1. Component 8 Installation and Maintenance of Health IT Systems Unit 1b Elements of a Typical Electronic Health Record System 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.

2. 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) Component 8/Unit 1b2Health IT Workforce Curriculum Version 2.0/Spring 2011

3. Server Software Elements of the EHR IOM: 8 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 Component 8/Unit 1b3Health IT Workforce Curriculum Version 2.0/Spring 2011

4. 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. Component 8/Unit 1b4Health IT Workforce Curriculum Version 2.0/Spring 2011

5. EHR Hardware – Defined Hardware is: –the physical components that make up a computer system. –necessary to make the computer work and run properly. Component 8/Unit 1b5Health IT Workforce Curriculum Version 2.0/Spring 2011

6. EHR Hardware – Most Common Servers Workstations Laptops Tablets PDAs/smartphones Flat-panel monitors Scanners Printers Storage and backup Shredders Medical diagnostic and treatment items Component 8/Unit 1b6Health IT Workforce Curriculum Version 2.0/Spring 2011

7. 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 Component 8/Unit 1b7Health IT Workforce Curriculum Version 2.0/Spring 2011

8. 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 Component 8/Unit 1b8Health IT Workforce Curriculum Version 2.0/Spring 2011

9. 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 Component 8/Unit 1b9Health IT Workforce Curriculum Version 2.0/Spring 2011

10. 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 Component 8/Unit 1b10Health IT Workforce Curriculum Version 2.0/Spring 2011

11. 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) Component 8/Unit 1b11Health IT Workforce Curriculum Version 2.0/Spring 2011

12. 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 Component 8/Unit 1b12Health IT Workforce Curriculum Version 2.0/Spring 2011

13. 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 Component 8/Unit 1b13Health IT Workforce Curriculum Version 2.0/Spring 2011

14. 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 Component 8/Unit 1b14Health IT Workforce Curriculum Version 2.0/Spring 2011

15. 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 Component 8/Unit 1b15Health IT Workforce Curriculum Version 2.0/Spring 2011

16. EHR Hardware – PDAs and Smart Phones Personal Digital Assistants (PDAs) and Smart Phones 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 Component 8/Unit 1b16Health IT Workforce Curriculum Version 2.0/Spring 2011

17. Network Collection of computers and devices connected by communication channels Allows users to communicate and share resources with other users Important terms –Ethernet –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 Component 8/Unit 1b17Health IT Workforce Curriculum Version 2.0/Spring 2011

18. Local Area Network (Corporate Offices, NYC) Server Room(s) Wiring Closet(s) Wireless Connectivity (WLAN) Hard-Wired (Cabled) Local Users (On Premises) Component 8/Unit 1b18Health IT Workforce Curriculum Version 2.0/Spring 2011

19. Wide Area Network Corporate Offices New York City Branch Offices Tokyo, Japan Regional Offices Raleigh, NC Internet / ISP Connectivity Satellite Connectivity Component 8/Unit 1b19Health IT Workforce Curriculum Version 2.0/Spring 2011

20. 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 Component 8/Unit 1b20Health IT Workforce Curriculum Version 2.0/Spring 2011

21. 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 Component 8/Unit 1b21Health IT Workforce Curriculum Version 2.0/Spring 2011

22. Network – Assessing Usage Conduct a wireless connectivity survey Explore remote connectivity options, including VPN (Virtual Private Networks) Component 8/Unit 1b22Health IT Workforce Curriculum Version 2.0/Spring 2011