1 The Long Jump to Build Epic Printers in SoftPresented by Michael Camp & James Shin
2 Epic Passed the printing torch
3 Leaping towards successJesse Owens In 1936 he leaped 8.06 m (26.44 ft). This record stood for 25 years. Building Epic printers felt like we were just like Jesse Owens, soaring through the air.
4 Quick OverView of JHH PrintingApproximately 3,000 printers built in Soft and VPSX – (Lab and Epic) Around 1,700 are USB Tethered to a computer Zebra Printers are used for nursing floor printing A majority of the lab printers are Datamax (3 different models)
5 How are Epic printers connected?
6 3 types of epic printer connectionsUSB Tethered Printer Epic’s most common connection Requires that you know the Computers host name and Domain Installations of VPSX windows client on computer 1700 Epic printers installed this way
7 3 types of epic printer connectionsEthernet(IP) connected Epic’s second most common connection at JHH Requires IP of printer device 1000 Lab/Epic printers setup this way
8 3 types of epic printer connections (Cont.)Wireless Connection Requires ip of printer device Hostname can be used to stabilize internet on the device. (Used when internet drops from device because of Access point transfers) Switching of subnets JHH has 250 of these Epic printers in operation
9 Zebra Label configurationEvery wireless zebra printer had to be updated with a soft configuration file. This prevented the zebra printer from printing 4 blank labels with each order ^XA ^LT-030 ^JUS ^XZ
10 Soft/VPSX setup up for the Epic Printers
11 EPIC PRINTERs within SOFt SECURITYPrinters do not need to be checked off in Soft Security. For troubleshooting purposes they are checked off to send a label across from Soft.
12 Label naming changes Initially all of the Soft printers were setup with in VPSX with an underscore _. BAA_BMC_Burnunit Epic could not accept the underscore and needed us to replace it with a Dash – BAA-BMC-Burnunit
13 Naming Format Spread sheet shared by Soft/Epic and IT departmentusing Spread sheet shared by Soft/Epic and IT department IT played a vital part on getting all of the Printer information
14 Lab Naming convention useda numerical character first for lab, unique to the hospital Johns Hopkins Ex. 1AA – JHH Lab Suburban, ex. 2AA – Suburban Lab Bayview , ex. 3AA - Bayview lab Sibley, ex. 4AA – Sibley Lab Howard, ex. 5AA - Howard Lab
15 Epic Naming convention usedan alpha character would be first for Epic printers, unique to the hospital Johns Hopkins Ex. jAA/kAA – JHH Lab Suburban, ex. sAA – Suburban Lab Bayview , ex. bAA - Bayview lab Sibley, ex. mAA – Sibley Lab Howard co., ex. HAA - Howard co. Lab
16 VPSX SETUP IP connected SetupKeep the Printer Name and Printer Long name the same Have the correct CommType for correct IP Address. The Remote Port should be adjusted for the connection setup
17 VPSX SETUP Hostname/domain name setupKeep the Printer Name and Printer Long name the same but add the Printer Group to the printer name IPP should be used for Host/Domain configuration. It can be encrypted and allows access control. The Remote Port should be 5631 for the connection setup
18 WIRELESS Connected PrintersVPSX SETUP WIRELESS Connected Printers CommType should be ZPL for all Zebras and Port 6101 is used for all wireless devices.
19 Installation of vPSx WINDOWS Client
20 Troubleshooting vPSx WINDOWS ClientPlease make sure all printers and devices are turned on. Virtual printer selected FAIL Client deactivated
21 Remove unused printers formatsAdditional changes Remove unused printers formats We have 7 different label formats but would like to make it one or two. We will be exchanging all of the Datamax printers for Zebra printers.
