1. Lecture b Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System This material Comp 8 Unit1b 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. Installation and Maintenance of Health IT Systems Learning Objectives 2 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b 1.Identify the core elements that comprise an EHR system (Lecture a) 2.Describe the use of client and server hardware for access to and storage of EHRs (Lecture a, b) 3.Describe network needs for access to and storage of EHRs (Lecture b) 4.Identify the application software and back-end data storage software needed for a comprehensive, effective health IT System (Lecture a, b)

3. 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture 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)

4. 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b Server Software Elements of the EHR IOM: Eight Core Components 1.Health information in database 2.Results management 3.Order entry and management 4.Decision support 5.Electronic communication/connectivity 6.Patient support 7.Administrative processes 8.Reporting and population health management (Torrey, 2011)

5. 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. 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b

6. EHR Hardware – Defined Hardware is: –the physical components that make up a computer system. –necessary to make the computer work and run properly. 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b

7. 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 EHR Hardware – Most Common Servers Workstations Laptops Tablets PDAs/smartphones Flat-panel monitors Scanners Printers Storage and backup Shredders Medical diagnostic and treatment items Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b

8. 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 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b

9. EHR Hardware – Servers 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 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b

10. EHR Hardware – Servers Storage requirements depend on EHR/PM application, volume of scanned documents –Check with your EHR vendor. –Rule of thumb: 5 GB/year/provider (Kleaveland) 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b

11. EHR Hardware – Servers Purchase considerations –Brand e.g. Dell vs. “white box” –Operating system (OS) e.g. Windows XP –Processors e.g. 2.4 GHz Xeon 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b

12. EHR Hardware – Servers Purchase considerations (cont’d) –RAM e.g. 1 GB –Hard drive configuration e.g. RAID 5 –Network card e.g. 1 GB/second –Accessories: monitor, keyboard, CD/DVD drive, UPS (Uninterruptible Power Supply) 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b

13. 1.1 Table: EHR Hardware-Servers (Neal, 2011) 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 EHR Hardware – Servers InternalExternal/Hosted CostHigher initial costsMonthly fees ManagementNeed staff to implement & manage server(s), perform software/hardware maintenance & backup Dependent on vendor for scheduled maintenance PowerCapable of utilizing full power of server Often share resources with other institutions ConnectivityControl speed & connectivity to server(s) Remote locations, so connectivity may be shared with other customers, reducing speed Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b

14. 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 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b

15. EHR Hardware – Clients 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 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b

16. EHR Hardware – Clients 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 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b

17. 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 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b

18. 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 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b

19. Local Area Network (LAN) 19 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b (Neal, 2011)

20. Wide Area Network (WAN) 20 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b (Neal, 2011)

21. 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 21 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b

22. Network – Assessing Usage 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 22 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b

23. Network – Assessing Usage Conduct a wireless connectivity survey Explore remote connectivity options, including VPN (Virtual Private Networks) 23 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b

24. 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 24 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b

25. Elements of a Typical Electronic Health Record System References – Lecture b References 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 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.htmhttp://patients.about.com/od/electronicpatientrecords/a/emr.htm Torrieri, M. (2011, August 23). EHR adoption grows slowly, steadily at small practices. Retrieved from physicianspractice.com: http://www.searchmedica.com/resource.html?rurl=http%3A%2F%2Fwww.physicianspractice.com%2Fblog%2Fcon tent%2Farticle%2F1462168%2F1933985%3FCID%3Drss&q=Kleaveland&c=pm&ss=physiciansPractice&p=Conve ra&fr=true&ds=0&srid=3 http://www.searchmedica.com/resource.html?rurl=http%3A%2F%2Fwww.physicianspractice.com%2Fblog%2Fcon tent%2Farticle%2F1462168%2F1933985%3FCID%3Drss&q=Kleaveland&c=pm&ss=physiciansPractice&p=Conve ra&fr=true&ds=0&srid=3 Wikipedia. Thin Client. Retrieved from Wikipedia.com: http://en.wikipedia.org/wiki/Thin_clienthttp://en.wikipedia.org/wiki/Thin_client Wikipedia. Computer Network. Retrieved from Wikipedia.com. http://en.wikipedia.org/wiki/Computer_networkhttp://en.wikipedia.org/wiki/Computer_network Images Slide 15: Laptop. Courtesy Scott Neal. Used with permission. Slide 19: Local Area Network (LAN). Courtesy Scott Neal. Used with permission. Slide 20: Wide Area Network (WAN). Courtesy Scott Neal. Used with permission. Charts, Tables, Figures 1.1 Table: Neal, Scott. EHR Hardware – Servers. Used with permission. 25 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture b