NYC Health + Hospitals Improves Patient Care With Full-Stack Observability

Key Challenges

Lacking visibility into its many systems and data streams, the team found itself in reactive mode trying to find and resolve performance issues before they affected clinicians or the patient experience.

Key Results

NYC Health + Hospitals continues to accelerate and improve clinical services, from time-sensitive radiology readings to bedside ventilators in its emergency facilities, improving care for millions.

With over a million New Yorkers relying on NYC Health + Hospitals for fast, reliable services, IT performance could be a matter of life and death.

NYC Health + Hospitals doesn’t just serve America’s biggest city. It is the largest public healthcare system in the country. Spread across more than 70 locations, its 43,000 healthcare professionals serve 1.1 million people across New York State in over 200 languages.

Despite the scale of its operation, NYC Health + Hospitals is committed to making healthcare fast and accessible for every patient and to empowering its clinicians with accurate and reliable digital services. In fact, nine of its facilities are certified by Planetree International for excellence in person-centered care.

Modernizing America’s largest public healthcare organization

The organization’s biggest challenge is to keep operations that underpin lifesaving services running 24/7. The stakes are incredibly high. Even a short outage might force ER staff to divert patients to another emergency facility, delaying treatment and adding stress to an already overburdened system.

“We provide care to every New Yorker, regardless of their ability to pay, their condition or their citizenship status,” explains CTO Jeffrey Lutz. “If our services go down, we let them down, and that’s not an option.”

Adding to the complexity for NYC Health + Hospitals is the rise of mobile devices and technologies like Artificial Intelligence (AI), which have unlocked new opportunities for fast and effective care but also placed major demands on the organization’s IT environment. In the past, the enterprise operations center charged with monitoring NYC Health + Hospitals’ systems could be overwhelmed by thousands of alerts each day. Lacking visibility into its many systems and data streams, the team found itself in reactive mode trying to find and resolve performance issues before they affected clinicians or the patient experience.

“Our clinicians expect on-demand technologies to perform their jobs, and our patients expect on-demand access to digital healthcare services, especially as they receive more care remotely,” says Lutz. “To support them, we needed to expand our monitoring capabilities and get more proactive about the way we manage our IT operations, from our infrastructure to our end-user services.”

Outcomes

Accelerates and improves life-saving clinical services and patient experiences
Reduces network downtime by identifying and resolving slowdowns at the source
Empowers clinicians to adopt powerful cloud and AI healthcare solutions

Better digital experiences built to improve full-stack observability

With a mandate to improve observability across the IT stack, Lutz and his team brought in AppDynamics and ThousandEyes and set out to meet three business objectives: adopt a more proactive approach to performance monitoring across NYC Health + Hospitals’ network and public internet, improve digital experiences for staff and patients, and reduce the time required to identify and resolve IT issues.

“Network issues can come from anywhere. An application, an anti-intrusion security protocol, a carrier, or another element of our complex IT environment,” says Lutz. “The full-stack observability we get with AppDynamics and ThousandEyes enables us to trace slowdowns to their source, understand their cause, and address them right away.”

For instance, Lutz and his team noticed that staff trying to gain VPN access to its ServiceNow application via one of NYC Health + Hospitals’ data centers experienced slow load times and latency. Meanwhile, those going through its second data center site had no issues. Using AppDynamics and ThousandEyes to cross-correlate performance between both data centers, the team pinpointed and resolved the discrepancy before clinicians felt any service interruptions.

“Our staff depends on a number of critical SaaS applications to do their jobs. The most gratifying part of working with Cisco is that we get to improve their experience each day and see that translate to better care for our patients,” says Lutz.

Our staff depends on many critical applications and devices to do their jobs. The most gratifying part of working with Cisco AppDynamics is that we get to improve their experience each day and see that translate to better care for our patients.

Jeffrey Lutz Chief Technology Officer, NYC Health + Hospitals

Seeing the big picture of digital care

The ability to overlay and understand performance data across NYC Health + Hospitals empowered Lutz’ team to refine its monitoring and support the organization as it adopts new technologies to power its services.

For example, radiologists previously ran into performance issues with their Picture Archiving and Communication System (PACS), which is provided by a third-party vendor. Speed is of the essence when it comes to imaging, as delays not only affect radiologists’ productivity but also force patients to anxiously await the results of major tests like MRIs and PET scans.

Today, Cisco ThousandEyes allows Lutz’s team to see if performance issues stem from the network or one of its internal systems. When issues originate within the application environments, AppDynamics gives Lutz and team quick visibility into the root cause of slowdowns. In one case, the solution revealed that a recurring latency issue, which had long been attributed to network troubles, was in fact caused by an overloaded CPU in one of NYC Health + Hospitals’ application servers. Lutz and his team quickly addressed the issue.

Making care more accessible to more people

Most importantly, improved PACS monitoring and faster resolution times empowered radiologists to work remotely while treating more patients across multiple NYC Health + Hospitals facilities. Remote treatment is not only more efficient and economical, but it also makes care more accessible to more people across the state.

“The fact that our radiologists can reliably read and assess PACS imaging from any location is a game changer. The reliability of this system would not be possible without our integrated Splunk AppDynamics and Cisco ThousandEyes dashboards,” says Lutz.

With its investment in Cisco’s full-stack observability solutions, NYC Health + Hospitals not only improved its current standard of performance monitoring and patient care. It positioned its staff to continue embracing new healthcare technologies in the future. That includes AI, which promises to revolutionize the way clinicians diagnose, treat, and communicate with patients.

For Lutz, NYC Health + Hospitals’ relationship with Cisco is instrumental to that journey. “I’ve always been impressed by Cisco’s willingness to partner with us. They don’t just sell us technologies. They want to understand who we are as a business and where we want to go,” he says. “Best of all, they know how to get us there.”

The full-stack observability we get with Splunk AppDynamics and Cisco ThousandEyes enables us to trace slowdowns to their source, understand their cause, and address them right away.

Jeffrey Lutz Chief Technology Officer, NYC Health + Hospitals