Customer Story

MEDHOST Uses Wire Data to Drive Meaningful Use of EHR Systems

Greater meaningful use from EHR Systems and higher levels of physician adoption

Extremely fast time to value and much faster troubleshooting and remediation

Real-time visibility into health and performance of HL7 interfaces

The Beginning

To help its customers drive meaningful use, MEDHOST needed more visibility into how physicians were using hosted applications.

MEDHOST delivers software and services to roughly 20 percent of the hospitals in the United States — everything from electronic health record (EHR) systems and general financials to patient accounting and the nation's #2 patient portal.

To improve meaningful use of its certified EHR systems (as defined under the American Relief and Recovery Act of 2009), MEDHOST sought additional capabilities to monitor application performance and gather IT operational intelligence.

"We thought we would need to invest heavily in tools from the big four vendors to get more visibility into our applications, networks, and databases," says Todd Forgie, VP of Hosted & Managed Services for MEDHOST. "But when we examined ExtraHop, we realized that we could jump past all or most of that very quickly by utilizing wire data."

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We've never seen this kind of speed-to-value from a technology vendor. What ExtraHop does is really unprecedented.

Todd Forgie
VP of Hosted & Managed Services, MEDHOST

The Transformation

MEDHOST uses the ExtraHop platform to get real-time visibility into it's software.


MEDHOST deployed ExtraHop to gain granular visibility into how users at hospitals experience and use its software. The ExtraHop platform provides this visibility by analyzing real-time wire data — all L2-L7 communications between servers, including full bi-directional transaction payloads.

"ExtraHop is an extremely disruptive technology for healthcare IT," says Forgie. "Being able to look across a large heterogeneous infrastructure without having to install agents everywhere — it's an elegant and forward-thinking approach. And it's an easy way for us to gain information across what used to be IT silos."

MEDHOST most recently added HL7 analysis capabilities to its ExtraHop deployment, enabling IT teams to see the performance of HL7 messages between interfaces, regardless of the vendor.

The Outcome

With ExtraHop, MEDHOST can analyze user behavior and is able to see real-time application performance for each user.

With ExtraHop, MEDHOST has greatly accelerated customer remediation efforts and gained critical insight into how physicians and other users are interacting with applications.

Increased Physician Adoption to Drive Meaningful Use

Hospitals spend millions of dollars demonstrating meaningful use of certified EHR systems because of the federal incentives available. Physician adoption is the key to showing meaningful use, and performance is the key to physician adoption.

"Hospitals can mandate that nurses and staff use systems, but physicians have more freedom—especially with a huge shortfall of doctors over the next few years. If application delivery is wonky in terms of speed or stability, physicians will walk away," says Forgie.

Having a difficult time, or just being difficult?

Physician adoption is the key to meeting meaningful use goals. But doctors can be reluctant adopters for many reasons — ranging from slow performance to just being uncomfortable with technology.

ExtraHop helps hospitals overcome obstacles by pinpointing performance issues for individual users and showing when a specific physician is in need of training or support.

ExtraHop drives physician adoption in two ways:

  1. By showing the user activity and the performance of applications per user, ExtraHop gives clinical informatics professionals the insight they need to tune and optimize order sets and workflows — "a difficult task without ExtraHop," says Forgie.
  2. ExtraHop also identifies, in real time, which physicians are falling behind, so the informatics team can proactively reach out to offer training or support.

Extremely Fast Time to Value

Within 15 minutes of connecting to the MEDHOST network infrastructure, the ExtraHop platform opened up new insights into application delivery.

"Thirty minutes into deployment, we were already getting infrastructure summary pages far beyond anything we ever had before," says Forgie. "Two days into deployment, we were finding low-hanging fruit to drive down error rates and drive up performance for our applications. Within a week, we were improving our own offerings that we go to market with. We've never seen this kind of speed-to-value from a technology vendor. What ExtraHop does is really unprecedented."

Much Faster Remediation

MEDHOST can identify and fix application performance issues more quickly with ExtraHop. Starting with proactive, trend-based alerts to detect poor enduser experience, engineers and other support personnel can easily explore the communications between servers to find the root cause of a slowdown.

"ExtraHop provides holistic visibility into applications and the infrastructure they run on, as well as the ability to compare performance for elements during different time periods," says Forgie. "These capabilities have helped us to save days when troubleshooting complex issues."

The visibility that ExtraHop provides into Citrix delivery has proved particularly valuable. "Healthcare organizations spend millions of dollars on VDI and virtualized application delivery, but need a solution like ExtraHop to make the most of those investments. ExtraHop provides the correlated, cross-tier visibility needed to troubleshoot complex Citrix issues fast," explains Forgie.

Better Visibility into HL7 Activity

Almost every process and workflow — from processing claims, to admitting patients, to conducting medical necessity checks — traverses an HL7 interface. When hospitals experience errors or downtime in their HL7 interface ecosystem, that has an immediate and sometimes very punitive impact on revenue.

When an HL7 interface goes down or performs poorly, identifying the issue and pinpointing the root cause can be extremely difficult — especially since most HL7 monitoring tools are vendor-specific, covering only a small portion of the overall interface ecosystem.

"One of the major HL7 problems my peers see is a 'vendor blame game,' where the interface provider and EHR provider are blaming one another for an issue," says Forgie. "ExtraHop is the source of truth, providing information across silos — so we can have an honest, collaborative discussion around what the problem is and how do we solve it. That can knock two weeks or more off a resolution."