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Ensuring access to electronic medical records with Stratus^® ftServer^® System

Hachioji Gastroenterology Hospital, a major health care institution associated with Tokyo Women's Medical University, specializes in treating diseases of the digestive system. The well-known hospital completely revamped its information system when relocating to a new facility in Hachioji City.

"Our aim was to maintain efficiency throughout the entire medical operation, and provide a safe and comfortable environment for patients," says Dr. Mamoru Suzuki, director of the hospital. A Gigabit Ethernet network connects the entire hospital, enabling staff to access patient care information as well as financial systems: clinical examinations, medical images, and accounting. The hospital's network also supports filmless digital imaging for diagnostic procedures such as CT scans, X-rays, and endoscopy.

"The key to these improvements in efficiency is the electronic medical record system," says Dr. Suzuki. Not only does the system provide clinicians with records of diagnosis and treatment - as do conventional paper medical records - but it also plays an active role in patient care. Physicians' instructions are transmitted to each department accurately and immediately after diagnosis and treatment. Patients' waiting time in the examination room, at the pharmacy, or accounting office is shortened considerably.

"Of course, mistakes are eliminated. The workload of the medical staff is reduced dramatically. Once it started, it's impossible to go back to the paper system," Dr. Suzuki notes. "If the system were to break down, the effect on the hospital and patients would be huge. The electronic medical record system requires 24 hours of non-stop operation."

The electronic medical record data server must operate at a sufficient level of performance to deal with patients' medical records - as many as 300 to 500 records daily - and with continuous reliability.

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Cure for cluster concerns

Merits Co., Ltd. is an expert at providing medical information systems. The firm's Medical Station application is a highly regarded electronic medical record system for hospitals and clinics, and has been implemented by more than 300 facilities. Merits also integrates and deploys systems on behalf of its health care clients, which include Hachioji Hospital.

Merits first proposed a cluster of conventional servers for the hospital's record system. "At that time, the ftServer system had not yet been released. The cluster system was the realistic choice," says Mr. Nobuhiro Hayakawa, chief of the Merits 2nd System Department, Electronic Medical Record Development 2 Division.

The cluster implementation presented several concerns, however. One was reliability. High-availability clusters require manual operation, as well as recovery time to switch from a failed server node to a working one. Moreover, system implementation and ongoing operation are complicated and require high-level skills. "The operational load is a big concern for hospitals without a full-time person in charge of the system," explains Mr. Hayakawa.

A development system was delivered in spite of these shortcomings. The inherent limitations of the cluster became evident immediately.

"First of all, it took much time to set up," Mr. Hayakawa observes. A minimum of two weeks would be needed. The hardware vendor, a specialist in clusters, required one week to assemble and deliver the product; a second week was needed to install the system on-site. Combined with the other concerns, the lengthy installation process led Merits to conclude that the cluster was not a suitable answer.

Stratus Technologies released its ftServer family before the cluster production system was to be ordered. Unprecedented advantages including continuous 24-hour operation, operational simplicity, and remote system monitoring convinced the system developers and the hospital to make a major change and select the new ftServer system instead.

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Reliability and simplicity in a single server

The main reasons for the decision to adopt the Stratus ftServer system were its continuous availability together with its advanced technology in a single server. The ftServer line is a fault-tolerant family of Intel^® processor-based servers for Microsoft^® Windows^® server environments. A dual modular redundancy (DMR) ftServer model was chosen for the hospital's production system.

If the ftServer system detects trouble in one area of the server, the affected CPU-memory unit is isolated automatically while the server's replicated components continue to operate normally. There is no downtime, no data is lost, and no human intervention is necessary. The source of a problem can be determined readily because management and diagnostic features capture, analyze, and report on system hardware and software issues.

"In addition, its simplicity is also very attractive. The single software image made system development easy," comments Mr. Hayakawa. The operating system and applications perceive the fault-tolerant server's replicated components as a single, industry-standard Windows system. The ftServer system therefore doesn't require the complicated installation or middleware necessary with high-availability clusters. This reduces cost as well because the single server needs only one license for each software component, such as the operating system and database.

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Enabling advanced medical care

After two months of test operation, the new medical record system went into full operation - the same time Hachioji Hospital moved to its new facility. The solution has been trouble-free from its first day of service. The implementation of the ftServer system also led the hospital to upgrade from 100BaseT to a Gigabit Ethernet network, which took place without complications.

"We are realizing the positive effects of the reliability and simplicity of the ftServer system. We want to use it for other medical systems," states Dr. Suzuki. For example, he says that applications for the clinical examination server and other areas are now under discussion.

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