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Allscripts End User Experience Monitoring

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CUSTOMERS

AWARDS

Founded in 2005

Headquartered outside of Boston, MA

Used by F500 companies in every major vertical

Closes the visibility gap within all APM tools

Any Application

Any Device

Any User

Deployments from 1K to 100K+ devices

• Physical & Virtual Desktops

• Mobile Devices

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Management Service

Analytic Service

Aggregation Service

Unlike many products that attempt to

understand end user activity through

transaction monitoring, Aternity uniquely

combines the multiple data streams that

separately describe different aspects of end

user experience providing an integrated

multidimensional portrait.

“Directory Server

TicketingSystems

EmailSystems

Management Systems

Data Collection Service”

AllScripts Value

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The Allscripts Activity Pack includes the following Activities:

An “Activity Signature” is a template which monitors duration and latency associated with navigating from one point

in an application to another. For example, clicking the ‘submit’ button, until a web-page page completes rendering.

Activity Signatures can be created to monitor specific actions, or left generic to monitor all actions of a certain type.

1. Assess Problem2. Go To Documents3. Go To Tasks4. Go To Vitals5. Launch6. Med Encounter Summary7. New Allergy Button8. New Problem Icon9. New v10 Structured Note10. New v11 Structured Note11. Open Meds-Orders ACI Search12. Open Note From Schedule13. Open Note Selector14. Open v11 Sign Note Dialog

15. Patient Toolbar Activate16. Record Vitals17. Save and Continue new Med18. Select Immunization Item19. Select Med20. Sign v11 Structured Note21. View Note Output22. View qChart23. View Results Data24. Qverify25. Launch26. Qverify – All27. Go To Work-list28. Etc.

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AllScripts – Qverify Activity Example

Pack includes the following Activities:

An “Activity Signature” is a template which monitors duration and latency associated with navigating from one point

in an application to another. For example, clicking the ‘submit’ button, until a web-page page completes rendering.

Activity Signatures can be created to monitor specific actions, or left generic to monitor all actions of a certain type.

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Average Response time across all sites for a week. The top portion of the chart shows average response times, the bottom

portion shows volume per location.

The Go-To Tasks Activity took the longest and was executed 2,500+ times over the given timeframe.

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Average Response time across all sites for a week. The top portion of the chart shows average response times, the bottom

portion shows volume per location.

Average Site Performance (and volume) varies significantly between locations accessing AllScripts

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The chart above compares the true render-time in seconds of all application Activities executed across all Citrix Servers.

The 50th percentile represents the mean, the height of the bubble represents the variability and the size of the bubble

represents volume. The further the bubble is to the left, the better its comparative performance. The further the bubble is to

the right, the worse its comparative response.

Worst Performing Citrix Server

Normal Performing Citrix Servers

Best Performing Citrix Server

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CPU Speed is an influencing factor in the performance of activities, however, it is not the only determining factor when

making decisions based on performance.

The faster the CPU, the quicker the Goto Task Activity is executed.

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The above chart breaks down the overall activity response time (BLUE) into it’s subcomponents. The amount of time spent

on the client side machine (RED) and total infrastructure response time (YELLOW)

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Users experienced a significant improvement in the login activity (Activity Response) due to the reduction in network

latency. While the difference was small, it’s affects are compounded due to the number of network round trips done during

the login activity (Total Network Response time). Other activities are not as “chatty” as the login activity.

A significant reduction in total Infrastructure Response Times drove an improvement in the overall Response of the Activity.

Aternity Value

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Validation. Truly having the ability to validate end-user experience—eliminating the questions that often come up in IT: Is there really a problem, or is the user simply perceiving one? So often we’ve had to spend countless hours trying to reproduce a customer issue just to see if one exists. Aternity allows us not only to validate that a problem exists, but identify when, where and how big of an issue it truly is.

Hot Fix 8. We used Aternity to analysis the performance difference between Allscripts Enterprise before and after Hotfix 8. Providing the visibility into exactly what benefits and disadvantages the upgrade brought to our end-users.

ICA Latency Spikes. Despite other performance monitoring software that works in the backend infrastructure, Aternity was the only solution that revealed an ICA latency issue that caused slowness and performance spikes throughout three of Sharp’s sites. Sharp’s hardworking Network Team and Aternity’s data forced AT&T to recognize that there was an issue, which was then corrected.

Allscripts Enterprise SQL hardware upgrade. Aternity proved its use early, during our Proof of Concept, the Allscripts SQL hardware was upgraded. Reports were coming in that performance was worse, and thanks to Aternity, we proved that there was a noticeable drop in performance AFTER the supposed “upgrade”. The hardware upgrade was reverted back to its previous state for analysis.

