Can some please outline whats involved in running a large Hospital computer system.

[Bill Poster]

I have recently attended a large University hospital , and it struck me that nearly every thing is carried out via a computer screen.

 

The Doctor looks at my medical history.

 

My next appointment information was done via a computer screen and one of the few things that were actually printed out on paper.

 

The doctor consulted with another doctor in the same hospital via his computer screen .

 

The doctor prescribed a range of drugs and sent that information to the drugs pharmacy department in the hospital .

 

It seems that may be 90% of information and records are stored on the hospital computer.

 

I know it may be a bit simplistic ( I’m not very computer literate ) but whats going on in the hospitals computer department .

 

1. what about backing up all the daily changes to the hospitals computer records.

 

2. what about the well known Thai electric power interruptions to the hospital building that may
 affect the computer system.

 

3. what about the ever present computer virus / ransom possibility's.

 

4. what about when the computer fails through miss management / age and physically needs upgrading .

 

5. what about a malicious action by a hospital computer technician ( disgruntled employee ) .

 

6. whats would be the approximate number of hospital staff involved on a daily basis keeping the hospitals computers up and running.

 

7. Is it possible that the people involved in maintaining the hospitals computers , may not actually be physically be at the hospital.

 

8. Etc .

 

I’m just wondering from a non computer person , just what is in involved in the day to day running of a large hospitals computer system. 

 

 

 

 

Thanks .
 

[frantick]

8 hours ago, Bill Poster said:

1. what about backing up all the daily changes to the hospitals computer records.

 

2. what about the well known Thai electric power interruptions to the hospital building that may
 affect the computer system.

 

3. what about the ever present computer virus / ransom possibility's.

 

4. what about when the computer fails through miss management / age and physically needs upgrading .

 

5. what about a malicious action by a hospital computer technician ( disgruntled employee ) .

 

6. whats would be the approximate number of hospital staff involved on a daily basis keeping the hospitals computers up and running.

 

7. Is it possible that the people involved in maintaining the hospitals computers , may not actually be physically be at the hospital.

I don't know about Thailand, but if you're interested here's how it's done in the States, using an example from my previous employer having 2 500 bed hospitals, about 10 clinics, and multiple specialty outpatient services all using the same system. Skip to next post if you're looking for Thailand specific methods.

 

1. Transactions are backed up continuously and entire databases every night, usually to multiple locations to be used for backup, reporting, training systems, and testing systems. Recovery is down to within a minute or two of a failure. Databases and online systems are mirrored or shared to a 2nd off site location and always available for HA; high availability.

 

2. Both datacenters run battery backup systems. However, the 20 or so minutes of power in these systems running big diesel generators is not to provide continued service, but to allow a failover to the 2nd datacenter, or clean shutdown of all systems if both locations have lost power.

 

3. Viruses are a big threat. Healthcare IT departments spend a bunch on security consultants, email anti-virus filters, multiple firewalls, PC anti-virus. Additionally, much is spent to automate server and workstation bug fixes, software, and OS updates.

 

4. Equipment and software aging is an ongoing maintenance, planning, and budgeting issue. IT staff work internally with vendors, and sometimes specialized consultants, ie storage systems architecture, to define long term goals and needs. Due to budget constraints, there is usually some compromising going on, but generally minimal compromising on important 24/7 systems.

There are downtimes. For example when testing failover or installing new raid array systems, etc. But these are planned with the medical staff during low patient volume times, and few and far between. Our Electronic Medical Record system, Epic, provided some apps and utilities to minimize downtime recovery time; ie patient data capture on specific PC's synced later to the primary system.

 

5. "Disgruntled employees" is a weak point at most IT shops I'm sure. You try to minimize the impact any one person could have by limiting their access to only what they need. Also monitoring that access and other activities; websites, etc. Also, good IT shops will have staff trained to cover equivalent jobs so the loss of one does not negatively affect (too much) the business. In real life, some employees have too much access and some employees know more than others.

