“You’ll have to call back in an hour,” the receptionist said, and I could hear other phones ringing off the hook in the background.
An hour later, I tried again and got the same harried receptionist, stuck without a network and a way to schedule appointments.
For me, it was a slightly annoying – calling and calling and calling again, only to make an appointment for a checkup I’m reluctant to get anyway.
Multiply my frustration with the number of patients both coming in for appointments that can’t be carried out, and patients who can’t cancel, reschedule, or make appointments. Add to that the frustration of patients calling for any number of other reasons: change insurance plans, get lab results, or consult their physician about a health issue.
All of this patient angst, however, pales in comparison with the headache a server fault brings upon the medical office personnel. The doctors, nurses, and administrators are all brought to a halt, helpless to do anything without access to their scheduling system, email, or their electronic health records.
Unfortunately, it happens all the time. Downtime disrupts business, costs time and money, as well as the reputation of the office. Comment below, or send us a tweet at @Stratus4uptime if this has happened to you, and how you manage your business’ uptime.
Today, your Danskos are going to power over the linoleum floors, moving from patient room to patient room. In a sea of charts, beeping machines, gurneys and meal carts, you know that one small misstep can set back your whole day.
It isn’t a large leap, then, to understand that one lapse of even a small amount of downtime for the a hospital’s electronic health record (EHR) system can bring the entire hospital – staff, patients, and machines alike – to a standstill.
Ten years ago, when doctors and nurses used paper charts, the risk of inaccessible data was low, as was the level of efficiency. Aside from the occasional misfile or lost folder, patient medical histories were never completely unavailable. Electronic medical records have done wonders to streamline accessibility to patient information, but they also created vulnerability and a single point of failure in the server.
Click here to learn how Alice Peck Day Memorial Hospital prevents downtime.
The HITECH (Health Information Technology for Economic and Clinical Health) Act, however, demands “meaningful use” of technology in healthcare environments, with a $2 billion incentive behind it. Designed to make the exchange of healthcare information between healthcare professionals easier and more accurate while improving the level of care patients receive, the bill strongly encourages healthcare practices to adopt EMR .
Once the tedious process of data entry and document scanning is complete, medical practices can reap the rewards of a paper-less system, but that efficiency comes with a catch: If the EHR system goes down, medical records are as good as gone. As a result, protecting servers and applications from downtime becomes paramount.
Alice Peck Day Memorial Hospital , a 25-bed hospital in the northeast, implemented virtualization technology with high availability software to address concerns over medical records accessibility. To see their prescription for success, read the case study.
At Software Advice we hear often from individuals who are looking for an EMR for a particular specialty. We decided it would be useful to go out and interview those within one specialty, Ophthalmology, who had strong opinions on what characteristics were the most important to look for in an EMR solution. I spoke with four ophthalmologists and a practice manager to research this piece. Here are the major takeaways.
1) It’s important that your solution can handle large image files efficiently.
You probably already know that ophthalmologists deal with lots of very high-resolution images of the eye. Since the file sizes for those images can be quite large, without the right solution your image files could slow down the rest of your EMR system. Dr. Dean Calson of Eye Associates of Colorado Springs told me that his system allows him to run his images off a second server, eliminating any possible competition for processing power between his images and the rest of his EMR. Dr. Valla Djafari of the Texas Retina Institute, on the other hand, noted that his Web-based EMR allowed him to use the wireless network of whatever office he was working at to easily access the files he needed. As a more mobile doctor who worked at multiple locations that referred patients to him, he stressed the ease of the Web-based option for its convenience as well.
2) Interconnectivity with eye measurement tools is key.
If your EMR platform can connect directly to your testing equipment, your life will be made a lot easier. Dr. Byron Tabbut of Wheaton Eye Clinic mentioned that having all information available from one source–your EMR–can save you from “having to hunting and pecking all over” for data from various different places.
On the topic of interconnectivity, here’s a useful tip that one ophthalmologist, Dr. Walter Harris of Rittenhouse Eye Associates, shared. It’s related to pricing questions you should keep in mind when speaking with vendors:
“It’s worth the money for a system to be able to intersect with your testing equipment. But different companies will charge differently for this ability; one might offer an unlimited option, while others might charge you per piece of equipment.”
Dr. Harris recommended asking each vendor about the pricing structure of the feature, and also suggested having a list of all your exam equipment in hand when you meet with vendors.
Having just returned from the eClinicalWorks Northeast Users Conference – a really helpful and informative conference of 1200 enthusiastic users – the IT challenges that face small to mid-sized EHR practitioners were never so apparent. Unlike larger facilities and hospitals with IT staffs and expertise, the small practitioners are jumping on the EHR bandwagon without a parachute – in otherwords moving to an EHR system which, no matter how great the software is, is going to fail.
Why is that?
A standard computer is not designed for high availability and is going to fail. That’s annoying if it’s your family pictures on the disk drive that crashed, and having your data backed up is critical. It’s different however for EHR – your system is down, the records are not available at the point of patient care, back up data may not be current and introduces the very risks that EHR is supposed to avoid like prescription error, false diagnosis, never mind lost appointments, lost productivity and costs.