22 Trouble Shooting printing issuesCheck if device is on. Check if device cable is plugged in to port/USB. Check if to see IP/Hostname has changed by Pinging the IP/Hostname. Check the VPSX client and assure it is active. Check the VPSX client to assure it has the correct printer selected
23 How Epic users send prints
24 LABEL SETUP TABLE (TTY PRINTING)Epic printers were setup in Soft under the Label setup table with Soft
25 Label setup table benefitsEasy to setup within Soft takes minutes Some modification to interface is needed Printing is contained within Soft Required little additional setup from epic builders (TTY Names for Terminal) Epic Users cannot select the incorrect printer
26 Label SETUP TABLE ISSUESTakes ~30 to 60 Seconds for a label to print (very consistent) If a label printer broke the nursing unit didn’t have another Printer to switch to. Patient’s would change wards and the labels would print to the correct location
27 Epic’s New way of printingWe removed the epic printers from the label printing setup for a user selection printing option. Similar to Soft’s User selection printing
28 Benefits of user selection PrintingUser can print to any printers in the list Works great with mobile handheld printers Patient ward changes didn’t affect where labels would print
29 Issues with Epic user selection PrintingDelays in label printing due to interface message hisoe(10 seconds to 7 minutes) Users selecting incorrect printers Users scanning barcode before messages are sent from Epic to soft back to epic Users not having the printer on in order to get labels
30 Issues with Epic user selection printing7 minute labels Prints REALLY?!?!? The Cause? Epic’s morning draw released at 00:35 consisted of 1600 orders sending to Soft at once
31 Issues with Epic user selection printingBarcodes that took more than 60 seconds to print for Epic users
32 Issues with Epic user selection printingTime of day # >60 sec % 00:00-00:34 72 2.12% 0:35 1619 47.65% 00:36-00:40 155 4.56% 00:41-01:00 170 5.00% 1:00 101 2.97% 2:00 77 2.27% 3:00 132 3.88% 4:00 84 2.47% 5:00 62 1.82% 6:00 46 1.35% 7:00 24 0.71% 8:00 51 1.50% 9:00 39 1.15% 10:00 98 2.88% 11:00 49 1.44% 12:00 69 2.03% 13:00 59 1.74% 14:00 74 2.18% 15:00 16:00 41 1.21% 17:00 68 2.00% 18:00 45 1.32% 19:00 31 0.91% 20:00 64 1.88% 21:00 34 1.00% 22:00 40 1.18% 23:00 22 0.65% Total 3398 100.00%
33 Printing Jobs falling to the wayside
34 The Interface printing lineThe Famous Epic Print Button Soft Epic Receiving Interface (1) Soft HISOE Interface (1) Soft Label Server Interface (2) Specimen Label Prints Designated Epic Label Printer VPSX
35 Epic Printers are defined in ORC-18 Within HISOE14:57: read fd=14 <\11/MSH|^~\\&|EPIC|JHM|JHH SOFT|ALAB| |EPI C-IPRN|ORM^O01| |T|2.3|||\rPID|1||SH ^^^& &ISO^^& &ISO|E |RLBTEST^PATIENTD|HELEN^ ^^| |F|||1928 LANCASTER ST^^BALTIMORE^MD^21202^USA|30|(479) |||M|| | ||Tstmom^Helen^^|||||||||||\rPV1||I|SH-4300|||^^|James Shin^^^^^^^^^^NPI| ^James^SHin||IM||||||| ^ABBASI^ ABDUL^^^^^^^^^^NPI|| ||||||||||||||||||||||||| ||||||\rORC |NW| ^EPC|| |||^Once^^ ^ ^R^^Standing^^^^1|| |IPRN||James Shin^^^^^^NPI& &ISO^^ ^^NPI|SH-4300&SH ADULT MEDICAL 4300&OBDEPID^^^110500^^^^^|(301) ^^^^^301^ ||||BAA-BMC-BRSTLLB|||||||||||I|VERBAL WITH|||\rOBR|1| ^EPIC^ ^ISO||CNTU^CHLAMYDIA / N.GONORRHOEAE / TRICH COMBO NAT, URI NE^SHSOFTEAP^^CHLAMYDIA / N.GONORRHOEAE / TRICH COMBO NAT, URINE|| |||||O||||URINE,OTHER^^^| ^ABBASI^ABDUL^^^^^^^^^^NPI|(301) ^^^^^ 301^ |||||||Lab|||^Once^^ ^ ^R^^^^^^1||||||||| |||||||||\r\28/> len=1184
36 Hisoe Interface delay The 1600 epic label prints were being delayed in the HISOE interface. only one HISOE interface was processing the messages. Routing orders to 10 HISOE by ENDING MRN NUMBER
37 Printing jobs were Routed to the correct HISOE lane
38 HISOE INTERFACE Delay The Solution for hisoe delay routing orders to 10 different HISOE interfaces based on the ending MRN number
39 Routing HISOE InterfacePre HISOE FIX Post HISOE FIX Send to file # of Labels % <=30 sec 11178 71.91% 31-60 sec 2277 14.65% 1-2 min 535 3.44% 2-5 min 332 2.14% >5 min 1222 7.86% Total 15544 100.00% Send to file # of Labels % <=30 sec 7781 73.81% 31-60 sec 1536 14.57% 1-2 min 340 3.23% 2-5 min 188 1.78% >5 min 697 6.61% Total 10542 100.00%
40 Today’s Epic printing time<30 seconds on ~99% of label prints >31 seconds 1% of labels prints due to outliers such as User not having printer on or plugged in The order is locked by the user making modifications
41 Lessons learned Try to do a stress test to ensure that interfaces can handle bulk labels Soft’s Mom might need to be adjusted to handle more messages Test each printer connection setup VPSX windows client should be tested with VPN and without VPN Spot check/test VPSX before doing a bulk load Any information can be wrong leading to thousands of manual corrections (I.E. REMOTE PORT) Spot check/test printers (Soft Security) Extra characters or spaces can cause printers to not work
42 Questions