This is part 2 in a three-part series on hardware. Part 3, on device selection, will appear in the November issue of Health Data Management magazine.
As community hospitals gear up their clinical automation efforts and reach out to help area physicians adopt electronic health records, they're taking a closer look at whether their data centers will meet their needs. Many are coming to the same conclusion: It's time to replace their servers and related technologies to better support clinical applications.
"Smaller hospitals have to do exactly the same work as larger hospitals" to prepare for ramping up clinical applications, says Becky Quammen, CEO of the Quammen Group, an Orlando-based consulting firm. As hospitals of all sizes adopt comprehensive electronic health records systems to qualify for incentives under the federal stimulus package, many are discovering that their data centers may not be up to the task, she says.
In addition, some hospitals are helping area clinics adopt EHRs, hosting the applications at their data centers. And this often requires a data center upgrade.
Here are some examples of ongoing projects:

  • Infirmary Health System, which owns five hospitals in Alabama, upgraded its data center as it prepared to remotely host electronic records for independent physicians and roll out a new inpatient and outpatient clinical system.
  • Metro Health Corp. in Wyoming, Mich., recently began hosting records software for area physicians following completion of a major data center upgrade.
  • A recent data center revamp at Regional West Health Services in Scottsbluff, Neb., will help support automation at the delivery system's new 50-physician clinic.
  • At St. Joseph Hospital in Bangor, Maine, a data center enhancement primarily is supporting an inpatient clinical automation effort.

These organizations, and many others like them, are investing in a new generation of data center technologies. For example, they're all using "virtualization" software that creates several "virtual machines" within a server running separate operating systems and applications. Many hospitals also are using blade servers, a box that holds eight to 10 servers. These two technologies are helping hospitals to ramp up their data center capacity using less space and electricity, executives at the organizations say.
Many hospitals also are implementing storage area networks, commonly called SANs, that enable them to share storage space to improve efficiency. The architecture is used to attach remote storage devices to servers in such a way that the devices appear as though they are locally attached to the operating system.

Shifting to Blades

Mobile, Ala.-based Infirmary Health System, which owns a tertiary care hospital plus four community hospitals, recently shifted from conventional servers to blade servers and virtualization software in preparation for a massive clinical automation project.
The delivery system's hospitals, as well as 25 affiliated clinics, will be phasing in clinical software from Epic Systems Corp., Verona, Wis. Infirmary will host the records system for the independent physicians who work at the clinics, says Eddy Stephens, vice president and CIO. It will subsidize part of the cost using the exemptions to the so-called Stark law and safe harbors to the federal anti-kickback statutes.
"As we have grown and added hospitals, our emphasis initially was to standardize protocols of care," Stephens says. "The easiest way to enforce protocols is through clinical automation."
Infirmary Health System installed blade servers from IBM Corp., Armonk, N.Y., equipped with virtualization software. It's also using a SAN from IBM to make better use of its storage capacity. By shifting to blade servers and virtualization software, the provider has avoided having to physically expand its data center, Stephens says.
Infirmary Health System also uses a leased remote storage facility in Jackson, Miss., for backing up files, sending data there daily through a dedicated fiber-optic link.
Metro Health Corp., which owns one 208-bed hospital and 14 clinics serving Grand Rapids, Mich., is taking a similar approach as it gears up its clinical automation efforts. The hospital will shift to Epic software in November, when it phases out an older clinical system from McKesson Corp., San Francisco. Its clinics already use Epic records software, which is hosted at the data centers. Plus, Metro plans to remotely host the records software for several independent physicians, although it will not subsidize the cost, says William Lewkowski, executive vice president and CIO.
Metro Health uses blade servers from Hewlett-Packard Co., Palo Alto, Calif., as well as conventional servers. Like Infirmary Health System, Metro also is using virtualization software. The organization has its own second, smaller backup data center that's set up to assure continuous operations. If the main site goes down, the secondary site automatically runs the applications.
The long-term goal of Metro's clinical automation project is to enable physicians in the Grand Rapids area to access any inpatient or outpatient record using the same front-end system, says Art King, technical support manager.

Growing Pains

Although Regional West Health Services hasn't yet decided whether to remotely host electronic records for independent physicians, it nevertheless has upgraded its data center to support other clinical automation projects.
The delivery system, which owns a 184-bed hospital, recently created a 50-physician clinic by acquiring several area practices, explains Lisa Bewley, R.N. the organization's CIO. Regional West is now shopping for a records system for the clinic. The hospital uses a core clinical information system from McKesson and is phasing in computerized physician order entry.
The Nebraska provider recently spent more than $2 million to upgrade its data center. It uses virtualization software on conventional HP servers, and it has implemented a SAN to meet its storage needs.
"The old data center we built was supposed to last five years, but we outgrew it in three," Bewley says. The biggest challenge Regional West faced, she says, is the electricity demands for the servers, which required more cooling as their horsepower grew.
The organization installed server cabinets to accommodate multiple devices and positioned them back-to-back to ease the need for cooling while using far less space. Working with Syracuse, N.Y.-based CXtec, Regional West also installed simplified wiring called trunking, which groups six cables and makes it far easier to add another server, Bewley explains.
In Maine, St. Joseph Hospital revamped its two data centers while phasing in an inpatient clinical system from Siemens Medical Solutions, Malvern, Pa. It will activate CPOE late this year, says Karen Bowling, CIO.
The hospital is using HP blade servers and virtualization software as well as a SAN. It also runs its own backup center. "The advantage of virtualization is that your dollars go a lot further" by better managing capacity, Bowling says.
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