CPR for Data

Robert Theiss is CIO of Bloomsburg Hospital in Bloomsburg, Pa.
Contact him at [email protected].

Roughly three years ago, the board of directors for the Bloomsburg Health System brought in a new management team to streamline the operations of the struggling 72-bed rural Pennsylvania acute care hospital. The team determined that delivering strategic, accurate and timely data was essential to achieving this mission. As a result, providing this vital data became my primary charge as the new CIO at Bloomsburg.

Historically, Bloomsburg never considered information technology (IT) to be a component of the strategic plan, but instead an unavoidable expense, relegated to the mundane tasks of patient accounting and payroll. For this reason, the hospital’s systems and infrastructure lacked the ability to deliver on the new demands for data. To get where we needed to be, our data management philosophies and practices needed CPR, which to us stands for Capture, Protect and Recover mission critical data.

Capturing Critical Data

We needed to vertically integrate the entire health system, and to do so Bloomsburg needed a new health information system (HIS) to collect the required data. We wanted to provide continuity between our owned physician practices, the hospital’s ancillary departments and the rest of our medical staff. We also wanted to rationalize our information systems, which we felt would reduce inconvenience and dissatisfaction among patients and providers, while capturing every piece of critical data.

We chose Computer Programs and Systems Inc. (CPSI) as our HIS vendor because they could deliver comprehensive integrated applications for the hospital and our owned physician practices, as well as tools for our medical staff. CPSI also had home health and nursing facility applications that we could “grow into” when required to accomplish vertical integration.

Bloomsburg uses a full suite of financial applications, including an executive information system, enterprisewide scheduling and budgeting modules. More than 80 percent of our claims are electronically submitted and adjudicated through the processing of ANSI 837 and 835 files. Our base clinical systems include lab, radiology and pharmacy, and our advanced clinical systems include mobile bedside nursing documentation, medication administration with barcode scanning and operating room management. Practice management and ambulatory clinical documentation systems are being installed at our physician practices. Bloomsburg can now analyze both the financial and clinical data we need to achieve our strategic goals.

Protecting the Data Flow

Protecting the flow of data on which the organization now relies is of the utmost importance. The hospital’s earlier HIS was a hosted solution, which required a very small technology footprint within the hospital. The system was composed of pre-Windows, green-screen applications that were limited to registration, patient accounting, general accounting and payroll. The infrastructure and the physical environment would need a major overhaul to implement a system that would provide full financial, advanced clinical and imaging applications. In addition to serving the hospital, my goal was to be in a position to provide data center services to all entities of the health system. It was clear that the makeshift computer closet that housed the old technology footprint would not meet the new requirements.

Along with the coordination of the CPSI installation, we also worked on building an environment that would serve to protect the systems and the data upon which we would base our business. The plans included building a 676-square foot data center, the recabling of the entire physical plant, the installation of a new end-to-end gigabit network, and the implementation of a campuswide secure wireless network.

Because the building of the new data center was just one component of a much larger project, I looked for a partner that could provide an integrated solution. I didn’t want to waste time with the nuts and bolts of ladder racks and power troughs. I needed a solution that could provide redundancy in all major environmental components and deliver not just piecemeal components but a full solution. American Power Conversion’s (APC) InfraStruXure system was the right one. Its integrated architecture, which uses scalable, modular components, offered us a true “pay as you grow” approach and a lower total cost of ownership. APC was able to meet all of my design requirements including N+1 power redundancy, easily maintainable battery systems and a redundant cooling solution. They also included Web-based management tools at the outlet level on power distribution units, and environmental monitoring and alerting.

I needed an environment that would ensure our new software, servers and networking gear could provide the level of service required for the 24/7 operation of a robust financial and clinical information solution. We chose vendors and equipment that provide redundancy options in their offerings. We held all of our vendors to the same standard, regardless of whether they were providing a network switch, a server or a data center solution. Our technology is on display at every level of patient interaction. Patients are acutely aware of interruptions or system outages. Downtime in front of the patient puts the public’s confidence in us at risk. In a competitive market where patients have a choice of eight hospitals within 30 miles, that can be as devastating as any natural disaster.

Recovering and Backing Up the Data

Bloomberg is situated along the banks of the Susquehanna River in northeastern/central Pa., and has endured two 100-year floods in the last three years. As an institution on which communities rely during times of crisis, living through those challenges brought into sharp focus the need for a comprehensive recovery plan. We had always followed the standard rules for tape rotations and off-site storage. We even had been going to the extent of sending a tape monthly to CPSI so that they could validate and test the information on our backups. In light of recent events, those essential measures no longer seemed adequate.

Due to expense, logistics and complexity, we had never gone to the next level of contracting with a disaster recovery service. The prospect of spending tens of thousands of dollars monthly for a service I was not convinced could perform was not very appealing. Even the logistics of sending a crew of employees to Philadelphia for annual hot-site testing was daunting and unattractive. I thought it shouldn’t be that expensive—it should be easier to test—tests should be done more frequently—there had to be a better way.

Out of necessity, I sought an alternative. It occurred to me that we had the perfect environment to host a hot site, which led to the idea that perhaps another hospital was in a similar situation. Maybe we could find a partner hospital that would act as our disaster hot site while we acted as theirs. We could both save a ton of money and in the end have a better solution. They would certainly understand and abide by the security and privacy needs we all live by every day. Of course, a solid contract would be required to take care of all the details. It seemed like a perfect solution.

I searched for a hospital that was outside of our competitive market, but close enough to allow for ease of maintenance and testing. I needed a partner who would have a single or small server HIS footprint. In trying to keep the value proposition even, I wanted a partner that would have a footprint in my data center similar to the one I would need in theirs. Our CPSI solution includes a “warm server” that essentially works as a shadow of the live server. Placing it at another institution would require 5U of rack space in a comparable data center environment. An out-of-band, shared cost, leased line for the shadow traffic between networks with each facility providing their own router would also be required.

My plan also included provisions for backing up one another’s warm server, physical hardware access and quarterly testing guidelines. In addition, workspace for a temporary business office complete with Internet access would be provided, in case a disaster prohibited access to the physical plant. We recently identified a potential partner and hope to have the entire solution in place later this month.

Wrap Up

Part of our competitive strategy is to offer patients complete access to advanced healthcare technology throughout the continuum of health services. Our new architecture makes a major contribution by delivering the availability and reliability that we need to deliver patient care at the highest possible levels while optimizing the patient experience.

Our philosophies of capturing, protecting and recovering data provide reliable and stable information systems that allow us to be financially competitive and offer the best possible care to the communities we serve.

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