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Allscripts Enterprise – Record Vitals. With Aternity we were able to identify the performance of the Record Vitals activity degraded over time. As a result, staff began to alter their workflow, raising a concern for patient safety. Sharp provided this Aternity data to Allscripts—who were able to identify an issue with the workflow and provided a fix to the issue.

Grossmont vs. Memorial. A major performance analysis was performed over the course of 3 months between two of our major hospitals due to reports of one being “slower” than the other. Every IS team at Sharp was involved, from networking, database, and Distributed System Support to Enterprise Device Architecture and Cerner Technical. No one was able to discern any significant performance difference, and Aternity helped by providing the numbers to back it up, as well as a hardware comparison between sites.

SummarySharp is now enabled with Aternity to become proactive with supporting their users leveraging Allscripts, and justifying the business decisions required to improve their delivered quality of service based on true end user performance data.

Their support teams and their end users are more productive, and doctors are enabled to deliver on their critical business processes.

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"We chose the Aternity platform for its unique ability to proactively identify and remediate application performance issues before our end users are impacted.” Keith Bernier, Vice President of IT, Centene Corporation

“With Aternity, we can now preemptively detect issues, dynamically isolate the impacted users, and automatically identify probable cause, while also ensuring that our mission-critical business applications stay on target to deliver optimal up-time and service levels.” Royce Uehara, Director of Clinical Information Systems, HealthCare Partners

“Aternity was able to offer the monitoring capabilities we require coupled with real-time analytics that will provide us with the proactive IT management approach to both application and desktop management we are looking for.” Jeremy Meller, Director of Enterprise Operations, Spectrum Health

Gaining visibility into our end user’s EHR experience is key to achieving solid clinician adoption. That is why we chose Aternity. When we do have end user issues, we can demonstrate progress and not be hindered by a user perception that often trails reality.”Will Weider, Chief Information Officer (CIO), Ministry Health Care

Demonstration

Aternity Value

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The chart above compares the activities executed by Client 1 clinicians to those executed by peers at Client 2. Each

colored bar on the left has a corresponding bar on the right of the same color—except in instances where the same activity

was not tracked within both environments.

On average, the Client 1 activities take significantly longer to execute than similar activities at other clients.

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The chart above compares the total network response time of activities executed by Client 1 clinicians, to those executed

by peers at Client 2. This represents ONLY the time spent processing the activity within the infrastructure.

On average, at Client 1, activities spend a vastly greater time being processed within the infrastructure.

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The above chart compares a single activity between Client 1 and Client 2, while breaking down the activity into its sub-

components. The BLUE bars represent the infrastructure processing time. The RED bars represent client side processing

time and the GREEN bar is the sum of the other two bars, representing total activity response.

At Client 1 the Infrastructure side processing time is significantly worse, Although Client side processing time is poorer as well. Lets explore the worst first—infrastructure processing time.

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The above chart represents the Average Total Network Response Time by Backend Application Server for the 10 highest

volume activities.: (Middleware Application Node)The top portion of the chart represents infrastructure processing time

separated by application node. The bottom portion of the chart represents volume.

No –All middleware application nodes seem to be processing activities at similar rates. Either the problem is systemic, or not related to an individual backend node.

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The following chart shows the top 15 activities, by volume, executed by associates within the Clinical Applications. In BLUE

are Vergence servers (70 or so) utilizing SSO technology. In RED are the 5 non-Vergence servers not utilizing SSO

technology Some activities should not be impacted by SSO, while others such as the Open Patient Chart activities are.

Using the Single Sign-On Technology Sentillion Vergence causes performance to be vastly worse. Blue = Single Sign-On Utilized, RED = No Single Sign-On Utilized

Aternity Value

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The above chart shows the client side (Citrix) processing time for various activities on two sets of servers. In RED are

servers whose hard drives are significantly fragmented—as seen on the previous chart. In BLUE are servers whose drives

were defragmented the previous night. A dramatic decrease in client side processing time occurs after the disks have been

defragmented. Additionally, this lowers disk wear and lengthens disk life.

After defragmenting the Citrix servers, end-users experienced a dramatic increase in activity response time

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The above chart shows the total percent of disk fragmentation (BLUE) and the total percent of file fragmentation (RED)

across a handful of Citrix servers. This is not an all inclusive list, however, shows extremely high levels of file fragmentation

across the Citrix farm. A defrag of ALL Citrix servers is highly recommended.

The entire Citrix farm had extremely high levels of File and Disk Fragmentation—Performing a defrag on all servers is highly recommended.

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