Zero-Failure Option

West: Yes, they all have the same digital imaging engines, but the two big archives are at the two hospitals; the smaller hospitals send their data to the big ones. Merge is PACS; RIS [radiology information system] and EHR are both Cerner.

A ZERO-DOWNTIME STRATEGY

HCI: What was your strategy in creating this storage innovation?

West: We were the first replicated content management that had been deployed by what was once Emageon. They are now a part of [the Chicago-based] Merge Healthcare. There were two parts of our strategy. One, we determined that, implementing this strategy, if we lost one of the nodes at the large hospital during any kind of disaster or failure, then we could fail over to the node at the other hospital. Our claim to fame, if you will, is that we've never had a ‘severity 1′ downtime at either hospital, since we've never had two failures at the same time, which would be unlikely.

HCI: Was it expensive to do this?

West: It was less expensive than the alternative, which is having your second copy spooled off to tape. Now, they're putting that second copy of the images on a SAN. This is a live copy, you can log into an application. To explain how this works by analogy, it's like having two laptops sitting next to each other, and whatever file you created on laptop A would immediately be sent over to laptop B. So each has its own operating system and its own Oracle database, but the transaction is taking place at the DICOM engine level. It's truly replicated. The other way, with mirrored sites, you still have a down system, just with a second copy of images.

Middle Tennessee Medical Center

Middle Tennessee Medical Center, Murfreesboro, Tenn., is a 286-bed community hospital, the anchor in the five-hospital Saint Thomas Health Services regional health system; Saint Thomas Health Services is itself one of the divisions of the St. Louis-based Ascension Health system, the largest not-for-profit health system in the U.S.

The Saint Thomas Health Services system encompasses more than 1,450 beds. Altogether, more than 575,000 diagnostic imaging studies are performed in the system every year. Murfreesboro has a population of about 100,000, and is located 35 miles southeast of Nashville.

The other aspect of how we created this was that our strategy for purchasing what was the Emageon solution at the time was because of its adherence to open DICOM connectivity; as a result, we have no proprietary DICOM studies at all. And there are no studies that have not been worklisted via HL-7 from the Cerner EHR, as opposed to having a technologist enter in from a piece of paper the patient's name, date of birth, etc. Instead, all of that data is fed into the modalities, CTs, MRs, whatever, into the worklists, so all the header information is now correct.

THERE'S A GEOGRAPHIC FACTOR INVOLVED THAT WE CALL THE GOLDILOCKS SYNDROME, BECAUSE EVERYTHING HAS TO BE JUST RIGHT; IF THE TWO NODES ARE TOO FAR APART, AS WE DISCOVERED IN ONE ASCENSION SYSTEM, THEN CREATING THE CONNECTIVITY CAN BE PROHIBITIVE.

HCI: The doctors have liked this?

West: Yes, very much so.

HCI: As far as you know, are there other multi-hospital systems that have done this?

West: Since we went live, four hospital systems within Ascension Health have done this. This architecture would not fit well if you were a single hospital; it would just be too darned expensive. We were the reference site for Emageon, and Johns Hopkins visited us, and duplicated what we had done.

LESSONS LEARNED

HCI: What lessons has your organization learned from creating this innovation?

West: The lesson learned is that there is a distinct advantage to having the capability to fail over.

HCI: Have you had situations where you would have been down otherwise?