Common Performance-Management Strategies for Healthcare Environments

Pointers and suggestions on how to manage the performance of applications that are common in the healthcare industry

Networks in the healthcare industry are under siege: more traffic and more technologies going more places. Healthcare organizations must balance the network demands of large digital radiology files, electronic patient records, web-based telemedicine applications, and a variety of other medical and business applications.

Browse the list of common issues and descriptions below. For all that sound like your environment, follow the management suggestions. If the instructions for a topic are short, then they're embedded right here in this file. But if they're longer or covered elsewhere, a link leads to another PacketGuide Recommendation.

• Digital image transfers monopolize the network.

  Without adequate control, large image files dominate WAN links to the detriment of most other applications. Digital images are not good network citizens, consuming as much bandwidth as possible without regard for urgent, interactive applications. Your goal is to keep images moving at a pace that still leaves bandwidth for others: Balance DICOM's Bandwidth Demands.

• Urgent applications using the HL7 standard to exchange information have frustratingly slow response.

  HL7 (Health Level Seven) is an ANSI-accredited organization whose standards facilitate the exchange of clinical and administrative data between many healthcare applications. For example, as an emergency room awaits the results of a lab test before initiating treatment, the lab finishes the test and relays results via HL7. An ambulance communicates with a hospital over satellite to retrieve critical patient information using HL7.
  
  HL7 flows are very critical, particularly time-sensitive, and typically small. They tend to get crushed under the bandwidth demands of larger traffic flows that aren't necessarily urgent, resulting in inconsistent and sluggish performance.
  
  Let PacketWise discover your HL7 traffic automatically and create traffic classes, appropriately named HL7. Then assign a priority policy of a high priority (6 or 7) to your HL7 classes.

  Turn on PacketWise's compression. This feature offers lossless compression for HL7 and other types of network traffic by creating compression tunnels between compression-enabled PacketShapers. No manual configuration is required, as the PacketWise application-specific plug-in architecture automatically selects the algorithm that will yield the best compression ratio for HL7 and every other compressible application or service type.
  
  The compression feature also allows you to define which hosts are allowed to send data through the Xpress tunnel (such as hosts in radiology labs and other hospitals), or specify which PacketShaper units can be a tunnel partner (tunnel discovery partner).
  
  

• Important server-based Citrix applications suffer spotty performance.
  

  The healthcare industry frequently deploys clinical and business applications to distributed employees over a Citrix platform to take advantage of associated centralized management and cost savings. But thin-client/server-based applications can suffer unpredictable or poor performance on a contention-filled network. The solution is to protect Citrix applications, contain unsanctioned applications, and balance important but greedy applications. See Manage Citrix Performance for help.
  

• Urgent, interactive applications that are critical for patient care or business functions suffer sluggish and inconsistent performance.

  Applications from companies such as Cerner, Keane, Epic, SAP, Oracle, and McKesson need predictable, prompt performance in any healthcare organization. For help protecting the performance of these applications, see Protect Application Performance.

• Collaborative sessions between remote professionals suffer stutter and static.

  Diagnostic videos, collaborative VoIP (Voice over IP) sessions, online continuing education, and other streaming traffic arrive in sporadic, irritating bursts as their flows speed up and slow down. To give streaming traffic smooth performance and to limit the number of streaming users to those you can accommodate, see Control Streaming Media, or, for voice/video over IP, see Manage VoIP Sessions.
  

• Recreational traffic undermines other applications' performance.
  

  Even in the healthcare industry, there are a few users who don't realize that the network and WAN are literally lifesaving tools. Staff can innocently request music downloads or listen to Internet radio and inadvertently monopolize the network for minutes at a time.
  
  A recreational traffic problem becomes visible because PacketWise's automatic classification and analysis features not only reveal the unsanctioned traffic but also the associated users. You can either block the traffic or reserve a small percentage of the network for such purposes.
  
  To see if recreational traffic is undermining your network's performance, see Identify Performance Saboteurs. For help in blocking or containing recreational traffic, see Block Unwanted Traffic and Control Peer-to-Peer Downloads.