture a

14. Troubleshooting: Tiered Approach (cont’d) Communication is key. –Especially with separate IT teams for projects & support; critical need for written documentation. –Lines of communication between all facets of support infrastructure. –Periodic training for communicating enhancements & known issues, soliciting feedback. –Listening & communication skills; glean enhancement ideas from users. (Boyer, 2005) 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Troubleshooting, Maintenance & Upgrades & Interaction with Vendors, Developers and Users Lecture a

15. Troubleshooting: Prioritizing Requests Routine (Low) –Intermittent; needs to be addressed but no impact on workflow or patient care. Important (Medium) –Device nonfunctional but not impacting patient care. (Boyer, 2005) 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Troubleshooting, Maintenance & Upgrades & Interaction with Vendors, Developers and Users Lecture a

16. Troubleshooting: Prioritizing Requests (cont’d) Urgent (High) –Severely impacting individual or department workflow. Critical –Critical device affected, with no other alternative for user; or directly affecting patient care. (Boyer, 2005) 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Troubleshooting, Maintenance & Upgrades & Interaction with Vendors, Developers and Users Lecture a

17. Troubleshooting: Concerns for Small Practices Lack of financing, technical staffing resources, and knowledge of best practices hinder small practice adoption rates. May need to contract with an IT consultant, an affiliated institution or IPA. Need go-to person assigned both to administer the system and to interface directly with IT consultants and vendor. (Felt-Lisk, 2005; Lake, 2011; Pereira, 2010) 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Troubleshooting, Maintenance & Upgrades & Interaction with Vendors, Developers and Users Lecture a

18. Troubleshooting: Concerns for Small Practices Purchase an EHR from a Vendor equipped to provide ongoing EHR support for your organization’s technical needs Consider partnering with your affiliate hospital or IPA for EHR and IT Support Services or a hosted solution Consider hiring a Health Information Management (HIM) Professional Take advantage of EHR system training (Felt-Lisk, 2009; Lake, 2011; Heubusch, 2008; Pereira, 2010) 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Troubleshooting, Maintenance & Upgrades & Interaction with Vendors, Developers and Users Lecture a

19. Troubleshooting; Maintenance and Upgrades; Interaction with Vendors, Developers, and Users Summary Support staff –Smaller healthcare settings might contract out IT services; larger institutions require in-house IT staff. Requests for support –Triage & prioritize upon receipt to avoid urgent issues being overlooked. –Forward requests to appropriate specialist. 19 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Troubleshooting, Maintenance & Upgrades & Interaction with Vendors, Developers and Users Lecture a

20. Troubleshooting; Maintenance and Upgrades; Interaction with Vendors, Developers, and Users Summary (cont’d) Tiered structure can help manage workloads & user requests in larger institutions. Specialists with wide variety of skills –Application support & development –Networking infrastructure & security –Hardware support 20 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Troubleshooting, Maintenance & Upgrades & Interaction with Vendors, Developers and Users Lecture a

21. Troubleshooting; Maintenance and Upgrades; Interaction with Vendors, Developers, and Users References – Lecture a 21 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Troubleshooting, Maintenance & Upgrades & Interaction with Vendors, Developers and Users Lecture a References Boyer, E. and Soback, M. (2005). Production Support. Implementing an Electronic Health Record System. J. M. Walker, E. J. Bieber and F. Richards, Springer London: 95-100. http://www.springerlink.com/content/n520ghg078416463/ http://www.springerlink.com/content/n520ghg078416463/ Felt-Lisk, S; Johnson, L; Fleming, C; Shapiro, R; Natzke, B. 2009 September 22 [Internet].. Toward understanding EHR use in small physician practices. Available from: http://www.thefreelibrary.com/Toward+understanding+EHR+use+in+small+physician+practices.-a0216632134 Heubusch, K. "Physician Practices and Information Management: HIM Professionals Offer Value in Changing Practices." Journal of AHIMA 79, no.8 (August 2008): 18-22. Lake,T, Collins, T, and Ginsburg, P (2011). “Fostering Health Information Technology in Small Physician Practices: Lessons from Independent Practice Associations”. National Institute for Health Care Reform. [Internet]. http://www.nihcr.org/HIT-and-IPAs.html. http://www.nihcr.org/HIT-and-IPAs.html Pereira, P (2010). “After EHR system implementation, maintenance, service questions remain “, SearchHealthIT. [Internet]. http://searchhealthit.techtarget.com/news/2240020962/After-EHR-system-implementation-maintenance- service-questions-remainhttp://searchhealthit.techtarget.com/news/2240020962/After-EHR-system-implementation-maintenance- service-questions-remain Images Slide 8: “EHR Troubleshooting Workflow” by Scott Neal. Used with Permission