An Abnormal Definition of Normal

By David Hallberg

Thanks to all of you who stopped by last week during the Cerner Health Conference. We had some great talks about your Millennium^® performance expectations, although I was discouraged to find that for a number of you your expectations were exceedingly low. For example:

• Some of you claimed, “You cannot fix the performance of the application.”
• Others told me, “We are remote hosted and have been assured that we get the best performance that anyone can. When the applications are slow, that’s just the way it is.”
• One client showed me their Lights On Network data for the number of transactions that took over 9 seconds, and I almost fell off my chair. Though the percentage was low, the actual number of transactions was enormous. “That’s way too many,” I said. “It’s the best we can get,” he replied.
• Still another client was told they needed to spend more than $1 million in hardware upgrades to fix their problem.

If you’ve been coaxed into believing any of these statements, let me tell you what I told them: Slow performance is not normal. OK performance is not OK. Don’t believe that you are the fastest Millennium client and there is nothing more for you to do. Your clinicians should not have to wait for 9 seconds for a transaction to go through. Many problems can be fixed without any additional hardware. I know. I have seen Millennium perform extremely well over the past 14 years.

When you are equipped with just a little knowledge of where you have bottlenecks in your system and take the appropriate corrective action, you can see immediate improvements. These improvements do not need to take years and do not require a new version of code, a new operating system or new version of Oracle. You can improve what you have. In the case of the client told to spend $1 million on hardware, we were able to work with the existing hardware and make a couple of uptime changes. Lights On showed that transaction speed for the clinicians had increased and variability had decreased.

Readers of this blog know that I regularly encourage you to trust your clinicians and believe your own eyes rather than blindly accepting performance excuses from the company that wrote the software and is now managing the environment. If the responsiveness of the system is slow, you should be able to see the first level of issues immediately. In a matter of hours or a few days — not months or years — you can determine the initial action steps.

I need to emphasize the words “initial steps.” There is no single silver bullet that will slay your performance dragon; you’ll need a magazine full of lead bullets. The beast is immune to silver but is susceptible to a lead overdose, to an ongoing maintenance regimen that accounts for your continually evolving EMR system. Every new package or service pack you install has the potential to change the processing of the entire system. Make sure you have the right people using the right tools to evaluate what is happening, to identify performance issues and to take action to correct the problems.

Prognosis: If your current support structure is not helping you help your clinicians deliver care more effectively, it’s time to find one that will.

Comments

[Roland Young]

Yes this all very sounds familiar. I regularly attend with my laptop and stop watch, to compare my eyes against the data provided by the Lights On.

I do find the supplier in question is not very forthcoming in providing information about the actual system, potential solutions (often for UK clients they do not have the answers; if only I was a direct KC customer). I call what they have the firewall, where they hold critical system build, system documentation from customers who have paid millions to implement the system. If we were to become too competent, how could they sell you more services and consultancy?

What are you to do? Well, blogs like this help unlock the system. I am looking forward to reading with interest . . .