Healthcare IT Performance

5 Key Considerations to improve your performance and security

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/

What are the key challenges?

• Security

• Uptime / Availability

• Application Performance

• Scalability

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

Lead vs Lag Metrics

Lead Measure (Metric) Lag Measure (Metric)

Predictive : Measures something that leads to a goalInfluenceable : 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

Ah, bandwidth….

Q. Which one has a higher bandwidth?

Bandwidth is a TERRIBLE METRIC!

Mathis FormulaRate <= (MSS/RTT)*(1 / sqrt{p})

http://www.slac.stanford.edu/comp/net/wan-mon/thru-vs-loss.html

Bandwidth Thinking leads to Poor Performance

YOU CAN’T SEE IN

HERE!!!!

YOU CAN’T SEE IN

HERE!!!!

100 Mbps

3 M

bps

2 Choices:1) Buffer2) Drop

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

Getting a handle on your Assets

WS-C

3750

-48P

S-S

CISCO18

11/K

9

AIR-A

P1131

AG-A-K

9

WS-C

3750

X-48P

-S

WS-C

2960

-8TC-L

WS-C

3560

-48P

S-S

WS-C

2960

-24L

T-L

CISCO18

410

200

400

600

800

1000

1200

1400

16001335

912822 784 767

607 591 567

Network Equipment

Model

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)SEE12.2(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)SE112.2(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)SE212.2(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)SE312.2(55)SE4 12.2(55)SE5 12.2(55)SE6 12.2(58)SE2

Software Details – Cisco 3750

1 to 5 6 to 15 16 to 30 31 to 50 51 to 100 100+

1.33

2

3.8

4.6

6.66

6

Different Software Loads

Different Software Loads

70 % of Healthcare Organizations have Security Vulnerabilities in their Network Software

Break out of Technology Silos

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)

Is it the Network or the Server?

Yes50%No

50%

Server Links with Dropped Packets

Average Healthcare customer with server interface issues has 62 interfaces with issues

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%16%

15%

14%

Total Oversubscribed PortsWS-X4548-GB-RJ45V Oversubscribed 8:1WS-X4648-RJ45V+E Oversubscribed 2:1WS-X4548-GB-RJ45 Oversubscribed 8:1WS-X6148-GE-TX Oversubscribed 8:1

Look for known offenders

0

200

400

600

800

1000

1200

985

500

373304

247 223 188

Module

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

Predict your Future….

• Can we deploy the new POS app?

• Can we put video everywhere?

• What would happen if we did X?

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)

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

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

Contact RISC Networks

(866) 808-1227

1 Rankin Ave, 2nd Floor

Asheville, NC 28801

info@riscnetworks.com