 

6. The system I worked for listed above, had about 150 full time IT employees (maybe 3500 - 4000 regular employees, medical staff, HR, education, etc.). This 150 included those involved in training the software used by the medical staff, designers of each piece of the software; ie Admitting, Orders, Pharmacy, Lab, etc. And then the technical side, PC techs, HELPDESK, network, storage, server, interfaces, etc. We would occasionally hire outside consultants to provide additional help for large projects or for projects requiring unavailable skillsets.

 

7. Yes, our systems did not have physical bodies on site during off hours unless we were performing a hardware or software upgrade. All support is done remotely via OnCall SMS messaging and remote access software. And now with covid there are very few bodies on site during daytime hours either. This I'm told because I retired right before we knew Corona wasn't just a beer. My coworkers are now working from home 90% of the time. Some happy about that and some not.

Our 2 datacenters were not located at the hospitals. The primary datacenter was close to one of the hospitals, 2 city blocks, but the secondary was 10km away. Not real important, but relevant.

 

Sorry if I rambled on, but what else do ya do when the bars and restaurants are shut?!

 

Edit: At 150 IT employees, we were considered lean for our size compared to the industry average.

Edited August 4, 2021 by frantick
Clarify

[scooterboy]

Interesting to read ...... and very well written.

 

Cheers ????

[Bill Poster]

6 hours ago, frantick said:

I don't know about Thailand, but if you're interested here's how it's done in the States, using an example from my previous employer having 2 500 bed hospitals, about 10 clinics, and multiple specialty outpatient services all using the same system. Skip to next post if you're looking for Thailand specific methods.

 

1. Transactions are backed up continuously and entire databases every night, usually to multiple locations to be used for backup, reporting, training systems, and testing systems. Recovery is down to within a minute or two of a failure. Databases and online systems are mirrored or shared to a 2nd off site location and always available for HA; high availability.

 

2. Both datacenters run battery backup systems. However, the 20 or so minutes of power in these systems running big diesel generators is not to provide continued service, but to allow a failover to the 2nd datacenter, or clean shutdown of all systems if both locations have lost power.

 

3. Viruses are a big threat. Healthcare IT departments spend a bunch on security consultants, email anti-virus filters, multiple firewalls, PC anti-virus. Additionally, much is spent to automate server and workstation bug fixes, software, and OS updates.

 

4. Equipment and software aging is an ongoing maintenance, planning, and budgeting issue. IT staff work internally with vendors, and sometimes specialized consultants, ie storage systems architecture, to define long term goals and needs. Due to budget constraints, there is usually some compromising going on, but generally minimal compromising on important 24/7 systems.

There are downtimes. For example when testing failover or installing new raid array systems, etc. But these are planned with the medical staff during low patient volume times, and few and far between. Our Electronic Medical Record system, Epic, provided some apps and utilities to minimize downtime recovery time; ie patient data capture on specific PC's synced later to the primary system.

 

5. "Disgruntled employees" is a weak point at most IT shops I'm sure. You try to minimize the impact any one person could have by limiting their access to only what they need. Also monitoring that access and other activities; websites, etc. Also, good IT shops will have staff trained to cover equivalent jobs so the loss of one does not negatively affect (too much) the business. In real life, some employees have too much access and some employees know more than others.

 

6. The system I worked for listed above, had about 150 full time IT employees (maybe 3500 - 4000 regular employees, medical staff, HR, education, etc.). This 150 included those involved in training the software used by the medical staff, designers of each piece of the software; ie Admitting, Orders, Pharmacy, Lab, etc. And then the technical side, PC techs, HELPDESK, network, storage, server, interfaces, etc. We would occasionally hire outside consultants to provide additional help for large projects or for projects requiring unavailable skillsets.

 

7. Yes, our systems did not have physical bodies on site during off hours unless we were performing a hardware or software upgrade. All support is done remotely via OnCall SMS messaging and remote access software. And now with covid there are very few bodies on site during daytime hours either. This I'm told because I retired right before we knew Corona wasn't just a beer. My coworkers are now working from home 90% of the time. Some happy about that and some not.

