7 Tips to Fix McKesson Paragon & Citrix

Five weeks into remediating a McKesson Paragon EHR deployment on Citrix it has become clear that the challenges we are helping this regional healthcare organization through are not unique problems in the McKesson Paragon healthcare community.

With that in mind, here are some basic tips that might help you if you find yourself in a difficult environment with Citrix, Paragon, HPF or now McKesson Patient Folder (MPF), webstation, nTier, etc.

1. Get an assessment of the current state of your build.  This Assessment does not have to be some super fancy 3^rd party deliverable, if you have the expertise in house.  From our experience there are multiple perspectives on each issue and where and who the problems “really” are.  What the actual problems are, what the root cause is, etc. is subject to early-diagnosis syndrome (EDS.) EDS is when well-meaning staff take the first signs of some success at resolving a problem and circulate that information before it can be vetted.  Shoot first, test and confirm later is a good way to lose credibility with executive management and key staff that want to celebrate wins just as bad as you do. 
2. If your support infrastructure is not broken, this one will not likely mean as much to you.  If there is not process for the way support is handled at your organization, this might help a bit to get you going.  Get a single triage point and assemble a team that can tackle the issues from multiple angles simultaneously.  We divide issues into McKesson Financial, McKesson Clinical, and IT.  We assign specialists to address challenges in their respective category, reporting problems, issue resolution and provide updates back to the team.
3. Get a rock solid test environment.  Keeping this environment up to date will allow clinical staff a place to train, practice and get up to speed, allow changes to be tested and allow for new versions and upgrades to be vetted before being sprung on the live environment.
4. Don’t touch the jobstream.  Don’t do it.  If close fails, call McKesson, they will gladly help you.  Setup alerts to notify you in the middle of the night when there is an issue.  Problems here are solved by working through each new issue nightly until you eventually arrive at a stable, reliable close process.
5. Medical Records should not be printing out of Paragon; this can be a patient safety issue for reasons that will be obvious if that is what you are doing today.  HPF is your friend for printing.  Get it setup in Citrix and print away.
6. If the Citrix infrastructure is not working properly, McKesson Paragon will not work properly.  Period, end of discussion.   Typically we see printing issues where clinical staff move from location to location but their ability to print to the correct printer does not move with them.  We see profile problems; we see slow logins and sluggish response.  
7. Even in a Citrix environment, a full PC with Paragon on it in each major department can come in handy if your Citrix environment is sketchy and subject to frequent downtime.  The best answer is to find someone to get Citrix right and redundant.  Plan B would be to use 1 full blown PC in key areas to make sure work can continue in an outage situation.