Customers of Modernizing Medicine purchased EMA to help optimize their time for improved patient care and practice management. “To have an application that would be unresponsive would be completely unacceptable to our user base,” said Adam Gresh, Director of Software Engineering. “We couldn't have an application out there where users had to wait five to ten seconds for your average page load. We had to ensure that we were delivering that in a timely way.”
As the company grew, so did the demands on its application, and Modernizing Medicine had to find a way to more efficiently diagnose bottlenecks. This was especially true when new versions of the software were released as no matter how rigorously the code was tested prior to release, real-world conditions often brought about unanticipated use cases that could affect performance.
“We did a major software release and noticed the performance profile of the application had changed,” recalled Gresh. “So we went to the tools that we had in our toolbox and we could figure out where things were slow, but it was extremely labor intensive. We would spend hours digesting logs and trying to pin down the source.” Modernizing Medicine needed to modernize its application intelligence and searched for an application performance management (APM) solution.
Modernizing Medicine is transforming how healthcare information is created, consumed, and utilized in order to increase efficiency and improve outcomes. Its Electronic Medical Assistant® (EMATM), is a cloud-based, specialty-specific electronic medical record (EMR) system with a massive library of built-in medical content. Available as a native iPad application or from almost any web-enabled device, EMA adapts to each provider’s unique style of practice and is designed to interface with hundreds of different practice management systems. Modernizing Medicine provides specialty-specific offerings for the dermatology, plastic and cosmetic surgery, ophthalmology, otolaryngology, gastroenterology, urology, and orthopedics markets, and to more than 1,300 physician practices across the United States.
When Modernizing Medicine researched APM solutions, Gresh indicated that, “the main criterion was something we could deploy into a production environment without impacting performance.” He added, “It's not really helpful to have something to track what's happening in your application if you can't actually deploy it in the real world.”
Built from the ground up for the production environment, the AppDynamics Application Intelligence Platform proved a good fit for Modernizing Medicine. “You can only do so much with load testing. It doesn't tell you what happens in your real environment,” said Gresh. “And so when users are using the application in a way you didn't expect, or the critical path isn't the critical path you believed it to be, you don't have a load test for that.”
After deploying the AppDynamics APM solution, Modernizing Medicine not only continued to gain valuable data in load tests, but could now better understand how new code releases performed for customers. “Having instrumentation in the production environment that lets you see exactly where they're experiencing these slow calls, is a huge leg up,” he said.
The self-learning performance baselines—using intelligence gathered from continually monitoring site response times to adjust performance thresholds automatically—also set the AppDynamics APM solution apart from the competition. “That was another big selling point for AppDynamics,” added Gresh. “Even though on average the application is performing well, it's those outliers that people are concerned about,” said Gresh. “Those are the ones that get you your customer calls. We need those outliers.”
“The biggest advantage to AppDynamics for us has been identifying blind spots,” said Gresh. For example, when Modernizing Medicine customers were experiencing slower connection times, Gresh was able to use the AppDynamics solution to determine the source—an infrastructure, not application, problem—that might have otherwise gone undetected. “It turned out to be a setting on our load balancer,” recalled Gresh. “So we determined the load balancer had reached an artificial limit and we were able to greatly improve performance by changing that artificial limit.”
“We’ve pretty much got it to the point now where we can confidently say within 10 to 15 minutes what is causing the problem,” said Gresh about improved MTTR at Modernizing Medicine. In addition, he said the data provided by AppDynamics has helped his department make more informed infrastructure decisions, “It's been a great go to tool for making arguments against scaling up.” AppDynamics improves infrastructure efficiency while maintaining a low overhead.
The value provided by the AppDynamics APM encouraged Modernizing Medicine to expand its use of the AppDynamics Application Intelligence Platform. The company also deployed the AppDynamics Web End-User Experience Monitoring solution to better understand the UI level on the web. “It's absolutely fabulous that we can go and track by domain,” he said. “And now we're looking of course at the mobile app to see if that can help us determine where you're slow on your native iPad app.”
“I would recommend AppDynamics to companies that are growing rapidly and don't understand where their next scaling limit is going to be,” said Gresh. “I would also recommend it to companies that have currently had software releases that went bad on them—everybody's been there, where you have a performance problem that you just can't figure out.”
Adam Gresh, Director of Software Engineering, Modernizing Medicine
