5 key considerations in Healthcare Information Technology Performance

1. Healthcare IT
Performance
5 Key Considerations to improve your performance and security

2. How important is IT to Healthcare?
• IT boosts Adventist cash by $2.2M
• http://www.healthcareitnews.com/news/group-increases-pos-
collections-2m
• Health system sees 50 percent increase in POS collections with
new platform
• "Right now eight of our 17 facilities are hitting or besting that target,"
Gary Friestad, Adventist Health
• Adventist HealthCare is a myITassessment Top 5 performer!
http://www.myitassessment.com/my-it-assessment-2013-top-5/

3. What are the key challenges?
• Security
• Uptime / Availability
• Application Performance
• Scalability

4. 5 Key Considerations
• Get a handle on your Assets (Scalability)
• Break out of Technology Silos (Reliability)
• Target specific areas for improvement (Performance)
• Predict future performance issues (Scalability & Performance)
• Implement a methodology for improvement, not reaction
• Focus on Lead, not Lag Metrics

5. Lead vs Lag Metrics
Lead Measure (Metric) Lag Measure (Metric)
Predictive : Measures something that leads to a
goal
Influenceable : We can impact this metric.
Trackable : We can see improvement and know
that this will help us reach our goals
Measures the goal
Example: Packet Loss, Jitter, Delay Example: MOS Score, Application Response
Time, Help Desk Ticket counts, User Complaints

6. Ah, bandwidth….
Q. Which one has a higher bandwidth?

7. Bandwidth is a TERRIBLE METRIC!
Mathis Formula
Rate <= (MSS/RTT)*(1 / sqrt{p})
http://www.slac.stanford.edu/comp/net/wan-mon/thru-vs-loss.html

8. Bandwidth Thinking leads to Poor
Performance
YOU CAN’T
SEE IN
HERE!!!!
100 Mbps
3Mbps
2 Choices:
1) Buffer
2) Drop

9. 5 Key Considerations
• Get a handle on your Assets (Scalability)
• Break out of Technology Silos (Reliability)
• Target specific areas for improvement (Performance)
• Predict future performance issues (Scalability & Performance)
• Implement a methodology for improvement, not reaction
• Focus on Lead, not Lag Metrics

10. Getting a handle on your Assets
1335
912
822 784 767
607 591 567
0
200
400
600
800
1000
1200
1400
1600
Network Equipment
Model

11. Software Details – Cisco 3750
1%
1%0%2%
0% 0% 0%
0% 0%
2%
0%
0%
0%
1%7% 1% 2%
1%
0%
27%
2%2%1%1%
10%3%
3%
0%
10%
1% 8%
1%
7%
1%
1% 0%
Count
12.2(20)SE4 12.2(25)SEA 12.2(25)SEB2 12.2(25)SEB4 12.2(25)SEC 12.2(25)SEC2 12.2(25)SED1 12.2(25)SEE
12.2(25)SEE1 12.2(25)SEE2 12.2(25)SEE3 12.2(25)SEE4 12.2(35)SE 12.2(35)SE2 12.2(35)SE5 12.2(37)SE1
12.2(40)SE 12.2(44)SE1 12.2(44)SE2 12.2(44)SE6 12.2(46)SE 12.2(50)SE 12.2(50)SE1 12.2(50)SE2
12.2(50)SE3 12.2(52)SE 12.2(53)SE 12.2(53)SE1 12.2(53)SE2 12.2(55)SE 12.2(55)SE1 12.2(55)SE3
12.2(55)SE4 12.2(55)SE5 12.2(55)SE6 12.2(58)SE2

12. Software Details – Cisco 3750
1.33
2
3.8
4.6
6.66
6
1 to 5 6 to 15 16 to 30 31 to 50 51 to 100 100+
Different Software Loads
70 % of Healthcare
Organizations have
Security Vulnerabilities in
their Network Software

13. Break out of Technology Silos

14. See the context of your network
What are the most
important links and how are
they performing?Some Considerations:
• Video Surveillance
• VMware (Virtualization)
• Cloud Services purchased
by LoB (Lines of Business)

15. Is it the Network or the Server?
Yes
50%
No
50%
SERVER LINKS WITH DROPPED PACKETS
Average Healthcare
customer with server
interface issues has 62
interfaces with issues

16. Be Targeted in your Approach
• 41 % of Healthcare Customers have Oversubscribed Line
Cards
• 130 – The average number of interfaces that drop packets due
to the oversubscription (Per Customer!)
56%
15%
15%
14%
Total Oversubscribed Ports
WS-X4548-GB-RJ45V
Oversubscribed 8:1
WS-X4648-RJ45V+E
Oversubscribed 2:1
WS-X4548-GB-RJ45
Oversubscribed 8:1
WS-X6148-GE-TX
Oversubscribed 8:1

17. Look for known offenders
985
500
373
304
247 223 188
0
200
400
600
800
1000
1200
WS-X6748-GE-TX
WS-X6148A-GE-45AF
WS-X6348-RJ-45
WS-X6724-SFP
WS-X6148-GE-TX
WS-X6148A-GE-TX
WS-X6548-GE-TX
33 % of Cisco 6500
Ports are on
Oversubscribed Line
Cards
“It is important to note that the 6148A-GE and the 6548-GE are both engineered with 8:1 oversubscription ratios and, as such,
while suitable at the access layer, these linecards would not be recommended to deploy as uplinks or within the distribution and
core layers – Cisco QoS Design Guide (Telepresence) “http://www.cisco.com/en/US/docs/solutions/Enterprise/Video/tpqoscampus.html

18. Predict your Future….
• Can we deploy the new POS app?
• Can we put video everywhere?
• What would happen if we did X?

19. How to predict the future
• Stop looking at charts and get some numbers
• Calculate the 95th Percentile of BW Usage
• Determine what you can add on top of the 95th Percentile.
• This is your green light number
• Before you deploy any applications….Simulate the traffic you
expect to have on the network
• Tons of open source options here (D-ITG (recommended), iPerf, Cisco
IP SLA, etc)
• Or use a service (like ours)

20. 5 Key Considerations
• Get a handle on your Assets (Scalability)
• Break out of Technology Silos (Reliability)
• Target specific areas for improvement (Performance)
• Predict future performance issues (Scalability & Performance)
• Implement a methodology for improvement, not reaction
• Focus on Lead, not Lag Metrics

21. What do you do next
• Define your lead metrics
• Start with packet loss on the network (Best Lead Metric)
• Standardize your Network Software
• Identify context of Critical Interfaces
• Identify key target devices/interfaces
• Once you have that done, and are working on those metrics,
start to predict future state

22. Contact RISC Networks
(866) 808-1227
1 Rankin Ave, 2nd Floor
Asheville, NC 28801
info@riscnetworks.com