In today’s healthcare environment, computers are typically hardened to meet clinical requirements. Many are outfitted with touch-screen capabilities, have ample battery backup, and are self-contained to prevent contamination. However, healthcare IT departments are increasingly deferring the support of these computers to biomed teams. Suddenly, the biomed team has the responsibility of not only setting up the computer, but also for its long-term care. In this article, I will detail maintenance issues and best practices that biomed teams can follow to help keep the clinical workstation functioning properly.

Disk Management

My 13–year-old son recently said to me, “Dad, we’re running out of space on the F: drive.” Not only did it bring a tear to my eye that my little boy could figure this out, but it also highlighted one of the most basic indicators of PC health: disk size, free disk space, and the percentage of disk space used. Via the Windows File Explorer, click on “Computer” and you can see the total size of your hard drive and how much space is remaining. This ratio is important for your home machines and your clinical machines.

Clinical workstations in today’s medical spaces contain a lot of data that sits on the hard drive— from medical images and reports to databases and HL7 data. Look over the free space of the clinical workstation: Does the C: drive need more space? If so, there is an easy fix. You can add a secondary hard drive and place the database there, or add a network drive or dedicated folder on the C: drive. Make sure that the doctors and nurses place images or reports on their home drive and write a Windows PowerShell script that moves old reports or images from the dedicated folders to network storage.

PowerShell

PowerShell is a command-line scripting language. It sounds complicated, but PowerShell is a descendant from the old DOS commands that we used before Windows XP. These commands will be very familiar to those who tinkered with Windows years ago (before it turned into icons and start menus).

By using PowerShell and Windows Task Scheduler, you can program the daily IT tasks you need to perform. With some Internet searching, you can write a few lines of Power Shell code, save them as an executable file, and schedule. Some popular topics that you could script include retrieving disk size, pulling the event log and copying it to another computer, and rebooting the workstation at a specific time. Once you have these tasks figured out on one workstation, copy the scripts to all your workstations.

Again, PowerShell is a powerful command-line tool. I would recommend that you start by searching for some basic topics and implementing them. When you feel comfortable, expand and add more complicated tasks to make your life easier.

Event Logs

Every crime show has a police officer gathering evidence. When dealing with computer workstations, the “evidence” is the logs. With Microsoft’s operating system, the logs are stored in the Event Viewer. If you look in Microsoft’s Computer Management (right click on the Computer and you will see the “Manage” selection) you will see the Event Viewer. This tool has grown in importance as well as complexity.

Clinical Workstations_Figure 1

Accessing the workstation’s event log can reveal problems with the computer hardware and applications.

When I check over the health of a workstation, I look at the Application, Security, and System folders. The Application folder will show issues or forthcoming issues pertaining to Microsoft applications like SQL server, Outlook, or Office. The Security folder will show problems with your computer or your application, and the System folder will detail any issues with the operating system or hardware.

Looking over errors in the Event Log can be frustrating, as the record may not point directly to the source of a problem, but rather indicate the time when something happened. The details can also be very technical. That’s why I like to search such topics online to see if the offending issue is relevant or not to my problem before I spend a lot of time trying to resolve it. You may need to interface with your IT department because some concerns may be related to network problems that are outside your control.

Vendor Logs

Vendor logs are similar to Microsoft Event logs, though they relate to a specific third-party application or hardware product. A good example is the log for your antivirus application, which will detail updates, report infections, and record the last time you ran a scan. Vendor hardware logs will detail any issues found in your hard drive, network card, or video card. These vendor-specific logs usually provide more detail than what you would see in the Event Viewer, which can help during troubleshooting.

System Resources

As a technician, you should periodically monitor the resources that a workstation is using, including hard drive space, network bandwidth, memory usage, and CPU utilization. These metrics can be viewed via the Windows Task Manager.

To bring up the Task Manager, select CTRL+ALT+DEL, then select start Task Manager. The Task Manager has several tabs. The Applications tab displays the currently running applications. If you came to the tab to look for a nonresponsive application, this is where you can close a hung-up application.

