Updated: Sep 21, 2018
by Chris Lanaman
Like Goldilocks trying out chairs at the cottage of the Three Bears, every healthcare organization is looking to land on a system that is sized “just right.” When you first had Cerner Millennium® installed, smart people thought through what kind of hardware and how much of it would need to be deployed in order to meet your organization’s needs. Most likely they also considered the projected growth of the organization over the next five to 10 years. Buying too much would add complexity for your users, loss of control in managing the system and, of course, wasted cost and time. No one wanted Millennium to be like Papa Bear’s too-big chair.
I would suggest that a bigger problem exists when the Millennium system is not sized big enough for the demands of your organization. Any one of the following symptoms might indicate that your workload has outgrown your system: lower than expected productivity of outcomes, the loss of business revenue because of turning away patients or poor response time for end-users.
I recommend starting with the following five steps if you are concerned that your organization has outgrown its current Millennium size.
Data, data and more data. You must have data in order to see if your organization is suffering from a sizing issue. This data is gathered by your team of data-miners (IT analysts) or through an application that is generating reports for your system, such as Cerner’s PowerInsight or PowerVision. Use this information to see if there has been a drop in activity, a workflow slowdown or loss of productivity.
Patient management cycle. Once you have obtained measurements for your organization’s workflow, you will need to evaluate where you are in your patient cycle — is this the time of year that you have increased patient traffic or are these your slower months? Your metrics should also include a staffing model to meet patient demand. Understanding your cycle will keep you from over-sizing your system if you evaluate during the high point of the year or under-sizing if you are in a valley part of your cycle. These measurements will identify the revenue cycle expectations for your organization.
Mergers and acquisitions. When your organization merges with another healthcare organization, great pains are taken to try and unify the new organization under a common vision. The impact of the merger on the EMR system’s workload, however, might be overlooked. The IT analyst needs visibility into the new organization’s past data to understand how workloads might increase.
Market share. Does your organization understand the footprint it has in your market? When trying to understand growth potential, you need an understanding of your opportunities and who the suppliers in the market are. Theoretically, one can say a set percentage of business equals a set amount of hardware needed, but this is an educated guess at best and should never be the rule of thumb.
Is your Millennium system healthy? As I alluded to earlier, when your system is not sized correctly, you will see an increase in performance issues. If your end-users are telling you, “The system seems slower than it used to be” or “It seems to take longer for me to do my job in the system,” the first thing on your mind should be the health — i.e., the efficiency — of your system. Before joining the Softek team, I used Softek Panther for a number of years to uncover trouble spots. It let me know when Millennium stepped out of line. Additionally, Softek’s Queuing Performance Spreadsheet (QPS) allows you to see where within Millennium your user transactions are getting clogged, and the Messaging Performance Audit (MPA) gives your system an overall checkup. The audit lets you see if you have build issues in Millennium, if transactions are going where they’re supposed to go, if your servers are configured correctly and when your servers are being over-tasked. If you have other monitoring tools you recommend, please let me know. Whatever you use, it’s important to check your system thoroughly before buying more hardware. Hardware purchases should always be considered the last resort for resolving performance problems.
In a blog, I only have space to give you the Reader’s Digest Condensed version for scoping your organization’s size and determining how that affects Millennium’s performance. But addressing these key points will help keep your organization healthy and your users happy.
Prognosis: Evaluating all of the different factors that make up your organization is the first step in understanding if your Millennium system is sized “just right.”