Our 2 datacenters were not located at the hospitals. The primary datacenter was close to one of the hospitals, 2 city blocks, but the secondary was 10km away. Not real important, but relevant.

 

Sorry if I rambled on, but what else do ya do when the bars and restaurants are shut?!

 

Edit: At 150 IT employees, we were considered lean for our size compared to the industry average.

Thanks for taking the time to reply , its really appreciated. ????

 

Just a few more questions if you don't mind 

 

 

Thanks .

 

[mtls2005]

It is pretty impressive these days.

 

My GP orients the screen and walks through everything for me.

 

Full tabulated test results, with green, yellow and red designations. 

 

MRI, Cat scan, ultrasound, all available on the screen.

 

 

Still, I imagine billing, purchasing/inventory, payroll get quite a bit of attention.

 

 

[Bill Poster]

4 hours ago, mtls2005 said:

It is pretty impressive these days.

 

My GP orients the screen and walks through everything for me.

 

Full tabulated test results, with green, yellow and red designations. 

 

MRI, Cat scan, ultrasound, all available on the screen.

 

 

Still, I imagine billing, purchasing/inventory, payroll get quite a bit of attention.

 

 

I had forgotten about the financial side of the hospitals computer system , now theres an area that must be ‘’ guarded ‘’and locked down tight .

 

The thing that surprises me is just the numbers of people employed on a daily basis to keep the hospitals computer system safe and fully functioning.

 

 

Thanks.

[Liverpool Lou]

9 hours ago, scooterboy said:

Interesting to read ...... and very well written.

 

Cheers ????

Very patronising.   10/10, have a gold star!

Edited August 5, 2021 by Liverpool Lou

[frantick]

2 hours ago, Liverpool Lou said:

Very patronising.   10/10, have a gold star!

What am I missing? If he meant it to be patronizing, I didn't take it that way.

[HappyExpat57]

I used to be a database manager at Naval Hospital Roosevelt Roads in Puerto Rico, and we had just about everything you WOULDN'T want in a system. No more than a one-week backup, everyone had access to the main personnel database when I first got there, I could go on and on. Somehow we limped along, but the attitude from the IT manager was "Meh." There was a HUGE loss of important health records that could never be retrieved. I've been to numerous hospitals in Thailand and am saddened by the number of Windows XP computers I see.

[recom273]

4 hours ago, HappyExpat57 said:

I used to be a database manager at Naval Hospital Roosevelt Roads in Puerto Rico, and we had just about everything you WOULDN'T want in a system. No more than a one-week backup, everyone had access to the main personnel database when I first got there, I could go on and on. Somehow we limped along, but the attitude from the IT manager was "Meh." There was a HUGE loss of important health records that could never be retrieved. I've been to numerous hospitals in Thailand and am saddened by the number of Windows XP computers I see.

Was about to say, after reading @mtls2005 post - Jeez, I went to a hospital last week and they were running xp.

[scooterboy]

12 hours ago, frantick said:

What am I missing? If he meant it to be patronizing, I didn't take it that way.

Just ignore the guy (LL) - he's like this in other threads, too. Maybe he's forgetting to take his meds ...

 

Cheers

[robblok]

21 hours ago, Bill Poster said:

I had forgotten about the financial side of the hospitals computer system , now theres an area that must be ‘’ guarded ‘’and locked down tight .

 

The thing that surprises me is just the numbers of people employed on a daily basis to keep the hospitals computer system safe and fully functioning.

 

 

Thanks.

Its still less then doing it manually. Also far safer for patients and faster. Not sure why its so important to you. 

 

Most computer stuff can be pretty secure if you want it all depends on the time and effort and money. 

 

I think you should not look at the people who do the upkeep alone but also the time saved by all the other departments from having to do everything manually and getting files and making mistakes ect.

Edited August 6, 2021 by robblok

[Liverpool Lou]

On 8/5/2021 at 5:05 PM, frantick said:

What am I missing? If he meant it to be patronizing, I didn't take it that way.

That's ok then.