Clinical Workstations_Windows Task Manager

Metrics like hard drive space, network bandwidth, memory usage, and CPU utilization can be viewed via the Windows Task Manager.

The Process tab details the background processes running on the system. These processes are initiated without you even knowing it. You can click on the header of each column and sort the column accordingly. If you click on the memory header, you will see the application that is using the most memory.

The Services tab displays your running services and the associated Process Identifier (PID). The PID is useful if you need to kill that process from the command line. The Performance tab gives a graphical representation of CPU usage and memory usage (basically showing you how hard your workstation is working). It will point to either your memory or CPU if you are having a problem.

Finally, the Networking tab displays your network utilization and the Users tab shows all currently logged-in users.

Visual Inspection of Hardware

Nothing beats visually inspecting the hardware. You can solve some problems just by looking over the workstation, which can catch issues like inserted USB drives (which prevent the workstation from starting) or accumulation of excessive dust in the fan. I have seen workstations that don’t work due to loose cables, missing peripherals (mice, keyboards, CD-ROMS), and damage to the device (touchscreen scratches, CD-ROM drive door malfunctions, and faulty power cords).

But I have also seen devices not working due to third-party issues such as employee negligence (coffee spills, slamming hands on the device) and environmental issues (humidity or overheating of the space). These types of issues won’t be solved remotely. They need to be seen and corrected on the spot.

Software Updates

Software updates are usually the responsibility of the IT department, but with the workstation now being defined as a medical device, the responsibility of updates often falls to the biomed department. This is where I start to emphasize having a good relationship with your IT department. How does IT push out updates? Does IT use an update server or do machines download their own updates? Who is responsible for patching the workstation? Is it the biomed team, IT, the manufacturer, or the third-party vendor? What about the operating system and third-party updates? Work out the relationship with your third-party vendor and IT team to see who performs these application updates.

Security and Passwords

Simply put, passwords are the keys to the workstation, which may have sensitive information valuable to cyber thieves. Again, you will have to work closely with IT to determine your facility’s password policy. Is the workstation on the network? If so, how often does the password need to be changed? Is the workstation in a public area and, if so, who can log in? Is there a generic (kiosk) account for the device, and if so, who has access?

Security goes hand-in-hand with passwords. How much access does an account have once it logs in? If a kiosk account logs in, what applications, file shares, and Internet access is the user allowed? Are the user names and passwords kept in a secure place (and not on a sticky note next to the monitor)?

Since a workstation may be in a public space and many people may have access to it, verify that the workstation follows your facility’s policy on antivirus/antimalware software and firewall usage. These precautions are your workstation’s insurance. Not only do you need to ensure that your device has the proper protection, but also make sure that it is up to date with the latest virus definitions.

Backup

My first IT boss gave me two pieces of advice about my job. Number one: Keep up the device. (And if you are vigilant about the topics discussed above, you are well on your way to doing so.) Number two: Back up.

I cannot emphasize enough the importance of backing up your data. Does your workstation contain sensitive information? Is your workstation performing a critical function? Does it need to be up 24/7? What are you doing to ensure that the device’s information is being properly captured? Is it being copied to a network-share drive that is backed up via the facility’s backup process? Is there a database on the workstation that needs to be copied periodically to ensure the data is not corrupt? And if the workstation crashes, how will you bring it back up? Do you have an image of the hard drive in case of a disaster? Do you have a service contract with the workstation manufacturer for hardware replacement?

These topics are not new concepts, and they can be researched online with ease. Google “Task Manager” and you will find a multitude of ways to customize and evaluate the data it displays. What I have presented here is a group of topics that you, as a biomed professional, should know about.

From a support perspective, I have seen many technicians look at just one of these topics, such as hard drive space, but ignore something critical like backup. Some technicians always remote in to a workstation and never physically look it over. Take all these topics and apply them to your workstations, and see if issues decline and performance improves.

Joe Mitura is a systems and network administrator and IT technical trainer at Draeger Medical. For more information, contact chief editor Jenny Lower at [email protected]

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