|
Reprints
TRADITIONAL DATA CENTERS ARE GOING TO START TO HAVE A MUCH SMALLER FOOTPRINT THAN THEY DO TODAY, AND WE ARE GOING TO START TO SEE THEM GO AWAY.-RUSSell p. BRANZELL
Just prior to the flood, Columbus Regional participated in a multi-county disaster recovery drill based on a potential terrorism incident. The hospital is now expanding on the command center model that was developed then. One of the biggest lessons of the flood had to do with the role reversal: hospitals traditionally receive disaster victims, but are not usually victims themselves. “That was a huge turnaround for us,” she says.
REACHING UP TO THE CLOUD
Interestingly, even though Columbus Regional has successfully completed and relocated its new data centers, which it operates, it plans to move to remote hosting of its electronic health record (EHR) system when the hospital moves to Kansas City-based Cerner Corp. from its current vendor next summer. (The hospital will continue to host its own PACS and financial system.) Boyer says she is comfortable with the decision, noting that the hospital has successfully hosted its lab system remotely with Cerner for six years. Financially, remote hosting makes sense, saving the hospital the costs of buying and maintaining its own hardware and maintaining an Oracle database, she says.
The decision is part of a trend in which cloud providers, application service providers, and other third-party relationships are becoming an increasingly important partner with hospital IT departments when it comes to storing and processing data and housing hardware.
Case in point: Good Samaritan is a member of the Indiana Network for Patient Care (INPC) in Indianapolis, part of a service for the Indiana Health Information Exchange that acts as a repository for clinical information. When an HL7 registration for a new patient hits the INPC server, it returns clinical histories for each individual patient, providing the physician with the patient's history. Christian says Good Samaritan is now planning on using the service as a disaster recovery tool, which he describes as a secondary on-line ready access to the EMR. “We are already paying for the service, so we can add value to that expense by providing access to a clinical record in case we have a failure,” he says.
Poudre Valley's Branzell believes the cloud is going to be a game-changer for the entire applications market. “Traditional data centers are going to start to have a much smaller footprint than they do today, and we are going to start to see them go away,” he says.
That's not to say that the trend does not bring its own concerns. Every healthcare data center in the country has some single point of failure, Branzell says. In his own experience, he realized that Poudre Valley had dual grid power, both going through the same switch. “No matter what you do, there is some place where you have got something goofy, where you have got a single point of failure,” Branzell says.
Single point of failure is becoming increasingly important as more solutions become cloud-based or application specific provider-(ASP) based, Branzell says. “If all of my transcription services are done in Boston via a cloud solution or a Web solution, and I can't get to that, how do I do my transcription?” he asks. That concern has led him to seek lower bandwidth alternative paths to its Internet service provider that can be used as a failover. Poudre Valley's imaging is an ASP-based solution through Phillips; however, it also stores 90 days worth of images locally, as a backup.
Bruce Smith, senior vice president and CIO of Advocate Health Care, Oak Brook, Ill., notes that the IT environment has become extremely complex over the last 30 years. In October 2009 the organization was evaluating a hardware and software upgrade that was going to cost in the $20 million range, and decided to contract with Cerner's cloud services, including its main EMR, physician order entry, clinical information retrieval, laboratory results and radiology results, and disaster recovery. “All clinical information for inpatient, outpatient, and the ED is maintained through this system,” he says. Advocate still maintains some systems separately, including registration and billing, as well as the EMR for its physician group and independent physician offices.
Smith says the decision to use the cloud was based on a combination of business issues, and the timing of the upgrade was one of the deciding factors in deciding to use Cerner's cloud service. “We asked ourselves if we really wanted to make this hardware investment that we would have to replenish in 10 years, or just bundle the stuff into an agreement,” he says. The hardware covered in the agreement includes a Citrix server farm, which Smith says is difficult to maintain, and a secure state-of-the-art data center that is protected against class 6 tornados. Cerner's two data centers are located 20 miles apart in the Kansas City area, one for primary use and the other providing backup.