Larger facilities who understand IT design their systems with high availability to reduce or eliminate the risk of system downtime in the first place. Stratus helps them do so and, as we discussed last week, we can help small and mid size practices also implement uptime assurance for their EHR systems to avoid the risk of system downtime to their patients and their practices.
It’s like health care really – yes, go to the doctor when you are sick and take your medicine (back up and recovery), but focus on preventive medicine (Stratus and uptime assurance) and not be sick in the first place.
speak at the Microsoft Connected Health Conference in Chicago this week, where Stratus was among a number of Microsoft partners sponsoring this event. This was a well received conference with good insights on technology and services. Talking with practitioners and other partners also laid bare some limitations with Microsoft products – and why Microsoft embraces their healthcare partners so readily. A few important gaps in healthcare IT are solved with Stratus capabilities in line with key Microsoft products:I had the chance to
Microsoft SQL Server: It is the foundation of just about every EHR system. And few if any practice under 25 doctors or 100 users need Enterprise edition. However the Standard edition does not support high availability. So many practices that ask for high availability see their costs skyrocket because of this, along with the other costs involved with Windows Clustering. And yet many of these practices don’t have the IT expertise to install and manage Windows Clustering in the first place. The result? Most small to mid size EHR installations have NO high availability and are extremely vulnerable to these systems going down.
Answer? Stratus Avance and Microsoft SQL – provides high availability for any version of SQL Server, ease of implementation and operation so little IT knowledge is needed, and far lower costs to make this approach much more affordable to small and mid size practices.
Microsoft BizTalk: Is widely deployed for information exchange requirements so think HL7, EDI, CPOE, etc – critical healthcare applications which need to be available. Downtime for these systems can have serious consequenses. BizTalk is widely deployed for these kind of critical data interchange needs yet isn’t really supported by Windows Clustering – talking with several consulting partners who specialize in this area it’s a critical application need that doesn’t have a viable Microsoft high availability solution.
Answer? Stratus Avance or ftServer and Microsoft BizTalk – viewed as a single system, either of these Stratus solutions provide higher availability than Microsoft Clustering could hope to achieve, and give a powerful, yet cost effective solution for BizTalk high availability.
Microsoft has it right with it’s partner ecosystem.
Columbia Memorial Hospital serves more than 100,000 residents in the Columbia, Greene and Dutchess counties of New York State. The hospital focuses on advanced surgery, primary care and health education. It is a 192-bed acute care hospital, operates a 120-bed long-term care site as well as 26 outlying primary and specialty care centers.
It is also an innovator in using healthcare IT to improve the quality and access to patient care in its community.
And for that, it has been named a Laureate by the prestidious Computerworld Honors Program, which recognizes organizations and individuals who have used information technology to promote and advance public welfare, benefit society and change the world for the better.
We’re especially pleased that Stratus, and our partners eClinicalWorks and VMware, were chosen by the Hospital and Cathleen Crowley, CIO, for a solution that met their objectives: creating a private cloud environment to make electronic medical records (EMRs) accessible across the many settings where patients receive treatment: the hospital campus, physicians’ offices and local nursing homes. The benefits were considerable – so too was the challenge of serving over 200 clinicians, in more than 25 locations, who would access patient records over a secure Web interface on a 24/7 basis.
Columbia turned to trusted partners in achieving these objectives and ultimately succeeding – Stratus ftServers and storage arrays form the core of this cloud infrastructure to ensure the uptime required while simplifying operations and management. Columbia selected eClinicalWorks for a robust ambulatory EMR solution which met the requirements across this broad set of users and facilities. And implementing virtualization on the Stratus fault-tolerant servers with VMware allows Columbia to run the eClinicalWorks applications within virtual machines to increase flexibility and efficiency in delivering services within the data center.
Congratulations to Columbia Memorial for such a well deserved honor, and we at Stratus thank our partners, eClinicalWorks and VMware, for working together in creating a showcase that others can apply to their own environments.
We made a video about EMR software and crashes. Enjoy!
“Our Disaster Recovery ‘Fire Drill.'”
Preparedness is always a good thing, but I had some comments about disaster recovery as opposed to disaster prevention.
Preparedness in the event of an outage is essential and – amidst the rush to EHR adoption – it’s often done too late, after a failure. In that regard Dr. Koriwchak’s approach and insights are excellent. So too is the comment from Mr. Bletnitsky regarding the implications of downtime.
But more emphasis should be placed on reducing the risk of downtime in the first case. Call it preventive medicine for EHR. Yes, you need effective back up, recovery and continuity measures, like you need a doctor when you’re sick. But common sense is to try and avoid being sick. Or in this case, reduce the risk up front of downtime. Ironically, healthcare reform is ultimately trying to achieve this, so should the implementation of an EHR system.
Virtualization doesn’t ensure uptime in the case of hardware problems. It efficiently uses resources but still requires an application and associated processes to restart – and if your SQL server is one of those processes that went down you’re looking at hours and not minutes of recovery even if everything goes perfectly. Too often things don’t however.
Ensuring uptime requires three things – resilient technologies, proactive monitoring to identify and mitigate failures before they occur, and best practices. These can be achieved working with companies like Stratus and achieve lower costs with far less IT staff time and keep your EHR system healthy.