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A work in progress: centralized network monitoring and management get a boost from the right software suite. (Network/Systems Integration).

Taking a customer satisfaction rating from 95 percent to 99 percent is a problem many organizations would love to have. That said, manicuring results on that level usually brings to mind a laundry list of loose ends that are compounded when dealing with a healthcare network composed of more than 100 servers and 10,000 employees. For INTEGRIS, the solution came down to maximizing return on existing investment.

As the second largest employer in Oklahoma, INTEGRIS Health spans the state's 69,919 square miles and is composed of 15 hospitals, rehabilitation centers, physician clinics and mental health facilities. It's a $1.2 billion organization and is Oklahoma's largest health system.

While INTEGRIS was used to leveraging the resources of a large network, efficiently managing this sizeable and diverse system put a strain on its IT budget. Practically speaking, we lacked the capability to monitor operations from our headquarters in Oklahoma City.

For years, our IT department had devoted resources to afford INTEGRIS branches the best technology tools available to put the patients first. INTEGRIS pursued this by investing in top-of-the-line applications, allowing staff to provide patient care in a well informed, efficient manner.

INTEGRIS developed safeguards to ensure educated decisions and rapid response time from staff. Large investments in IT infrastructure kept mission-critical applications like e-mail and prescription rules engines working. Recently installed wireless Internet connections increased access, reducing physicians' downtime spent in lines at terminals waiting to get a patient file or enter a prescription.

Headquarters' Hang-ups

The biggest problem for INTEGRIS was that after all of the emphasis placed on updating its member locations, headquarters was left without the means to efficiently manage those 15 branches. Network and system failures would occur without headquarters knowing, and when problems were spotted, high-end technicians would be dispatched to remote locations to solve routine problems.

For INTEGRIS and its member hospitals, a network failure translated into doctors not being able to input prescriptions, or worse, having to make decisions without patient files. For patients, it could mean mentally preparing for surgery and then dealing with the letdown of postponement because systems were not ready.

Keeping remote terminals up to speed with the rest of the network was a challenge. It could take days to get updated software working in isolated locations, and up to four months for a new computer to be shipped and running.

The end result was a return on the existing investment that registered far below potential. A system specifically configured and designed to be efficient was monitored by a central command post without the means to grease the wheels. Specialized personnel had to be trained to troubleshoot a battery of different programs; once they were trained, they were dispatched across Oklahoma trying to glue the pieces together. The network lacked standardization, cohesion and a well-informed central authority.

The question remained: how to bridge the gap from 95 percent to 99 percent satisfaction, based on our internal customer satisfaction surveys. INTEGRIS had to find solutions that could maximize the value of investments already made. Instead of a grassroots overhaul, the organization needed a set of products that could integrate with its wireless applications, advanced rules engines and cutting edge business-oriented applications. After narrowing it down to three contenders, INTEGRIS selected IBM's Tivoli Software.

The Action Plan

INTEGRIS singled out Tivoli as its top choice in large part due to the breadth and depth of resources IBM brought to the table, or what I call "the strength of its bench."

INTEGRIS saw the value of this decision from the beginning as IBM Global Services (IGS) facilitated the rollout phase by building an architecture, identifying weak points, and setting up a test lab where INTEGRIS employees could become familiar with the products. IGS then began to transition from the role of instructor to mentor, gradually handing over the reigns to the INTEGRIS staff. By using best practices, IGS aggressively deployed the products, smoothly transferred responsibility to INTEGRIS, and currently remain as counsel.

The rollout of Tivoli management solutions is presently focusing on metro area hospitals, where the IT staff is working to smooth out early issues with the network. Throughout the deployment, we have discovered network troubles like mismatched DNS addresses causing problems with endpoints that had previously gone unnoticed.

While the rollout is at about 60 percent, INTEGRIS is already beginning to see value. An early high point has been increased access to network problems. One of the major complications INTEGRIS had previously experienced was the limited number of people who could fix system failures. With software like Tivoli Remote Control, anybody can troubleshoot, not just a small group designated within the IT staff. Additionally, new software offers real-time ticket opening, alleviating the clogs that used to slow down systems that selectively opened requests.

INTEGRIS is looking to improve remote control over rural branches where coordination historically has been difficult. The plan is to insert a comprehensive package of Tivoli software into metro locales, resolve the related network issues, and then move into more far reaching units within the next 12 months.

Single View of Operations

When fully deployed, Tivoli products will address a number of concerns under a single umbrella. Under the old regime, multiple platforms accessed INTEGRIS' tool set. For the operators in charge of monitoring, this meant each station could be showing a different view of what was going on. Without a standardized approach, INTEGRIS had to buy additional equipment and extensively train technicians to work with the varying software.

Inserting Tivoli Enterprise Console, INTEGRIS will give everybody the same single view of the entire network environment. It will act as the front man for a host of other programs working behind the scenes at INTEGRIS to give administrators real-time information. Tivoli Enterprise Console now is being used at INTEGRIS with noted success, and we look forward to seeing the full monitoring potential when the additional software gets deployed.

Tivoli Inventory, the next major piece to be installed, will report the type of software, memory use and application access specific to INTEGRIS' 3,500 end-users. Eventually, a distributed monitoring component will check network availability via agents placed on end-user desktops and relay that data to headquarters. Other programs will address the issue of updating end-users by allowing headquarters to "push" new software out to member branches.

Because of heavy reliance on applications like Microsoft Exchange and Oracle's database technology, it was important that new software be compatible with third party applications. To meet this demand, specific products will be deployed to monitor and provide automated responses to problems on INTEGRIS' Oracle databases and Microsoft's e-mail system, widely considered the lifeblood of the INTEGRIS network.

At the end of deployment, checks will be in place to help headquarters spot a problem and fix it before the branch knows the glitch even existed. For problems that do make it to headquarters, help desk staff will respond with hard numbers on issues like system downtime and other information necessary to resolve complaints on the first call. It will mean seamless coordination between units, an informed central command post and another step in the direction of continuous systems availability. These are improvements that patients might never see, but changes that INTEGRIS feels will take us the final mile to complete internal customer satisfaction.

Avery Cloud is the chief information officer at INTEGRIS Health, Oklahoma City. Contact him a
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Author:Cloud, Avery
Publication:Health Management Technology
Geographic Code:1USA
Date:May 1, 2002
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